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n 1987, the Occupational Safety and Health Administration (OSHA) requested the National Institute for Occupational Safety and Health (NIOSH) to investigate the validity of reported adverse health effects in workers occupationally exposed to chemicals contained in or released from carbonless copy paper (CCP). OSHA also requested that NIOSH publish its ﬁndings if health effects were confirmed. The OSHA request was based on one worker's concern that skin, respiratory problems, and possible brain damage were due to consistent exposure to CCP [ 52 Fed. Reg. 22534 (1987)]. In addition, 10 to 12 of the initial complainant's coworkers who were also exposed to CCP were reported to have suffered adverse health effects.

Thus in 1987, NIOSH issued a Federal Register notice soliciting information about possible adverse health effects from CCP exposure [52 Fed. Reg. 22534 (1987)]. On the basis of information available at that time, no strong conclusion could be reached concerning a consistent link between CCP and major health effects. Between 1987 and 1997, a number of additional incidents were identified as involving health problems potentially related to CCP. Therefore, in 1997 NIOSH issued a second Federal Register notice soliciting new information [62 Fed. Reg. 8023 (1997)].

This report contains a review of the published literature on CCP and the submissions from the two Federal Register notices. NIOSH prefers to use the published literature when investigating the relationship between an occupational exposure and adverse health effects, but some unpublished sources were used in this case because the published literature was limited. The unpublished information was found to be of variable quality, validity, and utility.

CCP was introduced in 1954 by the National Cash Register Company as no-carbon-required (NCR) paper—an alternative to separate sheets of carbon paper [Sandberg 1955; Green 1955; Miller and Phillips 1972; Calnan 1979; Buring and Hennekens 1991]. NCR was a patented name, but many of the patents have expired, and several companies have licenses in other countries.

The mechanism of CCP involves coating the under surface of the top sheet of CCP with an emulsion of a colorless dye in a solvent (see Chapter 2). The emulsion is held in microscopic capsules (microcapsules) that are ruptured by firm pressure from a writing instrument. The released dye reacts with a reagent on the surface of the paper and changes the dye to a colored product (generally violet, blue, or black). CCP may also be referred to as one of the following:

Pressure-sensitive paper 

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