1926.1153(h)(1): Silica Medical Surveillance Basics
Employers must offer medical surveillance at no cost, at a reasonable time and place, to each employee who will be required under the silica rule to wear a respirator for 30 or more days per year. All required exams and procedures must be done by a physician or other licensed health care professional (PLHCP).
Key takeaways
- 1926.1153(h)(1) is part of OSHA's construction standards (29 CFR Part 1926, Subpart Z).
- OSHA cited it 24 times in the last 3 years, in 24 inspections, with $26,928 in current penalties.
- Most citations: IL (3), AL (3), KY (2).
- Related part: 1926.1153(h) Medical surveillance (26 citations).
- Free 5-minute toolbox talk for your crew below.
In this article
What this rule covers
29 CFR 1926.1153(h)(1) ("General") is one requirement inside 1926.1153 Respirable crystalline silica, an OSHA construction standard (Part 1926, Subpart Z). It includes 2 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
(1) General. 24 citations
(i) The employer shall make medical surveillance available at no cost to the employee, and at a reasonable time and place, for each employee who will be required under this section to use a respirator for 30 or more days per year. Open (h)(1)(i) 23 citations
(ii) The employer shall ensure that all medical examinations and procedures required by this section are performed by a PLHCP as defined in paragraph (b) of this section.
Source: eCFR, text current as of 2026-10-15. Read all of 1926.1153.
Where and how often it was cited
| Year | Citations |
|---|---|
| 2023 | 4 |
| 2024 | 7 |
| 2025 | 10 |
| 2026 | 3 |
Top states: IL (3), AL (3), KY (2), FL (2), NY (2)
Largest penalties
| Employer | Location | Penalty for this rule |
|---|---|---|
| JOVIN DEMO NEW YORK, INC | WHITE PLAINS, NY | $9,210 |
| 107691 - ASTECH LLC | COTTAGE GROVE, MN | $4,800 |
| OHIO STATE HOME SERVICES, INC. | AVON, OH | $3,232 |
| 66080 - HALL INDUSTRIAL SERVICES INC | LEXINGTON, KY | $2,800 |
| 66290 - REDLEE CONSTRUCTION AND DEVELOPMENT INC | LOUISVILLE, KY | $2,800 |
Free toolbox talk
A 5-minute crew talk on 1926.1153(h)(1), plus alerts when this rule changes. Free.
OSHA interpretation letters
- Silica in Construction, Integrated Water Delivery System, Exposure Assessment, Medical Surveillance, Respiratory Protection (2019-03-04)
- Medical surveillance requirements in OSHA’s respirable crystalline silica standard for construction (2018-02-02)
Related parts of this rule
- 1926.1153(h) Medical surveillance 26 citations
- 1926.1153(h)(1)(i) 23 citations
- 1926.1153(h)(2) Initial examination 2 citations
- 1926.1153(h)(2)(iv)
- 1926.1153(h)(6) PLHCP's written medical opinion for the employer
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Frequently asked questions
Who must be offered silica medical surveillance?
Each employee required under this section to use a respirator for 30 or more days per year.
Who pays for the medical surveillance?
The employer. It must be at no cost to the employee.
Who performs the exams?
A PLHCP, as defined in paragraph (b) of 1926.1153.
About this page
Sources
- 29 CFR 1926.1153 (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 2026-10-19
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.