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9. Centers for Disease Control and Prevention (CDC); Guidelines for Preventing the
transmission of mycobacterium tuberculosis in Health Care Facilities, 1994; MMWR
October 26, 1994 Vol. 43, No. RR-13.

D. Action. OSHA Regional Administrators and Area Directors will use this instruction to ensure
uniformity when performing inspections for occupational exposures to tuberculosis (TB). The
Directorate of Compliance Programs will provide support as necessary to assist the Regional
Administrators and Area Directors in enforcing this directive. Issuance of this directive cancels
the Memorandum to Regional Administers dated October 8, 1993, and entitled Enforcement
Policy and Procedures for Occupational Exposure to Tuberculosis.

E. Federal Program Change. This is a federal program change which impacts state programs.

1. The Regional Administrator (RA) will ensure that this change is promptly forwarded to
each state designee using a format consistent with the Plan Change Two-way
Memorandum in Appendix A, State Plan Policies and Procedures Manual (SPM).

2. The RA shall explain the content of this change to the state designee as required.

3. The state shall respond to this change within 70 days in accordance with paragraph
I.1.a.(2).(a). and (b)., Part I, Chapter III of the SPM.

4. The state’s acknowledgment shall include (a) the state’s plan to adopt and implement an
identical change, (b) the state’s plan to develop an alternative, which is as effective, or the
reasons why no change is necessary to maintain a program which is as effective. The
state shall submit a plan supplement within six months in accordance with I.1.a.(3).(c).,
Part I, Chapter III of the SPM.

5. The RA shall advise state designees of the following:

a. In order to ensure a sound and consistent national enforcement and litigation
strategy in relation to complex issues addressed by this instruction, state
implementation of the procedures in this instruction, or comparable state
procedures, must be carefully coordinated with OSHA.

b. The state is also responsible for extending coverage under its procedures for
addressing occupational exposure to tuberculosis to the public sector employees in
workplaces covered by this instruction.

c. The Directorate of Technical Support is available to assist the states in locating
expert witnesses (see paragraph M., expert witnesses). Also, the Directorate of
Compliance Programs will provide support to the states through the RA to assist
in the enforcement of this directive.

6. The RA shall review policies, instructions, and guidelines issued by the state to determine
that this change has been communicated to state compliance personnel.

F. Definitions. For a complete list of definitions applicable to tuberculosis please refer to the list of
definitions in the 1994 CDC guidelines found in Appendix A beginning on page 113.

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