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workplaces where the CDC has identified workers as having a higher incidence of
TB infection than the general population, when the employees are not provided
appropriate protection and who have exposure as defined below:

1. Exposure to the exhaled air of an individual with suspected or confirmed
pulmonary TB disease, or

Note: A suspected case is one in which the facility has identified an
individual as having symptoms consistent with TB. The CDC has
identified the symptoms to be:
productive cough, coughing up blood, weight loss, loss of appetite,
lethargy/weakness, night sweats, or fever.

2. Employee exposure without appropriate protection to a high hazard
procedure performed on an individual with suspected or confirmed
infectious TB disease and which has the potential to generate infectious
airborne droplet nuclei. Examples of high hazard procedures include
aerosolized medication treatment, bronchoscopy, sputum induction,
endotracheal intubation and suctioning procedures, emergency dental,
endoscopic procedures, and autopsies conducted in hospitals.

d. If a citation under 5(a)(1) is justified, the citation, after setting forth the SAVE for
section 5(a)(1), shall state:

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer
did not furnish employment and a place of employment which were free from
recognized hazards that were causing or likely to cause death or serious physical
harm to employees exposed to the hazard of being infected with Mycobacterium
tuberculosis through unprotected contact with [specify group such as patients,
inmates, clients, etc.] who was/were infectious or suspected to be infectious with
tuberculosis in that: [list deficiencies]

Feasible and useful abatement methods for reducing this hazard, as recommended
by the CDC, include, but are not limited to: [list abatement methods].

e. The following are examples of feasible and useful abatement methods, which must
be implemented to abate the hazard. Deficiencies found in any category can result
in the continued existence of a serious hazard and may, therefore, allow citation
under 5(a)(1).

1. Early Identification of Patient/Client. The employer shall implement a
protocol for the early identification of individuals with active TB. See
Appendix A pages 19 - 30.

2. Medical Surveillance:

a. Initial Exams. The employer, in covered workplaces, shall offer TB
skin tests (at no cost to the employees) to all current potentially
exposed employees and to all new employees prior to exposure. A
two-step baseline shall be used for new employees who have an

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