Chapter 3 – Health Services

Contents 

Approved by Timur Durrani
Revised 8/23

3.1 Policy
3.2 LBNL Health Services Program
3.3 Facility
3.4 Staff
3.5 Medical Evaluations
3.6 Physical Examinations
3.7 Worker Health Evaluations 
3.8 Medical Surveillance Program
3.8.1 Examinations for Laser Users
3.9 Mandatory Certifications 
3.10 Safety Glasses
3.11 Work Restrictions
3.12 Return-to-Work Policy
3.13 Pregnancy and Reproductive Assessments
3.14 Automated External Defibrillator (AED) Program
3.15 Medical Emergencies and First Aid
3.16 Transportation of Sick or Injured Personnel
3.17 Radiological Accidents
3.18 Aerosol Transmissible Disease (ATD) Standard
3.19 Health Promotion Program
3.20 Immunizations Against Biosafety Hazards
3.21 Medical Records
3.22 Privacy Notice
3.23 Responsible Parties
3.23.1 Site Occupational Medical Director
3.23.2 Health Services Occupational Medicine Providers
3.23.3 Health Services Occupational Health Nurses
3.23.4 Health Services Medical Assistants
3.23.5 Health Services Physicians and Nurse Practitioners
3.23.6 AED Program Manager
3.23.7 Laser Safety Officer
3.23 8 Analytical Services
3.23.9 Radiation Protection Program 
3.23.10 Berkeley Lab Workers
3.23.10.1 Employees With a Non-occupational Illness or Injury
3.23.10.2 Employees With an Occupational Illness or Injury
3.23.10.3 Pregnant Workers
3.23.10.4 Workers Working With Lasers
3.23.10.5 Employees Terminating Employment
3.23.10.6 Workers Enrolled in a Medical Surveillance Program
3.23.10.7 Workers Working at a site with an AED
3.23.11 Human Resources
3.23.12 Berkeley Lab Divisions/Departments and Management
3.23.13 Inclusion, Diversity, Equity, and Accountability (IDEA) Office
3.23.14 Security and Emergency Services (SES)
3.23.15 Environment, Health, and Safety Division (EHS)
3.24 Glossary
3.25 Standards
3.26 Related Berkeley and ES&H Manual Chapters
3.27 References

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3.1 Policy

LBNL Health Services provides comprehensive occupational medicine services to protect and promote the health of LBNL employees. Health Services policy ensures that employees are physically able to perform their assigned duties, ensures that employees with an occupational illness or injury receive medical care and rehabilitation, and provides for emergency treatment for serious illnesses or injuries. The policy also encourages all employees to maintain their physical and mental health and assists in maintaining a healthy and safe work environment.

Health Services is available to all full-time employees, part-time employees who work 30 days in a 12-month period, and all employees enrolled in a medical surveillance program. First Aid and/or emergency services may be provided to subcontractors and guests until they are referred to their employer for industrial injury care or their personal physician for nonindustrial illnesses.

3.2 LBNL Health Services Program

The Health Services programmatic goals are to:

• Ensure that employees are physically and psychologically capable of performing their assigned duties;
• Ensure that employees with an occupational illness or injury receive medical care and rehabilitation;
• Encourage all employees to maintain their physical and mental health; and
• Assist in maintaining a healthy and safe work environment.

To meet these goals, Health Services’ Clinical Program offers a variety of services and resources to employees, including:

• Conducting medical surveillance examinations;
• Offering worker health evaluations for the purpose of initial and continuing assessment of employee fitness for duty;
• Administering immunizations offered as part of work-related exposures or regulatory requirements (e.g., bloodborne pathogens, SARS-COV-2, travel medicine);
• Providing first aid, initial assessment of injuries and illnesses, and appropriate referrals;
• Providing case management for occupational health issues; and
• Offering resources and additional services directly benefiting employee well-being through the Health Promotion Program.

In addition to these direct services, the program staff works closely with other EHS staff to coordinate an effective Medical Surveillance Program and with staff from Human Resources to help implement the Laboratory’s Return-to-Work Policy. The Integrated Disability & Absence Management (IDAM) Office within Health Services provides assistance to employees and supervisors on all aspects of disability and leave of absence management. IDAM will assist Berkeley Lab staff with leaves of absence, reasonable accommodations, and return to work processes, whether occupational or non-occupational. The Human and Animal Regulatory Committees (HARC) Office, also found within Health Services, coordinates the Lab’s animal welfare and human subjects protection programs including the associated oversight committees (see Chapter 22, Research with Human and Animal Subjects).

3.3 Facility

The Health Services facility, located primarily on the first (top) floor of Building 26, houses the following:

• First aid room, containing eye wash station
• Emergency exam room with EKG Machine and crash cart
• 2 medical surveillance exam rooms
• Dedicated Phlebotomy station
• Audiometry booth and Pulmonary Function Testing (PFT) device
• Optometry Office for fitting and dispensing of safety glasses, examining laser users’ eyes, and performing refractions
• Rooms for administrative functions and storage of medical records and supplies

3.4 Staff

The Health Services Group is staffed by the Site Occupational Medical Director, physicians, nurse practitioners, registered nurses, and medical assistants. All occupational health personnel providing occupational medicine services are licensed, registered, or certified as required by federal or California law, and most have additional specialized training in occupational medicine. All staff are CPR (BLS) trained and some staff have additional training in Advanced Cardiac Life Support (ACLS).

3.5 Medical Evaluations

Regulations require that medical evaluations be offered as a part of a comprehensive occupational medicine program. These are divided into three main categories:

• Medical evaluations conducted when determined necessary by Health Services for the purpose of providing initial and continuing assessment of employee fitness for duty.
• Medical surveillance evaluations offered in accordance with Department of Energy (DOE) and California Occupational Safety and Health Administration (Cal/OSHA) regulations, as well as voluntary standards. The surveillance program is to ensure employees are not overexposed to hazards, and to detect early signs of disease, prevent disease progression, and protect other members of the workforce.
• Certifications required by DOE and Cal/OSHA regulations and standards depending on job classification. These periodic, hazard-based medical monitoring or qualification-based fitness for duty evaluations are considered mandatory unless otherwise specified.

3.6 Physical Examinations

As a part of medical evaluations, physical examinations may at times be warranted. The Site Occupational Medical Director establishes the frequency and content of physical examinations based on Cal/OSHA regulations, DOE guidelines, and the standards of medical practice. A physical examination may include:

• Personal medical history (see Section 3.22 (Privacy Notice))
• Physical examination
• Vision tests
• Hearing tests
• Measurement of pulmonary function
• Electrocardiograms , if indicated
• Chest x-ray (available off site) and/or Tuberculosis testing  
• Complete blood count
• Blood chemistries
• Special Blood Testing to include lead or beryllium
• Urinalysis
• Special procedures

Prior to testing, employees are provided a verbal and written description of all recommended tests, including the nature of the test, the purpose, and results of testing. This discussion is documented in the medical record by the consent form and test explanation sheet.

3.7 Worker Health Evaluations

Worker health evaluations are conducted under the direction of a licensed physician, in accordance with current sound and acceptable medical practices and all pertinent statutory and regulatory requirements, such as the Americans with Disabilities Act. Evaluations providing initial and continuing assessment of employee fitness for duty must be conducted when determined necessary by the Laboratory Medical Director or their designee and are offered by Health Services as follows:

• At the time of employment entrance or transfer to a job with new functions and hazards, a medical pre-placement evaluation of the individual’s general health and physical and psychological capacity to perform the essential duties of their position will establish a baseline record of physical condition and assure fitness for duty. These evaluations are tailored to the job demands, as described by the supervisor, and are required only for specific roles.
• Diagnostic evaluations will evaluate employees’ injuries and illnesses to determine work-relatedness, the applicability of medical restrictions, and referral for definitive care, as appropriate.
• After a work-related injury or illness or an absence due to any injury or illness lasting five or more consecutive workdays (or an equivalent time period for those individuals on an alternative work schedule), a return to work evaluation will determine the individual’s physical and psychological capacity to perform work and return to duty.
• At the time of separation from employment, individuals shall be offered a general health evaluation to establish a record of physical condition.
• Participation in worker health evaluations is typically voluntary. However, we recommend all employees discuss the offer of an evaluation and potential alternatives with one of our health providers to determine the best course of action. Mandatory evaluations may be necessary depending on the job duties, regulatory requirements, and Laboratory policy.

3.8 Medical Surveillance Program

The Medical Surveillance Program provides medical examinations and laboratory evaluations in accordance with Department of Energy (DOE) and California Occupational Safety and Health Administration (Cal/OSHA) regulations, as well as voluntary standards. The surveillance program is to ensure workers are not overexposed to hazards, and to detect early signs of disease, prevent disease progression, and protect other members of the workforce.  Berkeley Lab provides a wide variety of medical surveillance evaluations based upon the following:

• Actual exposure to certain hazardous chemicals, allergens, or biological agents.
• Actual or possible exposure to physical agents and radiation.
• The requirement or option to wear certain types of personal protective equipment.
• Requirements from collaborating institutions (e.g., Antarctic Field Station).

Health Services is typically required by regulations to offer medical surveillance evaluations to protect workers from known hazardous exposures. However, workers at the Lab, in most cases, have the option to decline part or all of the evaluation. These are handled on a case-by-case basis and are dependent on the regulatory requirements and Laboratory policy. New surveillance and monitoring programs may be initiated, as needed, when regulations change or new hazards are brought to the attention of EHS and Health Services. The following surveillance categories are included in the program:

• All individuals entering Animal Care Facilities such as:
  • Animal Care Technicians
  • Researchers
  • Maintenance/Facilities personnel
• Asbestos Construction workers
• Workers exposed to Beryllium, Lead, Silica, or Nanoparticles
• Drivers of vehicles with a Gross Vehicle Weight Rating (GVWR) of more than 10,000 pounds
• Carpenters
• Powered Industrial Truck operators including, crane, forklift and powered hand truck operators
• Geotechnical support staff
• Hazardous Waste Operations staff
• HAZMAT Response Team
• Workers who use lasers
• Painters
• Workers exposed to excessive noise levels as defined by Chapter 4
• Workers who work with blood, blood products, or human cell lines
• Workers who work with radioactive isotopes, x-ray devices, or accelerators
• Workers exposed to excessive levels of airborne dust, gasses and vapors
• Workers who work with specific pathogens and biosafety agents
• Welders

In addition, either workers or the Health Services group (in consultation with Industrial Hygienists) may arrange for voluntary medical evaluations under the following circumstances:

• Whenever a worker develops signs or symptoms associated with a hazardous chemical to which the employee may have been exposed in the laboratory,
• Exposure monitoring demonstrates exposure above the action level or permissible exposure limit for a regulated chemical with a medical surveillance requirement,
• Any laboratory incident that results in the likelihood of a hazardous exposure, or
• Significant questions arise about possible health effects of novel compounds, such as engineered nanoparticles.

In carrying out its medical surveillance activities, Health Services depends on the cooperation and collaboration of the Health & Safety Department, Analytical Services, and Radiation Protection. (For general health concerns, see also Section 3.7, Periodic Examinations.)

3.8.1 Examinations for Laser Users

Users of Class 3B and Class 4 lasers are required to undergo an eye examination performed by an optometrist before they can begin working with lasers and after any accidental exposure to a laser. Contact Health Services for an appointment (extension 6266) for an examination.

3.9 Mandatory Certifications

A subset of surveillance exams are termed Certifications, which are periodic, hazard-based medical monitoring or qualification-based fitness for duty evaluations required by regulations and standards, or as recommended by the occupational medicine services provider, and will be provided on the frequency required. Most often, this category will apply to qualification standards to operate certain types of equipment or vehicles.

Requirements for these exams are based on job duties and job title classifications, and the exam itself will be designed to meet the regulatory requirements for the position. As mandatory requirements, these will be included as a part of the job description and offer letter issued by HR. By definition, these evaluations are mandatory in order to perform the job duties.

3.10 Safety Glasses

Safety glasses are supplied to employees free of charge. Employees can make an appointment with the optometrist, ext. 6266, in Health Services to have safety glasses fitted. The optometrist can also perform refractions for employees who require safety glasses but do not have a current prescription.

3.11 Work Restrictions

Work restrictions may be placed on an employee’s work based on the results of his or her evaluation, illness, or injury.

3.12 Return To Work Policy

The Berkeley Lab Return-to-Work Policy requires employees returning to work after one full day or more of lost time due to a work-related illness or injury to report to Health Services for an evaluation of their condition and ability to resume customary work. Employees who have been absent for five or more consecutive workdays due to non-occupational illness or injury also are required to report to Health Services so that their ability to return to work safely can be determined.

3.13 Pregnancy and Reproductive Assessments

Health Services’ policy is to assess and control exposures that may affect the reproductive and developmental health of LBNL employees including;

• Radiation exposure
• Chemical exposure
• Physical hazards

Assessments are voluntary and include discussion with a health professional about the employee’s work environment and any possible reproductive or developmental concerns. Health Services will then coordinate with the EHS team to identify, assess and control reproductive and developmental exposures in the employee’s work environment. Pregnant employees are also offered enrollment in the Declared Pregnant Worker program, See ES&H Manual Chapter 21 (Radiological Control Manual), Chapter 2, Part 1, Section 215 and Chapter 4 Exposure Assessment, Section 4.7 Work Process A.

3.14 Automated External Defibrillator (AED) Program

The Health Services Group shares responsibility for the AED program at Berkeley Lab with Security and Emergency Services (SES). The following policy statement and implementation plan for the consistent and uniform deployment and ongoing management of an AED program at Berkeley Lab, applies to both on-site and off-site Laboratory locations, regardless of county location, for the treatment of victims eight years of age and older.

An AED is used to treat victims who experience sudden cardiac arrest (SCA). It is only to be applied to victims who are unconscious, without signs of circulation and normal breathing. The AED will analyze the heart rhythm and advise the operator if a shockable rhythm is detected. If a shockable rhythm is detected, the AED will charge to the appropriate energy level and advise the operator to deliver a shock.

AED purchases (and related items that may require periodic replacement) are coordinated by Health Services at the request of the division because AEDs are a standardized and controlled procurement item. The requesting division is responsible for coordinating the location of the AED with the building manager and an SES representative to ensure compliance with state and local Americans with Disabilities Act (ADA) access guidelines and for uniformity of setup.  Divisions are also responsible for the work order to install the AED storage box, posting instructions on how to use the AED in its location, and reporting final placement information to the program manager. A master list of AED locations is maintained by SES; this list is utilized to perform the required maintenance checks and for required reporting to the county. The program manager is responsible for ensuring that all of the requirements of the California Health and Safety Code are met as a part of a required annual review process.

Any AED use must be promptly reported to Health Services, which is responsible for organizing the post-event review and debriefing.

3.15 Medical Emergencies and First Aid

FOR EMERGENCIES, CALL:

911 from any phone

FROM 7:00 A.M. TO 4:30 P.M., First Aid and triage IS AVAILABLE IN HEALTH SERVICES, BLDG. 26, EXT. 6266.

AT ALL OTHER TIMES, EMERGENCY MEDICAL SERVICES ARE AVAILABLE FROM THE FIRE DEPARTMENT THROUGH THE 911 DISPATCH SYSTEM.

First aid and treatment is provided for occupational injuries and illnesses. Treatment for complex cases is coordinated with outside specialists, including therapists, according to Workers’ Compensation guidelines. Occupational therapy is available on site for upper extremity repetitive stress injuries.

Employees are provided with primary aid at the site where the injury occurred if they cannot be moved from the site; treatment is provided by Alameda County Fire Department in accordance with Alameda County Emergency Medical Services (EMS) policy and protocol.

REPORT EVERY INJURY SUSTAINED WHILE PERFORMING LBNL-ASSIGNED TASKS, NO MATTER HOW MINOR, TO YOUR MANAGER, SUPERVISOR, OR WORK LEAD, AND HEALTH SERVICES.

3.16 Transportation of Sick or Injured Personnel

Employees who are severely injured or become seriously ill at work will be transported to nearby hospitals by City of Berkeley Fire Department or the current city-contracted ambulance service, in accordance with Alameda County EMS policy and protocol.

Transportation of less seriously injured employees will be managed on a case-by-case basis.

3.17 Radiological Accidents

EHS notifies LBNL health care professionals of accidental exposures to radiation. In the event of contamination by radioactive isotopes or possible activation by high-energy beams, an employee may be given a whole-body count and have a radiochemical analysis of urine done by Technical Services staff. The actions of the health care professionals include possible decontamination, treatment and notification. The type and severity of the exposure or spill will determine the actions taken by the health care professionals.

LBNL has a collaborative relationship with a local hospital to admit and care for LBNL employees who are either radioactively contaminated or both radioactively contaminated and injured. Joint training is conducted with the local receiving facility for these types of events.

3.18 Aerosol Transmissible Disease (ATD) Standard

Health Services will provide screening and referral to all persons who present with respiratory symptoms in accordance with established front desk procedures and clinical guidelines. Health Services is considered a Referring Employer under the Aerosol Transmissible Disease Standard.

3.19 Health Promotion Program

As a Department of Energy site, Berkeley Lab is committed to the health and wellness of all employees and considers wellness programs to be an essential component of a preventative medicine program. Berkeley Lab provides employees and their families with opportunities for health promotion through a variety of means that are coordinated through Health Services. The program is centrally reviewed and approved by the Medical Director; however, content is a collaborative effort across the following groups:

• Health Services: provides health evaluations and wellness-associated services (e.g. consultations, vaccinations, etc.).
• Human Resources: provides access to information regarding options for employee benefits and how to access them.
• Inclusion, Diversity, Equity, and Accountability (IDEA) Office: supports several initiatives to promote well-being for all.
• University of California: provides a variety of tools for employees, including financial planning resources and the Employee Assistance Program (EAP). EAP is located at the University of California Health Center (the Tang Center) on the Berkeley campus. The program offers confidential, comprehensive counseling services and referral for personal or work-related problems. Employees may seek help directly from the EAP or may be referred by a supervisor or Health Services. EAP counseling records are maintained separately from LBNL Health Services medical records by EAP services.

Information about upcoming health promotion offerings is disseminated via the newsletter Elements, the Healthy & Well at LBNL website, or by direct communication with employees.

3.20 Immunizations Against Biosafety Hazards

Health Services encourages and promotes the safe use of vaccines to prevent occupational infections, with a goal to increase the safety of research with biological etiologic agents (See Biosafety Manual for more details). Immunizations are available to employees who require such protection during the course of their work at the Laboratory or during work-related travel. The following are examples of immunization offerings found through Health Services:

1. Yearly immunization against influenza is offered to all employees.
2. Bloodborne Pathogen training and offer or verification of Hepatitis B vaccine series is mandatory for all employees enrolled in WPC activities that involve human blood or unfixed tissue work, including employees of Health Services.
3. Health Services staff are further offered vaccines for MMR, Tdap, COVID-19, and Varicella Zoster as a part of ATD standard (Section 3.18 above)
4. For certain types of biological exposures reviewed by the LBNL Biosafety Committee (IBC).
   1. The IBC is required to invite the SOMD to all IBC meetings and solicit immunization recommendations accordingly. If the SOMD or his/her designee are not present at the meeting, the Biosafety Officer is responsible for getting the SOMD’s recommendations.
5. In some cases, it may additionally be recommended that a sample of employee blood serum be stored in advance of exposure to the biological agent.
6. Recommendations may be made by clinicians in Health Services as a part of worker health evaluations when medical conditions or exposures evaluated indicate the potential protection is warranted.

All employees are encouraged to make an appointment with Health Services if they fall into one of these or any other scenarios in which immunization may be potentially protective. Health Services will provide information on the potential risks of exposure while performing your work, the characteristics and potential risks of the available vaccines, as well as the potential benefits and any specific indications based on your health status. Recommended vaccines are provided at no cost to employees.

3.21 Medical Records

Complete medical records are maintained for employees from the time of their first evaluation. These records are confidential to the extent provided by law and remain in the custody and control of Health Services.

Information from an employee’s health records may be disclosed only as required by law or if an employee provides written consent for release of information. Records are retained for length of employment plus 75 years.

3.22 Privacy Notice

The State of California Information Practices Act of 1977 (effective July 1, 1978) requires LBNL to provide the information on the Privacy Notice form to individuals who are asked to complete medical history forms or otherwise supply personal information.

The information on the medical history forms is requested by Health Services for purposes of maintaining a complete medical record for each LBNL employee. Furnishing the requested information is voluntary and is intended to help protect the health of LBNL employees.

All information in employees’ medical records is available only to Health Services staff. Information from medical records is maintained confidentially according to California law. The information may be used as a basis for recommendations by Health Services to various LBNL and University departments in miscellaneous personnel matters (e.g., consideration for employment, transfer, work assignment, or eligibility for benefits).

Individuals have the right to review their records in accordance with LBNL Health Services and University policies. Information about these policies may be obtained from Health Services and/or the Human Resources Department. (See Section 3.23.1 (Site Occupational Medical Director).)

3.23 Responsible Parties

The following people and parties are responsible for implementing Health Services policies:

3.23.1 Site Occupational Medical Director

• Is responsible for ensuring that the LBNL Occupational Medical Program is available to all eligible employees and meets the highest professional standards.
• Plans and implements the site occupational medicine program.
• Must be a graduate of a school of medicine or osteopathy, and licensed for the practice of medicine in the State of California.
• Designs, implements, and oversees the medical surveillance program, including determining the frequency and content of all worker health evaluations based on current sound and acceptable medical practices and all pertinent statutory and regulatory requirements, such as the Americans with Disabilities Act.
  • Participates in worker protection teams to build and maintain necessary partnerships among workers, their representatives, managers, and safety and health protection specialists in establishing and maintaining a safe and healthful workplace.
  • Has access to all work areas for evaluation of job conditions and issues relating to workers’ health.
  • Notifies management and EHS Staff when worker health evaluations suggest a possible uncontrolled health hazard in the workplace.
• Reviews and makes recommendations on all medical aspects of biosafety programs including;
  • Consulting with the Laboratory Biosafety Officer, Institutional Biosafety Committee, and others to evaluate the risk of occupational infection from Laboratory research using biohazardous materials or biological etiologic agents.
  • Serves as the Laboratory Subject Matter Expert on health aspects of the Laboratory’ s vaccination policy and its application to specific work and workers.
    • Recommends for or against the use of vaccination for some or all workers as a means to reduce the risk of occupational infection, based on review of applicable standards.
    • Recommends other means, as appropriate, for reducing the risk of occupational infection.
• Develops and periodically reviews medical emergency response procedures included in site emergency and disaster preparedness plans. The medical emergency responses must be integrated with nearby community emergency and disaster plans.
  • Reviews AED use events.
• Reviews and approves the medical and behavioral aspects of employee counseling and health promotional programs. Including Contractor-sponsored or -supported EAPs; Contractor-sponsored or -supported alcohol and other substance abuse rehabilitation programs; and Contractor-sponsored or -supported wellness programs.

3.23.2 Health Services Occupational Medicine Providers

• Must be licensed, registered, or certified as required by federal or California law.
• Monitors ill and injured workers to facilitate their rehabilitation and safe return to work and to minimize lost time and its associated costs.
  • Must place an individual under medical restrictions when health evaluations indicate that the worker should not perform certain job tasks.
  • Must notify the worker and contractor management when employee work restrictions are imposed or removed.
• Informs workers of the purpose and nature of the medical evaluations and tests offered by the occupational medicine provider.
  • The purpose, nature, and results of evaluations and tests must be clearly communicated verbally and in writing to each worker provided testing.
  • The communication must be documented in the worker’s medical record.
  • Provides documentation of medical findings to employees as required by regulation.
• On a timely basis, communicates results of health evaluations to management and safety and health protection specialists to facilitate the mitigation of worksite hazards.
• Must include measures to identify and manage the principal preventable causes of premature morbidity and mortality affecting worker health and productivity.
  • Health Services must include programs to prevent and manage these causes of morbidity when evaluations demonstrate their cost effectiveness.
• Must develop and maintain a record containing any medical, health history, exposure history, and demographic data collected for the occupational medicine purposes, for each employee for whom medical services are provided. All occupational medical records must be maintained in accordance with Executive Order 13335, Incentives for the Use of Health Information Technology.
• Employee medical, psychological, and employee assistance program records must be kept confidential, protected from unauthorized access, and stored under conditions that ensure their long-term preservation. Psychological records must be maintained separately from medical records and in the custody of the designated psychologist in accordance with 10 CFR 712.38(b)(2).
• Access to these records must be provided in accordance with DOE regulations implementing the Privacy Act and the Energy Employees Occupational Illness Compensation Program Act.
• Staff must ensure that the work-related injuries and illnesses of its workers and subcontractor workers are recorded and reported accurately and consistent with DOE reporting directives (§ 851.23).

3.23.3 Health Services Occupational Health Nurses

• Are on duty from 7:00 a.m. to 4:30 p.m. on workdays.
• Follow standard initial treatment protocols for burns, eye injuries, severe allergies, heart attacks, and other emergencies.
• Assess and provide first aid for occupational injuries and illnesses in accordance with clinic protocols and standard operating procedures.
• Consult with physician or nurse practitioner staff for complex illness or injuries requiring medical treatment or emergency transport.
• When clinically indicated and in consultation with physician or nurse practitioner, refer employees to private physicians or selected medical specialists.
• Conduct vision tests; hearing tests; spirometry; electrocardiograms; perform phlebotomy  and urinalysis; and, when medically advisable, refer for chest x-rays.
• Follow up on all positive findings in employees’ evaluations with letters, telephone calls, or revisits with employees.
• Coordinate with the Integrated Disability and Absence Management (IDAM) staff, the return-to-work of employees who have been absent for medical reasons.
• Assist in decontamination of employees accidentally exposed to radioactive isotopes, and treatment of contaminated wounds.
• Work with the Radiation Protection Group to determine radiation doses for employees accidentally exposed to internal or external radiation.
• Notify Laboratory management and the family when employees are severely injured or become severely ill at work.
• Maintain State professional licenses and certifications as needed for their work; BLS is required.

3.23.4 Health Services Medical Assistants

• Front office tasks such as scheduling
• Back office tasks such as patient preparation and instrument sterilization

3.23.5 Health Services Physicians and Nurse Practitioners

• Conduct evaluations.
• Review medical charts and interpret clinical findings.
• Maintain State professional licenses and certifications as needed for their work.

3.23.6 AED Program Manager

• Collects data for reports to local emergency medical services (EMS) agencies.
• Reviews the AED Program annually.
• Partners with Strategic Communications to annually notify all Berkeley Lab employees of AED locations and training availability.

3.23.7 Laser Safety Officer

• Refers laser users to the Health Services Group for laser-user eye examinations.

3.23.8 Analytical Services

• Uses radiochemical analyses and the whole-body counter system to measure internal radiation exposures. Forwards results to Health Services.

3.23.9 Radiation Protection Program

• Makes radiation dose estimates, with Health Services Group professionals, for employees accidentally exposed to internal or external radiation. Forwards results to Health Services.
• Coordinates Declared Pregnant Worker program.

3.23.10 Berkeley Lab Workers

3.23.10.1 Employees with a Non-occupational Illness or Injury

• Must report to Health Services before returning to work after being ill or injured and absent from work for five or more consecutive workdays.

3.23.10.2 Employees with an Occupational Illness or Injury

• Must inform the MANAGER, SUPERVISOR, or WORK LEAD of the injury or illness.
• Must report to Health Services before returning to work if the employee has lost one full day or more of work due to occupational illness or injury.
• Must notify Health Services of the injury or illness and treatment received if the employee has seen a private physician off site.

REPORT TO HEALTH SERVICES WHEN AN ILLNESS OR INJURY OCCURS.

NOTIFY AN LBNL HEALTH CARE PROFESSIONAL OF ANY SERIOUS ACCIDENT THAT OCCURS AT LBNL AT ANY TIME.

3.23.10.3 Pregnant Workers

• May inform Health Services of the pregnancy as soon as the employee knows that they are pregnant.

3.23.10.4 Workers Working with Lasers

• Are required to complete an eye examination with the LBNL optometrist before beginning to work with lasers and after accidental exposure to lasers.

3.23.10.5 Employees Terminating Employment

• Are encouraged to complete a termination questionnaire when employment is terminated at LBNL.

3.23.10.6 Workers Enrolled in a Medical Surveillance Program

• When offered an evaluation for any of the evaluations described, respond and determine whether to participate in consultation with the trained health professionals in Health Services.
• For certification evaluation, or other mandatory evaluations, participate as needed to ensure compliance with regulatory or institutional requirements

3.23.10.7 Workers Working at a Site with an AED

• Be aware of where AEDs are located in your immediate work area.
• If interested, watch the training video that is offered for CPR/AED.
• If interested, complete voluntary AED training.

3.23.11 Human Resources

• Posts job demands along with job requisitions on the Berkeley Lab Careers site.
• In the case of required fitness for duty evaluations, prepares the job-offer letter describing the condition for successfully passing the medical evaluation.
• Assists the selected candidate in arranging a medical evaluation.
• In a timely manner, provides Health Services the names and contact information of employees subject to medical evaluations, as described above.
• Must make available to the occupational medicine provider appropriate access to information from health, disability, and other insurance plans (de-identified as necessary) in order to facilitate programs for prevention and management of premature morbidity and mortality affecting worker health and productivity.
• Responsible for providing education, consultation, and coordination of UC-sponsored benefit plans and the EAP vendor through webinars and events.
• Provides one-on-one employee counseling on available UC-sponsored benefits.
• Maintains the Lab’s Benefits website, to house available wellness resources through UC-sponsored plans.

3.23.12 Berkeley Lab Divisions/Departments and Management

• Provides occupational health providers access to the workplace for evaluation of job conditions and issues relating to workers’ health.
• Provides the occupational medicine providers information on, and the opportunity to participate in, worker safety and health team meetings and committees.
• Notifies Health Services when an employee has been off work for more than five consecutive work days due to illness or injury (or an equivalent time period for those individuals on an alternative work schedule)
• Provide the occupational medicine providers access to hazard information by promoting its communication, coordination, and sharing among operating and environment, safety, and health protection organizations.
• Must provide the occupational medicine providers with access to information on the following:
  • Current information about actual or potential work-related site hazards (chemical, radiological, physical, biological, or ergonomic);
  • Employee job-task and hazard analysis information, including essential job functions;
  • Actual or potential work-site exposures of each employee; and
  • Personnel actions resulting in a change of job functions, hazards or exposures.
• To facilitate the medical surveillance programs and employee accommodations, supervisors and work leads are responsible for:
  • Making employees available for medical surveillance evaluations.
  • Completing the Job Demands form prior to posting a job requisition.
  • Instructing the successful candidate to schedule a medical evaluation.
  • Receiving and complying with prescribed work restrictions, if any.
• When requesting and receiving an AED;
  • Coordinate the location of the AED with the building manager and SES.
  • Submit the work order to install the AED storage box.
  • Post the required instructions of how to use the AED.
  • Communicate final placement information to the AED program manager for reporting.

3.23.13 Inclusion, Diversity, Equity, and Accountability (IDEA) Office

• Assist in the maintenance of the Healthy and Well at LBNL website.
• Provide resources and support for initiatives that promote well-being.

3.23.14 Security and Emergency Services (SES)

• Responsible for AED inventory control
• Performs maintenance checks and testing as required by the manufacturer
• Maintains records of all checks for reporting to the Program Manager.

3.23.15 Environment, Health, and Safety Division (EHS)

• Coordinates AED equipment purchase
• Funds AED equipment replacement
• Maintains training materials for employees
• Maintains training records for those who have received CPR/AED use training through the Lab
• Coordinates its programs with Health Services to ensure worker safety.

3.24 Glossary

Automated external defibrillator (AED) is a device designed and programmed to analyze a life-threatening heart rhythm in an unresponsive, unconscious victim, and to provide electrical stimulation to the chest as needed in an effort to restore normal rhythm and circulation

Biohazardous Materials are environmental materials reasonably suspected of containing biological etiologic agent(s)

Biological Etiologic Agent is a microorganism, virus, or toxic protein (biologic toxin or prion) known to cause human disease.

Cardiopulmonary resuscitation (CPR) is a method for providing rescue breathing and external cardiac (heart) compressions to an unresponsive, pulseless victim

Confidentiality of medical records provides that medical information cannot be released outside Health Services without the written consent of the employee except as required by law.

Contract medical staff may include physicians, nurse practitioners, and nurses.

Fitness for Duty Evaluation is a medical evaluation tailored to the essential functions of the position. This evaluation may or may not include a health history, physical examination, medical testing, or functional capacity testing, etc. 

Health Promotion includes activities designed to increase awareness, and inform and motivate employees to decrease their health risks

Medical Surveillance are medical evaluations designed to detect adverse health effects from workplace exposures, with the intent of halting disease development and progression

Occupational illness or injury is an illness or injury arising out of or in the course of employment.

Sudden cardiac arrest (SCA) is the abrupt loss of heart function, breathing, and consciousness. The event usually results from a problem with the heart’s electrical system, which disrupts the heart’s pumping action and stops blood flow to the body.

Well-being is a good or satisfactory condition of existence; a state characterized by health, happiness, and prosperity.

Wellness is the quality or state of being healthy in body and mind.

3.25 Standards

• Americans with Disabilities Act (ADA)
• California Confidentiality of Medical Records Act (Civ. Code 56 et seq.)
• California Information Practices Act (Civ. Code 1798 et seq.)
• Federal Drug-Free Workplace Act
• 10 CFR 851
• California Code of Regulations, Title 8, Section 5199(c). Aerosol Transmissible Disease Standard, 2009
• State of California Nurse Practice Act
• ANSI Z136.1-2014
• Health Insurance Portability and Accountability Act (HIPAA)
• ANSI Z80.1-1989 and Appendices A, B, and C, Recommendations for Prescription Ophthalmic Lenses
• ANSI Z87-1989, Practice for Occupational and Educational Eye and Face Protection

3.26 Related Berkeley Lab Policies and ES&H Manual Chapters

• Medical Separation Policy, 02.12.002.000
• Sick Leave Policy, 02.07.002.000
• Family and Medical Leave Policy, 02.07.003.000
• Workers’ Compensation Policy, 02.06.008.000
• Exposure Assessment (Chapter 4)
• Laser Safety (Chapter 16)
• Personal Protective Equipment (Chapter 19)
• Radiation Safety (Chapter 21)
• Research with Human and Animal Subjects (Chapter 22)
• Biosafety (Chapter 26)
• Cranes, Hoists, and Rigging Safety (Chapter 27)
• Forklifts and Other Powered Industrial Trucks (Chapter 28)
• Asbestos Hazards and Controls (Chapter 36)
• Lead Hazards and Controls (Chapter 37)
• Beryllium Hazards and Controls (Chapter 38)
• Noise Hazards Assessment and Control (Chapter 39)
• Non-ionizing Radiation (Chapter 43)
• Respiratory Protection (Chapter 44)
• Chemical Hygiene and Safety Plan (Chapter 45)
• COVID-19 Prevention Program (Chapter 46)

3.27 References

• California Confidentiality of Medical Records Act (Civ. Code 56 et seq.)
• California Information Practices Act (Civ. Code 1798 et seq.)
• AED training video

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