1910.1053(i)(2): Initial Silica Medical Exam
Employers must make an initial (baseline) medical exam available within 30 days after assignment unless the employee had a qualifying exam in the last three years. It includes a medical and work history, a physical exam focused on the lungs, a chest X-ray read by a NIOSH-certified B Reader, a pulmonary function test by a certified spirometry technician, latent tuberculosis testing, and other tests the PLHCP deems appropriate.
Key takeaways
- 1910.1053(i)(2) is part of OSHA's general industry standards (29 CFR Part 1910).
- OSHA cited it 25 times in the last 3 years, in 21 inspections, with $63,717 in current penalties.
- Most citations: CO (4), KS (4), GA (4).
- Related part: 1910.1053(i) Medical surveillance (188 citations).
- Free 5-minute toolbox talk for your crew below.
In this article
What this rule covers
29 CFR 1910.1053(i)(2) is one requirement inside 1910.1053 Respirable crystalline silica, an OSHA general industry standard (Part 1910). It includes 6 sub-paragraphs. The official text below is copied word for word from the Electronic Code of Federal Regulations (eCFR). The numbers, injury cases and training on this page show how OSHA enforces it on real job sites.
Official text
(2) Initial examination. The employer shall make available an initial (baseline) medical examination within 30 days after initial assignment, unless the employee has received a medical examination that meets the requirements of this section within the last three years. The examination shall consist of: 25 citations
(i) A medical and work history, with emphasis on: Past, present, and anticipated exposure to respirable crystalline silica, dust, and other agents affecting the respiratory system; any history of respiratory system dysfunction, including signs and symptoms of respiratory disease (e.g., shortness of breath, cough, wheezing); history of tuberculosis; and smoking status and history; 1 citations
(ii) A physical examination with special emphasis on the respiratory system;
(iii) A chest X-ray (a single posteroanterior radiographic projection or radiograph of the chest at full inspiration recorded on either film (no less than 14 x 17 inches and no more than 16 x 17 inches) or digital radiography systems), interpreted and classified according to the International Labour Office (ILO) International Classification of Radiographs of Pneumoconioses by a NIOSH-certified B Reader; 2 citations
(iv) A pulmonary function test to include forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) and FEV1/FVC ratio, administered by a spirometry technician with a current certificate from a NIOSH-approved spirometry course; Open (i)(2)(iv) 1 citations
(v) Testing for latent tuberculosis infection; and 2 citations
(vi) Any other tests deemed appropriate by the PLHCP.
Source: eCFR, text current as of 2026-10-15. Read all of 1910.1053.
Where and how often it was cited
| Year | Citations |
|---|---|
| 2023 | 2 |
| 2024 | 14 |
| 2025 | 6 |
| 2026 | 3 |
Top states: CO (4), KS (4), GA (4), MD (2), WI (2)
Largest penalties
| Employer | Location | Penalty for this rule |
|---|---|---|
| OLDCASTLE APG NORTHEAST, INC. | BRISTOL, PA | $15,625 |
| STAR GRANITE & BRONZE INTERNATIONAL, INC. | ELBERTON, GA | $12,445 |
| ARTCO-BELL CORPORATION | TEMPLE, TX | $8,296 |
| KEOKUK MILLS, LLC | KEOKUK, IA | $7,150 |
| THE LAKEWOOD BRICK AND TILE COMPANY | LAKEWOOD, CO | $6,000 |
Free toolbox talk
A 5-minute crew talk on 1910.1053(i)(2), plus alerts when this rule changes. Free.
OSHA interpretation letters
- Who can perform a pulmonary function test (PFT) in compliance with the Respirable Crystalline Silica Standards? (2018-07-30)
Related parts of this rule
- 1910.1053(i) Medical surveillance 188 citations
- 1910.1053(i)(1)(i) 158 citations
- 1910.1053(i)(1) General 158 citations
- 1910.1053(i)(2)(iv) 1 citations
- 1910.1053(i)(6) PLHCP's written medical opinion for the employer
Get your crew competent
Trainers on Black Belt Safety: Marc Harvey, Dana Reyes
Trainers and suppliers: feature your business on this rule for $25/month.
Frequently asked questions
When must the initial exam be offered?
Within 30 days after initial assignment.
When can it be skipped?
When the employee received an exam meeting this section within the last three years.
Is tuberculosis testing included?
Yes, testing for latent tuberculosis infection is part of the initial exam.
About this page
Sources
- 29 CFR 1910.1053 (eCFR), text current as of 2026-10-15
- U.S. Department of Labor enforcement data: OSHA inspections, citations and accident records, copied nightly; data as of 2026-10-20
3-year window. Federal OSHA only; state-plan rules are not counted. Plain-language text is a summary, not legal advice; the official text controls. Black Belt Safety is not part of OSHA or the Department of Labor.