OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.

September 23, 1997

Mr. Chip Darius
Vice President
Holdsworth Associates, Inc.
1224 Mill Street
Post Office Box 503
East Berlin, Cincinnati 06023-0503

Dear Mr. Darius:

This is in response to your letter dated June 27. We apologize for the long delay. Your letter presented specific questions concerning the Occupational Safety and Health Administration's (OSHA) Occupation Exposure to Bloodborne Pathogen Standard and the Enforcement Procedures for Occupational Exposure to Tuberculosis (TB).

The first question you ask concerns when an employer hires a new employee who has been previously vaccinated, does OSHA require the employer to send this employee for a "current" evaluation by a healthcare professional? Paragraph (f)(2)(i) states that an employer must make an evaluation and vaccine available to all employees with reasonably anticipated occupational exposure. If the complete hepatitis B series was previously received, the employer can claim the exemption as stated in paragraph (f)(2). If the employer claims this exemption, it must be documented in the employee's medical record. This establishes a new medical record for the employee and it must be maintained for the duration of employment and for thirty years. This documentation does not require the employer to obtain a "current written opinion" from a professional healthcare provider. Evidence provided by the employee or their previous employer is acceptable for the purposes of recordkeeping. It would be beneficial for the employer to have a copy of the employee's vaccine information to include in the new record. It is suggested that one way to obtain the information would be to ask the employee if they would voluntarily provide a copy. The employer is encouraged to ask the employee for documentation of their vaccine status. The previous employer, who provided the vaccine, maintains the original medical record for the duration of employment plus thirty years.

Your second question pertains to tuberculosis skin testing and which employees are required to be tested. OSHA's position is that employers, in covered workplaces, shall offer Mantoux TB skin tests (at no cost to employees) to all current potentially exposed employees and to all new employees prior to exposure. A two-step baseline shall be used for new employees who have an initially negative TB skin test result and who have not had a documented negative TB skin test result during the preceding 12 months. Periodic skin testing frequency is to be based on the results of the employer's risk assessment, utilizing the methodology outlined in the Centers for Disease Control and Prevention's (CDC) document "Guideline for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994."

Using this methodology, the employer must offer TB skin testing every three months for workers in certain high risk categories, every six months for workers in intermediate categories, and annually for low risk personnel. In addition, OSHA requires that all other employees who "share the air" in the same building or facility be offered an annual TB skin test. Employees who do not work in the same building or facility where suspected or confirmed infectious TB patients are encountered or provided treatment and who do not "share the air" with such an area would not be required to have the TB skin offered to them. Workers with documented positive TB skin test who have received treatment for disease or preventive therapy for infection are exempt from the TB skin test but must be informed periodically about the symptoms of TB and the need for immediate evaluation of any pulmonary symptoms suggestive of TB by a physician or trained healthcare provider to determine if symptoms of TB disease have developed. In addition, if a facility has not encountered or treated any individuals with suspected or confirmed infectious TB, then there is no occupational exposure and TB skin test do not have to be made available. Finally, be aware that participation in the employer's skin testing program is voluntary on the part of the employee. OSHA does not require that employees participate in TB skin testing, only that the employer make such skin testing available to employees.

I hope this response provides you with useful information. Thank you for your interest in safety and health. Please contact Wanda Bissell of my staff at (202) 219-8036 Ext. 49 if you have further questions.


John B. Miles, Jr.
Directorate of Compliance Programs