Does OSHA require air conditioning in NEMT vans?

No federal standard requires it today. Under OSHA's 2024 proposal, a vehicle would count as an outdoor work area unless air conditioning consistently keeps it below 80 degrees, and work inside such a vehicle would be exempt. Nevada exempts drivers in vehicles whose climate control works properly, and Maryland exempts vehicles whose ventilation or fan holds the heat index under 80. State NEMT vehicle rules can require it anyway: Minnesota's special transportation rules say every heating and air conditioning unit a vehicle has must work.

Is there a temperature at which drivers must take breaks?

Not under federal law. Washington requires paid cool-down rest of at least 10 minutes every 2 hours when outdoor work reaches 90 degrees, and 15 minutes every hour at 100 degrees. Oregon lets employers use a written simplified schedule as one option: 10 minutes every two hours at a heat index of 90 and 20 minutes every hour at 95. OSHA's proposal would add a 90-degree heat index trigger nationally if it becomes final.

How long does it take a new driver to get used to the heat?

About one to two weeks. OSHA recommends shorter days in the heat during a new worker's first 1 to 2 weeks, starting at 20 percent of a normal day and adding 20 percent each day. California's rule says acclimatization peaks in most people within 4 to 14 days of regular work for at least two hours a day in the heat. OSHA has found that almost half of heat-related worker deaths happen on the first day on the job or the first day back.

Is a driver's heat illness recordable on the OSHA log?

Only if it goes beyond first aid. OSHA's heat enforcement directive gives the line: a worker who is only told to drink fluids for heat stress is a first aid case and not recordable, while a worker who loses consciousness or needs medical treatment beyond first aid must be recorded. A heat illness that leads to an in-patient hospital stay must also be reported to OSHA within 24 hours.

Will OSHA inspect a NEMT company for heat?

Rarely on its own initiative. The April 2026 heat emphasis program sends inspectors to 55 target industries on heat warning and advisory days, and ground passenger transportation is not on that list. A complaint, an injury report, or an inspection opened for another reason on a day with a heat index of 80 or more can still lead to heat questions and a General Duty Clause citation.

Heat illness prevention for NEMT drivers

OSHA has not finished its heat standard, but NEMT companies already have heat duties. The agency proposed a heat injury and illness rule in August 2024. Its current regulatory agenda dates the next step, a supplemental proposal, to December 2026, with final action listed for October 2027. Until then, OSHA cites heat hazards under the General Duty Clause, and five states have heat rules of their own that can reach drivers. The OSHA guide for NEMT companies covers the other OSHA rules that apply to a fleet. Vehicle air conditioning, pre-cooling, and riders left in parked vans are covered in the rear AC guide. This page is about the people: drivers working in the heat, and riders on the hottest days.

Is there a federal heat standard for drivers?

No. OSHA published a proposed rule, Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings, on August 30, 2024 (89 FR 70698). It held an informal public hearing starting June 16, 2025 and extended post-hearing comments to October 30, 2025. The Unified Agenda entry for the rule (RIN 1218-AD39) lists a supplemental proposal for December 2026 and a final action for October 2027, and nothing in the proposal is binding today.

The proposal shows how a national rule would treat vans if it is adopted as written:

Vehicles count as outdoor work areas unless air conditioning consistently keeps the ambient temperature below 80 degrees, in which case work inside the vehicle is exempt.
Two triggers. An initial heat trigger when the heat index reaches 80 degrees and a high heat trigger at 90.
Water. Enough cool drinking water for 1 quart per employee per hour at or above the initial trigger.
A plan. Every covered employer would need a heat injury and illness prevention plan, written if it has more than 10 employees, and a named heat safety coordinator.
Short exposures. Exposures of 15 minutes or less in any 60-minute period would be exempt.

A NEMT driver in a cool van who spends a few minutes at each curb could fall outside it. A wheelchair van driver who spends long stretches outside loading and securing riders on a 95-degree afternoon would not. The supplemental proposal could change any of these terms.

How does OSHA enforce heat today?

OSHA enforces heat through the General Duty Clause, section 5(a)(1) of the OSH Act, which obliges every employer to keep the workplace clear of recognized hazards that can kill or badly hurt workers. Its heat directive, CPL 03-00-024, was renewed with an effective date of April 10, 2026 and runs for up to five years. Under it:

Heat priority days are days when the heat index is expected to reach 80 degrees or more. On those days, inspectors in an inspection opened for any reason are told to ask about the employer’s heat program, and to expand the inspection when they see heat hazards in plain view.
Programmed heat inspections happen on days the National Weather Service issues a heat warning or advisory, at establishments in 55 target industries. Couriers, local delivery, and general freight trucking are on the list. Ground passenger transportation, the industry group that includes NEMT, is not.
Other triggers. Complaints, injury reports, and referrals from the Wage and Hour Division can still bring OSHA to a NEMT company.
Citations or letters. A heat citation is issued under the General Duty Clause once all its elements are proven. When they are not, OSHA can send a hazard alert letter instead.

Size is no shield here. The directive notes that appropriations limits spare employers with 10 or fewer employees in low-hazard industries from programmed safety inspections, but programmed health inspections are still permitted.

What an OSHA inspector asks about your heat program

Appendix I of the 2026 heat directive lists the questions inspectors use to judge a heat program. They make a practical checklist for a fleet:

Is there a heat program, written or verbal, that drivers actually know about?
How does the company track temperature and how hard the work is?
Is there enough cool water within easy reach?
Are drivers allowed extra breaks to drink?
Are there scheduled rest breaks?
Is there access to shade or a cool place?
Do new and returning drivers get time to acclimatize?
Are schedules adjusted on hot days, such as earlier starts, lighter loads, or rotating the heaviest wheelchair runs?
Have drivers been trained on heat illness signs, how to report symptoms, first aid, calling for emergency help, and hydration?
Do drivers and supervisors understand the program?
Is one named person responsible for running it?

Inspectors also record the heat index, temperature, humidity, wind, and any heat alerts in the days before an incident. Keep a copy of the day’s forecast with any heat incident report.

Which state heat rules reach NEMT drivers?

California, Washington, Oregon, Maryland, and Nevada have heat rules that can apply to drivers, and their treatment of vehicles differs. OSHA’s heat page also lists Minnesota and Colorado as states with heat laws.

California. Section 3395 covers all outdoor places of employment, so curbside loading counts. It requires drinking water of 1 quart per employee per hour, shade once the temperature passes 80 degrees, cool-down rest on request, close observation of everyone during a heat wave, and a written plan. It says a car in the sun is not acceptable shade unless it is running with the air conditioning on. The extra high-heat procedures at 95 degrees apply only to listed industries, and passenger transportation is not one of them. Section 3396, the indoor rule in effect since July 23, 2024, names vehicles directly: its short-exposure exception does not cover vehicles without effective and functioning air conditioning, and vehicles with working air conditioning are excused from its temperature-measuring requirement.
Washington. WAC 296-62-095 applies to outdoor work at 80 degrees in ordinary clothing, and the heat program has to be part of the written accident prevention program. Preventive cool-down rest must be allowed and paid. At 90 degrees, rest of at least 10 minutes every 2 hours is mandatory, and at 100 degrees, 15 minutes every hour. Outdoor work of 15 minutes or less in any hour is excluded.
Oregon. OAR 437-002-0156, in effect since June 15, 2022, applies indoors and outdoors once the heat index hits 80. Its ventilation exemption covers buildings and structures, not vehicles. Oregon OSHA’s own answer is that employees who spend most of the day in air-conditioned vehicles and no more than 15 minutes in any hour in the heat are fully exempt.
Maryland. COMAR 09.12.32, effective September 30, 2024, covers work where the heat index reaches 80. Vehicles are exempt when a ventilation system or fan holds the heat index under 80. Covered employers need a written heat plan and a written acclimatization schedule, such as a gradual increase over 5 to 14 days with no more than 20 percent more exposure each day.
Nevada. Regulation R131-24, filed November 15, 2024 and enforced since April 29, 2025, applies to employers with more than 10 employees. They complete a one-time written job hazard analysis that lists every job class in which most employees face heat for more than 30 minutes of any 60, not counting breaks. Employees working in a motor vehicle with properly functioning climate control are exempt. If the system fails, the employer must make a good-faith effort to fix it and protect drivers until it works.

The pattern across these states is the same for a NEMT company: a driver in a van with working air conditioning is largely outside the rules, while time spent loading, securing, and waiting at the curb, and any day the air fails, brings the driver back in.

A heat plan for a NEMT fleet

A workable plan fits on one page and runs through dispatch. Built from the steps the states and OSHA’s directive have in common:

Check the forecast every morning. The National Weather Service’s experimental HeatRisk map rates heat from 0 (green) to 4 (magenta) for the next seven days, based on how unusual the heat is, how long it lasts, and whether nights stay hot. Orange (2) affects heat-sensitive people without cooling, and red (3) affects anyone without cooling or hydration.
Put water in every van. Plan on a quart per driver per hour on hot days, the amount both California’s rule and OSHA’s proposal use, and keep it cool.
Check the air conditioning before the first trip. A van whose rear unit blows warm should be swapped before it carries a rider, as the rear AC guide explains.
Ease new and returning drivers in. OSHA has found that almost half of heat-related worker deaths happen on the first day on the job or the first day back after time off, and over 70 percent in the first week. It recommends the rule of 20 percent: 20 percent of a normal day in the heat on day one, adding 20 percent a day.
Build cool-down breaks into the schedule. Plan them in a running, air-conditioned van or inside a clinic, never in a parked van sitting in the sun.
Spread the heaviest runs. Rotate back-to-back wheelchair and stair-chair pickups among drivers on the hottest afternoons.
Check in by radio or app. Ask about water and symptoms during long outdoor waits.
Train for the signs. OSHA lists thirst, irritability, rash, cramps, heat exhaustion, and heat stroke. Confusion, slurred speech, disorientation, or unconsciousness signal heat stroke: cool the person immediately and call 911.
Write it down. California, Washington, and Maryland require a written plan, Nevada requires one when its hazard analysis finds heat exposure, and the federal proposal would require one at more than 10 employees.

Heat training fits the summer slot of a safety meeting calendar.

Riders on the hottest days

Riders are more vulnerable than drivers, and the dispatcher’s choices protect them. The rear AC guide covers state air conditioning rules for NEMT vehicles and why older riders and some medicines raise the risk, so only the day-of decisions are here.

Keep curb waits short. Call or text before arrival so riders wait indoors, especially on HeatRisk orange or red days.
Treat an air conditioning failure as a vehicle problem. Send a working van rather than continue a long route with riders in a hot cabin, and log the failure for repair.
Do not push water on dialysis riders. The National Institute of Diabetes and Digestive and Kidney Diseases says people on hemodialysis often limit fluids, because extra fluid can change blood pressure, strain the heart, and lead to cramps or a sudden blood pressure drop during treatment. Offer shade and cool air instead, and follow what the rider says their care team allows. The dialysis transport guide covers those runs.
Call 911 for a rider in distress. Confusion, collapse, or slurred speech in the heat is an emergency, and the medical emergency guide gives the driver’s steps.

Recording a driver’s heat illness

A heat illness goes on the OSHA log only when it goes beyond first aid. OSHA’s heat directive draws the line: a driver who is only told to drink fluids for heat stress is a first aid case, while a driver who loses consciousness or needs medical treatment beyond first aid is a recordable case. A heat illness that leads to an in-patient hospital stay must be reported to OSHA within 24 hours. The recordkeeping thresholds and reporting steps are in the OSHA guide.

Heat days in HealthRide

With HealthRide, every driver checks the van in the app when the shift begins, so an air conditioner that has quit can be flagged in the lot before a rider boards. Dispatch sees failed inspections right away, can send one announcement to every driver on a heat advisory morning with a reminder about water and breaks, and can follow every vehicle on the live map. The fleet features keep each van’s inspection records together.

Heat safety for NEMT drivers and riders: where OSHA's heat rule stands and what to do now