Thallium Industry Controls: Laboratory Work Production Wear gloves Yes No Glass Production Respirator use Yes No Electronic Industry Local exhaust ventilation Yes No Power Industry Overalls / work clothing Yes No Other (specify): __________ Laundering by employer Yes No Wash basins & showers (with hot Yes No & cold water) Smoking or eating in workshop Yes No Personal hygiene: Shaven Yes No Shower & change into clothes Yes No at end of shift BIOLOGICAL MONITORING RESULTS Include at least the previous two test results (if available) Date Recommended Action and/or Comment Test Performed 1. DD/MM/YYYY 2. DD/MM/YYYY 3. DD/MM/YYYY 4. DD/MM/YYYY 5. DD/MM/YYYY 6. DD/MM/YYYY 7. DD/MM/YYYY RECOMMENDATIONS (by Medical Practitioner) () all relevant boxes Suitable for work with thallium Counselling required Review workplace controls Repeat health assessment in ______ month(s) / ______ week(s) Removal from work with thallium On DD/MM/YYYY Medical examination by Medical Practitioner On DD/MM/YYYY Fit to resume thallium risk work From DD/MM/YYYY Referred to Medical Specialist (respiratory/dermatology/other): On DD/MM/YYYY Specialist’s name:
Thallium Industry Laboratory Work Production Glass Production Electronic Industry Power Industry Other (specify): __________ Controls: Wear gloves Yes No Respirator use Yes No Local exhaust ventilation Yes No Overalls / work clothing Yes No Laundering by employer Yes No Wash basins & showers (with hot & cold water) Yes No Smoking or eating in workshop Yes No Personal hygiene: Shaven Yes No Shower & change into clothes at end of shift Yes No BIOLOGICAL MONITORING RESULTS Include at least the previous two test results (if available) Date Test Performed Recommended Action and/or Comment 1. DD/MM/YYYY 2. DD/MM/YYYY 3. DD/MM/YYYY 4. DD/MM/YYYY 5. DD/MM/YYYY 6. DD/MM/YYYY 7. DD/MM/YYYY RECOMMENDATIONS (by Medical Practitioner) () all relevant boxes Suitable for work with thallium Counselling required Review workplace controls Repeat health assessment in ______ month(s) / ______ week(s) Removal from work with thallium On DD/MM/YYYY Medical examination by Medical Practitioner On DD/MM/YYYY Fit to resume thallium risk work From DD/MM/YYYY Referred to Medical Specialist (respiratory/dermatology/other): Specialist’s name: On DD/MM/YYYY