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The OSHA regulations indirectly define occupational medical practice by establishing what constitutes OSHA occupational medical information. By inference, physicians generating such regulated medical information are practicing occupational medicine as regulated by OSHA. The regulations apply to any employer "who makes, maintains, contracts for, or has access to employee ... medical records ... pertaining to employees exposed to toxic substances or harmful physical agents." The rules include all medical records maintained on a covered employee--not just those mandated by "specific occupational safety and health standards." The rules specifically include records maintained by physicians who are not employees of the covered employer but provide medical services on a contractual or fee-for-service basis. There are additional regulations that require monitoring of exposure to specific toxic substances. These regulations prevent employers from avoiding the rules on employee medical records by ignoring employee health entirely.

It is the definitions of exposure and toxic agents that account for the broad reach of these rules:

--"Exposure" or "exposed" means that an employee is subjected to a toxic substance or harmful physical agent in the course of employment through any route of entry (inhalation, ingestion, skin contact or absorption, etc.), and includes past exposure and potential (e.g., accidental or possible) exposure.

--"Toxic substance or harmful physical agent" means any chemical substance, biological agent (bacteria, virus, fungus, etc.), or physical stress (noise, heat, cold, vibration, repetitive motion, ionizing and non-ionizing radiation, hypo-or hyperbaric pressure, etc.) which: (i) Is listed in the latest printed edition of the National Institute for Occupational Safety and Health (NIOSH) Registry of Toxic Effects of Chemical Substances (RTECS); (ii) Has yielded positive evidence of an acute or chronic health hazard in testing conducted by, or known to, the employer; or (iii) Is the subject of a material safety data sheet kept by or known to the employer indicating that the material may pose a hazard to human health.

Given that the current edition of the RTECS contains over 45,000 chemicals, including nearly 6,000 that have been added in the past ten years, it is hard to imagine an industrial employee who is not covered by these regulations. The addition of biological agents expands coverage to most health care workers. The inclusion of repetitive motion and nonionizing radiation adds every office worker who touches or sits near a computer. There are exceptions for situations where the employer can "demonstrate that the toxic substance or harmful physical agent is not used, handled, stored, generated, or present in the workplace in any manner different from typical non-occupational situations," but these exceptions are construed strictly.

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