Reference Document for AF Form 2766
on Metals Technology
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 work on various ferrous and non-ferrous metals. Personnel fabricate and install
bearings. Qualified personnel perform welding operations include TIG, MIG, and ARC on cobalt,
Inconel, mild steel, stainless steel, and aluminum metals. Personnel repair, inspect, test, heat
treat, and manufacture parts. Personnel rework metal parts using metal working machines, cut
metals with abrasive saw and torch, using solvents, cleaners, and oils.
Surveillance requirements for workers in metals technology are established by general
considerations of the exposures associated with work in metals, by the specific exposure
hazards identified in workplace evaluations, and regulatory requirements for fitness for duty.
Shop name synonyms include Welding, Metal Working, and Metals Processing.
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.
Occupational, Medical, and Exposure History
Evaluations
Pre-placement: Medical history with attention to the respiratory system, eyes, and skin.
Periodic: Medical history with attention to the development of new symptoms related to
respiratory system, eyes, and skin.
Frequency: At least annually and with any development of respiratory, dermal, or ocular
symptoms.
Termination: Medical history with attention to respiratory system, eyes, and skin.
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.
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.
Aluminum
Evaluations
Selection for surveillance: All individuals with exposure near to, at, or above ACGIH TLV
for aluminum welding fumes (5 mg/m3, 8-hr TWA).
Pre-placement: Baseline spirometry and chest x-ray.
Periodic: At least annually and with development of respiratory or ocular symptoms on
exposure.
Frequency: Annually and with development of respiratory or ocular symptoms on
exposure.
Termination: Spirometry
Post-exposure emergency: N/A
Additional requirements: N/A
References
ACGIH TLV Aluminum and Insoluble Compounds 2008
Notes
N/A
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.
Beryllium
Evaluations
Selection for surveillance: All individuals working with or in proximity to operations using
beryllium or beryllium-containing materials.
Pre-placement: Questionnaire for beryllium health surveillance; respiratory questionnaire;
information and consent for Be-LPT testing; spirometry; a physical examination with
emphasis on respiratory system, skin, and eyes; chest x-ray. A Be-LPT will be offered but is
not mandatory for DOD personnel.
Periodic: (1) Annually: Questionnaire or medical exam for beryllium health surveillance;
respiratory questionnaire, with additional medical evaluation as indicated; spirometry. (2)
Every 5 years: Optional Chest X-ray.
Frequency: At least annually
Termination: N/A
Post-exposure emergency: Questionnaire or medical exam for beryllium health
surveillance; respiratory questionnaire; spirometry or pulmonary function test; any other
tests deemed appropriate by the examining physician for evaluating beryllium related health
effect.
Additional requirements: N/A
References
10 CFR 850.34
Notes
(1) The CFR reference above is not binding on DOD but does define a standard for
beryllium surveillance that can be used to establish a protocol for Occupational Medicine
programs.
(2) Abnormal findings on any evaluation after initiating work with beryllium should be
referred to an appropriate specialist for evaluation.
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
CdU
CdB
β2-M
Category B
Category C
Medical examinations every
other year.
Medical examinations at 90
days, at 1 year, and then
every year.
Medical examinations at 90
days, 6 months, and then
every 6 months.
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.
≤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
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 6 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
Cobalt
Evaluations
Selection for surveillance: All individuals exposed at or above the Action Level.
Pre-placement: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Periodic: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Frequency: Annually
Termination: N/A
Post-exposure emergency: Follow periodic evaluation procedure with additional
evaluation as needed for symptoms or signs of acute toxic effect.
Additional requirements: N/A
References
NIOSH Criteria Document, Criteria for a Recommended Standard: Occupational Exposure to
Cobalt, October 1981.
Notes
N/A
Copper
Evaluations
Selection for surveillance: All individuals exposed at or above the Action Level for copper
fumes.
Pre-placement: Medical and occupational history; physical examination with attention to
respiratory tract; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Periodic: Medical and occupational history; physical examination with attention to
respiratory tract; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Frequency: Annually or with any occurrence of signs or symptoms consistent with metal
fume fever.
Termination: N/A
Post-exposure emergency: Follow periodic evaluation procedure with additional
evaluation as needed for symptoms or signs of acute toxic effect.
Additional requirements: N/A
References
NIOSH Occupational Health Guidelines for Chemical Hazards, Publication Number 81-123,
Occupational Health Guideline for Copper Fume, January 1978
Notes
N/A
Ethylenediamine
Evaluations
Selection for surveillance: All individuals exposed at or above the Action Level.
Pre-placement: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Periodic: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Frequency: Annually or at any development of respiratory signs or symptoms after
exposure.
Termination: N/A
Post-exposure emergency: Immediate evaluation. Follow periodic evaluation procedure
with additional evaluation as needed for symptoms or signs of acute respiratory effect.
Additional requirements: N/A
References
NIOSH Occupational Health Guidelines for Chemical Hazards, Publication Number 81-123,
Occupational Health Guideline for Copper Fume, September 1978; Concise International
Chemical Assessment Document 15: Ethylenediamine, WHO, Geneva, 1999; NIOSH Pocket
Guide to Chemical Hazards Ethylenediamine at http://www.cdc.gov/niosh/npg/npgd0269.html
Notes
Ethylenediamine is an occupational asthmagen.
Iron Oxide Welding Fume
Evaluations
Selection for surveillance: All individuals exposed at or above the Action Level.
Pre-placement: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Periodic: Medical and occupational history; physical examination with attention to
respiratory tract and skin; respiratory questionnaire, with additional evaluation as indicated;
spirometry.
Frequency: Annually
Termination: N/A
Post-exposure emergency: Follow periodic evaluation procedure with additional
evaluation as needed for symptoms or signs of acute respiratory effect.
Additional requirements: N/A
References
NIOSH Occupational Health Guidelines for Chemical Hazards, Publication Number 81-123,
Occupational Health Guideline for Iron Oxide Fume, September 1978; NIOSH Pocket Guide to
Chemical Hazards Iron Oxide Dust and Fume at http://www.cdc.gov/niosh/npg/npgd0344.html
Notes
N/A
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.
Manganese
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 the nervous and
respiratory systems; physical examination with attention to respiratory and nervous
systems; respiratory questionnaire; spirometry; chest x-ray.
Periodic: Medical and occupational history with attention to the nervous and respiratory
systems; physical examination with attention to respiratory and nervous systems;
respiratory questionnaire; spirometry.
Frequency: Annually or with any occurrence of sign or symptoms consistent with
manganese toxicity.
Termination: N/A
Post-exposure emergency: Follow periodic evaluation procedure with additional
evaluation as needed for symptoms or signs of acute toxic effect.
Additional requirements: N/A
References
NIOSH Occupational Health Guidelines for Chemical Hazards, Publication Number 81-123,
Occupational Health Guideline for Manganese, September 1978; NIOSH Pocket Guide to
Chemical Hazards: Manganese compounds and fume at http://www.cdc.gov/niosh/npg/
npgd0379.html
Notes
N/A
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 increased incidence
of lung and prostate cancer with long post-exposure latency.
Molybdenum
Evaluations
Selection for surveillance: Routine surveillance not recommended.
Pre-placement: Medical and occupational history with attention to pre-existing kidney or
hematological, or a history of gout.
Periodic: N/A
Frequency: N/A
Termination: N/A
Post-exposure emergency: N/A
Additional requirements: N/A
References
NIOSH Pocket Guide to Chemical Hazards: Molybdenum, November 2010 at
http://www.cdc.gov/niosh/npg/npgd0433.html; NIOSH Occupational Health Guidelines for
Soluble Molybdenum Compounds, September 1978
Notes
N/A
Nickel
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 the respiratory system
and skin; physical examination with attention to nasopharynx, respiratory tract, and skin;
respiratory questionnaire, with additional evaluation as indicated; spirometry; chest x-ray.
Periodic: Medical and occupational history; physical examination with attention to
nasopharynx, respiratory tract, and skin; respiratory questionnaire, with additional
evaluation as indicated; spirometry.
Frequency: Annually or with any occurrence of signs or symptoms consistent with metal
fume fever.
Termination: Medical and occupational history; physical examination with attention to
nasopharynx, respiratory tract, and skin; respiratory questionnaire, with additional
evaluation as indicated; spirometry; chest x-ray.
Post-exposure emergency: Follow periodic evaluation procedure with additional
evaluation as needed for symptoms or signs of acute toxic effect.
Additional requirements: N/A
References
NIOSH Occupational Health Guidelines for Nickel Metal and Soluble Nickel Compounds,
September 1978; NIOSH Pocket Guide to Chemical Hazards: Nickel metal and other
compounds, November 2010 at http://www.cdc.gov/niosh/npg/npgd0445.html
Notes
(1) Classified as a human carcinogen.
(2) Suspected human occupational asthmagen.
Titanium
See Welding Fumes.
Zinc
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 the respiratory system;
physical examination with attention to respiratory tract; respiratory questionnaire, with
additional evaluation as indicated; spirometry; chest x-ray.
Periodic: Medical and occupational history with attention to the respiratory system;
physical examination with attention to respiratory tract; respiratory questionnaire, with
additional evaluation as indicated; spirometry.
Frequency: Annually or with any occurrence of signs or symptoms consistent with metal
fume fever.
Termination: N/A
Post-exposure emergency: N/A
Additional requirements: N/A
References
NIOSH Occupational Health Guideline for Zinc Oxide Fume, NIOSH 81-123, September 1978;
NIOSH Pocket Guide to Chemical Hazards: Zinc Oxide, November 2010 at http://www.cdc.gov/
niosh/npg/npgd0675.html
Notes
N/A
General References:
DOD 6055.05M Occupational Medical Examinations and Surveillance Manual (16 Sept 2008)
AFI 48-123 Medical Examinations and Standards (29 January 2013)
AFI 48-145 Occupational and Environmental Health Program (15 Sept 2011)
AFD TO 00-25-252 Aeronautical Equipment Welding Section 05: General Welding Certification
Requirements
NIOSH Criteria for a Recommended Standard “Welding, Brazing and Thermal Cutting” April
1988
Navy and Marine Corps Public Health Center, BUMED, Medical Surveillance Procedures and
Medical Matrix, Edition 11, July 2011 (NMCPHC – TM OM 6260)