Reference Document for AF Form 2766
on Structural Repair and Maintenance
NOTE: This reference document serves two purposes:
1. It provides the rationale for the recommendations in the associated AF Form 2766.
2. It provides guidance for (a) the removal of a particular OH clinical exam from the
associated AF Form 2766 (e.g., exam required only when exceeding an exposure limit) or
(b) inclusion of a particular OH clinical exam by the Aerospace Medicine Council
Chairman in the Notes section of the associated AF Form 2766.
Personnel design, repair, modify and fabricate aircraft, metal, plastic, composite,
advanced composite, low observables, and bonded structural parts and components.
Personnel apply preservative treatments to aircraft, missiles, and support equipment; assemble
and repair using special fasteners and adhesives; manufacture jigs, fixtures, forms, and molds,
paint aircraft, missiles, and support equipment; identify, remove, and treat corrosion using
mechanical and chemical procedures including electric and pneumatic sanders, buffers, bead
blasters, vacuum cleaners, scrapers, grinders, acids, caustics, solvents, alcohols, and other
agents for controlling corrosion. Pesonnel also apply corrosion protective and low observable
coatings; uses metalworking equipment and tools to form, cut, bend, and fasten replacement or
repair parts to damaged structures and components; and store, handle, and dispose of
hazardous waste and materials according to environmental standards.
Hazardous Noise
Evaluations
Selection for surveillance: All workers whose positions potentially will expose them to
hazardous noise that exceeds the limits contained in AFOSHSTD 48-20 (10 May 2013)
Table 3 (page 25).
Pre-placement: Audiogram
Periodic: Audiogram
Frequency: At least annually
Termination: Audiogram
Post-exposure emergency: N/A
Additional requirements: N/A
References
29 CFR 1910.95, AFOSH 48-20 (10 May 2013); DODI 6055.12
Notes
(1) A reference audiogram is required within 30 days of the start of any job with a noise
hazard exposure that exceeds the limits contained in AFOSHSTD 48-20 (10 May 2013)
Table 3 (page 25). Periodic (at least annual) and termination of exposure audiograms
are required for all workers with hazardous noise exposure risk. The audiograms should
be accomplished in strict compliance with AFOSHSTD 48-20 2.12.7.
(2) Air Reserve Component (ARC) members with fewer than 30 days per year of noise
exposure do not require annual audiograms, but are required to comply with all other
aspects of the Hearing Conservation Program (HCP).
(3) If a periodic audiogram suggests a Significant Threshold Shift in an ARC member, initial
follow-up audiograms must be completed within 60 days of the annual audiogram. If no
follow-up audiograms have been completed within 60 days after the annual audiogram,
the Threshold Shift must be considered a Permanent Threshold Shift (PTS) until further
follow-up is completed.
Isocyanate-based paints
Evaluations
Pre-placement: (1) OSHA respiratory questionnaire and (2) Medical examination (see
Note 1) (3) Spirometry (see Note 2)
Periodic: Respirator fit test; medical examination, and spirometry.
Frequency: At least annually
Termination: N/A
Post-exposure emergency: N/A
Additional requirements: N/A
References
NIOSH Workplace Safety and Health topics: Isocyanates at
http://www.cdc.gov/niosh/topics/isocyanates/
NIOSH Occupational Health Guideline for Methylene Bisphenyl Isocyanate, September 1978
NIOSH Criteria for a Recommended Standard: Occupational Exposure to Isocyanates, NIOSH
78-215, September 1978.
NMCPHC Medical Surveillance Procedures Manual and Medical Matrix 2011, Isocyanates,
pages 124-5
Notes
(1) Medical examination and spirometry are not requirements of the OSHA Respiratory
Protection Standard but, given the high risk of respiratory disease with isocyanate
exposure, best practice directs careful respiratory surveillance among exposed workers.
(2) History should focus on past sensitization to isocyanate paints and respiratory irritant.
Prior sensitization to isocyanates is a strong contraindication for work in environments
with additional exposure risk.
(3) Physical examination should focus on the lungs and respiratory function.
Vision Requirements and Examinations
Evaluations
Selection for surveillance: Eye exposure to welding operations.
Pre-placement: Complete optometric/ophthalmologic examination with attention or cornea,
lens and retina.
Periodic: Complete optometric/ophthalmologic examination with attention or cornea, lens
and retina.
Frequency: Annually
Termination: Complete optometric/ophthalmologic examination with attention or cornea,
lens and retina.
Post-exposure emergency: Complete optometric/ophthalmologic examination with
attention or cornea, lens and retina.
Additional requirements: N/A
References:
Injury Prevention 2005; 11 pages 175-178 Welding-related Occupational Eye Injuries
Notes
N/A
Heat Stress
Evaluations
Selection for surveillance: Workers whose positions may subject them to prolonged
exposure to frequent or prolonged extremes of high temperature.
Pre-placement: Medical history with attention to history of heat illness, cardiovascular
conditions that impair heat tolerance, use of medications that impair heat tolerance
Periodic: Occurrence of heat illness or significant symptoms related to heat strain; new or
changes in conditions and medications that affect heat tolerance.
Frequency: At least annually
Termination: N/A
Post-exposure emergency: Medical evaluation before re-exposure to heat stress.
Additional requirements: N/A
References
ACGIH TLVs and BEIs, Thermal Stress, Heat Stress and Strain (2012)
Notes
N/A
Cold Stress
Evaluations
Selection for surveillance: Workers whose positions may subject them to prolonged
exposure to frequent or prolonged extremes of cold temperature.
Pre-placement: Medical history with attention to history of cold injury or intolerance,
vascular conditions that impair distal circulation. Physical examination with attention to the
peripheral vascular and nervous systems, and skin conditions affecting the distal
extremities.
Periodic: Medical history with attention to history of cold injury or intolerance, vascular
conditions that impair distal circulation. Physical examination with attention to the peripheral
vascular and nervous systems, and skin conditions affecting the distal extremities.
Frequency: Biannually
Termination: N/A
Post-exposure emergency: Immediate medical evaluation of any evidence of cold injury
before any re-exposure to cold stress.
Additional requirements: N/A
References
ACGIH TLVs and BEIs, Cold Stress 2001; NMCPHC TO OM 6260 pp 209–211; NIOSH
Workplace Safety and Health Topics: Cold Stress (2012)
Notes
N/A
Cadmium
Evaluations
Selection for surveillance: All individuals exposed above the Action Level for 30 or more
days per year, previous exposure above the Action Level for a total of 60 months.
Pre-placement: Medical and work history (cadmium exposure history, review of systems,
smoking history). Physical examination with attention to the respiratory, renal, and skeletal
systems. Biological monitoring (CdU, CdB, and 2-M) may be performed. Assignment to a
surveillance category based on initial and subsequent biomonitoring results.
Category A
Category C
Medical examinations every
other year.
Medical examinations at 90
days, at 1 year, and then
every year.
Laboratory examinations
(CdU, CdB, β2-M) every year.
Laboratory examinations at 90 Laboratory examinations at 90
days, 6 months, and then
days, 3 months, and then
every 6 months.
every 3 months.
Medical examinations at 90
days, 6 months, and then
every 6 months.
≤3 µg/g Creatinine
>3 and ≤7 µg/g Creatinine
>7 µg/g Creatinine
≤5 µg/liters whole blood
>5 and ≤10 µg/liters whole
blood
>10 µg/liters whole blood
≤300 µg/g Creatinine
>300 and ≤750 µg/g Creatinine
>750 µg/g Creatinine
CdU
CdB
Category B
β2-M
Periodic: Medical and occupational history; physical examination including blood pressure
with attention to the respiratory system, and the urinary system; chest x-ray if deemed
clinically appropriate; spirometry; blood and urine biomonitoring of cadmium exposure;
prostate exam for males over 40 years old
Frequency: Per exposure category.
Termination: Required if more than six months since last periodic examination: Medical
history; physical examination; chest x-ray.
Post-exposure emergency: Medical evaluation equivalent to periodic examination.
Additional requirements: The OSHA cadmium standard includes provisions for medical
removal based on biomonitoring results or clinical concern about exposure.
References
DOD 6055.05M, Table C2.T6; 29 CFR 1910.1027
Notes
The cadmium standard is exacting and medical examiners should be familiar with its
requirements.
Chromium VI
Evaluations
Selection for surveillance: Workers exposed at or above the Action Level for 30 or more
days per year.
Pre-placement: Medical and occupational history; physical examination with attention to
nasopharynx and skin; respiratory questionnaire; spirometry.
Periodic: Medical and occupational history; physical examination with attention to
nasopharynx and skin; respiratory questionnaire; spirometry.
Frequency: Annually or at any symptoms or signs of chromium VI exposure.
Termination: Medical and occupational history; physical examination with attention to
respiratory tract, nasopharynx, and skin.
Post-exposure emergency: Similar to periodic evaluation within 30 days of significant
unexpected exposure.
Additional requirements: N/A
References
DOD 6055.05M Table C2.T7; 29 CFR 1910.1027
Notes
N/A
Methylene Chloride
Evaluations
Selection for surveillance: Workers exposed at or above the Action Level for 30 or more
days per year, or who are exposed above the 8 hour TWA PEL or STEL for more than 10
days per year.
Pre-placement: Medical and occupational history with attention to the neurological and
cardiovascular systems, diseases of the blood, liver and skin and prior exposures to
methylene chloride. Respiratory questionnaire.Physical examination with attention to
cardiovascular, respiratory and nervous systems, liver and skin.
Periodic: Medical and occupational history. Respiratory questionnaire. Physical
examination with attention to cardiovascular, respiratory and nervous systems, liver and
skin.
Frequency: Every three years under age 45; annually after age 45 or at any symptoms or
signs or methylene chloride exposure.
Termination: Medical and occupational history. Physical examination with attention to
cardiovascular, respiratory, and nervous systems, liver, and skin.
Post-exposure emergency: Similar to periodic evaluation within 30 days of significant
unexpected exposure.
Additional requirements: N/A
References
DOD 6055.05M Table C2.T12
29 CFR 1910.1052
Notes
N/A
Welding Fumes
Evaluations
Selection for surveillance: All individuals working in close proximity to welding
operations.
Pre-placement: Medical history with attention to respiratory system.
Periodic: Medical history with attention to respiratory system.
Frequency: At least annually and with any development of respiratory symptoms
associated with exposure.
Termination: Medical history with attention to respiratory system.
Post-exposure emergency: N/A.
Additional requirements: N/A
References
NIOSH Criteria Document: Welding, Brazing and Thermal Cutting. MMWR 1998 37(35); 545–7
(http://www.cdc.gov/niosh/docs/88-110/)
Notes
Principal concern is development of acute illnesses associated with exposure to welding fume
(e.g. metal fume fever) and occupational asthma.
Lead
Evaluations
Selection for surveillance: All individuals exposed at or above the Action Level for 30 or
more days per year.
Pre-placement: Medical and occupational history with attention to past lead exposure and
past gastrointestinal, renal, reproductive, neurological, and hematologic medical problems;
physical examination with attention to nervous system, cardiovascular system, and
abdomen; CBC; BUN/creatinine; blood lead and zinc protoporphyrin levels; urinalysis with
microscopic examination.
Periodic: Medical and occupational history with attention to past lead exposure and past
gastrointestinal, renal, reproductive, neurological, and hematologic medical problems;
physical examination with attention to nervous system, cardiovascular system, and
abdomen; CBC; BUN/creatinine; blood lead and zinc protoporphyrin levels; urinalysis with
microscopic examination.
Frequency: Per blood lead level, see Appendix C of the OSHA standard
Termination: Medical and occupational history with attention to past lead exposure and
past gastrointestinal, renal, reproductive, neurological, and hematologic medical problems;
physical examination with attention to nervous system, cardiovascular system, and
abdomen; CBC; BUN/creatinine; blood lead and zinc protoporphyrin levels; urinalysis with
microscopic examination.
Post-exposure emergency: N/A
Additional requirements: Certain blood level values require medical removal. Medical
examiners must be familiar with the medical removal provisions in the OSHA standard.
References
DOD 6055.05M Table C2.T11; 29 CFR 1910.1025
Notes
The lead medical surveillance requirement is exacting and medical examiners should be familiar
with all its provisions.
Metalworking Fluids
Evaluations
Selection for surveillance: All individuals engaged in or in close proximity processes
using metalworking (cutting) fluids (MWFs).
Pre-placement: Medical and occupational history with attention to the respiratory system,
eyes, and skin; physical examination with attention to the respiratory system, eyes, and
skin; respiratory questionnaire; spirometry; chest x-ray; urinalysis with microscopic
examination.
Periodic: Medical and occupational history with attention to the respiratory system, eyes,
and skin; physical examination with attention to the respiratory system, eyes, and skin;
respiratory questionnaire; spirometry; urinalysis with microscopic examination.
Frequency: Annually or with any occurrence of signs or symptoms consistent with MWF
exposure.
Termination: N/A
Post-exposure emergency: N/A
Additional requirements: N/A
References
NIOSH Criteria Document, Criteria for a Recommended Standard: Occupational Exposure to
Metalworking Fluids, NIOSH 98-102, January 1998; Final Report of the OSHA Metalworking
Fluids Standards Advisory Committee, July 1999; NIOSH Workplace Safety and Health Topics:
Metalworking Fluids, October 2012 at http://www.cdc.gov/niosh/topics/metalworking/
Notes
(1) Metalworking fluids are complex mixtures whose compositions change with use and
time. The specific clinical effects of exposure are affected by the changes in fluid
composition.
(2) In industrial studies, metalworking fluids have been associated with increases in the
incidence of lung and prostate cancer with long post-exposure latency.
Vitreous fibers* (Manmade Fibers, Glass Fibers, Refractory Fibers)
Evaluations
Selection for surveillance: Personnel potentially exposed to vitreous fibers in the course
of their workplace duties.
Pre-placement: (1) OSHA respiratory questionnaire and (2) Medical examination (see
Note 1) (3) Spirometry (see Note 2)
Periodic: Respirator fit test; medical examination, and spirometry.
Frequency: At least annually.
Termination: N/A
Post-exposure emergency: N/A
________________
*Asbestos fiber is not included among this hazard class. It is regulated separately. It is not encountered in the
Isochronal Inspection process.
Additional requirements
N/A
References
29 CFR 1910.134; DODI 6055.05-M, C4.13 Respirator Clearance; AFOSH Standard 48-137
Notes
(1) Medical examination and spirometry are not requirements of the OSHA Respiratory
Protection Standard but may be conducted as a local option.
(2) Based on the known respiratory toxicity of vitreous fibers, it is recommended that the
annual medical surveillance include a medical examination and spirometry.