Recommendations were made for a medical program for hazardous waste workers with multiple exposures based on established health hazards for those workers, a review of the available data on their exposures, and a review of several established medical programs for those workers. Preemployment screening, periodic screening, provisions for episodic and emergency medical care and record keeping were considered. Preemployment screening should ascertain whether the worker is physically fit to work in hazardous environments and should include a medical history and physical examination. A worker's ability to perform required tasks while wearing protective equipment should be determined. Baseline data should be obtained to evaluate the effects of subsequent toxic hazardous waste exposures. Periodic screening should take place at least yearly and include an interval history and physical examination. More frequent monitoring may be indicated in cases of significant exposures to chemicals such as polychlorinated-biphenyls (PCBs) and lead (7439921). Provisions for acute medical care, including emergency first aid at the site, episodic medical care, and arrangements for evacuating injured or ill personnel are necessary. Prior to the cleanup of hazardous waste sites, fire department and other emergency response personnel must be informed of potential hazards and procedures to limit their exposures must be enforced. Maintenance and review of records is important for periodic assessment of the efficacy of health and safety programs for a hazardous waste site, and for maintaining the effectiveness of the medical surveillance program. The author concludes that careful consideration of potential exposures and job duties can provide a basis for surveillance as part of an integrated occupational safety and health program.