s-2.1, r. 7 - Regulation respecting pulmonary health examinations for mine workers

À jour au 1^er septembre 2012

Ce document a valeur officielle.

chapter S-2.1, r. 7

Regulation respecting pulmonary health examinations for mine workers

Act respecting occupational health and safety

(chapter S-2.1, s. 223).

CHAPTER I INTERPRETATION AND SCOPE

1. In this Regulation,

“asbestos” means the fibrous form of mineral silicates belonging to rock-forming minerals of the serpentine group, that is, chrysotile, and of the amphibole group, that is, actinolite, amosite, anthophyllite, crocidolite, tremolite, or any mixture containing one or more of those minerals;

“mine” means any establishment, with or without a processing or transformation mill, at which exploration, other than the boring of an artesian well, or extraction from the ground or from bedrock is done for the purpose of removing a mineral substance to obtain a commercial or industrial product;

Buildings, warehouses, garages and workshops located on the surface and in which work related to exploration or extraction of a mineral substance is performed are part of a mine.

A mine includes a quarry or a sand pit, but not a peat bog;

“physician in charge of health services” means the physician in charge of health services in an establishment, as referred to in Division III of Chapter VIII of the Act respecting occupational health and safety (chapter S-2.1);

“silica” means cristobalite, quartz, tridymite, fused silica or any mixture containing one or more of those minerals.

O.C. 1325-95, s. 1.

2. The purpose of this Regulation is to ensure the medical monitoring of workers who perform work in a mine where they are exposed to asbestos or silica, in order to prevent and screen for pulmonary diseases caused by those contaminants.

This Regulation does not apply to a worker governed by the Act respecting labour relations, vocational training and workforce management in the construction industry (chapter R-20).

This Regulation does not apply to a worker does only office work on the site of a mine. Notwithstanding the foregoing, this Regulation, except sections 3, 4, 6, 7 and 8, applies to such a worker if he holds a pulmonary health certificate or has previously held a pulmonary health certificate or a medical certificate within the meaning of the Regulation respecting the medical certificate of workmen (R.R.Q., 1981, c. S-2.1, r. 3).

This Regulation applies to a worker who, on 2 November 1995, does not hold a medical certificate but is in the employ of an employer who operates a mine within the meaning of section 1. Subject to sections 13 to 15, such worker is deemed to hold a pulmonary health certificate.

O.C. 1325-95, s. 2.

CHAPTER II GENERAL PROVISIONS

3. An employer shall not hire a worker for the purpose of having him perform work referred to in section 2 unless the worker, in accordance with this Regulation, has undergone a pre-employment pulmonary health examination and holds a pulmonary health certificate.

Notwithstanding the foregoing, a worker who holds a valid pulmonary health certificate when hired is dispensed from that examination.

O.C. 1325-95, s. 3.

4. An employer shall not have a worker do work referred to in section 2 unless the worker, in accordance with this Regulation, has undergone the pulmonary health examinations during employment and holds a pulmonary health certificate.

Notwithstanding the foregoing, for a period of not more than one year, the employer may have such work done by a worker who, for a valid reason such as a layoff, was unable to undergo a new pulmonary health examination. The employer and the worker shall then take the necessary steps for the worker to undergo the examination as soon as possible.

O.C. 1325-95, s. 4.

5. Notwithstanding sections 3 and 4, an employer may hire a worker who does not hold a pulmonary health certificate and has a pulmonary occupational disease, for the purpose of having him perform work referred to in section 2, or may have such work performed by such worker during employment, if a decision rendered pursuant to the Act respecting industrial accidents and occupational diseases (chapter A-3.001) states that the worker is capable of performing work that exposes him to asbestos or to silica, despite functional limitations or an intolerance to either of those contaminants.

O.C. 1325-95, s. 5.

CHAPTER III PULMONARY HEALTH EXAMINATIONS

DIVISION I PRE-EMPLOYMENT PULMONARY HEALTH EXAMINATION

6. A pre-employment pulmonary health examination shall comprise the following elements:

(1)  a medical questionnaire conforming to Part I of Schedule I;

(2)  a physical examination comprising the elements described in Part II of Schedule I;

(3)  a lung x-ray conforming to the standards provided for in Part III of Schedule I; and

(4)  testing of the respiratory functions, including measurement of forced vital capacity (FVC), of timed vital capacity (TVC) and of maximum mid-expiratory flow rate (MMFR), conforming to standards BNQ 5725-050/1985 “Spiromètres” and BNQ 5725-900/1985 “Laboratoires d’examen spirométrique de dépistage en milieu de travail”, as amended.

O.C. 1325-95, s. 6.

7. That examination shall be administered by a physician designated by the employer who, where the worker so requests, shall send the worker a copy of his medical record set up by the employer under this Regulation.

If the worker is hired, that physician shall send a copy of the record including, where applicable, the x-ray provided for in section 8, to the establishment’s physician in charge of health services.

O.C. 1325-95, s. 7.

8. A worker who, in the 2 years preceding the examination, underwent a lung x-ray conforming to the standards provided for in Part III of Schedule I may be dispensed from undergoing the x-ray provided for in paragraph 3 of section 6 where he furnishes such x-ray to the physician administering the examination.

O.C. 1325-95, s. 8.

DIVISION II PULMONARY HEALTH EXAMINATIONS DURING EMPLOYMENT

9. A pulmonary health examination during employment shall be administered at least every 3 years by the physician in charge of health services at the establishment where the worker is employed.

Notwithstanding the foregoing, the first examination of a worker who has never in the past been exposed to asbestos or silica may be performed within 6 years after he is hired.

O.C. 1325-95, s. 9.

10. A pulmonary health examination during employment shall comprise

(1)  a physical examination pertaining to the elements described in Part II of Schedule I; and

(2)  a lung x-ray conforming to the standards provided for in Part III of Schedule I.

O.C. 1325-95, s. 10.

11. Notwithstanding sections 9 and 10, a health program specific to an establishment may prescribe a pulmonary health examination during employment that is more extensive and is held more frequently.

O.C. 1325-95, s. 11.

CHAPTER IV PULMONARY HEALTH CERTIFICATES

12. The physician administering a pre-employment pulmonary health examination shall, if the worker is capable of performing work referred to in section 2, issue a pulmonary health certificate whose form and tenor shall conform to Part I of Schedule II.

O.C. 1325-95, s. 12.

13. Where the physician administering a pulmonary health examination during employment is of the opinion that the worker should file with the Commission de la santé et de la sécurité du travail a claim for a pulmonary occupational disease resulting from his exposure to asbestos or silica, he shall so inform the worker by means of a notice of referral, whose form and tenor shall conform to Part II of Schedule II.

O.C. 1325-95, s. 13.

14. A worker’s pulmonary health certificate is suspended if he fails to file a claim for a pulmonary occupational disease within 6 months following receipt of a notice of referral. That suspension ceases as soon as such a claim is filed.

O.C. 1325-95, s. 14.

15. A pulmonary health certificate ceases to be valid,

(1)  where, subject to the second paragraph of section 4, more than 3 years have elapsed since the last pulmonary health examination or, where applicable, more than 6 years have elapsed since the pre-employment medical examination of a worker who has never in the past been exposed to asbestos or silica; or

(2)  where a final decision rendered pursuant to the Act respecting industrial accidents and occupational diseases (chapter A-3.001) states that the worker has a pulmonary occupational disease that results form exposure to asbestos or silica.

O.C. 1325-95, s. 15.

CHAPTER V MISCELLANEOUS PROVISIONS

16. This Regulation does not in any way restrict an employer’s right to require that a potential worker undergo, for other purposes, medical examinations that the employer considers useful.

O.C. 1325-95, s. 16.

17. A physician administering a pulmonary health examination may consult another physician before issuing a pulmonary health certificate or a notice of referral.

O.C. 1325-95, s. 17.

18. When issuing a pulmonary health certificate or a notice of referral, the physician shall provide the original to the employer and shall send a copy to the worker and to the director of public health. A copy of the notice of referral shall be sent to the worker’s accredited association.

That certificate and that notice shall be kept in the worker’s medical record in accordance with paragraph 5 of section 127 of the Act respecting occupational health and safety (chapter S-2.1).

O.C. 1325-95, s. 18.

19. An employer shall not have work performed that is incompatible with the functional limitations or with intolerance to asbestos or silica stated under a decision rendered pursuant to the Act respecting industrial accidents and occupational diseases (chapter A-3.001).

O.C. 1325-95, s. 19.

20. This Regulation replaces the Regulation respective the medical certificate of workmen (R.R.Q., 1981, c. S-2.1, r. 3)

O.C. 1325-95, s. 20.

21. (Omitted).

O.C. 1325-95, s. 21.

SCHEDULE I

(ss. 6, 8 and 10)

MEDICAL EXAMINATIONS

IMEDICAL QUESTIONNAIRE

Social insurance number _______________________________

Name ____________________________________________

Address ___________________________________________

___________________________________________

___________________________________________

Postal code

Telephone number __________________________________

Interviewer ________________________________________

Date _____________________________________________

DEMOGRAPHIC INFORMATION

i. Date of birth __________ __________ __________

year month date

ii. Sex 1. male _____

2. female _____

iii Race 1. white ________________

2. black ________________

3. oriental ________________

4. amerindian ________________

5. other (specify) ________________

iv. Name and address of employer

__________________________________________________

__________________________________________________

__________________________________________________

v. Occupation

__________________________________________________

__________________________________________________

RESPIRATORY DISORDERS

The following questions are mainly about your lungs. Please answer “yes” or “no” whenever possible. If you hesitate between “yes” and “no”, answer “no”.

1. COUGHING

A. Do you usually have a cough? Include a cough with a first cigarette or when first going outdoors. Do not include clearing your throat.

1. yes _______ 2. no _______

If you answered no, go to question C.

B. Do you usually cough at least 4 to 6 times a day for 4 or more days per week?

1. yes _______ 2. no _______

C. Do you usually cough when getting up or waking up in the morning?

1. yes _______ 2. no _______

D. Do you usually cough during the rest of the day or at night?

1. yes _______ 2. no _______

If you answered yes to at least one of questions 1A, B, C or D, answer the questions below.

If you answered no, go to question 2A.

E. Do you cough in this manner most of the time for at least 3 consecutive months every year?

1. yes _______ 2. no _______

F. For how many years have you coughed in this manner?

Number of years ____________

2. PHLEGM

A. Do you usually cough up phlegm from your lungs? Include phlegm coughed up when smoking a first cigarette of the day or when first going outdoors. Do not include phlegm from the nose. Include phlegm that is swallowed.

1. yes _______ 2. no _______

If you answered “no”, go to question C.

B. Do you usually cough up phlegm from your lungs at least twice a day for 4 or more days per week?

1. yes _______ 2. no _______

C. Do you usually cough up phlegm from your lungs when getting up or waking up in the morning?

1. yes _______ 2. no _______

D. Do you usually cough up phlegm from your lungs during the rest of the day or at night?

1. yes _______ 2. no _______

If you answered yes to at least one of questions 2A, B, C or D, answer the following questions. If you answered no, go to question 3A.

E. Do you cough up phlegm in this manner most of the time for at least 3 consecutive months each year?

1. yes _______ 2. no _______

F. For how long have you coughed up phlegm in this manner?

Number of years ____________

3. PERIODS OF COUGHING WITH PHLEGM

A. Have you had periods of coughing with increased* phlegm lasting for 3 or more weeks each year?

* for persons who usually have a cough or cough up phlegm from their lungs.

1. yes _______ 2. no _______

If you answered “yes” to question 3A

B. For how many years have you had such periods of coughing?

Number of years ____________

4. WHISTLING OR WHEEZING SOUND IN LUNGS

Do you sometimes hear a whistling or wheezing sound in your lungs?

A. When you have a cold?

1. yes _______ 2. no _______

B. Sometimes, even when you don’t have a cold?

1. yes _______ 2. no _______

C. Most of the time?

1. yes _______ 2. no _______

If you answered yes to question 4A, B or C

D. For how long have you had this condition?

Number of years ____________

5. A. Have you ever had an attack of wheezing that left you short of breath?

1. yes _______ 2. no _______

If you answered “yes” to question 5A

B. How old were you when you had the first attack?

Age______

C. Have you had more than one attack?

1. yes _______ 2. no _______

D. Have you ever needed medication or treatment for this(these) attack(s)?

1. yes _______ 2. no _______

6. SHORTNESS OF BREATH

If you suffer from an illness, other than a heart or lung disease, that prevents you from walking normally, describe that illness.

Nature of illness:

__________________________________________________

__________________________________________________

A. Do you become short of breath even when walking on level ground or when walking slightly uphill?

1. yes _______ 2. no _______

If you answered yes to question 6A

B. Do you have to walk more slowly than people of your age on level ground because you become short of breath?

1. yes _______ 2. no _______

C. Do you ever have to stop to catch your breath when walking at your own pace on level ground?

1. yes _______ 2. no _______

D. Do you ever have to stop to catch your breath after walking about 100 m (or for a few minutes) on level ground?

E. Are you too short of breath to leave the house or do you become short of breath when getting dressed or undressed?

1. yes _______ 2. no _______

F. For how many years have you become short of breath in this manner?

Number of years ____________

7. CHEST COLDS AND LUNG DISEASES

A. When you have a cold, is it usually a chest cold? (Here, “usually” means more than half the time)

1. yes ____ 2. no ____ 3. I never have a cold ____

B. In the past 3 years, have you had a lung disease that has kept you off work or forced you to stay home or in bed?

1. yes _______ 2. no _______

If you answered yes to question 7B

C. Did you cough up phlegm from your lungs when you had any of these lung diseases?

1. yes _______ 2. no _______

D. In the past 3 years, how many of these diseases, with increased phlegm, have lasted a week or longer?

Number of diseases __________ No diseases__________

MEDICAL HISTORY

8. Did you have a lung disease before the age of 16?

1. yes _______ 2. no _______

9. A. Have you ever had acute bronchitis?

1. yes _______ 2. no _______

If you answered yes to question 9A

B. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

10. A. Have you ever had pneumonia? (Include bronchopneumonia)

1. yes _______ 2. no _______

If you answered yes to question 10A

B. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

11. A. Have you ever had hay fever?

1. yes _______ 2. no _______

If you answered yes to question 11A

B. Was the allergy diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

12. A. Have you ever had chronic bronchitis?

1. yes _______ 2. no _______

If you answered yes to question 12A

B. Do you still have it?

1. yes _______ 2. no _______

C. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

D. At what age did you first suffer from it?

Age______

13. A. Have you ever had emphysema?

1. yes _______ 2. no _______

If you answered yes to question 13A

B. Do you still have it?

1. yes _______ 2. no _______

C. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

D. At what age did you first suffer from it?

Age______

14. A. Have you ever had asthma?

1. yes _______ 2. no _______

If you answered yes to question 14A

B. Do you still have it?

1. yes _______ 2. no _______

C. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

D. At what age did you begin to suffer from it?

Age______

E. If you no longer have it, at what age did it go away?

Age______

F. Do you currently require treatment or medication for asthma?

1. yes _______ 2. no _______

15. A. Have you ever had pulmonary tuberculosis?

1. yes _______ 2. no _______

If you answered yes to question 15A

B. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

D. What kind of treatment did you have?

1. none __________

2. medication __________

3. an operation __________

4. other (specify) __________

E. How long did the treatment last?

1. Number of months ____________

16. A. Have you ever had pleurisy?

1. yes _______ 2. no _______

If you answered yes to question 16A

B. Was the disease diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

17. A. Have you ever had sinus problems?

1. yes _______ 2. no _______

If you answered yes to question 17A

B. Were the problems diagnosed by a physician?

1. yes _______ 2. no _______

C. At what age did you first suffer from it?

Age______

18. Have you ever had

A. Other lung diseases?

1. yes _______ 2. no _______

If yes, specify _______________________________________

__________________________________________________

At what age _______

B. A chest or lung operation?

1. yes _______ 2. no _______

If yes, specify _______________________________________

__________________________________________________

At what age? ______

C. Chest injuries?

1. yes _______ 2. no _______

If yes, specify _______________________________________

__________________________________________________

At what age? ______

19. A. Has a physician ever diagnosed you with heart problems?

1. yes _______ 2. no _______

If you answered yes to question 19A

B. Have you been treated for heart problems in the past 10 years?

1. yes _______ 2. no _______

If yes, specify _______________________________________

__________________________________________________

20. A. Has a physician ever diagnosed you with high blood pressure?

1. yes _______ 2. no _______

If you answered yes to question 20A

B. Have you been treated for high school pressure in the past 10 years?

1. yes _______ 2. no _______

TOBACCO CONSUMPTION

21. CIGARETTES

A. Have you ever smoked cigarettes? “No” means fewer than 20 packs of cigarettes or less than 400 g of tobacco in your lifetime, or less than 1 cigarette per day for a year.

1. yes _______ 2. no _______

If you answered yes to question 21A

B. Do you currently smoke cigarettes or have you smoked cigarettes in the past month

1. yes _______ 2. no _______

C. How old were you when you started smoking cigarettes regularly?

Age______

D. If you stopped smoking cigarettes completely, at what age did you stop?

Age______

Tick here if you still smoke ____________________________

E. How many cigarettes do you currently smoke per day?

Number of cigarettes _______

F. When you smoked cigarettes, how many cigarettes did you smoke on average per day?

Number of cigarettes _______

G. Do you or did you inhale the smoke?

1. not at all ________

2. a little ________

3. moderately ________

4. deeply ________

H. Did you smoke filter-tipped cigarettes?

0. never ________

1. less than half the time ________

2. half the time ________

3. more than half the time ________

4. always ________

I. When you smoked, what kind of cigarettes did you smoke most of the time?

1. regular ________

2. king size ________

3. hand rolled ________

22. PIPE

A. Have you ever smoked a pipe regularly? “Yes” means more than 400 g or 8 pouches of tobacco in your lifetime

1. yes _______ 2. no _______

If you answered yes to question 22A

B. Do you currently smoke a pipe or have you smoked a pipe in the past month?

1. yes _______ 2. no _______

C. How old were you when you started smoking a pipe regularly?

Age______

D. If you stopped smoking a pipe completely, how old were you stopped?

Age _______ Tick here if you still smoke a pipe _______

E. How many grams of tobacco do you currently smoke per week?

_______ grams per week (a pouch contains 50 g of tobacco)

F. When you smoke a pipe, how much tobacco did you smoke on average per week?

_______ grams per week (a pouch contains 50 g of tobacco)

G. Do you or did you inhale the smoke?

1. not at all ________

2. a little ________

3. moderately ________

4. deeply ________

23. CIGARS/CIGARILLOS

A. Have you ever smoked cigars or cigarillos regularly? “Yes” means more than one cigar or cigarillo per week for a year.

1. yes _______ 2. no _______

If you answered yes to question 23A

B. Do you currently smoke cigars or have you smoked cigars in the past month?

1. yes _______ 2. no _______

C. How old were you when you began to smoke cigars regularly?

Age______

D. If you stopped smoking cigars completely, how old were you when you stopped?

Age _______ Tick here if you still smoke cigars _______

E. How many cigars do you currently smoke per week?

Number of cigars _______

F. When you smoked cigars, how many did you smoke on average per week?

Number of cigars _______

G. Do you or did you inhale the smoke?

1. not at all ________

2. a little ________

3. moderately ________

4. deeply ________

H. What kind of cigars did you smoke most of the time?

1. mini (cigarette length) ________

2. small (cigarillo) ________

3. large (real cigar) ________

FAMILY HISTORY

24. Has a member of your family been diagnosed with a chronic lung disease?

Brother

Father Mother or sister

1. yes 1. yes 1. yes

2. no 2. no 2. no

3. don’t 3. don’t 3. don’t

know know know

A. Chronic

bronchitis _____ _____ _____

B. Emphysema _____ _____ _____

C. Asthma _____ _____ _____

D. Lung

cancer _____ _____ _____

E. Tuberculosis _____ _____ _____

F. Other

respiratory

diseases _____ _____ _____

G. Eczema or

hives _____ _____ _____

H. Hay fever _____ _____ _____

25. Are you parents still living?

Father Mother

1. yes ___ 1. yes ___

2. no ___ 2. no ___

3. don’t know ___ 3. don’t know ___

26. If your parents are deceased, please specify the cause of their death.

Father ___________________________________________

Mother ___________________________________________

27. Please specify your parents’ current age or, if they are decreased, the age at which they died.

Father’s age _______

Mother’s age _______

WORKPLACE

28. A. Have you ever worked full time? (at least 30 hours a week for at least 6 months)

1. yes _______ 2. no _______

If you answered yes to question 28A

B. Have you ever worked in a dusty place for 1 year or longer?

1. yes _______ 2. no _______

Specify the type of work and the type of industry

__________________________________________________

__________________________________________________

Number of years of work _______

Was the exposure to dust

1. light ________ 2. moderate ________ 3. grave ________

C. Have you ever been exposed to gases or chemical fumes in your workplace?

1. yes _______ 2. no _______

Specify the type of work and the type of industry

__________________________________________________

__________________________________________________

Number of years of work _______

Was the exposure

1. light ________ 2. moderate ________ 3. grave ________

D. What is the occupation that you carried on for the longest time?

1. Occupation ______________________________________

2. Number of years of work ___________________________

3. Position and/or job title _____________________________

4. Field or industry work ______________________________

E. What is your current or most recent job?

1. Occupation ______________________________________

2. Number of years of work ___________________________

3. Position and/or job title _____________________________

4. Field or industry work ______________________________

5. Do you still carry on this occupation? ___________________

1. no _______

2. yes, full time _______

3. yes, part time _______

6. If you no longer carry on this occupation, how old were you when you left it? _____________________________________

29. When was the last time you had a cold or the flu?

1. I currently have a cold or the flu _____________________

2. 1 to 2 weeks ago _____________________

3. 3 to 4 weeks ago _____________________

4. 5 to 6 weeks ago _____________________

5. More than 6 weeks ago _____________________

IIPHYSICAL EXAMINATION

1. Determination of weight and size.

2. Determination of blood pressure and pulse.

3. Physical examination of the heart including an auscultation oriented specifically towards the detection of arrhythmia, murmurs and abnormal sounds.

4. Physical examination of the lungs, including an auscultation oriented towards determining the quality of the vesicular murmur and the presence of sonorous rhonchus or rales.

IIILUNG X-RAY

1. A lung x-ray shall be a post-anterior projection of the lungs on 355 mm by 432 mm x-ray film.

2. The x-ray equipment shall conform to the characteristics relating to the high kilovoltage technique described in Appendix A of Guidelines for the Use of ILO International Classification of Radiographs of Pneumoconiosis, as amended, published by the International Labour Office in 1980.

3. The examination procedure and the interpretation of a lung x-ray shall conform to Appendix A of the guidelines referred to in paragraph 2.

4. A standard set of films from the International Labour Office shall always be used in the interpretation of a lung x-ray.

O.C. 1325-95, Sch. I.

SCHEDULE II

(ss. 12 and 13)

PULMONARY HEALTH CERTIFICATE AND NOTICE OF REFERRAL

PART I

PULMONORY HEALTH CERTIFICATE

		
		Commision de la
		santé et de la sécurité
		du travail du Québec		
				Pulmonary health certificate
Name and address of holder			I certify that I have examined the holder of this certificate pursuant to the Regulation respecting
			pulmonary health examinations for mine workers and that, to the best of my knowledge, the
			holder of this certificate is entitled thereto.
2302 (94-12)

PART II

NOTICE OF REFERRAL

		
		Commision de la
		santé et de la sécurité
		du travail du Québec		
					Notice of referral
Name and address of holder			I certify that I have examined the holder of this certificate pursuant to the Regulation respecting
			pulmonary health examinations for mine workers and that, to the best of my knowledge, the 
			holder of this certificate should file a claim for a pulmonary occupational disease relating from
			exposure to:			
						asbestos	
						silica	
			If you fail to file a claim within 6 months following this notice, your pulmonary health 
			certificate will be suspended until such time as you file a claim with the CSST.
2301 (95-04)

O.C. 1325-95, Sch. II.

REFERENCES

O.C. 1325-95, 1995 G.O. 2, 2973

S.Q. 2001, c. 60, s. 167