Characteristics of US workers whose blood lead levels trigger the medical removal protection provision, and conformity with biological monitoring requirements, 2003–2005


  • The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

  • This article is a US Government work and, as such, is in the public domain in the United States of America.



Workers with blood lead levels (BLL) ≥60 µg/dl (50 µg/dl for construction workers) or with three or more consecutive BLLs over at least 6 months that average 50 µg/dl or greater are required to be removed from work involving lead exposure that exceeds the OSHA action level. This study estimates the proportion of workers with BLLs that trigger the medical removal provision by industry sector, and examines whether workers received appropriate follow-up blood lead testing.


Three years (2003–2005) of data from the Adult Blood Lead Epidemiology and Surveillance program were analyzed to identify those industries with a high percentage of workers with BLLs that trigger the medical removal provision. Adjusted rate ratios (RR) of adults with such BLLs were estimated by industry sector compared to the battery manufacturing industry using Poisson regression models.


Out of 13,724 adults with BLLs ≥25 µg/dl, a total of 533 adults had BLLs that triggered the medical removal provision. RRs of adults with BLLs triggering medical removal were highest for “painting and wall covering contractors” (RR = 22.1) followed by “highway, street and bridge construction” (RR = 14.7), “amusement, gambling, and recreation” (RR = 11.4), and “glass product manufacturing” (RR = 10.1). Overall, 29% of adults with BLLs triggering medical removal received appropriate follow-up blood lead tests and met the eligibility to return to lead work.


These findings suggest that additional efforts are needed to prevent occupational overexposure to lead in adults, and to ensure proper medical management of those workers who meet medical removal criteria. Am. J. Ind. Med. 51:691–700, 2008. Published 2008 Wiley-Liss, Inc.