Does the silica standard preclude in-house health care providers from performing the required medical surveillance examinations?

No. For initial and periodic examinations, employers may choose to use any health care provider that meets the definition of a PLHCP in paragraph (b) of the standard, including a qualified in- house health care professional. Similarly, if an additional examination by a specialist is required by 29 C.F.R. § 1926.1153(h)(7), an employer with a specialist on staff may elect to have the additional examination(s) performed by that in-house physician. Employers must ensure that in- house PLHCPs, like all PLHCPs performing medical surveillance examinations and procedures under the silica standard, adhere to the standard’s confidentiality requirements. See 29 C.F.R. § 1926.1153(h)(6)(ii), (7)(iv).