OSHA TB Standard: Compliance Program, Inspections, and Penalties

There is no dedicated OSHA TB standard. OSHA enforces tuberculosis protections in the workplace through the General Duty Clause of the OSH Act, Section 5(a)(1), which requires employers to keep the workplace free of recognized hazards likely to cause death or serious harm.¹ OSHA’s position is that an employer following the most recent CDC guidelines on preventing TB transmission in healthcare settings satisfies that duty.² Alongside the General Duty Clause, OSHA applies existing rules on respiratory protection, recordkeeping, and access to medical records, and it uses enforcement directive CPL 02-02-078 to guide inspections and citation decisions.³

Which Employers Are Covered

Coverage is triggered by occupational exposure, not by industry label. If your workers share air with people who may have active TB disease, the requirements apply.⁴ In practice that means:

Hospitals, outpatient clinics, nursing homes, and other long-term care facilities.
Correctional institutions. About 3.6 percent of U.S. TB cases reported in 2023 were among residents of correctional facilities.⁴
Homeless shelters and other crowded congregate settings.
Laboratories handling clinical specimens that may contain Mycobacterium tuberculosis.

One coverage gap matters. Federal OSHA does not cover state or local government employees. Public-sector correctional officers, county hospital staff, and similar workers only get equivalent protection if their state runs an OSHA-approved state plan. In states without one, there is no federal OSHA coverage for those workers.⁵

The TB Compliance Program

OSHA and the CDC expect a layered program. Everything begins with a documented facility risk assessment; the level of controls, screening, and respirator use flow from that classification.² A facility that rarely sees TB patients has different obligations than a pulmonary clinic in a high-prevalence area. A compliance officer will ask to see the written assessment near the start of any inspection.⁶

Written Infection Control Plan

Every covered employer needs a written TB infection control plan. It has to assign responsibility to a qualified person or committee, describe how the facility will promptly identify and isolate people with suspected or confirmed TB, and lay out procedures for each control layer. The plan must be reviewed periodically for effectiveness.⁷

Triage is where many facilities slip. The plan must spell out how a person coughing for three or more weeks, coughing up blood, or losing weight unexpectedly gets flagged and separated from other patients quickly rather than sitting in a waiting room.⁶

Engineering Controls: Isolation Rooms

Any facility that houses suspected or confirmed TB patients must have an Airborne Infection Isolation Room (AIIR) available. An AIIR maintains negative pressure so air flows into the room rather than leaking into hallways. Existing rooms must achieve at least six air changes per hour; new construction or renovation should target 12 or more. Exhaust air should go directly outside, or through a HEPA filter if it is returned to the building’s air-handling system.⁸⁹

Original construction specs are not proof of current function. Compliance officers may run smoke-tube tests during an inspection to verify that isolation rooms actually maintain negative pressure, so the facility needs an ongoing verification routine.⁶ When AIIRs are full, portable HEPA units providing at least 12 equivalent air changes per hour can serve as a temporary measure in standard rooms, but they are not a substitute for maintaining enough permanent AIIRs.¹⁰

Respiratory Protection

When engineering and administrative controls cannot eliminate the risk, employers must provide respiratory protection under 29 CFR 1910.134. This applies whenever workers enter an AIIR with a suspected or confirmed TB patient, and during high-hazard procedures such as bronchoscopy, sputum induction, or intubation.⁸

The employer must establish a written respiratory protection program run by a qualified administrator, covering selection, medical evaluations, fit testing, training, and maintenance. Respirators, training, and medical evaluations must be provided at no cost to the employee.¹¹¹²

Before wearing a tight-fitting respirator, an employee needs a confidential medical evaluation done during work hours or at a time convenient to the employee. The minimum device is a NIOSH-certified air-purifying respirator rated N95 or higher. After medical clearance, the employee must pass a fit test using the exact make, model, style, and size they will wear on the job, and the fit test must be repeated at least annually or whenever they change respirators.¹²⁸

A fit test is not a user seal check. The fit test is the formal annual evaluation. The user seal check is the quick positive and negative pressure check the employee performs every single time they put the respirator on, before entering a hazardous area. If the seal check fails, the employee has to reseat the respirator or switch to a different one.¹³

Medical Surveillance and Screening

All healthcare personnel should receive a baseline TB screening on hire: a risk assessment, a symptom evaluation, and a TB test (either an IGRA blood test or a tuberculin skin test).¹⁴

Routine annual testing is no longer the default. Under the 2005 CDC guidelines, annual TB testing was standard for many healthcare workers. In 2019, the CDC dropped that recommendation absent a known exposure or ongoing transmission at the facility.¹⁴ OSHA confirmed in a 2020 letter that employers may discontinue the annual testing requirement from the 2005 guidelines as long as they follow all elements of the most recent CDC guidance and any applicable state and local rules.² Facilities may still screen annually for workers at elevated risk, such as pulmonologists and respiratory therapists, and any known exposure triggers immediate testing regardless of the baseline schedule.

Employees with a documented prior positive TB test do not need to be re-tested, but they still need a symptom screen, and any new symptoms trigger evaluation for active disease. Any new positive result or new symptoms require prompt medical follow-up, typically including a chest radiograph. If an employee is diagnosed with infectious TB, the employer must keep them out of the workplace until a clinician confirms they are no longer infectious, and must notify the local health department when TB is presumed or confirmed.¹⁴ All required testing and evaluations are at the employer’s expense.

Training

Every worker with occupational TB exposure has to be trained on how TB spreads, the signs and symptoms of active disease, the facility’s own infection control plan, and correct use of any required PPE. Training happens at the start of employment and is repeated as needed.⁸ When workers are not fluent in English, training has to be delivered in a language they actually understand; OSHA does not accept training a worker cannot comprehend as compliance.¹⁵

Recordkeeping

A work-related TB infection must be recorded on the OSHA 300 Log under the respiratory condition column. The trigger is an employee occupationally exposed to a known active TB case who then develops a TB infection, whether shown by a positive skin test or a physician’s diagnosis.¹⁶ TB is a privacy concern case: do not enter the employee’s name on the 300 Log. Write “privacy concern case” in the name field and keep a separate confidential list linking the case number to the employee.¹⁷ The case can be removed from the log if a medical investigation or the health department shows the infection came from a non-workplace source, such as a household contact.

Retention periods matter. Employee medical records, including TB test results and evaluations, must be kept for the duration of employment plus 30 years. Exposure records follow the same 30-year rule. Fit test records are kept until the next fit test.¹⁸

Citations and Penalties

Because TB exposure can cause death or serious harm, OSHA generally classifies TB-related violations as serious.⁶ As of 2025, the maximum penalty for a serious violation is $16,550, and willful or repeated violations can reach $165,514 per violation. These amounts are adjusted annually for inflation.¹⁹

Common citation scenarios under the General Duty Clause include letting workers share air with a suspected or confirmed pulmonary TB patient without adequate protection, and performing aerosol-generating procedures such as bronchoscopy, sputum induction, or intubation on a TB-suspected patient without proper controls. A gap in any single element of the program (the written plan, the risk assessment, medical surveillance, training, or engineering controls) can independently support a citation.⁶

What an OSHA TB Inspection Looks Like

Inspections follow CPL 02-02-078. The compliance officer will typically ask for the infection control director and the occupational health lead, and may pull in the training director, facility engineer, or director of nursing.⁶

The first question is usually whether the facility has had a suspected or confirmed TB case, in patients or employees, in the previous six months. If yes, the inspection deepens through employee interviews, direct observation, and document review. Expect requests for:

The written TB infection control plan with evidence of periodic updates.
The documented risk assessment with assigned risk classifications.
Medical surveillance records showing baseline testing and any follow-up.
Training records for exposed employees.
The respiratory protection program, including medical evaluations and fit test records.
Engineering controls documentation, including HEPA filter maintenance.
OSHA 300 Log entries for any recorded TB cases.

The officer may also walk patient rooms, emergency departments, laboratories, and procedure suites, and may run smoke-tube testing on isolation rooms to confirm negative pressure is working.⁶

Employee Rights

Workers who report TB safety concerns, to their employer or to OSHA, are protected from retaliation under Section 11(c) of the OSH Act. An employee who is fired, demoted, or otherwise punished for raising concerns can file a whistleblower complaint with OSHA. The deadline is 30 days from the retaliatory action, which is short compared to other whistleblower statutes, so acting quickly matters. OSHA may accept a late filing under limited extenuating circumstances.²⁰²¹

Employees can also request access to their own TB medical records and exposure records held by the employer. The 30-year retention rule exists in part so that current and former employees can obtain those records long after leaving a job.¹⁸

1
Occupational Safety and Health Administration. OSH Act of 1970 – Section 5 Duties
2
Occupational Safety and Health Administration. CDC Updates to Tuberculosis (TB) Guidelines
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Occupational Safety and Health Administration. Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis
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Occupational Safety and Health Administration. Tuberculosis – Overview
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Occupational Safety and Health Administration. State Plan – Frequently Asked Questions
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Occupational Safety and Health Administration. Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis
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eCFR. 29 CFR 1910.134 – Respiratory Protection
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Occupational Safety and Health Administration. 29 CFR 1910.134 – Respiratory Protection
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Occupational Safety and Health Administration. Appendix A to 29 CFR 1910.134 – Fit Testing Procedures
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Centers for Disease Control and Prevention. Frequency of Tuberculosis Screening and Testing for Health Care Personnel
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Occupational Safety and Health Administration. The Employer Must Provide the 1910.1200 Verbal Training in a Language That Is Comprehensible
16
eCFR. 29 CFR Part 1904 – Recording and Reporting Occupational Injuries and Illnesses
17
Occupational Safety and Health Administration. Detailed Guidance for OSHA’s Injury and Illness Recordkeeping Rule
18
Occupational Safety and Health Administration. 29 CFR 1910.1020 – Access to Employee Exposure and Medical Records
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Occupational Safety and Health Administration. OSHA Penalties
20
Whistleblowers.gov. Occupational Safety and Health Act (OSH Act), Section 11(c)
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Occupational Safety and Health Administration. OSHA Online Whistleblower Complaint Form