It is a sad fact that eery year, many thousands of employees suffer or are made ill by the work that they do. The harm may come from a range of occupation factors, such as:
-
Noise
- Noise
induced hearing loss (NIHL)
- Tinnitus
-
Vibration
- Hand-Arm
Vibration Syndrome
- Exposure to chemicals
- Dermatitis
- Skin
sensitization
- Reduced
lung capacity
- Occupational
asthma
- Respiratory
sensitization
- Poisoning
(such as by lead)
Health
Surveillance and Risk Assessment
It is well established that employers must carry out risk assessments. These assessments must be suitable and
sufficient to identify how employers (and also non-employees) can be harmed and
how that harm can be avoided or, if this is not reasonably practicable,
minimised. The Management of Health and
Safety at Work Regulations 1999 (MHSW) create this duty in all work situations
and other sets of Regulations enforce this requirement in certain
circumstances. Schedule 1 of MHSW
details a hierarchy that the employer must follow when considering control
measures (i.e. measures to avoid or reduce the harm that people may
suffer). Health Surveillance is at the
bottom of this hierarchy. The main
reason for this is:- Health
Surveillance does nothing to protect the employee from harm – it merely
allows the employee to determine t he amount of harm of the level of
exposure to harmful agents (chemicals, noise, vibration, etc.).
Health surveillance should be carried out when all of the following conditions are satisfied:
-
The work being
carried out (or the environment in which the work is being carried out) is
known to damage health in some particular way
- There are valid and
safe ways to detect the disease or condition – It is important to
understand that health surveillance is only worthwhile in situation where
it can reliably show that damage to health is starting to happen or that
there is a likelihood of such damage occurring. It is also important to
understand that a particular health surveillance technique is only useful
if:
- it provides
accurate results,
- it is safe, and
- it is practical.
- It is reasonably
likely that damage to health may occur under the particular conditions at
work?
- Health
surveillance is likely to benefit employees
|
Procedure
|
By
whom
|
Examples
|
|
Self
Checks
|
The
employee
|
Self
checks are suitable for those employees exposed to hazards who have been
properly trained in how to look for easily recognisable signs and symptoms of
disease. The employee should know who
to go to if they find anything that causes them concern.
|
|
Basic
(visual) checks for signs of disease
|
Responsible
Person
|
Skin
inspections where people work substances that can cause dermatitis, such as:
|
|
Enquiries
about
symptoms,
inspection
and
examination
|
Qualified
person
|
An
occupational health:
o
Checking for signs of asthma
o
Measuring lung function
Audiologist::
o
Measuring hearing
|
|
Clinical examinations
|
Should be carried out by or be supervised
by a doctor.
Interpretation of results may also require
a doctor.
|
In
some cases this is a legal duty (for example for employees exposed to lead);
in others the nature of the tests will require the expertise of a doctor to
interpret the results and advise on their significance.
Examination
by a doctor is also likely to be necessary where health surveillance by a
responsible person or an occupational health nurse has identified possible
work-related ill health that requires further investigation, diagnosis and
treatment.
|
|
Biological monitoring
and biological effect
monitoring
|
In general, these should be carried out by
or supervised by a doctor.
The samples may be taken by a suitably trained person.
|
Blood testing for:
Urine testing for:
Urine testing for breakdown products of:
|
Responsible
Person
Anyone
trained to identify straightforward signs and symptoms caused by working with
certain substances or processes. A
responsible person must not be expected to diagnose the possible cause of symptoms. Managers, supervisors or first aiders could
carry out these checks. An occupational health doctor or nurse should train
these people to recognise signs or symptoms requiring further assessment and to
know when and how to refer employees.
Qualified
person
A
qualified person usually means an occupational health nurse checking, for
example, for signs of asthma. It can
also be someone with appropriate technical knowledge, for example an
audiologist carrying out hearing tests or someone trained to conduct lung
function tests.
Typical health surveillance for those working with
substances that may cause dermatitis
Skin health surveillance should be considered in cases were workers:
- Have
the following occupations: construction work, health service work, rubber
making, printing, paint spraying, agriculture, horticulture,
electroplating, cleaning, catering, hairdressing, floristry
- Are
(potentially) exposed to any of the following substances: epoxy resins,
latex, rubber chemicals, soaps and cleaners, metalworking fluids, cement,
wet work, enzymes, corrosive chemicals, irritant chemicals, solvents and
other similar organic liquids (such as paint thinners, etc.)
- Are
(potentially) exposed to any products that are labelled:
- R43
‘May cause sensitisation by skin contact’
- R42/43
‘May cause sensitisation by inhalation and skin contact’.
- Assessing
the skin condition of workers as soon as possible after they start (and
preferably within six weeks) a relevant job to provide a baseline.
- Implementing
regular testing at appropriate intervals (such as monthly, every few
months or annually - as advised by an occupational health practitioner)
- The
regular testing could involve a suitable questionnaire and skin inspection
(hands, forearms and, if these can be contaminated, lower legs) by a
responsible person.
Respiratory health surveillance should
be considered in cases were workers:
- Have
the following occupations: bakers, food processors, beauty service
providers, cleaners, painters, repairers (including electronics), welders and
woodworkers (including forestry).
- Are
(potentially) exposed to any of the following substances: isocyanates
(such as in two-pack spray paints), glutaraldehyde, wood dust (hard wood,
soft wood, MDF, plywood, etc), latex (such as from powdered natural rubber
latex gloves), flour dust, grain dust, rosin-cored solder fume, laboratory
animals or glues and resins
- Are
(potentially) exposed to any products labelled:
- R42
‘May cause sensitisation by inhalation’ (may lead to asthma)
- R42/43
‘May cause sensitisation by inhalation and skin contact’; or
- Have
had a confirmed case of (occupational) asthma.
- Assessing
the respiratory health of workers before they start a relevant job to
provide a baseline. This could be
achieved by a combination of questionnaire and lung function assessment.
- Implementing
regular testing (again a combination of questionnaire and lung function assessment)
at appropriate intervals (nominally annually or as advised by the health professional.
- Arranging
for the results to be explained to the worker by the health professional.
- Arranging
for the health professional to report to the employer on the fitness of
the worker to work.
- Interpreting
the results of the health surveillance (in conjunction with the health
professional) and identify whether there is any requirement to revise the
risk assessment, and if so in what way.
- Appointing
a responsible person (supported by the health professional) to report any
symptoms that occur between tests.
- Setting
up a simple system to keep and monitor attendance records to identify any patterns
in sickness absence.
All health surveillance programmes should include the keeping of suitable records, including a health record for each individual. These are important as they provide:
- An historical
record of jobs involving exposure to substances or processes that require health
surveillance;
- A record of the
outcome of previous health surveillance procedures
- A demonstration
(to enforcing authorities) that health surveillance has been carried out.
- Useful information
that may later provide a defence in the event of prosecution or civil
proceedings.
- Full name
- Gender
- Date of birth
- Employee’s address
- NI Number
- Date of start of
current employment
- Brief employment
history (of jobs with exposure to hazardous substances, etc.)
- Conclusions of
health surveillance
Summary
Health
surveillance is important as a means of demonstrating that the control measures
put in place to protect workers from harm are effective. Health surveillance is, however, ineffective
as a control measure in its own right as it can only measure how much, or how
little, harm has been done to an individual – it cannot protect them from that
harm. Health surveillance can be carried
out in a number of different ways by different groups of people. Whenever an organisation is considering the
introduction of health surveillance, health professionals should be consulted
to help to plan and design the service to be provided. Health surveillance should be carried out at
appropriate, regular intervals and suitable records of should be maintained of
all health surveillance.
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