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Infection Control and Cal/OSHA FAQ

October 09, 2023 11191

Frequently Asked Questions

FAQ on infection control, other Cal/OSHA regulations, training, personal protective equipment and inspections. This resource is part of the Regulatory Compliance Manual. Updated Dec 2018.

Both Cal/OSHA and the Dental Board of California have regulations governing infection control practices in dental settings. Responses to the questions in this section include requirements for both agencies. You can refer to this Cal/OSHA website for more information on how Cal/OSHA enforces its blood-borne pathogens standard. In instances where neither Cal/OSHA nor the Dental Board has a regulation, a dental office should consider recommendations from the Centers for Disease Control and Prevention (CDC).

What are the infection control training requirements?

There are two separate requirements—one by the Dental Board and the other by Cal/OSHA. The Dental Board requires licensed professionals to take two hours of infection control training every license renewal period. The training should include at a minimum a discussion of the Dental Board's infection control regulations. A Dental Board-registered continuing education provider must provide training. The training course must be approved by the Dental Board.

In addition, the Dental Board requires a dentist employer to ensure that a dental assistant, who has been in continuous employment for 120 days, has successfully completed a board-approved, eight-hour infection control course.

Cal/OSHA requires employers to provide blood-borne pathogens training to occupationally exposed employees upon hire, and at least annually thereafter. (Refer to your Exposure Control Plan to identify occupationally exposed employees). Although there is no minimum time requirement, the training must include the 14 elements listed below. Many of the 14 elements are site-specific information. A person knowledgeable in the subject as it relates to the workplace must provide the training.

The Dental Board infection control course and the OSHA blood-borne pathogens training are often provided as separate educational programs. The two programs also can be combined into one educational offering because they cover similar subjects. A combined training program must be at least two hours in length, be approved by the Dental Board and be provided by a Dental Board-registered continuing education provider who is knowledgeable in blood-borne pathogens and infection control as it relates to a dental practice setting. (You can check registered providers on the Department of Consumer Affairs website ). If employees get most of their infection control training outside the office, specific office infection control policies and procedures as noted below should be reviewed in the office. The combined course must review the Dental Board infection control regulations and include these 14 elements mandated by Cal/OSHA:

  1. Explain the purpose of the Blood-borne Pathogens Standard (8 CCR 5193) and how to get a copy of the regulation. Office training shall identify location of the regulation in the office.
  2. Provide a general explanation of the epidemiology and symptoms of blood-borne diseases.
  3. Explain the modes of transmission of blood-borne pathogens.
  4. Explain the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan. This information is office-specific and shall be provided at the workplace.
  5. Explain the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious material. Information can be reinforced at the office.
  6. Explain the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, administrative or work practice controls and personal protective equipment. Office training shall review specific office protocols.
  7. Provide information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment. Office training will review specific office protocols.
  8. Provide explanation of the basis for selection of personal protective equipment. Office training shall review specific office criteria.
  9. Provide information on the hepatitis B vaccine. Include information on its efficacy, safety, method of administration, the benefits of being vaccinated and that the vaccine and vaccination will be offered free of charge.
  10. Describe the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious material. Office training shall review specific office protocol.
  11. Explain the procedure to follow if an exposure incident occurs, including the method of reporting the incident, the medical follow-up that will be made available and the procedure for recording the incident on the Sharps Injury Log. Office training shall review specific office protocol.
  12. Provide information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident. Office training shall review specific office protocol.
  13. Provide an explanation of required signs and labels and/or color coding required.
  14. Include an opportunity for interactive questions and answers with the person(s) conducting the training session.

Be sure to record information on employees trained, training subjects, date of training and name of trainer.

Cal/OSHA requires additional training upon the introduction of new tasks, procedures or equipment that may affect employees' occupational exposure.

What type of personal protective equipment (PPE) should employees wear?

The Dental Board has specific PPE requirements, whereas Cal/OSHA requires PPE to be "appropriate." The Dental Board's PPE requirements are stated clearly in the regulations you have posted in your office.

Cal/OSHA requires that PPE be "appropriate," which means PPE should not permit blood or other potential infectious materials pass through employees' underlying garments to reach the skin, eyes, mouth, etc. In a general dental office, PPE should go from the neck down to thigh length and down to the wrists, no high collars necessary. No V-necks permitted. Periodontal offices may require more elaborate PPE, orthodontic offices may allow less. Gloves, goggles, glasses with side shields or a face shield should be worn during procedures and when working with disinfectants and sterilants.

Uniforms typically are not PPE. Uniforms are not the responsibility of the employer, unless the employer requires a uniform be worn as a condition of employment. However, if the employer provides uniforms for the purpose of preventing contact with blood or other potentially infectious material, the uniforms become PPE and are subject to Cal/ OSHA requirements. During the course of the day, PPE should be changed if necessary to avoid cross contamination.

Employers are required to provide PPE for employees who come in contact with patients during treatment and who handle disinfectants/sterilants, at no cost to the employee.

Can employees take home their personal protective equipment (PPE) to launder? Does the dentist have to pay for a commercial laundry service?

Employees may NOT take home PPE. The employer is responsible for cleaning, laundering, repairing, replacing or disposing PPE and other contaminated laundry. To launder, the employer may choose one of the methods below. With each method, regulations on the handling and containment of contaminated laundry should be followed.

  • Use a commercial laundry service that picks up and delivers.
  • Install a washer and dryer at the office; train employees on appropriate handling of the laundry; list handling of the laundry as part of employees' job descriptions.
  • Employer, if not incorporated, may take laundry to his or her home to clean.

An employee was stuck with a contaminated needle (or sharp instrument) ...what do I do?

First, clean and treat the wound and offer an immediate confidential medical evaluation and follow-up. This is made available at no cost to the employee. Refer the employee to a health care provider who will perform all medical evaluations and procedures in accordance with current U.S. Public Health Service recommendations. These medical evaluations and procedures include the collection of the employee's blood and testing for HBV, HCV and HIV status, counseling, post-exposure prophylaxis and evaluation of reported illnesses. The U.S. Public Health Service recommends that post-exposure prophylaxis for HIV start as soon as possible even if the HIV status of the source patient is unknown (see "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV And Recommendations for Post-exposure Prophylaxis", Sept. 25, 2013, and "CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Post-exposure Management", Dec. 20, 2013). Post exposure blood testing of the employee for HIV seroconversion should occur as soon as possible after the incident, then at six weeks, 12 weeks and six months after the exposure incident. If the employee refuses the medical evaluation, document this refusal and include it as part of the Exposure Incident Report to be placed with the employee's medical records.

Determine and document how the exposure occurred. A sample Exposure Incident Report and Sharps Injury Log are included in the Records section of this manual. Both documents must be completed. A copy of the Exposure Incident Report should be provided to the health care provider and another copy placed in the employee's confidential medical record.

If a patient was treated with the same needle or instrument prior to the exposure incident, identify the patient if possible and document it in the Exposure Incident Report unless prohibited by state or local law. Contact the source patient and request his or her consent to test for HBV, HCV and HIV carrier status and to disclose the information to the employee. If consent is not obtained, have the individual sign a nonconsent form and include it as part of the Exposure Incident Report. Inform employee of test result when available.

Certain information must be provided to the health care provider who performs the medical evaluation or any follow-up treatment. These are:

  • A copy of the Blood-borne Pathogens Standard (Appendix 1 of this manual).
  • Description of employee job duties during incident.
  • Documentation on routes of entry/exposure circumstances (Exposure Incident Report).
  • Results of the source individual's blood testing, if available.
  • Medical record on employee's HBV vaccine.

The health care provider is to provide to the employer with a written opinion that is to be given to the employee within 15 days of completion of the evaluation. This written opinion must contain the following information:

  • Necessity of HBV vaccine or if it was provided to the employee.
  • That the employee was informed of evaluation results and medical conditions that require further evaluation or treatment.

All other findings remain confidential and are not included in the written report.

See Exposure Control Plan and Records sections in the CDA Regulatory Compliance Manual.

An employee was stuck with a sterile needle (or sharp instrument) ...what do I do?

The procedures described in response to the previous question do not have to be followed because an "exposure incident" did not occur. An exposure incident is defined by Cal/OSHA as a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious material that results from the performance of an employee's duties.

Am I required to use safety needles?

Amendments made in 1999 to Cal/OSHA's Blood-borne Pathogens standard require the use of "needleless systems, needle devices with engineered sharps injury protections and non-needle sharps with engineered sharps injury protection," subject to four (4) exceptions. These exceptions are: 1) lack of market availability, 2) information indicating that the device will jeopardize patient care or safety, 3) information indicating that the device is not more effective in reducing sharps injuries than the device currently used by the employer and 4) lack of sufficient information to determine whether a new device on the market will effectively reduce the changes of a sharps injury.

The requirements apply to dental instruments that are sharps as well as to needles. If you claim an exception to the requirement to use devices with engineered sharps injury protections, you must document it. At this time, dental offices may use exception 1 for many dental instruments. If applicable, you may use exceptions 2, 3 or 4 with regard to safety needles. Include all documentation as part of the Exposure Control Plan.

Note: Cal/OSHA's Policy and Procedures Manual states the following with regard to the utilization of Exception 4: "The effort required by the employer to keep abreast of new information will depend on the employer's size and sophistication. For small healthcare and dental offices, it will generally be sufficient if they rely on peer organizations, academic studies, and professional journals to track currently available information on devices. Larger, more sophisticated employers will be required to make more direct efforts to evaluate devices. The employer's approach to this issue must be reflected in the Exposure Control Plan." 

To identify available safety needles and other sharps with engineered sharps injury protection, you can make inquiries with your dental supplier, check trade publications and trade shows or review dental journals for information.

The Oral Health Division of the Centers for Disease Control has developed sample screening and device evaluation forms.

What are the requirements for hepatitis B vaccination? Are postvaccination testing and booster shots required? When does an employee get the vaccination? Where do I send them to be vaccinated?

The vaccination must be made available to employees, who are occupationally exposed, within 10 working days of initial assignment. The employee must be provided with information on its efficacy, safety, method of administration, benefits and that it is provided at no cost to the employee. Exceptions to the requirement to offer the vaccination include: 1) the employee has already received the complete vaccination series; 2) antibody testing has revealed that the employee is immune or 3) the vaccination is contraindicated for medical reasons. The employer may not require an employee to be screened for antibodies in order to receive the vaccination. An employer may not require the vaccination as a condition of employment.

Hepatitis B vaccinations are administered in three doses, with the second and third doses administered at one month and six months after the first. Vaccinations should be received intramuscularly (in the deltoid). A December 1997 update in CDC recommendations now makes mandatory postvaccination screenings for employees provided with the Hepatitis B vaccine. Serological conversion should be tested within one to two months of the last shot of the three-shot series. If the screening shows the vaccine did not work, the employer is required to offer and to pay for a second vaccine series. No additional vaccination is required if the second screening does not indicate the presence of antibodies. The U.S. Public Health Service does not recommend routine serologic testing and booster shots.

If an employee agrees to the vaccination, the employer is responsible for paying for the vaccination, postvaccination screening, and, if indicated, a second vaccination series. Check with public health clinics, outpatient clinics, hospital occupational health services departments or a physician for information where employees can receive the vaccination.

If an employee declines the vaccination, the employer must ensure the employee signs a declination form. The declination's wording must be identical to that found in the regulation (Appendix A of Section 5193, Blood-borne Pathogens). See the Records section in the manual.

If an employee initially declines the vaccination then decides to have it, the employer must pay for the vaccination, postvaccination screening and second vaccination series, if necessary.

What are the regulations related to tuberculosis and other aerosol transmissible diseases?

Cal/OSHA adopted in May 2009 a regulation, Section 5199, to prevent the transmission of aerosol transmissible diseases (ATDs) at health care facilities, including nursing homes, correctional facilities, homeless shelters, drug treatment programs and among specific service providers, such as emergency responders. Aerosol transmissible diseases include all types of influenza, chicken pox, tuberculosis and several more listed in the regulation's appendix. Most dental practices and many specialty medical practices are exempt from the regulation as long as the practices comply with specific conditions. For dental practices, all of the following criteria must be met in order to claim exemption from the regulation's other requirements:

  • The dental practice does not perform dental procedures on patients with aerosol ATDs or who are suspected ATD cases.
  • The dental practice's Injury and Illness Prevention Plan includes a written procedure for screening patients for ATDs that is consistent with current CDC guidelines for infection control in dental settings, and this procedure is followed before performing any dental procedure on a patient to determine whether the patient may present an ATD exposure risk.
  • Employees have been trained in the screening procedure. (Note: This can be easily incorporated into existing infection control or Cal/OSHA training and does not require a separate class dedicated to ATDs.)
  • Aerosol generating dental procedures are not performed on a patient identified through the screening procedure as presenting a possible ATD exposure risk unless a licensed physician determines that the patient does not currently have an ATD.

The regulation focuses on high-risk facilities such as hospitals, correctional institutions, homeless shelters, long-term care facilities and primary care clinics. Regulatory requirements include fit testing of respirators, use of airborne infection isolation rooms, regular TB testing of employees and mandatory vaccinations. Dental staff who work at these facilities would need to follow respective ATD exposure control plan.

TB testing of employees is not required for most dental practices but it is recommended by the CDC. CDC recommends all personnel in low-risk settings receive a two-step baseline tuberculin skin test (TST) at the beginning of employment. Should there be an exposure incident, post-exposure test results compared to baseline test results can identify TST conversions.

It is highly recommended for dental offices to follow the Centers for Disease Control "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, 2005" MMWR 54, (RR-17. Recommendations include prompt referral of patients to their primary care provider for suspicious symptoms, conducting periodic risk assessments in low-risk environments and requesting a patient's TB history.

Should we scrub the instruments before putting them in the sterilizer?

Clean instruments thoroughly before sterilization or high-level disinfection. An ultrasonic cleaner can be used, but if after using the cleaner material continues to stick to the instrument, use a long-handled brush with soap and water, or a detergent, to scrub off the material. Wear heavy-duty utility gloves when cleaning instruments. Cal/OSHA forbids sharps from being stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed.

Isn't there a prohibition on dental staff keeping long fingernails or using artificial nails?

Cal/OSHA and the Dental Board do not specifically prohibit staff from keeping long fingernails or using artificial nails. However, if a dental office is concerned that the practice may interfere with maintaining employee and patient safety procedures, the office may adopt a policy limiting fingernail length and prohibiting artificial nails. The CDC recommends this policy.

What type of flooring is a dental office allowed to have?

Cal/OSHA requires floors to be free from dangerous projections or obstructions, to be maintained in good repair and to be reasonably free of oil, grease or water. If work activities necessitate working on slippery floors, mats shall be used.

Cal/OSHA and the Dental Board do not prohibit the use of carpet in the dental office. However, the CDC advises against the use of carpet in treatment areas due to difficulties in cleaning and disinfecting the area.

Where can I find the Dental Board infection control regulation?

The regulations are in the California Code of Regulations Title 16 Section 1005. They must be posted in each dental facility. They are included in the CDA provided set of required employment posters. The regulations are based on CDC infection control recommendations.

How do the Dental Board regulations differ from Cal/OSHA requirements?

The Dental Board regulations have specific requirements for instrument sterilization and disinfection, environmental disinfection and require written protocols for instrument processing, operatory cleanliness and injury management. The regulations require weekly biological monitoring, use of sterile coolant/irrigants for surgical procedures, flushing and purging of dental unit lines and devices and more.

Another Dental Board infection control requirement, which is not part of the regulation, requires a dentist to use sterile water or other solution containing recognized disinfecting or antibacterial properties for irrigation when dental pulp is exposed.

Failure to follow both the Dental Board and Cal/OSHA blood-borne pathogens regulations is one of the top five most common violations for which citations are issued.

Cal/OSHA – Employee Health & Safety

What needs to be in a medical emergency kit?

Most dental offices have one emergency kit to be used for both employees and patients. For employees, Cal/OSHA does not specify what should be in a medical emergency kit, just that the employer have documentation that a physician approved the kit. For patients, it is recommended that the kit contain: oxygen, blood-pressure monitoring equipment, epinephrine, Benadryl, a quick source of glucose, nitroglycerin and a CPR pocket mask. The drugs should be checked periodically to ensure they have not expired. The ADA Council of Scientific Affairs has recommendations for office emergency kits. Dental benefit plans may require specific items be included in a medical emergency kit.

For offices where general anesthesia is used, the Dental Board of California requires specific equipment (Section 1043.3 of the Dental Practice Act).

Do I have to have a permit for my air compressor?

Cal/OSHA requires a permit for the air tanks associated with air compressors if the tank is 1.5 cubic feet in volume or larger or when the safety valve is set to open at greater than 150 psi. All compressor tanks should have a nameplate with the American Society of Mechanical Engineers (ASME) code symbol (a clover leaf with a "U" or "UM" in it) to indicate compliance with the ASME code. Contact Cal/OSHA's Pressure Vessel Section to arrange inspection of your tank so it may be permitted. You will be charged for the inspection and travel time ($160/hour) and the permit ($15). A permit is issued for five years, and then the compressor must be inspected again for a new permit.

You can call the Pressure Vessel Section in Oakland, 510.622.3066, or Santa Ana, 714.567.7208.

Are personal monitors required to monitor employee exposure to formaldehyde, glutaraldehyde or nitrous oxide?

Monitoring may be necessary if an employee expresses concern about exposure levels and the employer does not have information to substantiate that exposure levels are within allowed limits. If an employer can document, using objective data, that the presence of formaldehyde or formaldehyde-releasing products in the workplace cannot result in concentrations of airborne formaldehyde that would cause any employee to be exposed at or above the action level (AL) of 0.5 ppm, calculated as an eight-hour time-weighted average concentration, or 2 ppm, as a 15-minute short-term exposure limit, under foreseeable conditions of use, the employer is not required to provide personal formaldehyde monitors. Such objective data may be available from the manufacturer of your sterilizing unit. You could also do initial monitoring. If initial monitoring indicates an exposure level higher than either of the above limits, you must take steps to reduce it. Follow-up monitoring should be conducted every six months and may be discontinued if two consecutive measurements, taken at least one week apart, record levels below the limits.

For glutaraldehyde, an employer needs to monitor the work environment if he or she believes individual staff may be exposed to concentrations in excess of the ceiling limit or permissible exposure limit (PEL) of 0.05 ppm. The PEL is a time-weighted average for an eight-hour day. If initial monitoring indicates an exposure level higher than the above limit, you must take steps to reduce it through ventilation, covering the source, reducing amount of surface area exposed or use of another product. Follow-up monitoring should be conducted after changes are instituted and then every six months. Subsequent monitoring may be discontinued if two consecutive measurements, taken at least one week apart, record levels below the limit.

For nitrous oxide, an employer needs to monitor the work environment if he or she believes individual staff may be exposed to concentrations in excess of 50 ppm, which is a time-weighted average permissible exposure limit (PEL) for an eight-hour day. Effective scavenging equipment and periodic inspection of equipment should keep nitrous oxide exposures to within acceptable limits. The National Institute for Occupational Safety and Health (NIOSH) provides information on keeping employee exposure to nitrous oxide to a minimum.

NIOSH recommends not exceeding an average level of 25 ppm during an eight-hour day. However, Cal/OSHA has not adopted this more stringent limit. Federal OSHA has not established occupational exposure limits for nitrous oxide.

We use a product that contains formaldehyde — is it true we have to report this to Cal/OSHA?

According to Title 8 of California Code of Regulations, section 5203, the use of regulated carcinogens must be reported to Cal/OSHA. Formaldehyde is one of 30 regulated carcinogens. 

Obtain a "Report of Use of Regulated Carcinogens" form via email at [email protected] or by phone at 510.286.7362. It is not available on the agency's website.

What are the requirements for eyewash stations?

Cal-OSHA requires emergency eyewash facilities be accessible in locations that require no more than 10 seconds for the injured person to reach. Plumbed or self-contained eyewash equipment must meet the requirements of sections 5, 7 or 9 of ANSI Z358.1-1981, Emergency Eyewash and Shower Equipment. Water hoses, sink faucets or showers are not acceptable eyewash facilities. Eyewash stations must be plumbed, for each eye, to provide cold water.

What do I have to do to comply with the ergonomics regulation?

California's ergonomics regulation (CA Code of Regulations, Title 8, Section 5110) requires an employer to implement a repetitive motion injury prevention program when at least two employees performing the same job or work activity develop repetitive motion injuries. The program should include a worksite evaluation, control of exposures that caused the injuries and training employees. To learn more about what you can do to reduce repetitive motion injuries in the office, contact your worker's compensation company.

In addition to the blood-borne pathogens/infection control training, what are other Cal/OSHA training requirements?

All employees must be provided with training on injury and illness prevention, hazard communication and fire and emergency plans. Comprehensive training must be done at the time of hire. Additional training must be provided whenever new hazardous materials or potentially hazardous procedures are introduced. Training should be specific to the hazards of the job and to the particular worksite. Unlike the blood-borne pathogens training, annual training is not required. However, annual training in these areas is recommended.

Refer to the CDA's Required Employee Training resource for more information.

What workplace injuries and illness must I report? What is an OSHA Log 300?

Work-related incidents that lead to serious injury or illness or death must be reported immediately to the state Division of Occupational Safety and Health. Serious injury or illness is defined as any injury or illness that requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation or in which an employee suffers a loss of any member of the body or suffers any serious degree of permanent disfigurement.

Most dental offices are exempt from maintaining an OSHA Log 300. The OSHA Log 300 replaced the OSHA Log 200, which provided a summary of work-related injuries and illnesses during a calendar year.

Dental offices are required to record work-related injuries and illnesses when the business is requested to do so in writing by OSHA, the Bureau of Labor Statistics or Cal/OSHA. Any business that receives an injury and illness survey from these agencies is required to complete the survey and return it as directed.

Dental offices must continue to record sharps injuries on a sharps injury log and to document blood-borne pathogens exposure incidents.

How long must I store training records, inspection logs and other paperwork?

Injury and Illness Prevention Program safety inspection logs and employee training records must be kept for one year, except for employees who have worked for less than one year and to whom records were given upon termination.

Blood-borne Pathogens/Exposure Control Plan employee training records must be kept for three years from date of training. The Sharps Injury Log must be kept for five years from the date of the exposure incident.

Employee medical records, kept in accordance with the Blood-borne Pathogens and Access to Employee Exposure and Medical Records standards, must be kept for the duration of employment plus 30 years.

Safety Data Sheets must be kept for 30 years.

Are there OSHA consultants who can make on-site visits?

CDA does not have staff to provide on-site Cal/OSHA consultations. However, CDA staff is knowledgeable and can be consulted via telephone or email.

Private consultants are available. Check with your local dental society or with colleagues.

Cal/OSHA has a consultation service, 800.963.9424, and a list of regional offices. Consultation staff can answer your questions by telephone and are available to conduct mock inspections. A mock inspection is a good way to check your safety program. However, if Cal/OSHA consultation staff determines aspects of the program are deficient, you will be asked to correct them. If you do not act on the recommendations, consultation staff will file a report with the enforcement staff and enforcement staff will follow through with an inspection.

What other Cal/OSHA regulations do I need to comply with? Where can I find more information?

The purpose of Cal/OSHA regulations is to protect employees at the workplace. Cal/OSHA regulates a variety of industries including construction, mining, amusement parks and manufacturing. The Cal/OSHA regulations impacting dental practices can be found in Title 8 of the California Code of Regulations. These regulations include but are not limited to:

  • Blood-borne Pathogens Standard* (§5193)
  • Injury and Illness Prevention Program* (§3203)
  • Hazard Communication Program* (§5194)
  • Ergonomics/Repetitive Motion Injuries* (§5110)
  • Emergency Action Plan* (§3220)
  • Fire Prevention Plan* (§3221)
  • Formaldehyde (§5217)
  • Access to Employee Medical and Exposure Records (§3204)
  • Accident Prevention Signs and Tags (§§3340-3341)
  • Emergency Eyewash and Shower Equipment (§5162)
  • Storage of Hazardous Substances (§5164)
  • Compressed Gas and Air Equipment (§4649 - 4665)
  • Unfired Pressure Vessel Safety Orders (§450 - 560)
  • Nitrous Oxide (§5195)
  • Prohibition of Smoking in the Workplace (§5148)
  • Airborne Contaminants (§5155) – applicable to nitrous oxide, formaldehyde, mercury, glutaraldehyde
  • Consumption of Food and Beverages (§3368)
  • Medical Services and First Aid (§3400)
  • Use, Care and Protection of Abrasive Wheels (§3575 - 3583)
  • Exits (§3216, 3225 -3229)
  • Portable Fire Extinguishers (§6151)
  • Posting and Notification Requirements (§340 – 340.4.)
  • Aerosol Transmissible Diseases (§5199)
  • Electrical Safety Orders (§2300 et seq.)

Regulations marked with an asterisk require preparation of a written plan. Links to Cal/OSHA regulations can be found at Cal/OSHA's Policies and Procedures Manual is also available if you would like to review the agency's inspection procedures, enforcement guidelines, informal conference process and appeals and hearing process.

I use employees from a temporary employment agency (or employee leasing agency). What are my responsibilities with respect to these employees and Cal/OSHA?

Cal/OSHA refers to this as a "dual employer" situation and discusses it in detail in its Policies and Procedures Manual. You and the employment agency have a shared responsibility for assuring the employees are protected from workplace hazards. Typically, the agency provides the required training, medical evaluations and vaccinations required by Cal/OSHA. You are responsible for providing site-specific safety instructions and personal protective equipment. You should coordinate and confirm with the agency your respective responsibilities with regard to preventing on-the-job injuries and to post-exposure or post-injury protocol.

What triggers a Cal/OSHA inspection?

Cal/OSHA reviews all complaints and classifies each as to whether it presents an imminent hazard, is a serious complaint or is a nonserious complaint. Complaints from self-identified employees, employee representatives and government representatives are classified as formal complaints. All formal complaints trigger an on-site inspection.

Nonformal complaints are those made by employees who do not identify themselves and non-employees. Nonformal, serious complaints are investigated by telephone first and may be followed by letter or on-site inspection. Nonformal, nonserious complaints are investigated by letter to the employer in lieu of an on-site inspection. However, Cal/OSHA district managers have some discretion to do on-site investigations of these complaints.

A complaint is invalid if the district manager determines it is willful harassment of an employer. Cal/OSHA is not obligated to provide the employer with the identity of the complainant.

Cal/OSHA also conducts "programmed inspections" when the agency is targeting an industry. For example, agriculture and the garment industry have been targets of programmed inspections. There also is a possibility of an inspection of your practice if a neighboring dental office has had frequent complaints and inspections.

I received a letter from the Division of Occupational Safety & Health regarding a complaint – what should I do?

Respond to Cal/OSHA's request for information to the extent possible. Provide photographs if they are useful. Once you have provided the information, do not expect Cal/OSHA to send you any notice of having satisfactorily answered its inquiries. If Cal/OSHA finds your response unsatisfactory, an unannounced, on-site inspection will occur.

Cal/OSHA may choose to investigate some nonformal, serious complaints by telephone or fax. Employers are contacted first by telephone, then by faxed letter. The employer has five working days to respond; employers who do not respond are scheduled for an on-site inspection. Follow-up inspections may be done for some of the complaints that are handled through this process.

You can find Cal/OSHA's policy and procedure for complaint evaluation and documentation online at

Do I have to provide the Cal/OSHA inspector access to my staff and office?

Cal/OSHA prefers to have your permission to conduct the inspection. An inspector may be willing to wait while you finish treatment on a patient, but will not wait beyond a reasonable time. If you are not present at the office when the inspector arrives, Cal/OSHA staff will attempt to contact you by telephone to gain permission. If the inspector cannot contact you by telephone or other means, he or she will document the attempts to gain your permission then will commence the inspection.

If you refuse permission, the inspector will report back to the district manager who will initiate the process for obtaining a warrant or taking other appropriate action.

What happens during a Cal/OSHA inspection?

Complaint-based inspections are unannounced. Cal/OSHA will request the presence of the employer or a representative for the inspection. You can accompany the inspector during the walk-through of the facility, but you may not be present during the inspector's interviews with staff. An employee or employee representative also may accompany the inspector during the walk-through. The inspection starts with an opening conference where the inspector provides information on the purpose and scope of the inspection and how the inspection will be conducted. The inspector will request to see, or have a copy of, various documents such as your Injury and Illness Prevention Plan, Exposure Control Plan, Hazard Communication Plan, required posters and proof of workers' comp insurance.

The inspector will then walk through the facility, taking photographs and speaking with staff in private. At the end of the walk-through, the inspector will meet with the employer for an exit conference. If violations were observed, citations may be issued during the exit conference or the inspector will provide the employer with a preliminary report with citations to be issued at a closing conference to be scheduled later. The inspector may return for follow-up inspections.

At the closing conference, Cal/OSHA staff will review their findings with the employer. Staff also will review the nature of the violations and how they can be abated. Penalties are proposed, and the employer is informed of the requirement to post citation and other notices so employees may view them. The employer also is informed of the opportunity to have an informal conference with the district manager to discuss the citation and penalties and of the separate opportunity to appeal.

Cal/OSHA's inspection procedures are detailed in its policies and procedures manual.

I was cited by Cal/OSHA — what should I do? Do I need an attorney?

At the closing conference, Cal/OSHA staff will have reviewed their findings with you or your representative. You may choose to take one of these actions:

  • Correct the violations and pay the proposed penalties. In this scenario, you effectively agree that there were violations and you will not appeal the citations.
  • Appeal citations and proposed penalties. File an appeal with the Occupational Safety and Health Appeals Board within 15 working days of receiving citations.

You can also request an informal conference with the district manager. An informal conference provides an opportunity for you to present evidence, to offer explanations and to clarify issues. After an informal conference, a district manager will determine if it is appropriate to withdraw or amend citations and to revise penalties. Having an informal conference does not negate your right to a hearing before the Appeals Board. An informal conference is not the same as the prehearing conference scheduled by Appeals Board, although the scope is the same.

Request an informal conference any time before the day of the appeal hearing. Additional information on the appeals and hearing process and on informal conferences can be found in the Cal/OSHA policies and procedures manual.

Whether you need or want an attorney depends on the nature and scope of the citations. A few nonserious violations may not warrant the use of legal counsel. It is advisable to seek legal counsel for serious violations where employees have been injured or an unsafe work environment alleged.

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