Silica physicals: what OSHA requires for stone fabrication shops.

What a silica physical actually is

A silica physical is the medical surveillance examination defined by OSHA's respirable crystalline silica standards. It is performed by a physician or other licensed health care professional (PLHCP), paid for by the employer, and built for one purpose: to catch dust-related lung changes early — years before someone notices they are short of breath on the stairs.

It is not the same appointment as the medical evaluation required before an employee wears a respirator. The respirator evaluation clears someone to wear a mask; silica surveillance goes deeper, with imaging and lung-function testing aimed specifically at long-term dust exposure. A shop running both programs correctly treats them as two separate appointments with two separate purposes.

Who must be offered one

Under the general-industry standard (29 CFR 1910.1053 — the one most fabrication shops fall under), the employer must offer medical surveillance to each employee exposed at or above the action level of 25 micrograms per cubic meter of air (as an 8-hour time-weighted average) for 30 or more days per year. Under the construction standard (29 CFR 1926.1153), which covers install crews working under the rule, the trigger is being required by the standard to wear a respirator for 30 or more days per year.

For a stone shop, the practical question is what your exposure assessment shows. Cutting, grinding, polishing, dry shaping, and cleaning up dry debris are the tasks that push a worker toward that threshold; wet cutting, downdraft collection, and good housekeeping hold exposure below it. The requirement follows measured exposure and days per year — not job titles.

What is inside the exam

The contents are fixed by the standard, so the exam looks the same wherever you go. It includes:

• Medical and work history — past and current dust exposure, respiratory symptoms, smoking history, and job history.
• Physical examination with special emphasis on the respiratory system.
• Chest X-ray — a single posteroanterior (PA) image, interpreted and classified according to the International Labour Office (ILO) system by a NIOSH-certified B Reader.
• Pulmonary function test to measure how well the lungs move air.
• Test for latent tuberculosis infection — at the initial examination only.
• Any other tests the examining clinician considers appropriate for that worker.

The B Reader classification is the part to watch. If the reading is 1/0 or higher, the employee must be referred to a Board-Certified specialist in pulmonary disease or occupational medicine — and if the employee gives written authorization, the employer must make that specialist examination available within 30 days of receiving the clinician's written opinion.

The schedule: baseline, then every three years

The timeline is straightforward. An initial (baseline) examination must be made available within 30 days after initial assignment — unless the employee has already received an examination that meets the standard within the last three years, in which case that recent exam counts as the baseline.

After that, periodic examinations must be made available at least every three years, or more frequently if the PLHCP recommends it. The chest X-ray and physical follow that same three-year cadence; the tuberculosis test does not repeat. Before each exam, the employer must give the clinician a copy of the standard itself, plus details about the employee's exposure, tasks, and respirator use, so the exam is interpreted against the actual job.

Who pays, and what comes back to you

The employer pays — full stop. Exams must be provided at no cost to the employee, at a reasonable time and place. Scheduling them during work hours at a clinic near the shop is how compliant shops handle it; expecting employees to arrange and front the cost is not.

Within 30 days of each exam, the employer receives a written medical opinion — and it is deliberately narrow. It may contain only statements about limitations on the employee's exposure and recommendations for more frequent periodic exams. Everything else stays confidential between the employee and the clinician. The employee gets a full copy of their own results. This confidentiality boundary is why shops should never ask workers for the contents of their exams; you are only entitled to the two categories above.

Records that travel with the program

The exam itself is one thread in a larger documentation program: exposure assessments, respirator fit tests, training dates, the written exposure control plan, and the written medical opinions you receive. Under OSHA's access-to-medical-records rule, employee medical records are kept for the duration of employment plus 30 years — so the storage habit you pick today outlasts most of the equipment in the shop.

Good records are also good operations. When every date, signature, and result lives in one place instead of a filing cabinet and three phones, preparing for an inspection — or simply onboarding a new lead — takes minutes instead of an afternoon. The OSHA silica compliance checklist covers the full program around the exam, and the OSHA silica compliance guide walks through the standard end to end.

This article is a plain-English summary of OSHA's medical surveillance requirements, not legal or medical advice. Read the full text of 29 CFR 1910.1053 and 29 CFR 1926.1153, and work with your examining clinician and your safety advisor for decisions about your specific workforce.

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