OSHA's respirable crystalline silica standards require an employer to offer a medical exam to any worker whose silica exposure crosses a set threshold on 30 or more days a year. “The employer shall make medical surveillance available at no cost to the employee, and at a reasonable time and place, for each employee who will be required under this section to use a respirator for 30 or more days per year.” • Specialist must provide a written medical report to the employee and a medical opinion to the employer within 30 days (OSHA 1910.1053 Appendix B Form 1 and OSHA 1910.1053 Appendix B Form 2). When are silica medical surveillance requirements triggered? For construction, OSHA requires surveillance for employees who must use a respirator under the silica standard for 30 or more days per year. Many OSHA standards require medical surveillance — baseline and periodic exams — for workers exposed to specific hazards such as respirable crystalline silica, asbestos, lead, noise, and respirator use. NIOSH, part of the CDC, provides much of the underlying science and recommended exposure limits. An effective program ties together exposure monitoring (to confirm who needs surveillance. In this Section, the required components of medical surveillance under the respirable crystalline silica standard are reviewed, along with additional guidance and recommendations for PLHCPs performing medical surveillance examinations for silica-exposed employees. The first step in setting up a medical monitoring program is to find a health professional (referred to in the standard as a “Physician or Other Licensed Health Care Professional” or “PLTCP”) who can work with your company to set up the program. Within six months all initial medical examinations must be completed, including those for the employees listed in paragraph (b) (2) (ii), and each employee notified of the results of that employee's examination. The Occupational Safety and Health Administration (OSHA) mandates that employers provide free medical surveillance for employees exposed to respirable crystalline silica at levels of 25 micrograms per cubic meter of air or more during an eight-hour workday (the action level ) for 30 or more days each year. In this Section, the required components of medical surveillance under the respirable crystalline silica standard are reviewed, along with additional guidance and recommendations for PLHCPs performing medical surveillance examinations for silica-exposed employees.