Lead (Pb)
CFR29 CFR 1910.1025 (general industry) + 29 CFR 1926.62 (construction)
AL 30 ug/m3 TWA PEL 50 ug/m3 TWA
🇺🇸 United States 🇺🇸 United States · ADA 1990/ADAAA 2008 · ACOEM FFD · OSHA medical surveillance · FMLA · PWFA
Fitness for work + medical surveillance
US occupational fitness is more directive than the UK model: the occupational physician certifies fitness for duty (FFD) and writes functional restrictions. ADA Title I governs reasonable accommodation through an interactive process; OSHA standards mandate substance-specific medical surveillance; FMLA and PWFA add leave and accommodation floors.
Interactive decision-support wizards
Three operational tools — local computation, no patient data stored. Each supports the process under the physician's clinical judgement; the employer makes employment decisions.
ADA · EEOC · 29 CFR 1630
ADA Interactive Process
Disability + accommodation → 5-step process, reasonableness, undue-hardship analysis.
Open OSHA · 29 CFR 1904OSHA 300 Recordable
Incident → recordable?, forms (300/301/300A), 8/24-hour reporting deadlines.
Open State + federal · WCWorkers' Comp Claim
Program routing (state / FECA / FELA…), dual test, presumption laws, actions.
OpenFitness for Duty (FFD) — the central US concept
Unlike the UK's advisory "may be fit for work" note, the US occupational physician certifies fitness for duty and issues functional restrictions in a letter to the employer (ACOEM model). The written opinion contains functional limitations only — never diagnoses (ADA + HIPAA + GINA segregation). The employer still makes the employment decision, but US OH is historically more directive than the UK gatekeeping-averse model.
ADA Title I — essential functions + interactive process
Essential vs marginal functions
Per ADA Title I, fitness-for-duty must distinguish ESSENTIAL functions (the fundamental job duties) from MARGINAL functions (incidental). Restriction on a marginal function = accommodation likely possible. Restriction on essential function = interactive process to determine reasonable accommodation absent undue hardship.
Interactive process
Occupational physician documents capabilities and limitations. HR + employee conduct interactive process to determine reasonable accommodation. Physician is RESOURCE, not gatekeeper.
Physician is a resource, not a gatekeeper — HR + employee determine the accommodation.
Functional, not diagnostic
Restrictions should be written in FUNCTIONAL terms (lift X lb max for Y weeks; no ladder work for Z duration), NOT diagnostic terms (no degenerative disc disease patients lifting). Diagnoses go in segregated medical record; restrictions go in fitness-for-duty letter shared with employer.
Time-bound by default
Restrictions default to TIME-BOUND. Renewal requires reassessment. Open-ended permanent restrictions trigger ADA disability accommodation analysis.
Disability definition — ADA + ADAAA 2008
A physical or mental impairment that substantially limits a major life activity (42 U.S.C. § 12102). The ADA Amendments Act 2008 broadened this construction — there is no 12-month "long-term" threshold as in the UK Equality Act s.6, and impairments that are episodic or in remission still qualify if they would limit when active.
Fitness-for-duty letter — functional terms only
ADA + HIPAA + GINA require segregation: the personnel file gets functional limitations and duration, never the diagnosis.
Include
- ✓Functional capabilities (lift X lb max for Y weeks)
- ✓Restriction duration with re-evaluation date
- ✓Reference to ADA interactive process
- ✓Renewable / temporary nature where applicable
Never include
- ✕Specific diagnoses (e.g. 'lumbar disc herniation')
- ✕Treatment details
- ✕Medication names
- ✕Specific medical findings
- ✕Prognosis beyond functional duration
View standard FFD letter template
FITNESS FOR DUTY LETTER Worker Name: [Name] Date of Evaluation: [Date] Date of Letter: [Date] Referred By: [HR / Employer / Worker] Functional Capacity: - [Capability or limitation in functional terms] - [Capability or limitation in functional terms] Applicable Restrictions (effective for [duration] — re-evaluation [date]): - [Restriction code US-RESTR-XXX]: [Functional description] - [Restriction code US-RESTR-XXX]: [Functional description] The above functional limitations do not include diagnostic information per ADA + HIPAA + GINA. Medical records remain confidential and segregated. The worker should engage with HR in the ADA/PWFA interactive process to identify reasonable accommodations that allow performance of essential job functions absent undue hardship. Next re-evaluation: [Date] Signed: [Physician name + credentials]
Functional restrictions catalogue (50)
Written in functional terms, time-bound by default. Grouped across 24 ADA/OSHA categories. Codes (US-RESTR-*) map to the FFD letter.
Lifting, pushing, pulling restrictions 6
US-NO-LIFT-10LB · 6 wk No lifting >10 lb (4.5 kg) — frequent or sustained
US-NO-LIFT-25LB · 8 wk No lifting >25 lb (11 kg) — frequent or sustained
US-NO-LIFT-35LB · 12 wk No lifting >35 lb (16 kg) — patient handling threshold
US-NO-LIFT-50LB · 12 wk No lifting >50 lb (23 kg) — general industry standard threshold
US-NO-OVERHEAD-LIFT · 8 wk No overhead lifting or sustained overhead work
US-NO-PUSH-PULL-HEAVY · 6 wk No pushing/pulling forces >25 lbf (110 N)
Posture, repetitive motion restrictions 3
US-NO-REPETITIVE-WRIST · 4 wk No sustained or repetitive wrist flexion/extension (>30/min) — CTS or DeQuervain post-treatment
US-NO-PROLONGED-STAND-6H · 6 wk No standing >6 hours per shift without break; alternate sit-stand encouraged
US-NO-SUSTAINED-SQUAT-KNEEL · 8 wk No sustained squatting or kneeling >30 minutes continuous
VDT / computer use restrictions 2
US-VDT-BREAK-EVERY-2H · 12 wk VDT user: 10-minute break every 2 hours; ergonomic workstation evaluation
US-VDT-NO-PROLONGED-4H · 4 wk VDT use: no more than 4 hours continuous without significant break (computer vision syndrome / migraine accommodation)
Shift work / night work / on-call restrictions 4
US-NO-NIGHT-SHIFT · 12 wk No night shift work (defined as work between 11 PM and 7 AM)
US-NO-ROTATING-SHIFT · 12 wk No rotating shift work; fixed day or fixed evening shift only
US-MAX-HOURS-PER-SHIFT · 8 wk Maximum 8-hour shift; no overtime beyond 40 hours/week
US-NO-ON-CALL · 12 wk No on-call duty / no after-hours call rotation
Driving and DOT CDL-specific restrictions 4
US-NO-CDL-DRIVING Not medically qualified to drive commercial motor vehicle (CMV) per FMCSA 49 CFR 391.41
US-CDL-EXEMPTION-DIABETES · 52 wk CDL driver with insulin-treated diabetes — must meet FMCSA exemption criteria (49 CFR 391.46)
US-CDL-OSA-TREATMENT-REQ · 12 wk CDL driver with OSA (AHI >=20 untreated): treatment required; PAP compliance documentation needed for recertification
US-NO-COMMERCIAL-DRIVING · 8 wk No commercial driving (general, not CDL-specific) — passenger vehicle, delivery van, etc.
Working at heights / fall protection 2
US-NO-HEIGHTS-6FT · 8 wk No working at heights >6 feet (construction) / >4 feet (general industry) without fall protection — restriction on activity itself
US-NO-LADDER-WORK · 6 wk No ladder use, no aerial lift operation, no scaffolding
Confined spaces 1
US-NO-CONFINED-SPACE-ENTRY · 12 wk No permit-required confined space entry
Noise / hearing conservation 1
US-NO-NOISE-EXPOSURE-85DBA · 24 wk No exposure to noise >=85 dBA TWA — including PPE-protected environments if STS documented
Respiratory protection program restrictions 2
US-RESPIRATOR-NOT-CLEARED Not medically cleared for respiratory protection use under OSHA 1910.134 — pending evaluation or failed evaluation
US-NO-N95-FIT-TEST · 12 wk Not cleared for tight-fitting respirator (N95 or higher) — beard exemption requires PAPR or loose-fitting alternative
Bloodborne pathogen / biological exposure 1
US-NO-BBP-EXPOSURE · 12 wk No exposure to bloodborne pathogens (sharps, BBF) — non-immune HepB or pending PEP follow-up
Carcinogen exposure restrictions 2
US-NO-CYTOTOXIC-EXPOSURE · 40 wk No handling of antineoplastic / cytotoxic drugs (USP <800>) — applies during pregnancy or pre-conception with consent
US-NO-ETHYLENE-OXIDE · 26 wk No occupational ethylene oxide exposure (carcinogen + reproductive)
Lead exposure surveillance 2
US-LEAD-MEDICAL-REMOVAL · 8 wk Medical removal from lead exposure — return when BLL <40 ug/dL (general industry) or <30 ug/dL (construction) on two consecutive tests
US-LEAD-REPRO-FEMALE · 26 wk Medical removal of female of reproductive capacity at BLL >=30 ug/dL (or >=10 per CDC ABLES recommendation)
Asbestos exposure 1
US-NO-ASBESTOS-EXPOSURE · 26 wk No occupational asbestos exposure (Class I-IV work as defined in 29 CFR 1926.1101)
Ionizing radiation exposure 2
US-RADIATION-PREGNANT-DECLARED · 40 wk Declared pregnant radiation worker — conceptus dose limit 0.5 rem (5 mSv) total + 0.05 rem/month max
US-RADIATION-WORKER-RESTRICT Radiation worker restriction — exceeded administrative control level or annual occupational limit
Heat and cold stress 2
US-NO-HEAT-WORK · 12 wk No work in heat conditions >82°F (28°C) indoor or >85°F outdoor without acclimatization + water/shade/rest accommodations
US-NO-COLD-EXPOSURE · 12 wk No work in cold conditions <40°F (4°C) >2 hours continuous; PPE + warming breaks
Skin / dermal exposure 1
US-NO-SKIN-CONTACT-IRRITANT · 12 wk No skin contact with [specify substance] — irritant or sensitizing contact dermatitis documented
Allergic / sensitization 2
US-NO-LATEX-EXPOSURE · 52 wk No latex glove or product exposure — Type I latex hypersensitivity
US-NO-ANIMAL-EXPOSURE · 26 wk No exposure to specified animal — laboratory animal allergy (LAA) or asthma documented
Hand-arm + whole-body vibration 2
US-NO-HAV-EXPOSURE · 26 wk No exposure to hand-arm vibration tools — Stage 2+ HAVS Stockholm Workshop
US-NO-WBV-EXPOSURE · 12 wk No exposure to whole-body vibration — heavy equipment operation, prolonged truck driving
Pregnancy / lactation (cross-reference sprint16) 3
US-PWFA-PREG-LIFTING-15LB · 20 wk Pregnancy accommodation: no lifting >15 lb after 20 weeks gestation
US-PWFA-PREG-NO-NIGHT · 12 wk Pregnancy accommodation: no night shift after 28 weeks gestation
US-PUMP-ACT-BREAKS · 52 wk Lactation accommodation: reasonable break time + private space (non-bathroom) up to 1 year postpartum
Psychiatric / mental health fitness-for-duty 2
US-PSYCH-FFD-PENDING · 4 wk Psychiatric fitness-for-duty evaluation pending; not cleared for return to work
US-NO-FIREARM-CARRY · 12 wk Not cleared to carry firearm — psychiatric or cognitive restriction documented
Infection control / immunocompromise 2
US-NO-PATIENT-CONTACT-IMMUNOCOMPROMISED · 12 wk Immunocompromised worker: no contact with patients with active TB / measles / varicella / shingles / pertussis (until immune or excluded)
US-INFECTIOUS-EXCLUSION · 2 wk Worker exclusion: active infectious condition (varicella, measles, TB, scabies, etc.) — exclude until non-infectious
Organizational / schedule 1
US-NO-SHIFT-PERMANENT · 999 wk Permanent accommodation: cannot perform essential function due to ongoing disability — ADA interactive process for reassignment or alternative
Required medical follow-up 1
US-MEDICAL-FU-REQUIRED · 12 wk Required medical follow-up within [specify timeframe] — for OSHA-mandated surveillance or post-treatment
General medical surveillance requirement 1
US-SURVEILLANCE-PROGRAM-CONTINUED · 52 wk Continued in OSHA medical surveillance program (specify substance: lead, asbestos, cadmium, Cr VI, formaldehyde, EtO, etc.) — periodic exams required
OSHA medical surveillance triggers (20)
Surveillance is usually triggered at the action level (≈ 50 % of the PEL) for ≥ 30 days/year, not the PEL itself. The PLHCP issues a written opinion (functional only). Records kept employment + 30 years (29 CFR 1910.1020).
Asbestos (all fiber types)
CFR29 CFR 1910.1001 (general industry) + 29 CFR 1915.1001 (shipyards) + 29 CFR 1926.1101 (construction)
AL 0.1 fiber/cc TWA PEL 0.1 fiber/cc TWA + 1 f/cc 30-min excursion
Benzene
CFR29 CFR 1910.1028
AL 0.5 ppm TWA PEL 1 ppm TWA + 5 ppm STEL (15-min)
Cadmium
CFR29 CFR 1910.1027 (general industry) + 29 CFR 1926.1127 (construction)
AL 2.5 ug/m3 TWA PEL 5 ug/m3 TWA
Hexavalent chromium (Cr(VI))
CFR29 CFR 1910.1026
AL 2.5 ug/m3 TWA PEL 5 ug/m3 TWA
Methylene chloride (DCM)
CFR29 CFR 1910.1052
AL 12.5 ppm TWA PEL 25 ppm TWA + 125 ppm STEL
Formaldehyde
CFR29 CFR 1910.1048
AL 0.5 ppm TWA PEL 0.75 ppm TWA + 2 ppm STEL
Ethylene oxide (EtO)
CFR29 CFR 1910.1047
AL 0.5 ppm TWA PEL 1 ppm TWA + 5 ppm STEL (15-min)
Vinyl chloride monomer (VCM)
CFR29 CFR 1910.1017
AL 0.5 ppm TWA PEL 1 ppm TWA + 5 ppm 15-min ceiling
1,3-Butadiene
CFR29 CFR 1910.1051
AL 0.5 ppm TWA PEL 1 ppm TWA + 5 ppm STEL
Inorganic arsenic
CFR29 CFR 1910.1018
AL 5 ug/m3 TWA PEL 10 ug/m3 TWA
Coke oven emissions
CFR29 CFR 1910.1029
AL 150 ug/m3 TWA (PAH measured as BSF — Benzene-Soluble Fraction) PEL 150 ug/m3 TWA
Beryllium (Be) — updated 2017
CFR29 CFR 1910.1024 (general industry) + 29 CFR 1915.1024 (shipyards) + 29 CFR 1926.1124 (construction)
AL 0.1 ug/m3 TWA PEL 0.2 ug/m3 TWA + 2 ug/m3 STEL (15-min)
Respirable crystalline silica
CFR29 CFR 1910.1053 (general industry + maritime) + 29 CFR 1926.1153 (construction)
AL 25 ug/m3 TWA PEL 50 ug/m3 TWA
Bloodborne pathogens (HBV, HCV, HIV)
CFR29 CFR 1910.1030
Occupational noise / Hearing Conservation Program (HCP)
CFR29 CFR 1910.95 (general industry) + 29 CFR 1926.52 (construction)
AL 85 dBA TWA (8-hour) — 5 dB exchange rate (OSHA); NIOSH recommends 3 dB exchange PEL 90 dBA TWA
Respiratory Protection Program medical evaluation (Subpart I)
CFR29 CFR 1910.134(e)
Hazardous Waste Operations and Emergency Response (HAZWOPER)
CFR29 CFR 1910.120 (general industry) + 29 CFR 1926.65 (construction)
Laboratory Standard — Laboratory Use of Hazardous Chemicals
CFR29 CFR 1910.1450
Aerosol Transmissible Diseases (ATD) — Cal/OSHA STATE-SPECIFIC
CFRCal/OSHA 8 CCR 5199 (Aerosol Transmissible Diseases) + 8 CCR 5199.1 (zoonotic ATDs)
Medical Removal Protection (MRP)
Several OSHA standards (lead, cadmium, methylene chloride, formaldehyde, benzene with high BLLs) include Medical Removal Protection (MRP): the worker is removed from exposure when biological markers exceed defined thresholds, with full pay and benefits maintained during removal (up to 18 months for lead; varies for other substances).
FMLA — leave floor
The Family and Medical Leave Act grants up to 12 weeks of unpaid, job-protected leave per year for a serious health condition (29 U.S.C. § 2601; employers ≥ 50 employees). This is a federal floor — states may exceed it with paid leave (CA PFL, NY PFL, NJ FLI).
Workers' compensation — 50-state variation
Unlike the UK's centralized IIDB, US workers' comp is state-administered with no federal floor. Benefits, presumption laws (e.g. firefighter cancer/PTSD in CA, NY, TX) and procedures vary by state. See the specific state workers' compensation commission.
UK ↔ US divergence
| Dimension | 🇬🇧 UK | 🇺🇸 US |
|---|---|---|
| OH role | Advisory ("may be fit") | Directive (certifies FFD) |
| Disability test | Equality Act s.6 — 12-month long-term | ADA — "substantially limits" (no time threshold) |
| Accommodation | Reasonable adjustments (employer decides) | Interactive process (ADA Title I) |
| Compensation | IIDB — centralized federal | Workers' comp — 50-state, no federal floor |
| Record retention | COSHH reg 11 — 40 years | 29 CFR 1910.1020 — employment + 30 years |
Under the physician's clinical judgement
- OH provides advisory capability assessment + accommodation recommendations; the employer makes employment decisions (ACOEM Code of Ethical Conduct).
- The written opinion shares functional limitations only — never diagnoses (AMA Code of Medical Ethics Opinion 1.2.6 + HIPAA + ADA + GINA segregation).
- ADA medical-inquiry rules: no medical inquiry pre-offer; post-offer any inquiry if applied uniformly; current employees only if job-related and consistent with business necessity (29 CFR 1630.14).
- No patient data stored beyond statutory retention (OSHA medical records: employment + 30 years, 29 CFR 1910.1020).