OSHA term · Glossary
Medical Surveillance
Verified vs OSHA sources · 2026-10-05
An ongoing program of employer-provided medical exams and tests for workers exposed to specific hazards, required by substance-specific OSHA standards (silica, lead, asbestos, benzene, cadmium, and others). Its purpose is to detect early, often reversible signs of occupational disease — before permanent harm — and to determine fitness for tasks like respirator use. It's provided at no cost, on work time, and performed by or under a licensed health care professional (PLHCP), with results kept confidential.
Also known as: medical monitoring, occupational health surveillance
On this page
Medical Surveillance at a glance
- Required by substance-specific standards (silica, lead, asbestos, benzene, cadmium, etc.). The trigger is usually exposure at or above the action level for a set number of days — but not always: construction silica counts days of required RESPIRATOR USE instead, so read the standard that governs your work rather than assuming the pattern.
- Includes medical/work history, targeted exams, and tests (e.g., chest X-ray and lung-function testing for silica; blood lead level for lead).
- Provided at no cost, during working hours, by a licensed health care professional (PLHCP); results are confidential.
- Can trigger medical removal protection — moving a worker away from exposure while protecting pay/benefits.
In plain English
Regular check-ups your employer must provide (free, on the clock) if you work around certain dangerous substances. Doctors look for the earliest signs a chemical is affecting your health, so problems get caught while they can still be reversed.
What the rule says
“The employer shall make medical surveillance available at no cost to the employee, and at a reasonable time and place, for each employee who will be required under this section to use a respirator for 30 or more days per year.”
In context
An enforcement, recordkeeping, or general-duty concept under the Occupational Safety and Health Act and 29 CFR. These terms define how OSHA inspects, cites, and penalizes employers.
Where this is written in OSHA's rules
- 29 CFR 1926.1153(h)Read on eCFR / OSHA.gov
- 29 CFR 1926.1153(h)(1)(i)Read on eCFR / OSHA.gov
Example
Both silica standards say "30 or more days per year", and they count different things — the number matches, the condition does not. In CONSTRUCTION (1926.1153(h)(1)(i)) the trigger is 30+ days of REQUIRED RESPIRATOR USE under the standard, which a worker reaches either through a Table 1 task that specifies a respirator or through the exposure-assessment route at (e)(1)(ii); exposure alone is not the test. In GENERAL INDUSTRY (1910.1053(i)(1)(i)) the trigger is 30+ days exposed AT OR ABOVE THE ACTION LEVEL. A construction worker who reaches the respirator threshold is offered medical surveillance: a baseline exam, chest X-ray, and lung-function test, repeated periodically, so early silicosis changes can be caught while intervention still matters.
Why it matters
Many occupational diseases are silent until they're severe and permanent — medical surveillance is the safety net that catches them early enough to act. It also protects workers economically through medical removal protection, and its findings feed back into whether the employer's exposure controls are actually working.
Medical surveillance vs. biological monitoring
Biological monitoring is one tool — measuring a chemical or its metabolite in the body (e.g., blood lead level). Medical surveillance is the broader program that may include biological monitoring plus medical/work history, physical exams, imaging, and function tests, along with a physician's opinion on fitness and removal. Biomonitoring is a data point; surveillance is the whole clinical program around it.
Examples of OSHA medical surveillance triggers
| Standard | Typical trigger |
|---|---|
| Silica (1926.1153 / 1910.1053) | At/above action level ≥ 30 days/year |
| Lead (1910.1025) | At/above action level ≥ 30 days/year |
| Asbestos (1910.1001) | At/above the PEL / as specified |
| Benzene (1910.1028) | At/above action level / as specified |
Medical Surveillance: frequently asked questions
- What is medical surveillance?
- An ongoing program of employer-provided medical exams and tests for workers exposed to certain hazards, required by substance-specific OSHA standards. It aims to detect early signs of occupational disease and is provided at no cost and confidentially.
- How is medical surveillance different from biological monitoring?
- Biological monitoring measures a chemical or its metabolite in the body (like blood lead level). Medical surveillance is the broader program that may include that plus history, exams, imaging, and a physician's fitness opinion.
- Who pays for medical surveillance?
- The employer. Substance-specific standards require it to be provided at no cost to the employee, during working hours, and performed by or under a licensed health care professional, with confidential results.
Related terms
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Governing OSHA standards
More OSHA terms
The action an employer takes to fix a cited violation or eliminate a hazard OSHA identified during an inspection. The citation sets an abatement date, the deadline to correct the hazard, and within 10 calendar days after that date the employer must certify to OSHA that the violation was abated. Failure to abate accrues additional penalties of up to $16,550 per day.
Area DirectorThe senior OSHA official in charge of a specific OSHA Area Office — the local unit that runs inspections and enforcement in its geographic territory. The Area Director has the authority to issue citations, propose penalties, hold informal conferences with employers, and approve settlement agreements. When a Compliance Safety and Health Officer (CSHO) completes an inspection, it's the Area Director who ultimately issues the citation.
Bureau of Labor Statistics (BLS)The federal statistical agency within the U.S. Department of Labor that collects, analyzes, and publishes data on workplace injuries, illnesses, and fatalities. BLS conducts the annual Survey of Occupational Injuries and Illnesses (SOII) — compiled from employer OSHA 300 logs — and the Census of Fatal Occupational Injuries (CFOI). SOII data drives OSHA's Site-Specific Targeting (SST) program: establishments whose DART rates significantly exceed their BLS industry average are placed on the SST inspection list.
Competent PersonUnder OSHA's construction standards, a person who is capable of identifying existing and predictable hazards in the surroundings or working conditions, and who has the authorization to take prompt corrective measures to eliminate them. The role requires both knowledge and the authority to act, and is mandated by name in many specific standards — excavations, scaffolds, fall protection, asbestos, and more.
CitationThe formal written notice OSHA issues to an employer after an inspection, describing each alleged violation, the standard cited, the proposed penalty, and the date by which the hazard must be corrected (abated). OSHA must issue a citation with reasonable promptness and no later than six months after the violation occurred.
Closing ConferenceThe meeting at the end of an OSHA inspection where the compliance officer confers with the employer and informally advises them of any apparent violations found. Importantly, the closing conference discusses what was observed and the employer's rights — but it does NOT state final citations or penalties, which come later in the written Citation and Notification of Penalty.
Compliance Officer (CSHO)An OSHA Compliance Safety and Health Officer — the inspector who conducts workplace inspections. A CSHO presents credentials (a photo ID and a serial number), holds the opening conference, performs the walkaround, collects evidence, interviews employees, and recommends citations. CSHOs are either safety specialists or industrial hygienists.
ContestAn employer's formal challenge to an OSHA citation, penalty, or abatement date. To contest, the employer must file a written Notice of Contest with the OSHA Area Director within 15 working days of receiving the Citation and Notification of Penalty. Filing sends the case to the independent Occupational Safety and Health Review Commission (OSHRC); missing the deadline makes the citation a final, un-appealable order.
Sources & verification
- 29 CFR 1926.1153(h) (eCFR / OSHA.gov)
- 29 CFR 1926.1153(h)(1)(i) (eCFR / OSHA.gov)
- OSHA — Medical Screening and Surveillance
- OSHA — 1926.1153(h) (Silica Medical Surveillance)
Reviewed by HazComFast against eCFR, OSHA.gov, NIOSH, and the Federal Register. Last reviewed 2026-10-05. This glossary is general information, not legal advice; OSHA State-Plan states (e.g. California, Michigan) may adopt stricter requirements.
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