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.

June 2, 1998

Ms. Debra A. Rowland
Occupational Medicine of York (OMY)
Mobile Medical Testing
Commerce Commons #312
2180 White Street
York, PA 17404-4900

Dear Ms. Rowland:

This is in response to your letter of April 14, addressed to the Department of Labor. Your letter, which was sent to the Occupational Safety and Health Administration (OSHA), for response, requested clarification of several provisions the OSHA noise standard and required medical referrals. We will repeat each of your questions and follow with an answer.

What constitutes a medical referral? The professional reviewer determines if an employee needs a medical referral. Examples which might promote a referral are when an employee is unable to take a hearing test on a self-recording audiometer; does not respond reliably, or has visible irritation of the ear or pain in the ear canal which may be caused or aggravated by earplugs.

When is the company responsible for paying for the referral to a physician? The employer is responsible for paying for referrals that are needed to accurately determine an employee's hearing status, or if it is suspected that the provided earplugs are causing or aggravating an irritation or infection of the employee's ear canals.

Is a company responsible for any and all problems that an employee has with his ears or hearing if he is included in a hearing conservation program? The company must pay for any referrals that are for the purpose of further identifying the effects of occupational noise exposure or any detrimental effects from wearing hearing protectors. Medical pathologies which are clearly not related to the wearing of hearing protectors or an otoscopically abnormal eardrum due to an allergy or cold are not the employer's responsibility. However, the employee must be informed of the need for examination or treatment.

In the sample audiograms provided, which employees should be referred to a physician and who is responsible for paying for the visits, the company or the employee? An audiogram is not the sole indicator of a need for a referral. As mentioned above, the professional reviewer would determine if an employee needs to be referred for further testing or examination. Often, just a retest may be indicated, especially if the first test was done when the employee was suffering from an allergy or a cold.

If the employee refuses to see a physician, what kind of documentation does the company need to prove that they offered the referral? OSHA does not have any declination forms in the noise standard. Employers may use whatever documentation they prefer.

Is the company required to keep copies of employee notification letters? Keeping a copy of the letter is not required as long as the company keeps some other form of proof that the employee was notified of his standard threshold shift.

If the employee does not have a shift in hearing and has no medical problems, is it still mandatory to keep a copy of the employee notification letter? If the employee has no hearing loss and no medical problems then no notification letter is required.

We appreciate the opportunity to clarify these matters for you. If you have any further questions, you may contact Mr. Craig Moulton in our Office of Health Compliance Assistance at (202) 219-8036.


John B. Miles, Jr.
Directorate of Compliance