U.S. Department of Transportation
Federal Highway Administration
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Federal Highway Administration Research and Technology
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Publication Number: FHWA-RD-98-180
Safety and Health on Bridge Repair, Renovation and Demolition Projects
CRISP-CONNECTICUT ROAD INDUSTRY SURVEILLANCE PROJECT
LEAD HEALTH PROTECTION PROGRAM (LHPP)
Table of Contents
Description: The structure(s) on this project are coated with paint containing lead Any work that disturbs the paint coating may expose workers to health hazards. The Contractor is fully responsible for the protection of employees and ConnDOT project-related employees from exposure to lead under OSHA regulations At least 20 working days prior to performing any work on the structure, the Contractor shall submit to the Engineer and to the Connecticut Road Industry Surveillance Project (CRISP) a written Site-specific Lead Health Protection Program (LHPP) prepared by a Certified Industrial Hygienist (CIH) that covers all workers on the project (Contractor, Subcontractor, and Connecticut Department of Transportation (ConnDOT) representatives) The CIH shall be listed by the American Board of Industrial Hygiene The LHPP shall include procedures for medical surveillance of the contractors and the state project- related representatives, hazard communication procedures, employee training, protective equipment, and all other procedures that may be necessary to comply with 29 CFR part 1926.62 pertaining to lead exposure in construction.
Typical work tasks that pose a lead exposure risk consist of, but are not limited to, welding, burning paint, flame cutting, abrasive blast cleaning, grinding, chipping, needle gun cleaning, lead burning, manual scraping and sanding, manual demolition of structures, heat gun cleaning, peening on existing structural steel, abrasive blasting debris cleanup, using lead-containing mortar, abrasive blasting enclosure movement and removal, power tool cleaning, lead removal equipment cleaning, decontamination trailer cleaning, rehabilitation of existing structural steel, gouging, and rivet busting.
The Contractor shall comply with the requirements of the OSHA Standard for Lead in Construction, 29 CFR 1926.62, and any other applicable Federal and State laws. Additional Federal regulations that must be followed with respect to lead and this specification include, but are not limited to:
The Contractor shall also comply with all current CRISP guidelines and protocols.
FAILURE OF THE CONTRACTOR OR HIS/HER SUBCONTRACTORS TO COMPLY WITH THE PROVISIONS OF THIS SECTION WILL AFFECT WHETHER THE CONTRACTOR OR HIS/HER SUBCONTRACTOR WILL BE CONSIDERED A RESPONSIBLE CONTRACTOR OR SUBCONTRACTOR ON FUTURE WORK INVOLVING STRUCTURE REHABILITATION AND REMOVAL OF LEAD PAINT COATINGS ON DEPARTMENT OF TRANSPORTATION PROJECTS.
CRISP personnel shall be allowed access to each work site covered by the provisions of the LHPP and shall be furnished with such information and assistance by the contractor as is required to make a complete and detailed inspection.
Materials: Respiratory protective equipment shall conform to 30 CFR PART 11, 29 CFR PART 1910.134, and 29 CFR PART 1926.62. The requirement for protective clothing shall be in conformance with 29 CFR PART 1910.132 and 1910.133. The minimum protective clothing required shall be head covering, coveralls (reusable or disposable clothing), gloves, dedicated workboots or disposable overboots, eye protection, hearing protection, and hardhat There will be no direct payment for protective clothing under this item. The cost of protective clothing shall be considered included in the general cost of the contract.
All projects where employee lead exposure without regard to the use of respirators, may exceed the action level, that is, employee exposure to an airborne concentration of lead of 30 micrograms per cubic meter of air (30 µg/m³) averaged over an 8-hour period (i.e., removal of paint containing lead, bearing replacement , etc.) must have a decontamination facility as described in the Item “Decontamination Facility” on site and portable handwash facility as described in the item “Portable Handwash Facility” as directed by the engineer.
Construction Methods: Within 20 calendar days of the award of the contract, the contractor shall submit to the engineer written quotes from a minimum of three industrial hygiene firms (IH firms) for the performance of work under this item. The quotes shall be furnished on the proposal form made a part of these specifications.
The engineer will review the proposals submitted and notify the contractor in writing of the firm(s) acceptance within ten (10) calendar days of receipt of the proposals.
“Action level” means employee exposure, without regard to the use of respirators, to an airborne concentration of lead of 30 micrograms per cubic meter of air (30 µg/m³) averaged over an 8-hour period.
“Permissible Exposure Limit” (PEL) means employee exposure to airborne concentrations of lead equal to or greater than 50 micrograms per cubic meter of air (50 µg/m³) averaged over an 8-hour period If an employee is exposed to lead for more than 8 hours in any work day, the permissible exposure limit, as a time weighted average (TWA) for that day, shall be reduced according to the following formula: Maximum permissible limit (in µg/m³) = 400/number of hours worked in the day.
“Employee” means all workers on the project, including contractor, subcontractors and ConnDOT representatives.
“Lead” means metallic lead, all inorganic lead compounds, and organic lead soaps.
“Employee Lead Exposure” is that exposure that would occur if the employee were not using a respirator.
Lead Health Protection Program:
The LHPP consists of written LHPP procedures and on-site inspections, occupational air sampling, wide sampling, and reporting of the procedures by a CIH The frequency of the on-site surveillance and monitoring shall be dependent upon the type of work to be performed and shall be detailed in the written LHPP procedures.
At the outset of a given job, the IH firm must send to CRISP and ConnDOT all written procedures under this item If there are changes to these procedures, they shall be resubmitted.
The written LHPP procedures consist of, but are not limited to:
1. A written record of all employees involved in work tasks that pose an airborne lead exposure risk at the work site or who may on any day have an exposure exceeding the Action Level. Tasks where 30 µg/m³ may be exceeded include but are not limited to: welding, burning paint, flame cutting, gouging, abrasive blasting, grinding, chipping, needle gun cleaning, lead burning, manual scraping and sanding, manual demolition of structures, heat gun cleaning, peening on existing structural steel, abrasive blasting debris cleanup, using lead-containing mortar, containment moving and removal, power tool cleaning, lead removal equipment cleaning, decontamination trailer cleaning, rivet busting, etc Those working in the vicinity of these tasks may also be exposed.
For this purpose a daily sign in/out log provided by CRISP that identifies persons by name, Social Security Number, affiliation, and work task for all employees who were at the site during the reporting period must be maintained at the work site and submitted monthly to DOT and CRISP.
All workers exposed to airborne lead at or above the Action Level on any day will be required to participate in the medical surveillance program. The IH firm shall determine levels of airborne exposure by breathing zone air sampling for airborne lead exposure over a full representative shift In addition, all workers except those specifically exempted from the comprehensive medical surveillance program who do have or may be anticipated to have lead exposure will be enrolled in the comprehensive medical surveillance program. Those who are exempted from the comprehensive medical surveillance program will be enrolled in the limited medical surveillance program and the listed justification for their exemption by the site CIH will be submitted to ConnDOT and CRISP within 5 working days of the decision to exempt.
2. Procedures for instituting a medical surveillance program in accordance with 29 CFR 1926.62(j) except as noted herein Frequency of medical examination shall conform to 1926.62(j) except where additional testing is specified Medical surveillance will consist of, but not be limited to, an entry/annual testing protocol, an exit testing protocol, interval and comprehensive examination testing as indicated based upon exposure and prior surveillance data blood lead level and Zinc Protoporphyrin levels The medical surveillance data acquired under this special provision shall be collected according to current CRISP protocol and submitted by the CIH to the Department of Public Health and Addiction Services - CRISP Program Coordinator at the following address, CRISP, 150 Washington Street, Hartford, CT 06106. The General Contractor and any and all subcontractors shall cooperate fully and in a timely manner with the project IH firm to share information regarding blood lead levels on covered employees so that results are submitted accurately and in a timely manner to CRISP. The General Contractor and any and all subcontractors and IH firm will cooperate by identifying to the participating CRISP clinic the individuals who will be scheduling the CRISP examinations (the General Contractor or the CIH) All medical examinations and testing will be done at a CRISP- listed medical facility using appropriate CRISP protocols and forms.
3. An entry/annual testing protocol shall apply to workers covered under this specification and shall include the following:
4. The medical removal requirements shall be as follows:
For any employee with a blood lead level at or above 35 µg/dl (1994), every effort must be made to reduce exposure. The reasons for blood lead level will be investigated by the IH and the worker and a plan of action for reducing exposures will be developed and followed.
This will include: 1) Determination of the reasons for the elevated blood lead level will be made by the IH in consultation with the worker; 2) Development of a plan of action for reducing the exposures; 3) Implementation of the plan.
Should the employee's blood lead level not decrease to below 30 µg/dl on subsequent testing, the employee can be moved to a non-lead-exposed job or removed from the exposure at the employer’s expense if the doctor, in consultation with CRISP, so determines based on medical finding. Medical removal protection shall conform at a minimum, to 29 CFR 19.205.62(k) with the exception that medical removal may be required at 35 µg/dl. ConnDOT will not pay for any and all costs associated with the medical removal of an employee.
Employees removed for medical protection may return to their former job status as specified in 1926.62(k) with the exception that two consecutive test results taken at least 1 week apart indicate a level below 25 µg/dl.
5. Intervention. For any employee with a blood lead level at or above 35 µg/dl for 1994 (30 µg/dl for 1995 and beyond), the IH firm shall be immediately informed by the responsible clinic or medical facility and shall be responsible for determining the cause of the elevated lead level and instituting additional protective and hygiene measures against lead exposure at the jobsite A written statement of these determinations shall be sent to ConnDOT and the CRISP coordinator, with the monthly compliance report using the CRISP.
6. Procedures for employee notification. Within five (5) working days of receipt of the medical surveillance results, the employer shall notify all tested employees in writing of the results of their tests Also, the employee shall be immediately notified by the employer (within 24 hours of receipt of results) of the blood lead levels that require removal from lead exposure.
7. Employees' exposures should be assessed in accordance with OSHA Part 1926.62(d) and the current CRISP guidelines for air and wipe sampling Airborne lead samples shall be analyzed by a laboratory accredited by the American Industrial Hygiene Association (AIHA) for the analysis of lead in air. Wipe and chip samples may alternatively be analyzed by a laboratory meeting the proficiency requirement of the ELPAT program The results of all testing shall be reported to the CRISP Coordinator as part of the monthly compliance report.
8. The CIH shall determine and recommend the implementation of intervention measures based on the airborne lead exposure, wipe sampling, blood lead levels, and the observation of work practices. The determination and recommendations should not rely solely on airborne exposure levels (See Part 1926.62(h) & (j)).
9. Procedures for the selection of appropriate respiratory equipment and protective clothing for the particular work task shall be developed in conformance with 29 CFR 1926.62. The minimum respiratory protective equipment required shall conform to 29 CFR 1926.62 for particular work tasks unless a higher level protection is required by the project IH firm. If a higher level of protection is recommended, the CIH shall provide written justification of its need. The CIH will ensure that proper testing, training, cleaning/storage, or replacement and disposal of the utilized articles will be in accordance with 29 CFR 1926.62(f) and (g), especially 29 CFR 1926.62(g)(2) (ii-viii) The IH firm shall monitor the selection and use of respiratory equipment and protective clothing during on-site surveillance and monitoring inspections. The IH firm will conduct weekly inspections and the CIH will certify that the respirators are being cleaned properly. If the cleaning is found be unacceptable by the IH firm or the CIH, the Contractor will correct the situation, and the cost for reinspection by the IH firm or CIH will not be eligible for reimbursement by ConnDOT.
10. Procedures for conducting employee training on lead hazards in accordance with 29 CFR 1926.62(l). This training will cover a minimum of, but not limited to, those topics specified in 29 CFR 1926.62(1)(2)(i-viii) and the Lead Standard 29 CFR 1926.62. Employees must be given access to 29 CFR 1926.62 and its appendices and all relevant materials. The procedures shall define the site personnel requiring training, the frequency of training, maintenance and training records, and qualifications required of the instructor performing the training. In addition, a blood lead level >25 µg/dl will trigger a special retraining session where the IH works with the individual to determine the cause of the elevation and another session where the IH discusses with the individual the result of that determination and the protective measures instituted.
11. The Contractor shall establish and have available at the work site a written Hazard Communication Procedure in accordance with 29 CFR 1926.59 This written procedure shall describe how warning signs, labels, material safety data sheets, and employee training will be provided. It must also contain proper work practices for working around hazardous materials. Also contained in this procedure will be a list of hazardous materials generated by a work task, i.e., lead fumes, lead dust, etc Any training required to meet 1926.59 above that required of 1926.62 shall be provided.
12. A written Personal Hygiene Procedure shall be available at the work site and must be in accordance with 29 CFR 1926.62(e)(2)(ii)(F), paragraph (h) Housekeeping and paragraph (i) Hygiene Facilities and Practices of 29 CFR 1926.62 Workers will not be allowed to eat, drink, or smoke, or apply cosmetics in areas where there is a potential for lead exposure. The Contractor shall provide a climate-controlled decontamination facility containing washing and shower facilities with clean hot and cold water, soap, and disposable towels, which the workers will use to wash their hands and face before eating, drinking, or smoking and after each working shift In addition, portable wash units will be provided as the site dictates for use during breaks for personal hygiene. The Contractor shall provide a clean area for eating and drinking and a separate clothes-changing area to reduce the chance for lead cross contamination. After employees change clothes and shower, the work clothing, shoes, and protective equipment shall remain at the jobsite until properly cleaned or disposed of. The written plan shall also include procedures for cleaning and ensuring cleanliness of these facilities.
On a monthly basis, the CIH shall submit to CRISP and ConnDOT the following:
a) Certification that all requirements of the LHPP and CRISP guidelines and protocols, including occupational air and wipe sampling, training medical surveillance, and elevated blood lead level intervention and reporting, have been followed.
b) A monthly report including:
Projects lasting less than 1 year will provide a project summary report at the close of lead-related work, and projects lasting more than 1 year will provide and annual report.
The reports will include the following:
Method of Measurement. This work will be measured for payment as follows:
1. Written LHPP Procedures: The written LHPP procedures prepared by the CIH will be measured for payment on a lump sum basis and shall include the following:
2. Employee Training Class: Employee training classes will be measured for payment by the number of classes given by the CIH, IH and/or supervised technicians To be considered an employee training class the class must be site specific, held at the project site, and have a minimum of five trainees The engineer must be notified when a training class is scheduled. If the engineer is not notified, the class will not be measured for payment.
3. On-Site Services Performed by IH Firm: On-site services performed by the CIH, IH and/or supervised technicians to comply with and monitor the LHPP shall be measured for payment by the number of hours worked on-site by title of person providing service On-site services performed by the CIH, IH and/or supervised technicians for reinspection and recertification will not be measured for payment by the State.
4. Medical Examinations and Testing by Independent Clinics: Medical examinations and testing by independent clinics required under CRISP protocol and/or other testing as required and approved by the engineer shall be measured for payment by actual cost (receipted bills) plus allowable markup These examinations and tests shall include:
5. Equipment: The following equipment may be measured for payment on a monthly rental basis if an acceptable rental rate can be agreed upon by the contractor and engineer. If an acceptable rental rate cannot be agreed upon, the equipment shall be measured for payment by actual cost (receipted bills). Only new equipment will be eligible for reimbursement if rental rate cannot be agreed upon.
Basis of Payment: The sum of money shown on the estimate and in the itemized proposal as “estimated cost” for this work will be considered the bid price even though payment will be made as described below. The estimated cost figure is not to be altered in any manner by the bidder Should the bidder alter the amount shown, the altered figures will be disregarded and the original price will be used to determine the total amount for the contract The basis of payment for this work shall be as follows:
1. Written LHPP procedures: The written LHPP procedures will be paid a lump sum fee submitted by the selected IH firm plus 7 percent for overhead and profit, for the contractor. This price shall include all costs for labor, material, equipment, and services involved for the CIH to prepare, maintain, and revise the written LHPP as required.ITEM #603273A - PORTABLE HANDWASH FACILITY
2. Employee Training Class: Employee training classes will be paid the unit price submitted by the selected IH firm This price shall include all costs for labor, materials equipment, and services involved for the IH firm to provide an employee training class. There will be no markup allowed for the contractor on employee training classes.
3. On-Site Services Performed by IH Firm: On-site services performed by the CIH, IH, and/or supervised technicians will be paid at the appropriate unit price per hour submitted by the selected CIH based on the title of the person performing service Hourly rates shall not exceed 245 percent of certified payrolls and these rates shall include the costs of monitoring and maintaining the LHPP as well as all compensation for overhead, profit and direct and indirect costs related to this work. The IH firm's profit shall not exceed 7 percent The hourly rate for a company principal $35. No payment will be made by State services provided to reinspect and/or recertify contractor responsible reimburse IH firmThere markup allowed on-site performed firm.
4. Medical Examinations and Testing by Independent Clinics: Medical examinations and testing by independent clinics will be paid at the actual cost (receipted bills) incurred by the IH Firm or contractor plus 7 percent markup The allowable 7 percent markup will only be applied to actual receipted bills received from medical clinics and laboratories.
5. Equipment: Payment for equipment shall be as follows:
Respiratory equipment, excluding air supply hoses and compressors, will be paid at the agreed upon rental rate or the actual cost (receipted bills) if rental rate cannot be agreed upon Blast hoods will not be paid for under this item There will be no direct payment for air supply hoses, compressors, or replacement parts to maintain respiratory equipment in working condition. These costs shall be considered included in the general cost of the contract There will be no markup allowed for respiratory equipment.
HEPA vacuum system will be paid at the agreed upon rental rate or the actual cost (receipted bills) if rental rate cannot be agreed upon. There will be no direct payment to maintain HEPA vacuum system in working condition; this includes replacement parts. These costs shall be considered included in the general cost of the contract There will be no markup allowed for HEPA vacuum system.
Filtration devices, excluding air supply hoses and compressors, will be paid at the agreed upon rental rate or the actual cost (receipted bills) if rental rate cannot be agreed upon There will be no direct payment for air supply hoses, compressors, or replacement parts to maintain filtration devices in working condition These costs shall be considered included in the general cost of the contract There will be no markup allowed for filtration devices.
The intent of these specifications is to provide reimbursement for only those items listed The costs to contractors and subcontractors of having their personnel attend any training, retraining, or refresher courses, receive any testing or emitting of equipment, take any personal hygiene measures, time required for dress up and dress down, and of any other activity under the LHPP that requires or entails attendance of contractors' or subcontractorspersonnel will not be paid for under this item.All such costs considered included in the general cost of contract.
Description: Under this item, the contractor shall provide for the duration of the work where employees will be exposed to lead a portable handwash facility(ies) The number of facilities to be provided will be dictated by the site and approved by the engineer The facility will provide hot and cold clean water, hand soap or similar cleansing agents, and individual hand towels or sections made of cloth or paper, warm air blowers, or clean individual sections of continuous cloth toweling that the workers will use to wash and dry their hands, face, and any exposed skin prior to eating, drinking, smoking or applying cosmetics The facility shall be located as close to the work site as is physically possible Ownership of and liability for the facility shall remain with the contractor throughout the duration of the project The facility shall comply with 29 CFR Part 1926.51.
Materials: Materials shall be of satisfactory quality for the purpose intended and shall be approved by the engineer.
Requirements: The portable handwash facility shall be trailer, skid, or cart-mounted and have a minimum of one sink with a fresh water tank and a holding tank Hand soap or similar cleansing agents and individual hand towels or sections made of cloth or paper, warm air blowers, or clean individual sections of continuous cloth toweling shall be provided The facility will also be equipped with hot water heater, eye wash station, storage cabinets, lights for night use, an electric or pneumatic water pump, and lead filtration system Containers for the collection and disposal of refuse generated at the facility shall also be provided.
The facility shall be kept in a sanitary condition and clean as defined in the current CRISP protocol As a minimum, the facility shall be cleaned after every shift.
Method of Measurement: The furnishing of the portable handwash facility(ies) that are approved will be measured for payment by the number of calendar months that each facility is in place, operational, and being used by employees who are exposed to lead above the Action Level of 30 µg/m³, or have blood levels above 20 µg/dl or who have been directed by the CIH A portable handwash facility that is in operation for only a portion of a month will be measured for payment for the entire month.
Basis of Payment: The furnishing of the portable handwash facility will be paid for at the contract unit price per month for each “Portable Handwash Facility” as specified, which price shall include all material, equipment, labor, sampling, testing, treatment, and disposal of wastewater, cleaning, maintenance, disposal, cost of the CIH for monitoring the cleanliness of the facility, and work incidental thereto.
#603272A - DECONTAMINATION FACILITY
Description: Under this item, the contractor shall provide for the duration of the work where employees will be exposed to lead a climate-controlled decontamination facility The decontamination facility shall consist of a “clean” area where workers can remove and store clean street clothing when they arrive on site for work, shower room with hot and cold running water, soap and towels, and a “dirty” area where work clothing and personal protective equipment may be stored The showers shall be located between the two areas The facility shall be used by all employees as defined in Item “Lead Health Protection Program” who are exposed to lead above the Action Level of 30 µg/m³ or have blood levels above 20 µg/dl or who are directed by the CIH. The facility shall have adequate clean storage for all employees who are required to use the facility to store their non-work clothing The facility shall be located as close to the work site as is physically possible. If the contractor is unable to locate the decontamination facility close to specific work areas, a designated shuttle vehicle shall be provided This vehicle shall be classified as contaminated and shall remain at the jobsite in the decontamination zone This vehicle shall be operated and maintained to eliminate any possibility of cross contamination with the support zone The vehicle shall be cleaned as defined in the current CRISP protocol. Ownership of and liability for the facility and shuttle vehicle shall remain with the contractor throughout The facility shall comply with 29 CFR Part 1926.51.
Materials: Materials shall be of satisfactory quality for the purpose intended and shall be approved by the engineer. The walls, ceiling, and floors shall be constructed of impervious material to aid in the cleaning of the facility such as, but not limited to, fiberglass and plastic.
Requirements: The decontamination facility shall have adequate square feet of floor space to accommodate the workforce and a minimum ceiling height of 2.13 meters Windows shall be of a type that will open and close conveniently, shall be sufficient in number and size to provide adequate light and ventilation, and shall be fitted with locking devices and screens The entrance shall be secure, screened, and fitted with a lock.
The facility shall be provided with a lavatory with hot and cold running water or tepid running water and a lead filtration system. It shall also include hand soap or similar cleansing agents. Individual hand towels, paper or cloth, warm air blowers, or clean individual sections of continuous cloth toweling shall be provided.
Showers shall be provided for each 10 employees of each sex or numerical fraction thereof, who are required to shower during the same shift. Body soap or other appropriate cleansing agents convenient to the shower shall be provided. Showers shall be provided with hot and cold water feeding a common discharge line Employees using showers shall be provided with individual clean towels.
Where working clothes are provided by the employer and become wet or are washed between shifts, provision shall be made to ensure that such clothing is dry before reuse.
The decontamination facility and shuttle vehicle shall be cleaned as required or at least once a week The “clean” area shall be as defined in the current CRISP protocol. If wipe sampling shows that cleaning must be conducted more frequently to maintain this standard, then the frequency of cleaning must be increased. Any wastewater that is generated shall be filtered/ treated to be acceptable to current State and/or local standards for discharge into the existing public wastewater system.
The contractor shall equip the facility with an adequate and safe climate-controlled system, including all necessary fuel, adequate waterproof lighting fixtures, and waterproof electrical outlets. All electrical circuits shall be ground fault protected. The contractor shall also provide exterior illumination of the decontamination facility site. The minimum illumination level shall be 21 lux for a minimum distance of 3 meters on each side of the facility The contractor will provide proper trash receptacles and disposal.
If the decontamination facility remains in service through periods of winter weather, the contractor shall provide snow and ice removal services for the facility site, including but not limited to, driveways, walkways, parking areas, and adjacent sidewalks.
Method of Measurement: The furnishing of the decontamination facility and shuttle vehicle specified will be measured for payment by the number of calendar months that the facility and shuttle vehicle are in place, operational, and being used by employees who are exposed to lead above the action level of 30 µg/m3, or have blood levels above 20 µg/dl, or who have been directed by the CIH A decontamination facility and shuttle vehicle that are in operation for only a portion of a month will be measured for payment for the entire month.
Basis of Payment: The furnishing of the decontamination facility and shuttle vehicle will be paid for at the contract unit price per month for “Decontamination Facility” as specified, which price shall include all material, equipment, labor, cleaning, sampling, testing, treatment, and disposal of wastewater, utilities, maintenance, services, cost of CIH to perform wipe sampling, and work incidental thereto.
The cost of providing external illumination, trash removal, and snow and ice removal shall also be included in the monthly unit price bid for the item “Decontamination Facility” as specified.
CONNECTICUT ROAD INDUSTRY SURVEILLANCE PROJECT
150 Washington Street Hartford, CT 06106 Tel: 203-566-1454
The fundamental objective of CRISP (Connecticut Road Industry Surveillance Project) is to limit the toxicity from lead exposure in bridge repair and rehabilitation workers in the State of Connecticut It performs this function through active surveillance of the cohort of bridge workers on bridge sites at any given moment in the State.
The authority for medical visits and examinations is provided through Connecticut Department of Transportation (CONNDOT) bid contract specifications. These specifications provide for a Lead Health Protection Program (LHPP) in all circumstances where lead exposure is possible on a construction site.
In general, the workers screened through this program will be painters, blasters, and ironworkers These general groups do the most direct lead-associated work on the bridge sites. However, since the potential exposures to lead generated by these activities are so great (10,000 µg/m3 is not uncommon in burning activities), bystander exposures are also very important For example, a carpenter building forms near an ironworker replacing a bearing may receive substantial “bystander” exposure.
CRISP provides for five basic medical evaluations for workers in this cohort. The forms include the following:
The ENTRY/ANNUAL EVALUATION is designed to provide baseline medical information, to identify medical conditions that might be worsened by lead exposure, and to provide for medical certification for respirator wear It includes a section on occupational and medical history, physical examination findings, laboratory values, and recommendations For data management purposes, the five medical evaluation forms are used to record this information and enable accurate records to be kept and data management to be undertaken. Demographic data for each worker must be completely and accurately documented. This not only includes name, address, and so forth, but also includes jobsite/work site information and employer data This is important so that when a worker is identified with a high lead level, access to the site and worker for intervention will be expeditious The MEDICAL EVALUATION FOR RESPIRATOR USE is completed at the time of the Entry/Annual Evaluation.
The laboratory values required under the CONNDOT specifications include the following:
The physical examination is meant to examine and report findings on those organ systems that are known to be subject to harm from elevated lead exposure (i.e., neurologic, GI, etc.).
The INTERVAL EVALUATION is conducted on a variable protocol For all workers entered into the system (those seen by one of the participating CRISP clinics) monthly BLL and ZPP testing is required for the first 4 months and at month 6. If, after 6 months of testing, the BLL remains below 25 µg/dl, the worker is switched to a quarterly schedule and BLL and ZPP are drawn every 3 months. If at any time in the quarterly schedule, the BLL exceeds 25 µg/dl, the worker is switched to a monthly testing interval.
The Interval Evaluation form is designed to record the most recent BLL and ZPP levels and to update the workers' demographic/work site information and symptoms listing Hence, the form is designed to include those sections of the Entry/Annual Evaluation form relevant to these needs The only labs drawn at this time are the BLL and ZPP, except, of course, if the physician recommends additional work-up for an abnormal finding.
The COMPREHENSIVE EVALUATION is completed for all workers found to have lead levels in blood greater than 35 µg/dl. Again, the format of the reporting document closely parallels the Entry/Annual Evaluation form except that the occupational history is more expansive (to include direct and more comprehensive questions regarding work history). More information is gathered regarding the workers' possible alternate and prior lead exposures, and all of the demographic and past medical history information will be updated. Laboratories replicate those noted above except for spirometry.
These workers continue on a monthly BLL and ZPP testing interval and their lab and examination results initiate an intervention by the IH component of the project If a lead-toxicity related finding is detected on this or other evaluations, the worker is referred for specialty follow-up to one of the academic occupational medical clinics for specialist evaluation.
The EXIT EVALUATION is completed within 5 days of the completion of a project, or after the employee's last day employed on a project, or if an employee is terminated by his/her employer Exit Evaluation shall be required only for projects lasting 1 month or longer. The format of the examination is similar to the Interval Evaluation but does not require information on recommendations for working conditions. BLL and ZPP tests are performed.
In summary, the CRISP protocol includes the use of five separate documentation and reporting forms:
Entry/Annual Evaluation form is used only for entry of a particular worker into the system or for the worker's first evaluation of the construction season.
Medical Evaluation for Respirator Use form is used in conjunction with the Entry/Annual Evaluation form to record spirometry results.
Interval Evaluation form is utilized whenever a worker returns to the clinic system for repeat BLL and ZPP levels This form is intended only to serve as a reporting form for the most recent BLL and ZPP data and as an update to existing demographic, jobsite, and symptomatology information.
Comprehensive Evaluation form is utilized once the worker's BLL passes 35 µg/dl.It is not used for follow-up subsequent to this unless a lead-related abnormality found at an interval visit or the noted have increased.
Exit Evaluation form is used when a worker changes his/her work setting or employer or a project is completed.
Finally, CRISP and the CRISP medical examination protocol are not designed nor are they intended to serve as a pre-placement examination system to evaluate workers for fitness to work, except that medical problems that would be worsened by lead exposure are identified and considered If lead-related toxicity is detected in a worker, the CRISP system (Department of Public Health and Addiction Services and CRISP Project Director) manages the appropriate work site intervention strategy, including an IH investigation Any worker ill as a result of lead-related toxicity will be referred to an occupational medicine diagnostic clinic for full evaluation and will usually be placed in a medical removal classification
Changes to the CRISP Protocol for
CONNECTICUT ROAD INDUSTRY SURVEILLANCE PROJECT
150 Washington Street Hartford, CT 06106 Tel: 203-566-1454
CRISP Protocol and Financial Responsibility for Medical Evaluation
CRISP EXAMINATION VISIT TIMELINE
Biological monitoring under the OSHA Lead Rule is triggered from the time of employment CRISP has adapted its schedule to conform with the rule Therefore, once an employee begins a new job, he/she needs a baseline and four subsequent monthly visits, etc The annual exam is performed to determine medical fitness for respirator use (PE, PFT) and to perform annual bloodwork to evaluate for anemia, kidney disease, etc. (UA & Micro, CBC, SMAC) The annual exam is performed in addition to an interval screen when 12 or more months have elapsed since the last annual/entry exam.
Some examples follow:
A worker starts a job at month 0. There are four monthly interval exams and interval exams at month 6, 9, and 12 as long as BLLs remain less than 20 µg/dl. At month 12, an annual exam is performed since it has been 12 months since the entry exam. If the job continues past 1 year, the cycle of biological monitoring will repeat that of the first year (monthly interval exams, interval exams at month 6, 9, and 12 as long as BLL remain less than 20 µg/dl).
First- and second-year monitoring program:
A worker starts a job at month 0. There are monthly interval exams and an exit exam at month 6 (as long as BLL's remain less than 20 µg/dl). There is no other monitoring if the exit BLL is less than 20 µg/dl At month 7, the worker is hired by another employer. This triggers four monthly interval exams from month 8 thru 11, an interval at 6 , 9, and 12 from the date of the most recent hire (13, 16, and 18 months from entry into the CRISP system). At month 13, an annual exam is performed since it has been 12 months since the entry exam. If the job continues past this point, revert to the first year cycle of screening.
A worker starts at month zero There are two monthly interval exams and then an exit exam when he/she is laid off. There is no other monitoring if the exit BLL is less than 20 µg/dl The worker is re-hired twice more at month 6 or 10 for one-month jobs An entry annual exam is not needed to re-enter at month 6 or 10 Rather, interval exams are performed at these times. At month 13, the worker starts another job At this point, an annual (it has been 12 months since the last one) and interval (start of new monitoring schedule) exam are both needed This new job triggers subsequent interval exams from month 14 thru 17. An exit is performed at month 18 when the worker is laid off There is no other monitoring if the exit BLL is less than 20 µg/dl.
A worker starts a job at month 0 There are monthly interval exams and an interval exam at month 6. At month 6, the BLL is greater than 30 µg/dl, triggering a comprehensive exam Monthly interval exams are performed after the comprehensive exam until the BLL is less than 20 µg/dl (at month 8). At this point, the worker resumes the normal monitoring schedule (month 9 and 12) that was initiated at the time of hire on month 0 At month 12, an annual exam is performed since it has been 12 months since the entry exam. If the job continues past this point, revert to example 1 for guidance on the intensity of biological monitoring in the second year of the current job An exit exam is performed at month 13 when the worker is laid off. There is no other monitoring if the exit BLL is less than 20 µg/dl.
A worker starts a job at month 0 There are monthly interval exams and an interval at month 6. At month 6, the BLL is greater than 20 µg/dl. This triggers monthly interval exams at month 7 and 8 until the BLL is less than 20 µg/dl at month 8 At this point, the worker resumes the normal monitoring schedule (month 9 and 12) that was initiated at the time of hire at month 0 At month 12, an annual exam is performed since it has been 12 months since the entry exam If the job continues past this point, revert to example 1 for guidance on biological monitoring during the second year of the current job An exit exam is performed at month 15 when the worker is laid off. There is no other monitoring if the exit BLL is less than 20 µg/dl.
A worker starts a job at month 0 There are three monthly interval exams and an exit exam at month 4 when the worker is laid off At exit exam on month 4, the BLL is greater than 20 µg/dl This triggers monthly interval exams at month 5 and 6 until the BLL is less than 20 µg/dl at month 6. Even though the worker has stopped working for the employer at month 4, he/she is not allowed to exit the CRISP system until the BLL is less than 20 µg/dl There is no other monitoring after month 6 since the exit BLL is less than 20 µg/dl at month 6.
CONNECTICUT ROAD INDUSTRY SURVEILLANCE PROJECT
150 Washington Street Hartford, CT 06106 Tel: 203-566-1454
WIPE SAMPLE PROTOCOL
Wipe samples should be done using the technique specified in HUD using moistened wipes, and wiping flat surfaces of 1 square foot (so using a template, HUD suggests two passes over the surface in opposite directions, without scrubbing.) Wipe samples of non-flat surfaces should be done as follows:
Wipe sampling is conducted to ensure that areas are clean. The definition of clean for CRISP protocol is less than or equal to 100 µg/square foot (sq ft) for flat surfaces Areas that should always be clean (i.e., clean side of decontamination facility, eating area) should be below this level all the time, whereas areas expected to get dirty (i.e., dirty side of decontamination facility, portable handwash facility, hands) should be below this level after cleaning Steering wheels, insides of respirators, and blast helmets should also be maintained at less than 100 µg/sample.
Frequency of minimum sampling requested:
Clean side - Clean side of decontamination trailer should be maintained below 100 µg/sq ft Adequate samples must be taken to determine cleaning schedule to maintain all surfaces at less than 100 µg/sq ft at all times After that, sampling may be reduced to once per week or less, and done just before scheduled cleaning.
Dirty side - At least one floor and one outside-of-locker or bench sample should be taken just after cleaning at least once per week until 3 consecutive weeks of samples have all been below 100 µg/sq ft After that, dirty side samples may be reduced to one per month just after cleaning.
Guidelines for Installation and Operation of the CRISP IH Computer Reporting Program
CONNECTICUT ROAD INDUSTRY SURVEILLANCE PROJECT
150 Washington Street Hartford, CT 06106 Tel: 203-566-1454
Guidelines for Installation and Operation of the CRISP Industrial Hygiene (IH) Computer Reporting Program
To use the CRISP IH Database System you must have an IBM clone personal computer with the following minimum SYSTEM REQUIREMENTS:
To INSTALL the CRISP IH Database System (Do NOT install the CRISP IH Database System on more than one computer Request additional diskettes from Bob Iden or Kathie Hammond, PhD, if you want to install the program on more than one computer):
General Information: How Do I?
CRISP Industrial Hygiene (IH) Forms
A listing of the Industrial Hygiene Forms required for CRISP and where to locate the forms are explained below.
The following forms are contained on the CRISP IH Computer Data Reporting Program disks (the disks will be available at the time of contract award):
Each one of these forms is generated with unique form numbers. The forms listed above must NOT be photocopied.
Several forms not included on the disks but required for IH monthly reporting are the following:
These forms may be photocopied If new forms are needed they may be obtained from the CRISP IH, Judy Sparer.
Note: Information required by the CRISP IH for inclusion in monthly reports is detailed in the Connecticut Department of Transportation’s Lead Health Protection Program (LHPP).