Reference Document for AF Form 2766
on Weapons Element
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 repairs and perform preventive maintenance on aircraft weapons systems and all
associated AME (pylons, bomb racks and missile launchers). They use touch-up paints,
cleaners, oils and greases; clean the MER ejection systems with a soap solution; and coat
guns with aerosol Perma-slik. They may be exposed to environmental extremes, hazardous
noise, diesel exhaust, and JP-8.
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.
JP-8 Fuel
Evaluations
Selection for surveillance: All workers with an inhalational or dermal exposure risk to JP-8
should be enrolled in medical surveillance.
Pre-placement: The initial medical surveillance should include a health history and
physical exam. The health history should focus on pulmonary, dermal, neurologic, renal,
and hepatic systems. The physical exam should focus on the skin, or as directed by results
of review of systems or health history screening.
Periodic: The annual medical surveillance should include a health history and physical
exam. The health history should focus on pulmonary, dermal, neurologic, renal, and
hepatic systems. The physical exam should focus on the skin, or as directed by results of
review of systems or health history screening.
Frequency: Annually
Termination: Similar to annual exams.
Post-exposure emergency: Symptomatic acute exposure to JP-8 fuel should receive an
immediate post-exposure history and examination with a description of the magnitude and
route of exposure that is as quantitative as possible. Since JP-8 contains benzene, large
respiratory or dermal exposures should include a benzene exposure evaluation IAW 29
CFR 1910.1028.
Additional requirements: N/A
References
AFRL-SA-WP-SR-2012-0002: Interim Base-Level Guide for Exposure to Jet Fuel and Additives
(Dec 2011); ATSDR Toxicological Profile for JP-5 and JP-8 (August 1998)
Notes
N/A
Benzene
Evaluations
Selection for surveillance: Published literature suggests that workers with proximity to
JP-8 have significant exposure to the components of JP-8, including benzene, via the
dermal route, even if inhalational exposure is limited by respiratory protection. Such workers
should be considered at risk for benzene exposure unless such exposure has been
excluded by biological monitoring.
Pre-placement: Medical history: (1) Past work exposure to benzene or any other
hematological toxins, (2) a family history of blood dyscrasias including hematological
neoplasms, (3) a history of blood dyscrasias including genetic hemoglobin abnormalities,
bleeding abnormalities, or abnormal function of formed blood elements, (4) a history of
renal or liver dysfunction, (5) a history of medicinal drugs routinely taken, (6) a history of
previous exposure to ionizing radiation, or (7) exposure to marrow toxins outside of the
current work situation. Conduct a complete physical examination and a complete blood
count, including a leukocyte count with differential, a quantitative thrombocyte count,
hematocrit, hemoglobin, erythrocyte count and erythrocyte indices (MCV, MCH, MCHC).
The results of these tests shall be reviewed by the examining physician.
Periodic: (1) A brief history regarding any new exposure to potential marrow toxins,
changes in medicinal drug use, or the appearance of physical signs relating to blood
disorders. (2) A complete blood count including a leukocyte count with differential,
quantitative thrombocyte count, hemoglobin, hematocrit, erythrocyte count and erythrocyte
indices (MCV, MCH, MCHC).
Frequency: At least annually
Termination: N/A
Post-exposure emergency: If an employee is exposed to benzene in an emergency
situation, the employer shall have the employee provide a urine sample at the end of the
employee's shift and have a urinary phenol test performed on the sample within 72 hours.
The urine specific gravity shall be corrected to 1.024.
Additional requirements: Where the results of the complete blood count required for the
initial and periodic examinations indicate any of the following abnormal conditions exist, the
blood count shall be repeated within two weeks: (1) the hemoglobin level or the hematocrit
falls below the normal limit [outside the 95% confidence interval (C.I.)] as determined by the
laboratory for the particular geographic area and/or these indices show a persistent
downward trend from the individual's pre-exposure norms that cannot be explained by other
medical reasons, (2) the thrombocyte (platelet) count varies more than 20% below the
employee's most recent values or falls outside the normal limit (95% C.I.) as determined by
the laboratory, (3) the leukocyte count is below 4,000 per mm3 or there is an abnormal
differential count. If the abnormality persists, the examining physician shall refer the
employee to a hematologist or an internist for further evaluation, unless the physician has
good reason to believe such referral is unnecessary.
References
29 CFR 1910.1028; Env Health Perspectives 2006; 114:182-5
Notes
(1) The employer shall make a medical surveillance program available for personnel who
fall into one of the following categories:
a. Employees who have been or may be exposed to benzene at or above the action
level 30 or more days per year;
b. Employees who have been or may be exposed to benzene at or above the PELs
10 or more days per year;
c. Employees who have been exposed to more than 10 ppm of benzene for 30 or
more days in a year prior to the effective date of the standard (when employed by
their current employer; and
d. Employees who are classified as tire building machine operators, who use
solvents containing greater than 0.1 percent benzene.
(2) If none of the above conditions applies, remove the associated exam (i.e., benzene
surveillance) from AF Form 2766.
(3) Performance of medical surveillance for benzene should be based on formal exposure
assessment and identification of sufficient exposure to warrant benzene surveillance.
Respiratory Hazards
Evaluations
Selection for surveillance: Workers whose positions may expose them to respiratory
hazards, including noxious fumes, products of combustion, or particulate or non-particulate
respiratory irritants.
Pre-placement: (1) OSHA respiratory questionnaire and respiratory fit test, (2) medical
examination (see Note 1), and (3) spirometry (see Notes 2 and 3).
Periodic: Respirator fit test at least annually or upon request of an employee or
supervisor. The Respiratory Protection Standard does not require periodic completion of
the respiratory questionnaire or medical examination. However, best practice suggests a
review of the respiratory questionnaire during the annual medical surveillance evaluation by
the health care provider and appropriate medical evaluation if indicated by that review.
Frequency: Annual respirator fit test
Termination: N/A
Post-exposure emergency: N/A
Additional requirements: N/A
References
29 CFR 1910.134; DODI 6055.05-M, C4.13 Respirator Clearance; AFOSH Standard 48-137
Notes
(1) Based on worker responses to the respiratory questionnaire, a medical evaluation may
be required either if the criteria in 29 CFR 1910.134 (e)(3) are met or at the discretion of
the responsible PLHCP. Additional criteria may be established locally.
(2) Medical examination is not required as part of the OSHA Respiratory Protection
Standard but may be conducted as a local option.
(3) Annual spirometry is not a requirement of the OSHA Respiratory Protection Standard but
may be conducted as a local option. Spirometry is required, independent of 29 CFR
1910.134, for surveillance for pulmonary function changes related to exposure to
products of combustion. Spirometry may also be of value in routine surveillance to
identity early changes in respiratory function prior to onset of symptoms.
Heat Stress
Evaluations
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
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, 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, 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
Diesel Exhaust
Evaluations
Pre-placement: Medical history with attention to respiratory illness, prior exposure to
irritants and symptoms of respiratory intolerance to diesel exhaust or airborne particulates.
Physical examination with attention to the respiratory system.
Periodic: Medical history with attention to respiratory symptoms associated with diesel
exhaust exposure. Physical examination with attention to the respiratory system.
Frequency: Annually
Termination: N/A
Post-emergency exposure: N/A
Additional requirements: N/A
References
NIOSH Pocket Guide to Chemical Hazards: Diesel Exhaust
Notes
Diesel exhaust has been recognized as a human carcinogen and careful attention to exposure
control is warranted.
Perma-slik Lubricant/Sealant
Used to protect aircraft gun systems. Applied by aerosol. Contains molybdenum disulfide, lead
phosphite, antimony trioxide, xylenes (5–10%) and methyl-ethyl ketone (60–65%).
Antimony disulfide
Evaluations
Pre-placement: Medical history with attention to respiratory illness, prior exposure to
irritants and symptoms of respiratory intolerance to diesel exhaust or airborne particulates.
Physical examination with attention to the respiratory and cardiovascular systems and skin.
ECG. Spirometry. Chest X-ray.
Periodic: Medical history with attention to respiratory illness, prior exposure to irritants and
symptoms of respiratory intolerance to diesel exhaust or airborne particulates. Physical
examination with attention to the respiratory and cardiovascular systems and skin. ECG.
Spirometry.
Frequency: Annually
Termination: Medical history with attention to respiratory illness, prior exposure to irritants
and symptoms of respiratory intolerance to diesel exhaust or airborne particulates. Physical
examination with attention to the respiratory and cardiovascular systems and skin. ECG.
Spirometry.
Post-emergency exposure: N/A
Additional requirements: N/A
References
NIOSH Pocket Guide to Chemical Hazards: Antimony (November 2010); NIOSH Criteria for a
Recommended Standard: Occupational Exposure to Antimony, NIOSH 78-216 (1988); ATSDR
Toxicological Profile for Antimony and Compounds September 1992; NMCPHC TM OM 6260,
pp. 19-20; NIOSH Pocket Guide to Chemical Hazards: Antimony (November 2010); NIOSH
Criteria for a Recommended Standard: Occupational Exposure to Antimony, NIOSH 78-216
(1988)
Notes
N/A
2-Butanone
Evaluations
Pre-placement: Medical and occupational history with attention to past exposures to
solvents and irritants, nervous system and psychological changes. Laboratory: liver profile,
renal function.
Periodic: Medical and occupational history with attention to past exposures to solvents
and irritants, nervous system and psychological changes. Laboratory: AST
Frequency: Annually
Termination: N/A
Post-emergency exposure: N/A
Additional requirements: N/A
References
ATSDR Toxicological Profile for 2-Butanone, July 1992; ATSDR Toxicological Profile for 2Butanone, Addendum 2010; NIOSH Occupational Health and Safety Guideline for 2-Butanone
(1988) ATSDR Toxicological Profile for 2-Butanone, July 1992; ATSDR Toxicological Profile for
2-Butanone, Addendum 2010; NIOSH Occupational Health and Safety Guideline for 2-Butanone
(1988)
Notes
N/A
Lead phosphite
Evaluations
Pre-placement: Medical and occupational history attention to past lead exposure, past
gastrointestinal, renal, reproductive, neurological and hematologic medical problems.
Physical examination with attention to nervous system, cardiovascular system and
abdomen. Additional tests: CBC, BUN/creatinine, blood lead, and zinc protoporphyrin
levels, urinanalysis with microscopic examination.
Periodic: Medical and occupational history attention to past lead exposure, past
gastrointestinal, renal, reproductive, neurological and hematologic medical problems.
Physical examination with attention to nervous system, cardiovascular system and
abdomen. Additional tests: 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: Required unless periodic examination completed within the six months prior
to the termination of exposure: Medical and occupational history attention to past lead
exposure, past gastrointestinal, renal, reproductive, neurological and hematologic medical
problems. Physical examination with attention to nervous system, cardiovascular system
and abdomen. Additional tests: CBC, BUN/creatinine, blood lead, and zinc protoporphyrin
levels, urinalysis with microscopic examination.
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: 29 CFR 1910.1025.
Molybdenum
Evaluations
Pre-placement: Medical and occupational history with attention to pre-existing renal,
pulmonary or liver disease. Physical examination with attention to the respiratory system.
Periodic: No current recommendations for periodic medical surveillance.
Frequency: N/A
Termination: N/A
Post-emergency exposure: N/A
Additional requirements: N/A
References
NIOSH Pocket Guide to Chemical Hazards: Molybdenum; NIOSH Occupational Health
Guidelines for Molybdenum and Insoluble Compounds (September 1978)
Notes
N/A
Xylenes
Evaluations
Pre-placement: Medical and occupational history with attention to past exposures to
solvents and irritants, and the nervous system. Physical examination with attention to the
nervous and respiratory systems and the skin. Laboratory: liver profile, urinalysis with
microscopic examination.
Periodic: Medical and occupational history with attention to past exposures to solvents
and irritants, and the nervous system. Physical examination with attention to the
nervous and respiratory systems and the skin. Laboratory: AST and urinalysis with
microscopic examination.
Frequency: Annually
Termination: N/A
Post-emergency exposure: N/A
Additional requirements: N/A
References
Criteria for a Recommended Standard: Occupational Exposure to Xylene; NIOSH 75-168;
NMCPHC TM OM 6260 206-7
Notes
N/A