(1) General requirements.

(a) Each employer must institute a medical surveillance program for all employees who are employed in the regulated areas at least 30 days per year.

(b) This program must provide each employee covered under subsection (1)(a) of this section with an opportunity for medical examinations in accordance with this section.

(c) The employer must inform any employee who refuses any required medical examination of the possible health consequences of such refusal and must obtain a signed statement from the employee indicating that the employee understands the risk involved in the refusal to be examined.

(d) The employer must ensure that all medical examinations and procedures are performed by or under the supervision of a licensed physician, and are provided without cost to the employee.

(2) Initial examinations. At the time of initial assignment to a regulated area or upon the institution of the medical surveillance program, the employer must provide a medical examination including at least the following elements:

(a) A work history and medical history which must include smoking history and the presence and degree of respiratory symptoms, such as breathlessness, cough, sputum production, and wheezing;

(b) A 14" x 17" posterior-anterior chest X-ray and International Labour Office UICC/Cincinnati (ILO U/C) rating;

(c) Pulmonary function tests including forced vital capacity (FVC) and forced expiratory volume at one second (FEV 1.0) with recording of type of equipment used;

(d) Weight;

(e) A skin examination;

(f) Urinalysis for sugar, albumin, and hematuria; and

(g) A urinary cytology examination.

(3) Periodic examinations.

(a) The employer must provide the examinations specified in subsection (2)(a) through (f) of this section at least annually for employees covered under subsection (1)(a) of this section.

(b) The employer must provide the examinations specified in subsection (2)(a) and (c) through (g) of this section at least semi-annually for employees forty-five years of age or older or with five or more years employment in the regulated area.

(c) Whenever an employee who is forty-five years of age or older or with five or more years employment in the regulated area transfers or is transferred from employment in a regulated area, the employer must continue to provide the examinations specified in subsection (2)(a) and (c) through (g) of this section semi-annually, as long as that employee is employed by the same employer or a successor employer.

(d) The employer must provide the X-ray specified in subsection (2)(b) of this section at least annually for employees covered under this subsection.

(e) Whenever an employee has not taken the examination specified in subsection (3)(a) through (c) of this section within the six months preceding the termination of employment, the employer must provide such examinations to the employee upon termination of employment.

(4) Information provided to the physician. The employer must provide the following information to the examining physician:

(a) A copy of this regulation and its Appendixes;

(b) A description of the affected employee's duties as they relate to the employee's exposure;

(c) The employee's exposure level or anticipated exposure level;

(d) A description of any personal protective equipment used or to be used; and

(e) Information from previous medical examinations of the affected employee which is not readily available to the examining physician.

(5) Physician's written opinion.

(a) The employer must obtain a written opinion from the examining physician which shall include:

(i) The results of the medical examinations;

(ii) The physician's opinion as to whether the employee has any detected medical conditions which would place the employee at increased risk of material impairment of the employee's health from exposure to coke oven emissions;

(iii) Any recommended limitations upon the employee's exposure to coke oven emissions or upon the use of protective clothing or equipment such as respirators; and

(iv) A statement that the employee has been informed by the physician of the results of the medical examination and any medical conditions which require further explanation or treatment.

(b) The employer must instruct the physician not to reveal in the written opinion specific findings or diagnoses unrelated to occupational exposure.

(c) The employer must provide a copy of the written opinion to the affected employee.