Does the standard require employees to participate in medical surveillance?

No, although the standard requires employers to make medical surveillance available to qualifying employees, the standard does not require qualifying employees to participate in medical surveillance. However, the employer must offer the examination fairly and in good faith, at no cost to employees, and at a reasonable time and place, and must make another examination available if the employee requests it or, at a minimum, the next time an examination is due (i.e., within three years). See 29 C.F.R. § 1926.1153(h). In addition, the standard requires employers to train employees on the purpose of the medical surveillance program. See 29 C.F.R. § 1926.1153(i)(2)(i)(F). If an employer wishes to document an employee’s decision to decline a medical examination, the employer could ask the employee to sign a statement affirming that he or she was offered the benefits and declined to participate.

Note that the medical examination under the silica standard is different than the medical evaluations required under the respiratory protection standard. If an employee declines a medical evaluation under the respiratory protection standard, then the employer may not assign him or her a task requiring respirator use.