Chapter 3
HEALTH SERVICES

Contents

Approved by Peter Lichty
Revised 11/08

3.1 Policy
3.2 LBNL Health Services Program

3.3 Facility

3.4
Staff

3.5 Physical Examinations

3.6 Preplacement and Job Transfer Examinations

3.7 Periodic Examinations

3.8 Termination Examinations

3.9 Medical Surveillance Program

3.10 Examinations for Laser Users

3.11 Return-to-Work Policy

3.12 Medical Records

3.13 Work Restrictions

3.14 Pregnancy

3.15 Medical Emergencies and First Aid

3.16 Transportation of Sick or Injured Personnel

3.17 Radiological Accidents

3.18 Safety Glasses

3.19 The Employee Assistance Program (EAP)

3.20 Immunizations and Biosafety Concerns

3.21 Privacy Notice

3.22 Responsible Parties

3.22.1 Site Occupational Medical Director
3.22.2 LBNL Occupational Health Nurses

3.22.3 LBNL Contract Physicians and Nurse Practitioners
3.22.4 Laser Safety Officer

3.22 5 Analytical Services

3.22.6 Radiation Protection Program

3.22.7 Career and Temporary Employees

3.22.8 Employees With a Nonoccupational Illness or Injury

3.22.9 Employees With an Occupational Illness or Injury

3.22.10 Pregnant Employees

3.22.11 Employees Working With Lasers

3.22.12 Employees Terminating Employment

3.22.13 Human Resources

3.23 Glossary
3.24 Standards

3.25 Related LBNL/PUB-3000 Chapters

3.26 References

NOTE:
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3.1 Policy

The LBNL Health Services provides comprehensive occupational medicine services to LBNL full-time employees, part-time employees who work 30 days in a 12-month period, or all employees who participate in a medical surveillance program. Health Services policy ensures that employees are physically able to perform their assigned duties, ensures that employees with an occupational illness or injury receive medical care and rehabilitation, and provides for emergency treatment for serious illnesses or injuries. The policy also encourages all employees to maintain their physical and mental health and assists in maintaining a healthy and safe work environment. Health Services also supports LBNL’s provision of employee benefits through the Disability Management Program, which provides counseling and helps injured and ill employees rehabilitate and return to work safely. The Human and Animal Research Committees Office in Health Services coordinates the Lab's animal welfare and human subjects protection programs including the associated oversight committees.

Health Services is available to all employees hired for 30 days or more, or any employee subject to a medical surveillance program. First Aid and/or emergency services may be provided to subcontractors and guests until they are referred to their employer for industrial injury care or their personal physician for nonindustrial illnesses.

3.2 LBNL Health Services Program

The Health Services Clinical Program manages medical surveillance; provides preplacement, termination, and periodic health evaluations; provides first aid, initial assessment of injuries and illnesses, and appropriate referrals; provides case management; and contributes to health promotion through its Wellness Program. The program staff works closely with other EH&S staff to ensure the existence of an effective Medical Surveillance Program and with staff from Human Resources to help implement the Laboratory's Return-to-Work Policy.

3.3 Facility

The Health Services facility, located primarily on the first (top) floor of Building 26, houses the following:

  • First aid room
  • Examination rooms
  • One-bed holding ward
  • Office for fitting and dispensing of safety glasses, examining laser users' eyes, and performing refractions
  • Rooms for administrative functions and storage of medical records
  • 3.4 Staff

    The Health Services Group is staffed by the Site Occupational Medical Director, physicians, and registered nurses. The Site Occupational Medical Director and other LBNL health-care professionals providing clinical services are all licensed to practice in California, and most have additional special training in occupational medicine.

    3.5 Physical Examinations

    The Site Occupational Medical Director establishes the frequency and content of physical examinations based on OSHA regulations, DOE guidelines, and the standards of medical practice. A physical examination may include:

  • Personal medical history (see Section 3.21 (Privacy Notice))
  • Physical examination
  • Vision tests
  • Hearing tests
  • Measurement of pulmonary function
  • Electrocardiograms , if indicated
  • Chest x-ray (available off site) or tuberculin test (if requested by examining physician)
  • Complete blood count
  • Blood chemistries
  • Urinalysis
  • Special procedures
  • Prior to testing, employees are provided a verbal and written description of all recommended tests, including the nature of the test, the purpose, and results of testing. This discussion is documented in the medical record by the consent form and test explanation sheet.

    3.6 Preplacement and Job Transfer Examinations

    A complete and confidential medical examination is offered to new career employees and temporary employees hired for one month or longer. The components of the recommended examination are derived from the new employee's report of potential exposures. Unless there is a regulatory requirement stating otherwise, all components of the new employee physical examination are voluntary.

    Current employees changing to a position that may result in exposure to new job hazards should complete the Job Hazards Questionnaire and a new “Employees Report of Potential Exposures” form.  This will allow for inclusion in new medical surveillance examinations, if appropriate.

    3.7 Periodic Examinations

    General health promotion examinations are also available on an age-related schedule. Employees under age 40 are offered a complete physical examination every five years; those between age 40 and 50, every three years; and those above age 50, every two years.

    3.8 Termination Examinations

    Employees terminating employment at LBNL may be advised to have a termination examination, depending on how recently the employee has undergone a periodic examination. (See Section 3.22.12 (Employees Terminating Employment).)

    3.9 Medical Surveillance Program

    The Medical Surveillance Program provides medical examinations and laboratory evaluations to monitor and protect employees who may be at risk from health hazards at work. Employees who may benefit from more frequent or additional voluntary medical examinations and laboratory evaluations include the following:

  • Animal care staff
  • Asbestos workers
  • Bus drivers
  • Carpenters
  • Crane and forklift operators
  • Geotechnical support staff
  • Hazardous Waste Operations staff
  • HAZMAT Response Team
  • Laser users
  • Painters
  • Staff exposed to excessive noise levels as defined by Chapter 4
  • Staff who work with blood, blood products, or human cell lines
  • Staff who work with radioactive isotopes, x-ray devices, or accelerators
  • Staff exposed to excessive levels of airborne dust gases and vapors
  • Welders
  • In addition, either LBNL employees or the Health Services group (in consultation with Industrial Hygienists) may arrange for voluntary medical evaluations under the following circumstances:

    • Whenever an employee develops signs or symptoms associated with a hazardous chemical to which the employee may have been exposed in the laboratory,
    • Exposure monitoring demonstrates exposure above the action level or permissible exposure limit for a regulated chemical with a medical surveillance requirement,
    • Any laboratory incident that results in the likelihood of a hazardous exposure, or
    • Significant questions arise about possible health effects of novel compounds, such as engineered nanoparticles.

    In carrying out its medical surveillance activities, Health Services depends on the cooperation and collaboration of Industrial Hygiene, Analytical Services, and Radiation Protection. (For general health concerns, see also Section 3.7, Periodic Examinations.)

    3.10 Examinations for Laser Users

    Users of Class 3B and Class 4 lasers are required to undergo an eye examination performed by an optometrist before they can begin working with lasers and after any accidental exposure to a laser. Contact Health Services for an appointment (extension 6266) for an examination.

    3.11 Return-to-Work Policy

    The Berkeley Lab Return-to-Work Policy requires employees returning to work after one full day or more of lost time due to a work-related illness or injury to report to Health Services for an evaluation of their condition and ability to resume customary work. Employees who have been absent for five or more consecutive workdays due to nonoccupational illness or injury also are required to report to Health Services so that their ability to return to work can be determined.

    3.12 Medical Records

    Complete medical records are maintained for employees from the time of their first physical examination. These records are confidential to the extent provided by law and remain in the custody and control of Health Services.

    Information from an employee's health records may be disclosed only as required by law or if an employee provides written consent for release of information. Records are retained indefinitely.

    3.13 Work Restrictions

    Work restrictions may be placed on an employee's work based on the results of his or her physical examination, illness, or injury.

    3.14 Pregnancy

    A health professional will discuss with a pregnant employee her work environment and determine whether any changes are required to protect the employee and her baby. See Section 21.9.4 (Declared Pregnant Workers), in Chapter 21 (Radiation Safety).

    3.15 Medical Emergencies and First Aid

    FOR EMERGENCIES, CALL:

    From any LBNL phone on-site or off-site: DIAL 7911

    From a 642 or 643 PREFIX: DIAL 9-911

    From a cellular phone: DIAL 911

    FROM 7:30 A.M. TO 3:30 P.M., FIRST AID IS AVAILABLE IN HEALTH SERVICES, BLDG. 26, EXT. 6266.

    AT ALL OTHER TIMES, EMERGENCY MEDICAL SERVICES ARE AVAILABLE FROM THE FIRE DEPARTMENT THROUGH THE 7-911 DISPATCH SYSTEM.

    First aid is provided for occupational injuries and illnesses. Treatment is coordinated with outside specialists according to Workers' Compensation guidelines.

    Employees are provided with primary aid at the site where the injury occurred if they cannot be moved from the site; treatment is provided by LBNL physicians, nurses, firefighters, and emergency medical technicians (EMTs) in charge of the LBNL ambulance

    REPORT EVERY INJURY SUSTAINED WHILE PERFORMING LBNL-ASSIGNED TASKS, NO MATTER HOW MINOR, TO YOUR MANAGER, SUPERVISOR, OR WORK LEAD, AND HEALTH SERVICES.

    3.16 Transportation of Sick or Injured Personnel

    Employees who are severely injured or become seriously ill at work will be transported to nearby hospitals, according to dispatch center directions.

    Transportation of less seriously injured employees will be managed on a case-by-case basis.

    3.17 Radiological Accidents

    EH&S notifies LBNL health care professionals of accidental exposures to radiation. In the event of contamination by radioactive isotopes or possible activation by high-energy beams, an employee may be given a whole-body count and have a radiochemical analysis of urine done by Technical Services staff. The actions of the health care professionals include possible treatment and notification. The type and severity of the exposure or spill will determine the actions taken by the health care professionals.

    LBNL has a mutual aid agreement with a local hospital to admit and care for LBNL employees who are either radioactively contaminated or both radioactively contaminated and injured.

    3.18 Safety Glasses

    Safety glasses are supplied to employees free of charge. Employees can make an appointment with the optometrist, ext. 6266, in Health Services to have safety glasses fitted. The optometrist can also perform refractions for a fee for employees who require safety glasses but do not have a recent prescription.

    3.19 The Employee Assistance Program (EAP)

    The Employee Assistance Program (EAP), an off-site contract service provided by CARE Services of the University of California Health Center (the Tang Center) on the Berkeley campus, offers confidential consultation, assessment, and referral for personal or work-related problems. Employees may seek help directly from the EAP or may be referred by a supervisor. EAP psychological records are maintained separately from LBNL Health Services medical records at an off-site location.

    3.20 Immunizations and Biosafety Concerns

    Immunizations are available to employees who require such protection during the course of their work at the Laboratory or during work-related travel. Yearly immunization against influenza may be offered to all employees. For certain types of biological exposures reviewed by the LBNL Biosafety Committee, it may be recommended that a sample of employee blood serum be stored in advance of exposure to the biological agent. Details of the immunization and serum banking procedures are available on the Health Services Web site.

    3.21 Privacy Notice

    The State of California Information Practices Act of 1977 (effective July 1, 1978) requires LBNL to provide the information on the Privacy Notice form to individuals who are asked to complete medical history forms or otherwise supply personal information.

    The information on the forms is requested by Health Services for purposes of maintaining a complete medical record for each LBNL employee. Furnishing the requested information is voluntary and is intended to help protect the health of LBNL employees.

    All information in employees' medical records is available only to Health Services staff. Information from medical records is maintained confidentially according to current laws. The information may be used as a basis for recommendations by Health Services to various LBNL and University departments in miscellaneous personnel matters (e.g., consideration for employment, transfer, work assignment, or eligibility for benefits).

    Individuals have the right to review their records in accordance with LBNL and University policies. Information about these policies may be obtained from the Human Resources Department. (See Section 3.22.1 (Site Occupational Medical Director).)

    3.22 Responsible Parties

    The following people and parties are responsible for implementing Health Services policies:

    3.22.1 Site Occupational Medical Director

  • Is responsible for ensuring that the LBNL Occupational Medical Program is available to all eligible employees and meets the highest professional standards.
  • Plans and implements the site occupational medicine program.
  • Designs and implements the medical surveillance program.
  • Is responsible for establishing the frequency and content of physical examinations based on OSHA regulations, DOE guidelines, and the standards of medical practice.
  • Must be a graduate of a school of medicine or osteopathy, and licensed for the practice of medicine in the State of California.
  • Is invited to all worker health-and-safety meetings and inspections, and participates at his/her discretion.
  • Has access to all work areas to evaluate environmental health conditions.
  • Reviews and approves the medical and behavioral aspects of employee counseling and health promotion programs.
  • Notifies management and EH&S Staff when worker health evaluations suggest a possible uncontrolled health hazard in the workplace.
  • Reviews and approves the Employee Assistance Program (EAP) contract, and reviews EAP contract services as needed.
  • Reviews the medical aspects of biosafety programs, including immunization programs, bloodborne pathogen programs, and biohazardous waste programs for regulatory compliance.
  • Designs and implements medical emergency response procedures within the site emergency and disaster plans, integrating them with community disaster and emergency plans.
  • 3.22.2 LBNL Occupational Health Nurses

  • Are on duty from 7:30 a.m. to 3:30 p.m. on workdays.
  • Are available for medical emergencies.
  • Follow standard initial treatment procedures for burns, eye injuries, severe allergies, heart attacks, and other emergencies.
  • Assess and provide first aid for occupational injuries and illnesses.
  • When clinically indicated, refer employees to private physicians or selected medical specialists, or provide transport by ambulance to a nearby hospital emergency room.
  • Conduct physical examinations, including vision tests; hearing tests; spirometry; electrocardiograms; laboratory tests, including blood counts and chemistries and urinalysis; and, when medically advisable, refer for chest x-rays.
  • Follow up on all positive findings in employees' physical examinations with letters, telephone calls, or revisits with employees.
  • Coordinate return-to-work of employees who have been absent for medical reasons.
  • Assist in decontamination of employees accidentally exposed to radioactive isotopes, and treat contaminated wounds.
  • Work with the Radiation Protection Group to determine radiation doses for employees accidentally exposed to internal or external radiation.
  • Notify Laboratory management and the family when employees are severely injured or become severely ill at work.
  • Maintain State professional licenses and certifications as needed for their work.
  • 3.22.3 LBNL Contract Physicians and Nurse Practitioners

  • Conduct physical examinations.
  • Review medical charts and interpret clinical findings.
  • Maintain State professional licenses and certifications as needed for their work.
  • 3.22.4 Laser Safety Officer

  • Refers laser users to the Health Services Group for laser-user eye examinations.
  • 3.22 5 Analytical Services

  • Uses radiochemical analyses and the whole-body counter system to measure internal radiation exposures. Forwards results to Health Services.
  • 3.22.6 Radiation Protection Program

  • Makes radiation dose estimates, with Health Services Group professionals, for employees accidentally exposed to internal or external radiation. Forwards results to Health Services.
  • Coordinates Declared Pregnant Worker program.
  • 3.22.7 Career and Temporary Employees

  • Must complete a potential exposure report form if hired for 30 days or longer.
  • 3.22.8 Employees with a Nonoccupational Illness or Injury

  • Must report to Health Services before returning to work after being ill or injured and absent from work for five or more consecutive workdays.
  • 3.22.9 Employees with an Occupational Illness or Injury

  • Must inform the MANAGER, SUPERVISOR, or WORK LEAD of the injury or illness.
  • Must report to Health Services before returning to work if the employee has lost one full day or more of work due to occupational illness or injury.
  • Must notify Health Services of the injury or illness and treatment received if the employee has seen a private physician off site.

    REPORT TO HEALTH SERVICES WHEN AN ILLNESS OR INJURY OCCURS.

    NOTIFY AN LBNL HEALTH CARE PROFESSIONAL OF ANY SERIOUS ACCIDENT THAT OCCURS AT LBNL AT ANY TIME.

  • 3.22.10 Pregnant Employees

  • May inform Health Services of the pregnancy as soon as the employee knows that she is pregnant.
  • 3.22.11 Employees Working with Lasers

  • Are encouraged to complete an eye examination with the LBNL optometrist before beginning to work with lasers and after accidental exposure to lasers.
  • 3.22.12 Employees Terminating Employment

    • Are encouraged to complete a termination questionnaire when employment is terminated at LBNL.

    3.22.13 Human Resources

    • Provides the Site Occupational Medical Director access to de-identified data from health, disability, and other insurance plans to help guide the creation of cost-effective health-promotion programs targeting preventable causes of morbidity and mortality.

    3.23 Glossary

    Confidentiality of medical records provides that medical information cannot be released outside Health Services without the written consent of the employee except as required by law.

    Contract medical staff include physicians, nurse practitioners, and nurses. Contract physicians are not LBNL employees.

    Occupational illness or injury is an illness or injury arising out of or in the course of employment.

    3.24 Standards

  • Americans with Disabilities Act (ADA)
  • California Confidentiality of Medical Records Act (Civ. Code 56 et seq.)
  • California Information Practices Act (Civ. Code 1798 et seq.)
  • Federal Drug-Free Workplace Act
  • OSHA 29 CFR 1910
  • State of California Nurse Practice Act
  • 10 CFR 851
  • ANSI Z136.1-2000
  • Health Insurance Portability and Accountability Act (HIPAA)
  • 3.25 Related LBNL/PUB-3000 Chapters

  • Industrial Hygiene (Chapter 4)
  • Lasers (Chapter 16)
  • Personal Protective Equipment (Chapter 19)
  • Radiation Protection (Chapter 21)
  • 3.26 References

  • American National Standards Institute (ANSI) N13.30-1987, Draft Performance Criteria for Radiobioassay
  • ANSI Z80.1-1989 and Appendices A, B, and C, Recommendations for Prescription Ophthalmic Lenses
  • ANSI Z87-1989, Practice for Occupational and Educational Eye and Face Protection
  • California Confidentiality of Medical Records Act (Civ. Code 56 et seq.)
  • California Information Practices Act (Civ. Code 1798 et seq.)
  • Lawrence Berkeley National Laboratory Health Services Group Program Plan
  • Lawrence Berkeley National Laboratory Medical Surveillance Program
  • Regulations and Procedures Manual (RPM), LBNL/PUB-201, Lawrence Berkeley National Laboratory

     

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