When should biological monitoring be considered as part of a surveillance program?

• A. Based on hazard assessment, presence of biomarkers, exposure potential, and regulatory or clinical relevance
• B. Only after workers report symptoms
• C. Only for high-risk workers
• D. It should never be used

Answer: (A)

Biological monitoring in a surveillance program is justified when there is real potential for workers to be exposed and there are validated biomarkers that can reliably reflect internal dose or early effect, with relevance to health protection or regulatory/clinical decisions. This means going through a hazard assessment to establish that a hazard exists and matters in the workplace, confirming that there are appropriate biomarkers available that can measure exposure or effect with sufficient sensitivity and specificity, and ensuring the exposure scenario is such that monitoring results will drive action—whether adjusting controls, enforcing regulations, or guiding medical surveillance.

This approach matters because monitoring is most useful when it can meaningfully influence protection outcomes. It allows detection of internal dose before symptoms appear, verifies the effectiveness of controls, and supports medical or regulatory decisions. If any of these elements are missing—no validated biomarker, uncertain exposure potential, or no clear health or regulatory relevance—monitoring may provide little value.