Version 0 (January 2017) Emergency Responder Health and Safety Manual
Medical History, Examination Results, or Other Medical Information
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- 6.2 Medical Clearance Statements/Identification of Limitations
- 6.3 Vaccination Records
- 6.4 Training Certification
- 6.5 Tracking Occupational Exposures
- 6.6 Evaluation Form
6.1 Medical History, Examination Results, or Other Medical InformationFor each medical examination performed, emergency responders and the examining physician must work together to complete the EPA Medical Evaluation Form (see the “Forms” section of the manual’s website). This form asks for information on medical, occupational, and exposure history, and diagnostic results. In addition, the physician must complete the OSHA Respirator Medical Evaluation Questionnaire. The physician and occupational health center must maintain the baseline and subsequent examination records, as they are considered confidential medical records and subject to customary patient-physician confidentiality restrictions, as well as completed versions of the OSHA Respirator Medical Evaluation Questionnaire. EPA managers and supervisors will not have access to completed medical examination forms. As discussed in Section 6.2, only the Medical Clearance Statement (which appears as page 10 of 10 of the EPA Medical Evaluation Form) will be provided to the SHEMP Manager (or another designated person), the employee’s supervisor, and the employee. 6.2 Medical Clearance Statements/Identification of LimitationsAs described in Section 3.4, EPA’s Medical Review Officer prepares Medical Clearance Statements (i.e., page 10 of the EPA Medical Evaluation Form) and submits them to the SHEMP Manager (or another designated person), who retains copies of these forms for each emergency responder and provides copies to an employee’s supervisor and the employee upon receipt. These records must not include specific medical information; results and recommendations must be expressed in general terms and not include diagnostic information. 6.3 Vaccination RecordsWhenever a vaccine is administered to an emergency responder, the physician must document this event on a Vaccine Administration Record (see the “Forms” section of the manual’s website) that will be retained in his or her files. In addition, a complete record of an individual’s vaccination history must also be recorded on a pocket-sized card. The card must be updated and certified by the medical provider annually or as appropriate. A copy of this vaccination card must be kept on file with the medical provider and the SHEMP Manager (or another designated person), but also retained by the employee. EPA recommends that emergency responders carry the card to work sites. If employees decline to receive vaccinations, they must sign a Vaccine Declination Statement (see the “Forms” section of the manual’s website), which will be retained by the physician and the SHEMP Manager (or another designated person). 6.4 Training CertificationThe SHEMP Manager (or another designated person) must provide a form of documentation to each employee who completes (1) a medical surveillance awareness course and (2) training on using nerve agent antidote kits. Documentation must be retained by the SHEMP Manager (or another designated person) and the individual employee. Variation in documentation format is acceptable across EPA organizations. The “Forms” section of the manual’s website provides one example of a training certification letter that could be used to document completion of the medical surveillance awareness course. In addition, EPA organizations must document the completion of all employee training (and any associated competency tests) in Field Readiness (see Section 5.3 of the Introduction). 6.5 Tracking Occupational ExposuresEmergency responders who experience any type of occupational exposure must report the exposure immediately to their direct supervisor. Procedures that emergency responders must follow when they encounter non-life threatening exposures are summarized in the Quick Reference Guide for Emergency Responders: Medical Surveillance; employees must ensure that they have a copy of these procedures with them when working in the field. Moreover, in the event of an exposure, injury, or illness, employees and their supervisors must complete EPA Form 1340-1, OSHA & EPA 301—Injury, Illness & Near Miss Report (see the “Forms” section of the manual’s website) within the month in which the incident occurred. The SHEMP Manager (or another designated person) must provide a summary of the exposures, injuries, and illnesses reported on EPA Form 1340-1 to SHEMD on a quarterly basis. Employees may also complete the form themselves and submit it to the SHEMP Manager (or another designated person) anonymously. The SHEMP Manager (or another designated person) must retain the forms, ensure that any other required forms are filled out, and ensure that any other necessary parties are notified (as required) of the occupational exposure. In addition, the SHEMP Manager (or another designated person) must investigate any reported accidents, injuries, illnesses, or near misses and follow up with an independent report. If employees report an accident or illness, it is their responsibility to consult the SHEMP Manager (or another designated person) for advice and to inform their supervisor and SHEMP Manager if they want or need a follow-up medical evaluation, treatment, or time off from work. In conjunction with the physician and with the assistance of the HSPC (or another designated person), the SHEMP Manager (or another designated person) must initiate procedures for follow-up care or workers’ compensation as warranted. The employee’s supervisor must retain approval authority in workers’ compensation and follow-up medical care cases. In an emergency in which immediate medical care is warranted, the appropriate forms may be submitted after emergency medical care has been provided. 6.6 Evaluation FormAs described in Section 7, the SHEMP Manager (or another designated person) must complete the Medical Surveillance Program Evaluation Form (see the “Forms” section of the manual’s website) annually and retain copies of completed forms in his or her files for a minimum of 5 years. Download 289.02 Kb. Share with your friends:
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