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This International Standard provides advice to those concerned with the safety of human exposures to extreme hot or cold thermal environments. Extreme thermal environments are those which result in a high rate of heat gain or loss by the body. A precise definition of such environments cannot easily be given, as the change in body heat storage depends on clothing and activity as well as the parameters of the climatic environment. As a guide, the boundaries of extreme environments might be considered to be as follows: for hot environments, a wet bulb globe temperature of 25 °C; for cold environments an air temperature of 0 °C or below. Extreme environments can only be tolerated for limited periods of time before a risk of ill health results. Control measures are necessary to ensure the safety of those so exposed, one of which is the provision of appropriate medical supervision prior to and during exposures. This International Standard is intended to assist those with responsibility for such exposures to reach decisions about the appropriate level of medical supervision in different situations. This International Standard should be read and used in the context of other relevant guidance and legislation. This guidance is applicable to laboratory and occupational exposures to extreme environments. In either case an assessment should be made of the expected thermal stress on the individual, but the detailed arrangements for medical supervision will differ. Control of occupational exposures must also satisfy national health and safety legislation.