CBH National Industry Standards

Transcription

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INDUSTRY STANDARDS
FOR WORKPLACE HEALTH
IN UK CONSTRUCTION
CONSTRUCTING BETTER HEALTH
B&CE Building
Manor Royal
Crawley
West Sussex
RH10 9QP
Tel: 0845 873 7726
Email: [email protected]
Helpline: 0845 873 7726
www.cbhscheme.com
Standards Issue 2 ©CBH 2012
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Table of Contents
Foreward .............................................................................................................................. 4
Introduction to the Construction Better Health Standards Background ......................... 4
Key Findings From The Pilot................................................................................................ 5
Chief Executives Welcome................................................................................................... 6
Purpose Scope and Applications of the Industry Standards ............................................. 7
Definitions and Glossary...................................................................................................... 8
List of Abbreviations ........................................................................................................... 10
Workplace Health ................................................................................................................ 11
Workplace Health Management ........................................................................................ 12
The General Principles of Prevention ................................................................................. 12
Health Risk Assessment ....................................................................................................... 13
Services that Can Enhance Health at Work........................................................................ 15
General Duties of Employers .............................................................................................. 17
RIDDOR................................................................................................................................. 17
Equality Act 2010 ................................................................................................................ 19
Do You Need a Professional OH Service Provider? ............................................................ 20
Occupational Health Service Providers............................................................................... 21
The Tendering Process ......................................................................................................... 24
Working with OHSPs ........................................................................................................... 24
Obtaining Consent in Occupational Health....................................................................... 25
The Mental Capacity Act 2005 ............................................................................................ 26
Language ............................................................................................................................. 27
Bio-Psychosocial Model ....................................................................................................... 27
Medical Records in Occupational Health ........................................................................... 27
Health Surveillance.............................................................................................................. 29
Health Screening ................................................................................................................. 29
OH Referral for Individuals ................................................................................................. 30
Additional Hazards in the Construction Sector:
• Heat Stress ........................................................................................................................ 31
• Night work ........................................................................................................................ 31
• Biological Hazards ............................................................................................................ 31
• Confined Space Working ................................................................................................. 32
• Lone Working ................................................................................................................... 32
• Musculoskeletal Disorders ............................................................................................... 32
• Working at Height .......................................................................................................... 33
• Contaminated Land ......................................................................................................... 33
Statutory Health Screening:
• Rail Track Side ................................................................................................................... 33
• Divers ................................................................................................................................ 34
• Seafarers and Maritime Workers ..................................................................................... 35
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Age and Work ..................................................................................................................... 35
Absence Management and Rehabilitation ....................................................................... 36
• The Return to Work ......................................................................................................... 37
• Fit Notes ............................................................................................................................ 37
Setting the Standards for Occupational Health ................................................................ 38
Guidance on the Use of the Industry Standards ............................................................... 38
Job Roles .............................................................................................................................. 40
How to Use the Matrix ........................................................................................................ 41
Key to Outcomes from Health Checks and Interpretation ............................................... 42
Summary of Frequency of Health Checks .......................................................................... 43
Industry Standards A – R .................................................................................................... 44
• AB Pre-placement/Baseline Assessment .......................................................................... 44
• C Safety Critical Worker ................................................................................................... 47
• D Statutory Medicals ........................................................................................................ 49
• E Musculoskeletal ............................................................................................................. 53
• F Skin Health ..................................................................................................................... 55
• G Respiratory Health Checks ............................................................................................ 57
• H Hearing Health Check ................................................................................................... 60
• I Vibration Health Check .................................................................................................. 62
• J Blood Pressure ................................................................................................................ 64
• K Urinalysis ........................................................................................................................ 65
• L Visual Acuity ................................................................................................................... 66
• M Mid Range Acuity (Display Screen Equipment Users) ................................................ 66
• N Colour Vision ................................................................................................................. 67
• O Biological Monitoring................................................................................................... 68
• P Workplace Stress/Mental Health Assessment............................................................... 69
• Q Drugs and Alcohol ........................................................................................................ 72
• R General Health/Lifestyle Checks ................................................................................... 76
Fitness for Work Standards for Specific Medical Conditions ............................................ 77
References............................................................................................................................ 88
Acknowledgements............................................................................................................. 89
Figures
Fig 1. Continuous Improvement for H & S Management Systems ................................... 15
Fig 2. Workplace Health Management .............................................................................. 15
Fig 3. What Sort of Occupational Health Service Do I Need? ........................................... 20
Fig 4. Health Assessment Matrix......................................................................................... 39
Fig 5. Key to the Outcomes from Health Checks and Interpretation .............................. 42
Fig 6. Frequency of Health Checks ..................................................................................... 43
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Foreword
The Construction Industry forms the largest employment sector in the UK with over 2
million workers and consists of large and small businesses; managed through sometimes
complex contractual chains involving large numbers of mobile workers. Health issues
are difficult to identify and manage, yet it makes good business sense to protect the
long term health of the highly skilled workforce. The reason that health issues remain
largely unresolved is due to the complex supply chain; the transience and mobility of
the workforce; and that approximately half of the workforce employs 5 or less in a
company.
It is well known that accidents on construction sites can be devastating in nature;
however, at least 100 times as many workers are made ill by work than are injured.
Added to that, construction workers have one of the highest rates of work related
illness of all occupational groups. An estimated 2.8 million working days are lost due to
an illness caused or made worse by a current or most recent job in construction. The
estimated annual cost of work related ill health to the Construction Industry is £760
million; with the overall cost to society being significantly higher.
It is therefore critical that skilled and experienced workers are retained in the industry
through an improvement in the way construction employers manage the health of
workers – called ‘workplace health’.
Constructing Better Health (CBH) has been established by the Construction Industry and
Trade Unions to set standards of what is required to meet the occupational health
requirements of the Construction Industry
Introduction to the Constructing
Better Health Industry Standards Background
Constructing Better Health (CBH) started in 2004 with the launch of a £1million pilot in
Leicestershire; the pilot was funded by industry, government and trade unions to look
at construction health issues. The aim was to explore work related health needs of the
industry and to identify and develop a robust business case for a national scheme.
During the pilot more than 360 construction employers had access to occupational
health services. There were over 1700 free and confidential health checks plus another
2800 workers attending awareness raising health talks centred on work health topics.
One third of those having health checks were found to have significant health issues
and referred for further advice for both work and non work related health issues.
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Key findings from the pilot:
• Employers were unsure of how occupational health and health checks should be
provided
• There was inconsistency and lack of co-ordinated feedback to management of
occupational health matters within the industry
• Inconsistency in the collection, reporting and communicating of individual and group
health information
Following the pilot Constructing Better Health was established and gave a clear
commitment to the Construction Industry to:
1. Set Industry Standards for consistent management of work-place health and for
occupational health service providers
2. Build a construction specific knowledge portal, giving construction advice, guidance
and support, in the management of work related health risks
3. Centralise the collection of work related health data to ensure the future
improvement of workforce health based on valid and reliable data and the provision
of a ‘benchmark’ for industry
4. Enable the collection and the transmission of health data to enable employers to
manage work related health risks at site level
5. Provide a referral route through to specialists in the field of return to work and
rehabilitation
CBH vision Statement and objectives
“To improve the work-place health and well-being
of the construction industry workforce”
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Chief Executive’s Welcome
Welcome to Constructing Better Health (CBH), the not-for-profit UK organisation
serving the best interests of occupational health across the Construction Industry. We
are committed to raising awareness of work related health issues in the industry, and
providing solutions to minimise the risks associated with them.
As champions of occupational health in construction and with the support of industry,
we are helping to shape the future health of our workforce, by ensuring that our
accredited occupational health providers adhere to the highest
standards of performance and integrity.
We are working together with Industry to actively prioritise work
related health issues in order to eliminate unnecessary health
risks, safeguard livelihoods and encourage good business
practice. The Health & Safety Executive (HSE) actively supports
the work of CBH.
We aim to drive best practice in the provision of occupational
health solutions to make the Construction Industry healthier and
more prosperous.
Michelle Aldous
Chief Executive
Constructing Better Health
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Purpose, Scope and Application
of the Industry Standards
Purpose
To provide those working in the UK Construction Industry with guidelines for work or
‘occupational’ health, whether for operating machinery or working in areas of added
risk.
The Industry Standards developed by Constructing Better Health are intended to inform
employers about what is required by law, what is considered best practice, and what
makes good business sense in terms of workplace health management in the
Construction Industry.
Scope of the Document
CBH define UK Construction to include workers in the following areas:•
•
•
•
•
•
•
Construction
Civil Engineering
Infrastructure
Building Services
Facilities Management
House Building
Repair, Maintenance & Improvement
And the Industry Standards are set out to:
• Define safety critical work (SCW)
• Define fitness for work and task requirements
• Outline the competencies required of occupational health service providers (OHSPs)
delivering services
• Outline the legal requirements for health checks (health surveillance) with guidance
on best practice.
• Outline the health checks required on different types of workers
Application
• The Industry Standards should be applied to all workers across Construction, Civil
Engineering, Infrastructure, Building Services, Facilities Management, House Building,
Repair, Maintenance & Improvement within the Construction Industry.
• Clients, contractors and employers should use the guidance documents which sets out
general health issues and how to manage workplace health at organisational and site
level
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Definitions and Glossary
AUDIOMETRY: A hearing test
BASELINE DATA: Collection of health information from employees before being
exposed to a known health risk, which is then used as a comparison going forward
COMPETENCE: Being capable, though an appropriate mixture of knowledge and
experience to complete a task in a safe and effective manner
ENSURE: To take all reasonable action as far as controllable factors will allow
FITNESS FOR TASK (FFT): Individuals are assessed against standards to ensure capability
to perform the specified tasks without damage to self or others
HAZARD: A source or situation with the potential for harm in terms of injury or ill
health
HEALTH CHECK: The group name used in the CBH electronic database for all types of
medicals carried out by occupational health service providers and includes health
surveillance, health screening, fitness for task medicals, health promotion activity
HEALTH SCREENING: A system of checking health against a standard set of
requirements for specific types of work e.g. fork lift truck driver
HEALTH SURVEILLANCE: A generic term to cover a group of specific health checks that
are specified in law. Not all types of health checks are legally required
HEALTH PROFESSIONAL: A nurse or doctor
INFORMATION: Providing factual material which tells people about risks and
precautions
HEALTH ASSESSMENT MATRIX: A reference guide within the Industry Standards, in a
table format, that lists jobs and health risks in the Construction Industry with analysis of
what type of health check is required
MUSCULOSKELETAL DISORDERS: Health issues which affect the bones, muscles,
ligaments e.g. back or wrist pain
OCCUPATIONAL HEALTH NURSE ADVISOR (OHNA): a qualified nurse working in the
specialised field of occupational health and is registered as having a specialist
qualification
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OCCUPATIONAL HEALTH PHYSICIAN (OHP): a doctor working in the specialised field of
occupational health with a qualification in OH medicine
OCCUPATIONAL HEALTH SERVICE PROVIDER (OHSP): An organisation or qualified
individual contracted to deliver occupational health services
QUESTIONNAIRE: A series of written questions regarding health issues. Employees
complete a questionnaire as the first step in many health checks. For some health
checks a questionnaire may be all that is required
REHABILITATION: Reducing the disabling effect of impairment and modifying the work
environment to take away barriers to employment
RESPONSIBLE PERSON: An employee who has had specific training in the recognition of
symptoms of work related ill health, which may require referral to a health
professional. The responsible person must not make a diagnosis and must keep any
records confidential
RISK: A combination of the frequency or probability of an occurrence and the
consequences of a specified hazardous event
RISK ASSESSMENT: The overall process of risk analysis and risk evaluation
SAFETY CRITICAL WORKER (SCW): A defined type of work requiring higher levels of
health and “Where the ill health of an individual may compromise their ability to
undertake a task defined as safety critical, thereby posing a significant risk to the health
and safety of others”
SHALL: To be understood as mandatory
SHOULD: To be understood as non-mandatory, that is, advisory or recommended
SO FAR AS IS REASONABLY PRACTICABLE: A legal term that places an ‘absolute duty’ on
the duty holder to balance the cost of improvements against the expected benefits
SPIROMETRY: a medical check that measures how lungs are working by measuring the
total volume of air and its passage out of the lungs
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List of Abbreviations
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ACOP
Approved Code of Practice
AFOM
Associateship of the Faculty of Occupational Medicine
BPS Model
Bio Psychosocial Model
CBH
Constructing Better Health
CHAT
Construction Health Action Toolkit
CLAW
Control of Lead at Work
CSCS
Construction Skills Certification Scheme
DoccMed
Diploma in Occupational Medicine
FFOM
Fellow of the Faculty of Occupational Medicine
FFT
Fitness for Task
GMC
General Medical Council
GP
General Practitioner (Family Doctor)
HASAWA
Health and Safety at Work etc. Act 1974
HAVS
Hand Arm Vibration Syndrome
HSE
Health and Safety Executive
HSG
Health and Safety Guidance
MFOM
Member of the Faculty of Occupational Medicine
MSD
Musculoskeletal Disorder
NMC
Nursing and Midwifery Council
OH
Occupational Health
OHA
Occupational Health Adviser
OHN
Occupational Health Nurse
OHP/OP
Occupational Health Physician
OHSP
Occupational Health Service Provider
PTS
Personal Track Safety
PPE
Personal Protective Equipment
SCW
Safety Critical Worker
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Workplace Health
Work or occupational health (OH) deals with work related health issues; assessing and
advising on the effect work could have on an employee’s health, and what effect an
employees health may have on work. It is a two way process.
The Health and Safety Executive states that good occupational health services are
central to the effective management of workplace health and can:
• Protect and promote the health and well-being of the working population
• Enhance a company’s image and reputation as a good employer
• Provide early advice to help prevent workers being absent for health-related reasons
• Improve opportunities for people to recover from illness while at work
• Provide critical support to the process of effective absence management and increase
the number of staff returning to work earlier
• Fulfil the statutory requirement to have access to ‘competent’ occupational health
advice as part of the organisational arrangements to ensure that the health of staff
and others is not adversely affected by their work
The starting point for deciding on how to monitor health is to assess the health risks in
the workplace; the risk assessment will show where there are significant residual risks to
health even after reasonably practicable control measures have been applied. Health
risks are perceived as being more difficult to assess than safety risks, as poor health
resulting from an exposure to a hazard can happen many years after the event.
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Workplace Health Management
Health at work within the Construction Industry can be a complicated process due
mainly to the complexity of the supply chain; often there are different contractors on
site, resulting in confusion about who should oversee and protect worker’s health.
The Construction (Design and Management) Regulations 2007 (CDM)
CDM 2007 places legal duties on virtually everyone involved in construction work.
Those with legal duties are commonly known as ‘duty holders'.
Duty holders under CDM 2007 are:
• Clients - A 'client' is anyone having construction or building work carried out as part
of their business. This could be an individual, partnership or company and includes
property developers or management companies for domestic properties
• CDM co-ordinators - A 'CDM co-ordinator' has to be appointed to advise the client on
projects that last more than 30 days or involve 500 person days of construction work.
The CDM co-ordinator's role is to advise the client on health and safety issues during
the design and planning phases of construction work
• Designers - The term 'designer' has a broad meaning and relates to the function
performed, rather than the profession or job title. Designers are those who, as part of
their work, prepare design drawings, specifications, bills of quantities and the
specification of articles and substances. This could include architects, engineers and
quantity surveyors
• Principal contractors - A 'principal contractor' has to be appointed for projects which
last more than 30 days or involve 500 person days of construction work. The principal
contractor's role is to plan, manage and co-ordinate health and safety while
construction work is being undertaken. The principal contractor is usually the main or
managing contractor for the work
• Contractors - A 'contractor' is a business involved in construction, alteration,
maintenance or demolition work. This could involve building, civil engineering,
mechanical, electrical, demolition and maintenance companies, partnerships and the
self-employed
• Workers - A 'worker' is anyone who carries out work during the construction,
alteration, maintenance or demolition of a building or structure. A worker could be,
for example, a plumber, electrician, scaffolder, painter, decorator, steel erector, as well
as those supervising the work, such as foreman and charge hands
The General Principles of Prevention
Duty holders should appoint competent assessors who would use the following
approach to risk management when identifying and implementing precautions
associated with health risks:
1. Avoid health risks as a first principle
2. Evaluate the remaining health risks which cannot be avoided
3. Combat remaining risks at source
4. Adapt the work to the individual, especially the design of workplaces, the choice of
work equipment and the choice of working and production methods
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5. Keep up to date with new technology
6. Replace the dangerous by the non-dangerous or the less dangerous
7. Develop a coherent overall prevention policy which covers technology, organisation
of work, working conditions, social relationships and the influence of factors
relating to the working environment
8. Give collective protective measures priority over individual protective measures
9. Giving appropriate instructions to employees
For further information visit:
http://www.hse.gov.uk/construction/cdm/responsibilities.htm
Health Risk Assessment
The basis for deciding on what kind of response is needed to health
risks should start with an organisational risk assessment undertaken
by those who understand health risks. Issues should focus on the
following:
1. Identify the hazards: Consider the workplace/site during all
stages of the project – you may need an accredited occupational
health service provider (OHSP) to assist especially if dealing with
unusual and complex processes. Are there substances, practices or processes which
have health risks - look at hazard data sheets, risk phrases such as R42 and R43,
check the HSE website, ask manufacturers, are there naturally occurring health
hazards e.g. radon and sunlight? Does the work involve asbestos, lead, compressed
air or ionising radiation? Is it hot or cold and will that have an impact? What sort of
equipment is used? Technical assistance may be required to objectively measure
physical hazards e.g. vibration, dusts levels. Are the results of measurements within
safe limits? Check the CBH website. Remember health effects can happen many
years after exposure
2. Who may be harmed?: Groups of employees may be more at risk of harm:
• Those taking certain types of medication
• On night work
• Young
• Disabled
• Returners to work after absence
• Pregnant employees etc
• Those with health issues such as epilepsy, diabetes
• Those involved in certain tasks – safety critical or painters, scaffolders
3. Evaluate the risks and decide on precautions:
• What are the health risks
• How many of the workforce is at risk? Prioritise the health risks found, based on
severity of harm and numbers likely to be harmed
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• What are the quantities involved
• Method of application (hand applying, spraying, remote pumping)
• Duration of exposure
• Work environment (enclosed area, outside, etc.)
• Exposure prevention controls in place or is more required e.g. noise dampening,
changing suppliers, practices
• Training programmes may be required for managers/supervisors regarding
identification of health risks
• Do employees know why personal protective equipment is necessary?
• Local exhaust ventilation (LEV)
• Good hygiene practices (hand and face washing facilities)
• Are health risks understood by those exposed? Information, instruction and
supervision will protect employees
• Can a responsible person monitor health symptoms?
Health checks programmes may be needed to check safety and control methods in
place. Check the CBH website for information.
4. Record and implement findings
• Make any changes to policy, arrangements or responsibilities
• Implement new methods of working or take on safer suppliers
of equipment and stock.
• Engage the necessary technical assistance e.g. toxicologist,
ergonomists, hygienists to manage and control risks identified and
to give professional advice.
• Engage an occupational health service provider for health checks on employees if
required
5. Review assessment
• Set a date for review or if health issues occur
• Review early if changes in company health e.g. absence levels increase or reports
back from occupational health service providers of emerging health problems in
groups of workers.
HSG 65 (http://www.hse.gov.uk/pubns/priced/hsg65.pdf) sets out a model of a
management system and how health concerns fits into the overall management of
risk. The first part of the health management system is to determine what is
required to ensure health issues are controlled, monitored, audited and reviewed.
The management of health should form part of the overall policy for health and
safety; setting out responsibilities and arrangements and provide a general
statement of intention regarding how the health of workers is to be protected and
monitored. A system of continuous improvement should reflect the process. Fig 1
provides a framework of health management that would dovetail with safety
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Organisation
Policy
Audit
and
Review
Plan
Improvement
Measure
and
Target
Fig 1 Continuous Improvement for Health and Safety Management Systems
The words ‘hazard’ and ‘risk’ are used throughout the Industry Standards
• Hazard means anything that can cause harm (e.g. chemicals, electricity, working
from ladders, etc.)
• Risk is the chance, high or low, that harm will occur from or by the hazard
Make sure that eliminating one health hazard new and possibly more significant
hazards are not created. Below is the Constructing Better Health model of how health
at work can be analysed and what services are available to protect, monitor and
maintain good health at work, whether from a statutory or best practice viewpoint.
Professional services may be needed to ensure that the health risk assessment steps are
suitable and sufficient.
Fig 2
Services that Can Enhance Health at Work
1. Specialist Support Services
• Occupational Hygienist: Scientific services that measure and monitor specific
substances and physical processes that could be hazardous to health e.g. dust,
fume, vibration, noise. Needed to ensure compliance with Work Exposure Levels
and Limits (WEL) as specified in legislation e.g. Control of Substances Hazardous
to Health (COSHH)
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• Toxicologist: Professional services that study the nature and effects of poisons and
treatment
• Ergonomist: Professional service that considers the dangers of poor body position,
repetitive work and how work is performed for maximum comfort and efficiency
• Physiotherapy: Hands on treatment of massage, exercise and advice/education
linked to health issues mostly associated with musculoskeletal injuries e.g. bad back
• Holistic services: Acupuncture, chiropractor, osteopaths who are professionally
qualified in hands on treatments for musculoskeletal issues
2. Risk Management: Specialist professionals to undertake unusual or high risk site
activities where competent advice is required
3. Education and Awareness: Companies who specialise in technical
training/education programmes for a particular work activity e.g. manual handling
training
4. Sickness Absence Management: A system of recording and monitoring sickness
absence levels by an organisation looking for:
• Possible links to work undertaken
• Issues of safety which could be linked to illness e.g. safety critical worker with a
heart condition
• Identifying lost revenues
5. Occupational Health Professionals: Those providing occupational health services
and accredited with Constructing Better Health. Can be engaged to advise on
health risk assessments, first aid and wellbeing services and to undertake health and
medical surveillance to comply with legislation e.g. Control of Noise at Work
Regulations
6. Reactive Support Services: Doctors, Nurses, Technicians, First Aid personnel who
provide various emergency on site services for accidents, emergencies and
treatments such as blood pressure monitoring to assist the employee
7. Legal: Qualified solicitors, barristers to advise on case law, mandatory
requirements, legislation relating to employment law and health and safety
application
8. Materials and Equipment Suppliers: Companies who supply tools, implements to
the trades that could cause or alleviate health issues e.g. with regard to vibration,
noise emission, fork lift trucks etc.
9. Employee Assistance Programmes: Support services providing debt, legal,
employment, welfare, counselling/advice to employees, provided by the employer
and accessed when required. Usually supported with web accessed information e.g.
hand-outs, leaflets
10. Counselling: Talking therapies for employee support when distressed or
experiencing stressful life/work events. Practitioners should be accredited to the
British Association of Counselling
11. Wellbeing: Programmes in the workplace that consider health aspects of the
employee not associated with the job role e.g. well man, blood pressure checks,
stop smoking advice etc.
12. Primary Care: The National Health Service – in particular the GP’s who provide free
‘cradle to grave’ personal confidential health advice and treatments to their
patients/employees
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13. Rehabilitation: The process of modifying the workplace for the employee
experiencing health issues whether on a temporary or permanent basis, specialist
organisations are Remploy or the Shaw Trust and supported by Access to Work
14. Drug and Alcohol Specialists: UKAS accredited laboratories who organise,
administer and oversee policy, testing and results of testing in the workplace
The professional services listed here all have a part to play in good health risk
management.
For more information contact Constructing Better Health
General Duties of Employers:
Section 2 of the Health and Safety at Work Act 1974 (HSAWA) states that employers
have a general duty of care to protect (so far as is reasonably practicable) the health,
safety and welfare of all employees.
To Employees
To provide relevant and comprehensible information about:
• Risks to health and safety
• Preventive and protective measures
• Emergency/evacuation procedures
• Health and safety law (via a poster or leaflet)
• Responsibilities to comply with site rules
• How to use work equipment and personal protective equipment
• The provision of information, instruction and training in order to ensure health and
safety
To Other Employees
In all construction sectors, where often workplaces are shared, each employer must take
steps to inform other employers of the risks to employees’ health and safety arising
from work activities as part of the business. (Reg. 11 of the 'Management' Regulations
1999)
To Non-Employees
To provide information, instruction and training, where necessary, for health and safety,
so far as is reasonably practicable.
The Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995 (RIDDOR)
RIDDOR places a legal duty on employers, self-employed and landlords to report
work-related deaths, major injuries or over-three-day injuries, work related diseases,
and dangerous occurrences (near miss accidents).
Certain cases of disease (as well as injury) are reportable to HSE or local authorities and
are listed in section 3 of RIDDOR. The duty for reporting diseases (which is different
than that of an accident) comes into effect when an employer receives a written
statement from a doctor, stating that an employee suffers from one of the diseases
listed in the schedule: (see next page)
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RIDDOR Diseases
Work activity
Blood disorders,
inflammation of the skin
Ionising radiation
Decompression illness and
associated conditions
Compressed air, diving
Conditions of the hand/arm/knees
Prolonged, repetitive and physically
demanding work
Hand arm vibration syndrome
Chain saws, hand held vibrating tools
Infections due to biological agents
e.g. Legionella
Ground clearing, maintenance, plumbing,
presence of animals
Some poisonings
Working in the presence of gases,
tunnelling
Some cancers
Working with silicosis, tunnel work
Peripheral neuropathy
Exposure to some fumes
Ulceration of the nose/throat/hands
Working with chrome
Skin conditions e.g. dermatitis, acne
Brickwork, plastering, wet cement
Diseases of the lungs linked with work
activity e.g. occupational asthma
Working with silica, flint, sand blasting
Diseases linked to working with
asbestos e.g. lung cancer, asbestosis
Maintenance, removal of asbestos
Off shore work requires a number of other infectious diseases to be reported
Adapted from Schedule 3 of the Reporting of Injury, Diseases and Dangerous
Occurrences Regulations 1995
The OHSP will be able to provide further advice to the employer about the reporting of
work related disease. It should be noted that diseases reported to the HSE will often
result in a follow up investigation and visit from an inspector.
For further information visit: http://www.hse.gov.uk/riddor/index.htm
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Equality Act 2010
The Equality Act brings together all discrimination legislation into one statute and aims
to strengthen and develop the law on equality. The Disability Discrimination Act is now
part of the Act and makes it illegal to use medical tests or questions as a means of
stopping candidates from getting a job. In order to comply with employment law,
pre-placement screening or baseline health data should be undertaken ONLY after a job
offer has been made.
The definition of disability remains unchanged
‘a physical or mental impairment that has a substantial and long-term adverse effect on
a person’s ability to carry out normal day to day activities.’
The Equality Act 2010 ensures that discrimination does not occur in the workplace for
those classified as disabled.
The employer has a duty to consider making reasonable adjustments to work when it
knows, or could reasonably expected to know, that an employee has a disability and is
likely to be substantially disadvantaged.
The OH professional should give advice to the manager regarding what adjustments are
indicated. It is up to the manager to decide if the adjustments required are reasonable.
(The Act does not require an employer to implement unreasonable adjustments).
Under the Equality Act, what may be considered as reasonable in the circumstances are:
• The effect of steps taken
• Practicability
• Cost and disruption
• Employer resources
It is vital therefore that that sufficient consideration is given to making reasonable
adjustments. Such as:
• Adjusting premises
• Altering working hours
• Providing a reader or interpreter
• Allocating some duties to another person
It is recommended that specialist medical advice is always sought and any proposed
restrictions be fully discussed with the employee.
The Disability Employment Adviser can be contacted through the local Job Centre and
can give advice to both employees and employers on adaptations and any help with
costs that may be available.
More information available from www.equalities.gov.uk
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Do You Need a Professional Occupational Health Service
Provider?
As a minimum, companies need to have health checks to ensure compliance with
legislation such as the Control of Substances Hazardous to Health (COSHH) or the
Control of Noise at Work Regulations. Other health checks that involve ensuring
workers are fit for the task such as safety critical work should be considered too.
Whether an occupational health (OH) service is needed will be based on the legislative
requirements and the health risk assessment and, for those health checks that are not
mandatory, the financial resources available. Health promotion and professional first
aid services are ideal to have for general wellbeing and business needs, especially for
bigger projects which may have added health risk due to the potential for more serious
accidents.
See Fig 3 for a flow chart of how to choose the type of OH service required.
WHAT SORT OF OCCUPATIONAL HEALTH SERVICE DO I NEED?
MUST DO
Health Surveillance
Details required to
be kept of who, when
where. Health records
to be generated
by OHSP.
Asbestos Lead
Ionising radiation
Compressed Air,
Night,
Computer workers
MUST DO
Start
Here
Risk
Assessment
Noise, Chemicals,
dust, fumes,
vibration
Health checks to
moniter health
and control
methods for risks
SHOULD DO
Health screening
required to ensure
safety of self
Fitness for work tasks,
safety critical,
Drugs & Alcohol,
Musculo-skeletal ,
stress, lone worker
and others
SHOULD DO
COULD DO
Cost/ benefit Analysis
(priority for business)
Welfare &
Wellbeing
Health Promotion &
Education/ Awareness eg
cholesterol, blood pressure,
exercise programmes
Absence &
Rehabilitation
Return to work programmes,
individual management of
causes of absence
Treatment & First
Aid centre
On site treatment for minor
injuries or health issues
What else can I do?
Key to colour coding: Traffic light system for requirements
Red = MUST DO Amber = SHOULD DO Green = COULD DO
All Occupational Health services should provide services for those coloured red as a minimum. Not all OHSP are able to offer all services and more than
one provider may be purchased. It is important that providers communicate regularly regarding health issues that could affect health surveillance or
screening requirements. Regular review with service providers is recommended on a 3 monthly basis to ensure quality and suitability of service.
© CBH 2011
Fig 3
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Occupational Health Service Providers
Occupational health service providers (OHSP) are health professionals accredited with
CBH, who can provide informed insight into health at work and how to protect and
monitor the health of the workforce especially if there are different types of hazards.
The Management of Health and Safety at Work Regulations 1999 (MHSAWA) state that,
‘employers who appoint doctors, nurses or other health professionals to advise them of
the effects of work on employee health, or to carry out certain procedures, for example,
health surveillance, should first check that the providers can offer evidence of sufficient
level of expertise or training in occupational health’.
Minimum Competency Standards for OHSPs
In addition to contract and employment law the Construction Industry (through CBH)
should apply the following minimum levels of competence:
Accredited OHSPs shall be assessed to these minimum requirements:
OCCUPATIONAL HEALTH PHYSICIANS
Occupational health physicians (OHP) are required to possess skills and expertise
including an understanding of the health hazards that can arise at work, the ability to
assess risks relating to the health of individuals and groups, knowledge of the law
relating to workplace issues and awareness and understanding of the way business
operates.
There are currently four levels of qualification in occupational medicine for physicians:
• The Diploma in Occupational Medicine (DOccMed.)
• The Associateship of the Faculty of Occupational Medicine (AFOM)
• Membership of the Faculty of Occupational Medicine (MFOM)
• Fellowship of the Faculty of Occupational Medicine (FFOM)
Physicians without these qualifications who rely solely on experience gained in the
workplace may not meet the requirements for competence that are demanded by many
aspects of health and safety legislation. Therefore, the Diploma in Occupational
Medicine has been identified as the minimum standard for the Construction Industry.
However, all physicians practising in the Construction Industry should work within the
limits of their competence and be aware of the need to have access to a nominated
Accredited Specialist Occupational Physician (Accredited Specialist in Occupational
Medicine who is on the GMC Specialist Register) for advice as needed. The level of
occupational health expertise will need to be equal to the level of health risk identified
for the project e.g. for a complex construction project it would be usual for the
occupational health provision to be led by a consultant occupational health physician.
For a physician led occupational health service (the occupational health services are
being managed and controlled by a physician), the lead physician must be either an
Accredited Specialist in Occupational Medicine (Accredited Specialist in Occupational
Medicine who is on the GMC Specialist Register) or have the necessary access to a
nominated Accredited Specialist Occupational Physician for advice as needed.
APPROVED DOCTORS
These are doctors approved by the HSE to undertake cetain medical checks e.g. divers
medicals.
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APPOINTED DOCTORS
These are doctors registered with the HSE who undertake statutory medicals e.g. Lead.
OCCUPATIONAL HEALTH ADVISER
Nurses who have qualifications in Occupational Health at Certificate, Diploma or
Degree level have a higher level of competence as recognised by the HSE and are
designated as Occupational Health Advisers.
For a nurse led occupational health service (the occupational health services are being
managed and controlled by a nurse), the lead nurse should also be registered as a
specialist community public health nurse (occupational health) with the Nursing and
Midwifery Council (NMC) and have access to a nominated Accredited Specialist
Occupational Physician (Accredited Specialist in Occupational Medicine who is on the
GMC Specialist Register) for advice as needed.
OCCUPATIONAL HEALTH NURSE (OHN)
OHN’s carrying out occupational health checks must be registered as a nurse with the
Nursing and Midwifery Council.
OCCUPATIONAL HEALTH TECHNICIAN
The OH technician is able to undertake routine medical tests such as breathing and
hearing tests with expert supervision from an OH professional. Currently there are no
set national standards for training so each should be assessed on a case by case basis by
CBH who will review and revise the standard when guidance is available.
Expert Opinion
Some aspects of health surveillance also require additional competences to be
demonstrated e.g.
• HAVS: a Faculty of Occupational Medicine approved training course in HAVS or
equivalent level of competency
• Noise induced hearing loss: a British Society for Audiology approved course for
industrial audiometricians or equivalent level of competency
• Respiratory: Association for Respiratory Technology and Physiology (ARTP) diploma or
equivalent level of competency
Occupational health service providers (OHSP) must hold appropriate business and
professional indemnity insurance, comply with applicable legislation, and should not
undertake work without having seen or had access to the employer’s relevant health
and safety policies to determine how health and safety is managed.
The health professional should be able to demonstrate awareness of legislation, policies
or programs that might interfere with or affect the performance of the health
assessment, for example, drug alcohol policy, critical incident management programs,
anti-discrimination legislation, medical ethics and privacy legislation.
Occupational health service providers should have:
• Appropriate quality monitoring processes i.e. a clinical audit programme
• Clinical training programmes
• Business and professional indemnity insurance
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• Appropriate registration under the Data Protection Act (1998)
• A health and safety policy for those with five or more employees
• Access to individual company health policy and procedures for reference
Construction Industry Knowledge:
The health professional should demonstrate familiarity with the CBH Industry Standards
for the UK Construction Industry and working knowledge of the assessment procedures
and medical criteria, including:
• Appreciation of the role of health assessments in ensuring construction safety
• Familiarity with the risk management approach used to identify the level of health
assessment required
• Familiarity with the tasks in construction operations and with major tasks of safety
critical workers
• Knowledge of construction safety worker risk categories and the rationale for health
assessments applied
• Knowledge of ability to perform the safety critical worker health assessment
• Understanding of requirements and reporting options for fitness for construction
safety duty
• Knowledge of the assessment’s administrative requirements, including form
completion and record keeping
• Understanding of ethical and legal obligations and the ability to conduct health
assessments accordingly, including appropriate communication with the worker and
the employer
• Understanding of ethical issues in relationships with the treating doctor/general
practitioner
For an OHSP to be accredited with CBH it is a condition that their record keeping meets
the requirements set out in the various regulatory bodies, i.e. The Nursing and
Midwifery Council (NMC), and the General Medical Council (GMC), the OHSP will also
be familiar with the recommendations made by the HSE in relation to the keeping of
health records that form part of a health surveillance programme.
It is expected that the Faculty of Occupational Medicine’s guidance on ethics for
occupational doctors is followed regarding the provisions for transfer and storage of
records, report writing and the confidentiality of health data.
There may be occasions where an OHSP may not meet all the criteria above. However
the OHSP may demonstrate the required knowledge, skills and experience, and have
the relevant procedures in place to enable them to provide an occupational health
service which is considered by CBH to be at least equivalent to the minimum Industry
Standards and compatible with registration with CBH.
Further guidance is contained in Health Surveillance at Work Guidance (HSG 61)
available from http://www.hse.gov.uk/pubns/books/hsg61.htm which states that it is the
duty of the employer to provide health surveillance for those employees considered at
risk and that it is essential those who carry out health surveillance are competent to do
so.
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The Tendering Process
Corporate members of Constructing Better Health will be encouraged to contact
accredited occupational health service providers to arrange the setting up of an
occupational health service. The discussion will be based around the action plan
generated by entering the company employee’s into the Construction Health Action
Toolkit (CHAT). Commercial issues will be agreed between the corporate member and
the occupational health service provider.
Prospective OHSPs should be asked to address some of the the following issues
regarding the provision of a new service:
• Will the service be site based or at a designated health centre
• Is there a mobile unit available
• What types of health checks are provided e.g. breathing, hearing, vibration
• Session times e.g. ½ or full day
• Will Doctors, nurses or technicians be undertaking the health checks
• What sort of reports are provided for management
• Expenses e.g. for travelling
• Additional expenses
More information is available from CBH at www.cbhscheme.com
Working with OHSPs
Flexibility of Decision Making for Occupational Health Professionals
The Industry Standards have been drafted by CBH to reflect best practice, taking into
account the requirements for safety and the practical needs of employers and
employees. It is recognised that there are specific circumstances where it would be safe
for someone to carry out a work task whilst not meeting a particular health standard.
For example, someone with a higher than recommended blood pressure may not
necessarily be unsafe to work because the blood pressure has probably been high for a
long time. Rarely, occupational health professionals will be required to make a
judgment on whether it is safe for a person to carry out a specific job when the health
standard has not been met.
In such circumstances the occupational health professional should follow the process
outlined below:
• Clearly identify the medical issue and all of its facets that could affect the work
situation e.g. medication, degree of disability
• Identify and have a clear understanding of the tasks of the job, and the location
• Identify and have a clear understanding of those aspects of the job that could be
affected by the medical issue
• Undertake a risk assessment and make a judgment of whether or not it is safe and
practicable for the person to be allowed to do the job, and any modifications that are
required for example, it may be that the person should not work shifts
• Make written notes in the person’s occupational health record to explain the relevant
factors and the reasons for the judgment
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• Advise the person about the decision and ensure that the restrictions, if any, are
clearly explained to the person
• Advise the management in writing of the decision, the restrictions that will apply and
the review date
• Examples of restrictions that could be applied are: limited location, limited time
period before health re-examination, limitation of some duties, not to work in
isolation etc.
The occupational health professional undertaking fitness judgments in these
circumstances shall be appropriately qualified and competent to make a decision. If in
doubt then the OH professional shall discuss the case with a more qualified or more
experienced OH professional.
Obtaining Consent in Occupational Health
Occupational health professionals are bound by medical confidentiality, in order to
release medical information to employers, it is an important part of OH practice that
consent is obtained to release medical information to others. Different types of
consent may be required depending on the process being undertaken, but the basic
principle is that an individual participating in an occupational health assessment should
be absolutely clear about the process, likely outcomes and what will be reported to a
third party (employer, insurer, pension scheme, OH provider, etc.).
Informed consent can be one of 5 categories in occupational health practice
1. Consent is required when requesting a report from an individual’s GP. This is
specified in the Access to Medical Reports Act and gives an employee certain rights
to see a report, correct errors or withhold the report from being seen by the
requester
2. Consent is required in order to enter individual’s health data onto the CBH national
database
3. Consent should be obtained from an individual prior to undergoing health checks
with the service provider
4. The Faculty of Occupational Medicine states that it is the duty of OH Physician’s to
ensure that the subject of a health assessment has been properly informed about
the purpose, nature and outputs, including likely consequences; further, that the
employee has consented to the process including the preparation and release of an
occupational health report. Where practicable the individual’s written consent
should be obtained. Consent may be withdrawn at any stage of the process.
5. Consent is required to undertake research whether anonymised or specific
Further information available:
http://www.facoccmed.ac.uk/library/docs/m_gmcconf_ethicsrev.pdf
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GP Specialist reports
Subsequent to a health check (e.g. pre-placement) or following a health incident, the
OHSP may feel it appropriate, subject to consent from the individual, to request a
GP/specialist report. Such a report can be useful in obtaining:
1. Clinical details e.g. results of MRI scan of lumbar spine
2. Details of treatment plan
3. Information on progress of disease
4. GP/Specialist view of current physical or mental capability
The OHSP should provide the GP/specialist with an outline of the job and the hazards
involved. It can be misleading to ask the GP/specialist opinion on whether the person is
fit for the job because GP’s are not specialist occupational health professionals and may
not understand the hazards and risks involved. Both employees and employers can
become confused about the differing roles of OHSPs and a GP.
Issues arising when obtaining GP or Specialist reports:
1. Reports generally take 4 weeks (sometimes longer) to be returned
2. The GP’s role is that of patient advocate, whereas an OH Specialist has a more
objective role
3. Often the reports provide little in the way of useful information as GP’s do not have
training or insight into the nature of construction job roles so may inadvertently
support an employee working in a dangerous occupation
4. Costs for reports are paid by the employer so permission should be gained before
requesting a report or if the report cost is excessive
5. By requesting copies of recent GP notes, there will be reports from Specialists (to
the GP) contained. This may be a more cost effective and rapid way of obtaining
relevant clinical information
6. Employee’s can withdraw consent
7. Employee’s can ask for changes to reports to be made before being seen by
occupational health
The Mental Capacity Act 2005
This Act aims to support and protect those who may lack capacity to make decisions;
this is relevant in instances of:
• Learning disabilities
• Dementia
• Mental health problems
• Brain or head injury
• Those who have had a stroke
Once an impairment or disturbance of mental functioning is detected, a clinician should
be aware of the likely impact on capacity, not only with giving consent, but also for
safety aspects on site. With this in mind, clinicians are advised to consider routinely
using simple open-ended screening questions to detect reduced capacity, for example
‘can you tell me what you understand this treatment will mean to you?’
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The Act also points out that if an employee is unable to make decisions:
• Employees should have as much help as possible to make a decision
• Other people can assist employees to make a particular decision
• Even if someone makes a decision on an employee’s behalf the employee must still be
involved as much as possible
• Anyone making a decision on another’s behalf should have their best interests at
heart.
Language
When talking to clients, contractors, employers and employees, healthcare professionals
should use everyday, jargon-free language with no acronyms. If technical terms are used
they should be explained.
Where possible OH services/employers should provide interpreters for employees whose
preferred language is not English.
Bio-Psychosocial Model
The bio psychosocial model (BPS) is a term used to describe how the symptoms
experienced by a person are influenced by biological, psychological and social factors.
The size of the impact of each factor depends on its seriousness compared to the other
factors. The BPS model relates to most medical situations and so is an important
consideration when an OH practitioner assesses an employee.
Consideration should be given to issues within this model when assessing individual
health issues. For example, OHSPs should enquire into beliefs and social circumstances
when undertaking health checks.
Medical records in Occupational Health
Data Processing in Occupational Health and Confidentiality
Medical information is classified as ‘sensitive personal data’ and is subject to stricter
controls than ordinary data under the Data Protection Act. OH service providers will
ensure that all personal medical information follows legislative and best practice
guidelines.
Occupational Health Recording and Reporting
Prior to commencing a programme of health checks, the employer should agree with
the OHSP
• The types of surveillance and screening required (refer to CBH Industry Standards for
guidance)
• The frequency of employee’s attending for health checks (refer to CBH Industry
Standards for guidance)
• Lists of employee names with information regarding shift work and availability
• What will be produced in the form of reports, feedback and time frames
• Any other feedback and reports required for company purposes
Feedback from the OHSP should be factual and not include medical details unless
consent is given by the individual. Reports should be clear on whether the individual is
fit for task or what an individual can or cannot do or any restrictions to work.
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Results from groups of workers who are exposed to identical risks or work in the same
area should be fed back to the employer in the form of statistical reports, so that health
can be easily monitored on a group basis. It is important to ensure that the ‘group’ is
big enough to protect the identity of the worker. This information can be particularly
useful for health comparisons over years or when a new process or system is started.
Health Records
It is a legal requirement for some health surveillance programmes for individual health
records to be kept. Health records do not contain confidential medical information and
should be kept in an easily accessible format for individuals to check their own record
or for visiting HSE inspectors.
A health record should include:
• Employee surname and forenames
• Gender
• Date of birth
• Permanent address and postcode
• National Insurance number
• Date of commencement in current role/employer
• A historical record of jobs involving exposure to substances or processes, in this
employment, that requires health surveillance.
• Conclusions of any health surveillance check will be expressed in terms of the
employee’s fitness for task and will include the conclusions of the occupational health
professional or responsible person, but NOT ‘confidential clinical data.’
Health records should be maintained for those employees for as long as they are under
health surveillance. Some regulations - COSHH and those for lead, asbestos, ionising
radiations and compressed air - state that records should be retained for much longer
(up to 50 years) as ill health effects might not emerge until some time after exposure.
Employers should check with the OHSP for arrangements in case of company closure or
a new OHSP taking over.
Medical Records
Medical records (occupational health records/case notes) may be created by an OHSP
throughout an individual’s employment in one company. Medical records are entirely
separate from the health record as they contain clinical information about the
individual. They are not the same as GP records which stay at the surgery. Employees
can have access to their own medical record on written request under the Data
Protection Act (1998), but details would only be released to others on receipt of
informed written consent of the employee or by court order.
Constructing Better Health Recording
All employers who are part of the CBH programme will enter employees personal
details onto the CHAT database for use by named occupational health service providers;
The OHSPs will then obtain individual consent from each employee to enter the results
of health checks onto the national database. This will provide a means of checking the
status of a construction worker’s health at any given time and ensure there is
consistency and clarity on the current health of any visiting contractor or site
professional. The database will also reduce the need for repeated health checks on
differing sites.
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Health Surveillance
HEALTH SURVEILLANCE is a legal requirement and a systematic check on health or
maintaining records on an individual engaged in certain work activities where;
• There is a valid way to detect a disease or condition
• It is reasonably likely that damage to health will occur under the particular conditions
at work
• Health surveillance is likely to benefit the employee
• Steps can be taken to eliminate or reduce the probability of further damage
In some instances health surveillance is specified by law e.g. workers with lead and
asbestos. In other cases the need is not so clear, as it will depend on how long, how
often, what control measures are in place and the likelihood of a worker being
affected. Therefore, in all cases the risk assessment process is fundamental in deciding
whether health surveillance is appropriate.
It is important that the purpose of health surveillance is set out in the company
occupational health policy arrangements. There should be lists of jobs considered to be
a risk to health, and the type of health surveillance or medical checks to monitor health.
The policy should identify how results will be fed back to employees and managers
whether individually or as a group.
Health surveillance programmes can vary from a full medical examination to merely
keeping a paper record of a workers employment history – the type of surveillance will
depend on the substance, type of work and what is required by law. Surveillance might
involve examination by an occupational health doctor, nurse, adviser, responsible
person or technician. Workers need to understand the possible health risks and what to
do if poor health is found within a health surveillance program; therefore it is
important that employee representatives are included early in the risk assessment
processes.
Health Screening
Where there are no specific legal requirements to undertake health surveillance as
defined in regulations or as part of the risk assessment conclusions, the implementation
of health screening procedures may be implemented as evidence based or best practice.
Health screening is designed to assess or monitor an individual’s health against a set
standard of requirements. The outcome will provide an indicator of risk from that
individual in the workplace for the future. Examples of health screening include
pre-placement and safety critical workers health checks.
Throughout the Industry Standards both health surveillance and health screening will
be referred to as health checks.
Safety Critical Workers - Fitness for Task (FFT)
Health issues can affect how individuals perform and sudden negative health incidents
could prove disastrous in construction operations.
Within the Construction Industry a number of workers are identified as ‘safety critical
workers’ (SCW). For the purpose of the Industry Standards SCW is defined as:
‘Where the ill health of an individual may compromise their ability to undertake a task
defined as safety critical, thereby posing a significant risk to the health and safety of
others’
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Candidates shall not be suffering from medical conditions, or be taking medical
treatment likely to cause:
•
•
•
•
•
Sudden loss of consciousness
Impairment of awareness or concentration
Sudden incapacity
Impairment of balance or co-ordination
Significant limitation of mobility
In construction the following roles have been defined as ‘safety critical’:
• Asbestos licensed worker
• Diver
• Geotechnical
• LGV/HGV Driver
• Maritime Operative (Specialist)
• Plant Operators
• Scaffolder/Rigger
• Slinger/Signaller/Banksman/Traffic Marshall
• Steel Erector Structural/Fabricator
• Steeplejack
• Tunnel Boring Gangs
• Roadside (high speed)
• Tunnelling
• Confined Space workers
• Working at Height where control measures not practicable
• Others as identified by the risk assessment process
OH Referral for Individuals
Other than undertaking health checks, occupational health service providers can assist
management in dealing with other health issues that may impact on work; issues such
as:
• Capability to undertake duties
• Long or short term repeated sickness absence
• Drug or alcohol issues
• Performance related to a health condition
• What could be considered as a reasonable adjustments for disability
It is important to note that the NHS should continue to be used for general health
issues which are not work related. The responsibility for investigations, diagnosis and
treatment for general health and well-being remains with the employee’s GP/hospital
specialist.
The process of referral to OH is useful when an objective medical opinion is required to
manage an individual in the workplace. Procedures should be agreed with employee
representatives and OH service provider prior to implementation.
If an employee refuses to attend the referral, then decisions on employment may have
to be made with the information available at the time.
An employee should attend an occupational health appointment within paid working
time.
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Additional Hazards in the Construction Sector
Heat Stress
Heat stress occurs when the body’s means of controlling the internal temperature of the
body starts to fail. As well as air temperature, factors such as work rate, humidity and
clothing worn while working may lead to heat stress.
Heat stress can occur in the Construction Industry when working in compressed air
tunnels and underground. Seasonal changes in the outside air temperature can be a
significant contributor to heat stress.
Monitoring the health of those at risk of heat stress should be undertaken by an
occupational health service provider.
For more information: http://www.hse.gov.uk/pubns/geis1.pdf
Night Work
Night work is a specific hazard identified by legislation as having the potential to harm
health in certain groups of workers. Many night workers thrive on night work and
have done so for years without any ill health effects. Night work is defined as working
at least three hours at night (on a regular basis), between the period of 11pm and 6am.
Employees who do the occasional night (rather than regular night work) would not be
classified as a night worker.
There are health issues which could be negatively affected by night work e.g. taking
medication either before bed or in the morning and disruption of the normal sleep
patterns. Due to this, regulations set out that all night workers should be offered a
health assessment before starting night work, followed by health assessment at regular
intervals after; this is generally repeated annually (although not specified in the
regulations).
The health assessment usually takes the form of a health questionnaire completed by
the employee, followed, if necessary, by a health check. The questionnaire will identify
medical conditions that could pose a potential risk to health and safety. It should be
noted that this medical is offered on voluntary basis, and there is no legal obligation on
the employee to complete a questionnaire or attend for a medical check because of
night work.
Biological Hazards
Contaminated water and/or soil can pose a risk of infection from diseases such as Weil’s
disease (Leptospirosis) and Legionella.
Discarded syringes/hypodermic needles can accidentally pierce the skin causing viral
infections such as hepatitis B and HIV.
Other diseases such as psittacosis (parrot disease) and toxicaria (round worms in dog
excrement) may be transmitted from animals to humans. Risk assessment processes
should be undertaken where there is a perceived risk from contaminated soil, water,
land or working in close proximity to animals.
Mobile workers may not have access to health care so employers should ensure new
employees are aware of any biological risks and have all the necessary vaccinations.
For more information regarding specific health issues contact the Health Protection
Agency: http://www.hpa.org.uk/Topics/
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Confined Space Working
Confined spaces are enclosed spaces with limited access and egress, and can include the
following:
• storage tanks
• silos
• reaction vessels
• enclosed drains
• sewers
Working in this type of environment can lead to serious injury from hazardous
substances or dangerous conditions (e.g. lack of oxygen). Workers should be fit to work
in confined space and also have the ability to escape in the event of impending danger.
Some health conditions can affect mobility and be a bar to working in such conditions.
Individual health risks assessments should be undertaken on all confined space workers
which may include a full health check from the occupational health service provider.
Lone Working
Most job roles have a protective factor in that there are other workers in the vicinity of
an individual working. In cases of emergency or need, the group can be called on to
help resolve a situation. For some workers there may be elements of lone working with
the individual being alone on site due to the time of day or nature of the task to be
undertaken. The task may also be hazardous in nature so it is important that there are
processes in place to ensure the health and safety of the lone worker. Risk assessment
should identify protective or control measures required but the individual must be able
to participate in the measures recommended. A full health check may be required from
an occupational health service provider to ensure fitness for working alone.
Musculoskeletal Disorders (MSDs)
The term musculoskeletal disorder (or ‘MSD’) refers to an injury that affects the muscles,
joints, tendons or spinal discs. Such injuries are most likely to affect the back, shoulders
and neck, and legs. Symptoms may include pain, aching, discomfort, numbness, tingling
and swelling.
Workers who suffer from MSDs may have a reduced ability to do tasks, as well as pain
or discomfort and the more serious cases can result in permanent disability. An ache or
discomfort can, unless spotted and dealt with effectively, turn into a long-term or
‘chronic’ injury.
Activities that cause MSDs
The Construction Industry has one of the highest rates of MSDs. The biggest cause of
injury is manual handling, which includes lifting, lowering, pushing, pulling and
carrying. However, handling heavy objects is not the only cause of injury - MSDs can also
result from doing a task repetitively, even if the load is relatively light (eg bricklaying),
or where the person’s body position is awkward or cramped (eg tying rebar). Other
common taks associated with MSDs include:
• block laying
• handling pipework
• laying kerbs and paving slabs
• moving and installing plasterboard
• installing M&E (mechanical and electrical equipment) at height.
The manual handling risk assessment and training should focus on controlling risks;
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however individual health issues and/or physical capabilities will influence lifting
abilities. Occupational health service providers can provide assessments for individuals
who may be at increased risk of injury.
Working at Height
Dangers from working at height are well known and there are many instances of work
at height in the Construction Industry:
• Crane drivers
• Scaffolders
• Roof workers
• Aerial riggers climb high aerials, telephone/radio masts, power pylons
• Deep level workers may be required to climb steep vertical ladders, often within
confined spaces
In order to ensure that the climb to and from the work area is safe, it is important that
the climbers are able to both deal with the strenuous nature of the work and be able to
maintain safety e.g. ability to grip, balance etc.
A full risk assessment should be undertaken for the task, which should include
environmental factors and a full rescue plan in case of medical emergency. Individuals
may be seen for a health check from an occupational health service provider prior to
working at height.
Contaminated Land
The UK has a substantial legacy of chemical contaminants in soil, much of it caused by
industrial and domestic pollution of the past. Land contamination can pose a threat to
the environment and the health of humans, animals and plants.
Most soils have a small presence of contaminants caused by natural geology and diffuse
pollution; levels of risk are usually low. However, some land has the potential to pose
unacceptable levels of risk to human health or the environment, including water
pollution, in particular some ex-industrial sites and ex-landfills sites. Land is only
considered to be ‘contaminated land’ in the legal sense if it poses an unacceptable risk.
More information is available from http://www.defra.gov.uk/environment/quality/land/
which sets out the legislative framework for remediation and how to prevent health
issues arising.
Occupational health service providers will be able to provide specific health information
and health checks for those exposed to such risks.
Statutory Health Screening
Rail Track Side
The Railways and Other Guided Transport Systems (Safety) (Amendment) Regulations
2011 (ROGS Regulations) impose prohibitions and requirements in relation to safety on
railways and other guided transport systems. These include the infrastructure and
operation of main line railways, metros, tramways, heritage railways and tramways and
other guided transport systems.
Every controller of safety critical work is required, so far as is reasonably practicable, to
ensure that a person under their management, supervision or control who carries out
safety critical work and voluntary work has been assessed as both competent and fit to
carry out that work (Regulation 24).
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There must also be an accurate and up to date record of assessment and be available
for inspection. There should be arrangements in place for monitoring the competence
and fitness of individuals with special consideration of fatigue (Reg 25).
Part 4 of the ROGS Regulations, sets out what are the safety critical jobs; there are a
dozen broad areas of work that ROGS define as ‘safety-critical tasks’ which fall into
three groups.
Group A: A higher level of fitness required:
1. Driving and train dispatch
2. Operating signals and level crossings, and related communication
3. Coupling or uncoupling vehicles
4. Controlling the power supply connected to track and vehicles
5. Checking vehicles are working properly and, if loaded, loaded correctly
6. Protecting the safety of people working on or near to the track
Health checks in this category should conform to individual company fitness
requirements eg London Underground, Railtrack etc.
Group B: Still classified as safety-critical work under ROGS and named Rail Trackside
(Personal Track Safety) in the Industry Standards matrix. For this group it is important
that tasks are supervised or the work checked by a competent person before the work
has the opportunity to affect the health and safety of people working or travelling on
the transport system:
1. Installing vehicle parts
2. Maintaining vehicles that are being used (and their parts)
3. Installing or maintaining any part of the infrastructure
4. Installing or maintaining the power supply
5. Installing, maintaining or operating the communications systems used to control
vehicles’ movement or call the emergency services
Group C: The final safety-critical task is training – or supervising training – in any of the
above tasks where the training involves carrying out the actual task. Refer to individual
company policy for health standards required.
The purpose of determining the fitness of an individual is to enable work to be carried
out competently and to reduce the risk to health and safety. The risk of any pre-existing
disability or ill health affecting the safety of the individual, others at work, and the
public should be reduced as far as possible.
For further information: The Railways and Other Guided Transport Systems (Safety)
Regulations 2006 Guidance on Regulations Office of Rail Regulation April 2006:
http://www.rail-eg.gov.uk/upload/pdf/283.pdf
Divers
All divers at work must have a valid certificate of medical fitness to dive issued by a HSE
medical examiner of divers. The certificate of medical fitness to dive is a statement of
the diver’s fitness to perform work underwater, and is valid for as long as the doctor
certifies and up to a maximum of 12 months.
Every diver or person who is likely to be subject to hyperbaric conditions as routine
rather than in an emergency, must have a valid certificate of medical fitness to dive. The
HSE approves doctors to carry out diving medical examinations and assessments. These
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medical examiners are selected for approval based on their training in diving physiology
and knowledge of diving. There is a regular review of the approved Doctors who must
attend refresher courses in order to continue practising in this area. Details are
available from HSE.
http://www.hse.gov.uk/diving/index.htm
Seafarers and Maritime Workers
The Merchant Shipping (Maritime Labour Convention) (Medical Certification)
Regulations 2010 apply to all seagoing UK ships, wherever they may be and to non UK
ships when in a UK port or UK waters and specifies that seafarers should hold a valid
certificate of health whilst at work.
A seafarer is defined as a person who is employed or engaged or works in any capacity
on board a seagoing ship on the business of the ship and includes the self-employed.
Medical certification (ENG1) is obtained from an Approved Doctor; a list of which is
published in a Merchant Shipping Notice on the Maritime and Coastguard Agency
(MCA) website www.mcga.gov.uk. Approved Doctors are required to determine a
seafarer’s fitness by reference to the statutory medical and eyesight standards set out in
Annex B available to download from the above website.
Age and Work
The Government is phasing out the compulsory retirement age and the Equality Act
urges employers to base employment practice on skills, competencies and wishes of the
employee rather than on age. This change in policy means that health issues may have
more impact in the aging worker with the Construction Industry already having a
higher than average proportion of workers over the age of 55. The Industry Standards
sets out the minimum standard for health check frequency however health and safety
considerations and individual susceptibility should form part of the health risk
assessment especially for deteriorating health conditions linked to age. If there is
concern about health then the occupational health service providers will be able to
advise on an individual’s fitness for task or the need for more frequent health checks.
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Absence Management and Rehabilitation
As part of a health monitoring programme, employers should record and monitor
absence; patterns of absence can identify emerging health issues on site. Also statutory
sick pay considerations means individuals may be at work when unwell and safety may
be compromised. It is important to undertake return to work interviews after
prolonged absence or unusual health events in order to ensure that health will not be
compromised or work affected negatively after absence.
OHSPs have a system of management referral which involves seeing individuals either
prior to or just after a return to work is made; recommendations can be made of how a
safe and effective return to work programme can be accomplished.
To manage sickness absence successfully it is a worth remembering that:
• Sickness absence can be affected by a combination of personal beliefs, social
circumstances and work factors
• In order to minimise absence early management intervention is of paramount
importance
• Research supports the fact that work is good for you. Returning to work after illness
can be part of the recovery process and can safely happen if properly supervised
• Long term absence can often lead to permanent incapacity but good management
and timely intervention can be the key to getting employees back to work
By taking action to prevent the loss of your employees through poor health
organisations will:
• Hold on to valued staff
• Avoid unnecessary recruitment and training costs and maintain competitiveness
• Retain a healthy workforce
• Reduce Statutory Sick Pay (SSP) and overall sickness absence costs
• Avoid significant penalties for discriminating against disabled employees
• Improve workplace relations
• Raise the organisation’s reputation
• Safeguard the livelihood of employees
For employees the benefits of returning to work are improved health and well-being.
There are no mandatory requirements for employers to assist ill or injured employees to
return to work. However there are legal requirements which impact on how ill health
and absence should be managed:
• Equality Act (2010): certain disabilities require the employer to make reasonable
adjustments to the workplace
• Health and Safety at Work etc. Act (HSWA) 1974: protect workers after a return to
work as there may be increased vulnerability because of illness, injury or disability
• Employment Law: dismissals and retirements due to ill health and excessive sickness
absence can be applied, but fair procedures must be followed. All employees should
have a contract of employment setting out fundamental rights relating to work
• Data Protection Act 1998: the collection and processing of sickness absence data has
to comply with this Act. If an absence record contains specific medical information
relating to the employee, then is classified as sensitive data and requires more careful
handling and processing
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The Return to Work
Employees should be encouraged to return to work early by having temporary
modifications to the workplace or tasks as part of a rehabilitation programme.
Occupational health service providers may be able to offer suggestions of how to
accommodate illness and disability. Return-to-work plans should determine the level,
type and frequency of interventions and services needed, including any psychological
support. A return-to-work plan could also identify if any of the following is required:
• a gradual return to the original job using staged increase in hours and days worked
(for example, starting with shorter hours and/or less days and gradually increasing)
• a return to partial duties of the original job or temporary/permanent redeployment
to another job
Also consider the following:
• Be flexible; treat each case individually but in a fair and consistent manner. Health
issues can affect everyone differently
• Don’t make assumptions about the employee’s situation or medical circumstances or
talk to others about personal or intimate details
• Encourage discussion about overcoming barriers of return to work with the employee
• Encourage mobile employees to keep in touch with colleagues and workplace by
suggesting lunch or coffee at the workplace
• Undertake ‘return to work’ interviews and give employees the opportunity to discuss
health or other concerns in private
• Some treatments and tablets can have side effects on physical stamina, mood, driving,
machinery operation and safety critical tasks etc. Be sure to ask about medication
that could affect work
Fit Notes
Sick notes have been replaced by the fit note – GP’s now have the option to say that an
individual may be fit for work if temporary adjustments are made to the workplace. It
is important that a risk assessment approach is taken to recommendations from fit
notes as GP’s generally have limited understanding in construction site matters and the
risks involved in specific roles. OHSPs will be able to offer competent advice if there is
doubt about safety in relation to a return to work.
Due to issues of medical confidentiality the circumstances of medical decisions taken by
the OHSP may not be fully discussed with the employer.
Further Help and Advice
HSE - Managing sickness absence and return to work: An employers and managers
guide http://www.hse.gov.uk/pubns/indg399.pdf
National Institute for Clinical Excellence (NICE) - Managing long-term sickness absence
and incapacity for work
http://www.nice.org.uk/nicemedia/live/11779/43545/43545.pdf
The department work and pensions at http://www.dwp.gov.uk/fitnote/
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Setting the Standards for Occupational Health
To assist the Construction Industry with ensuring competency of occupational health
service provider’s (OHSP), CBH has developed a service provider accreditation scheme.
In order to ensure consistency across construction, any OHSP wishing to deliver an OH
service to the Construction Industry is encouraged to register and become accredited
with CBH. The list of accredited OHSPs is freely available for the Construction Industry
employers, enabling informed choice in the knowledge that the OHSP understands the
standards and are committed to ensuring consistency and quality of service.
The standards now form the basis for OHSP delivery and accreditation; also included are
exemplar policy suggestions, advice on effective delivery of service and relevant
information on general health issues.
Occupational health service providers are organisations delivering all types of OH
services - from those directly employed by a construction employer (in house) to large
OH service providers, to independent OH physicians or nurse advisors. In house OH
services providing the full range of medical assessments are encouraged to register with
CBH for access to information and/or guidance.
Guidance on the use of the Industry Standards
The purpose of this section is to act as a reference guide to the standards.
Health Assessment Matrix
The purpose of the health assessment matrix (Fig 4), is in two sections, and is a guide to
the relationship between job roles within the construction and allied industries and the
type of health assessment that may be required subject to the risk assessment process.
The matrix can be used by both employers and occupational health providers as a
means of identifying the health assessments required for a particular job role. The
matrix sets out the health checks and fitness levels required for each job role found
within construction and associated industries.
It is important that employers understand the health risks and procedures to prevent ill
health, and the different categories of medical checks and what is mandatory, best
practice or desirable; so that informed choices can be made of the type of occupational
health service to purchase.
Coding
The coding within the body of the matrix uses the traffic light system – red, amber,
green and identifies: which health checks are:
RED
Legally required i.e. there is a legal requirement to undertake health
surveillance/statutory medicals
AMBER*
Evidence based or best practice (strongly recommended) and fitness for task
assessments
GREEN
Discretionary – should be chosen as an enhancement to the two categories
above and decided on a cost/benefit analysis basis
* CBH strongly suggest that safety critical roles are upgraded to that of an essential
requirement and designated with a ‘C’ on the health matrix
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L
M
N
O
P
Q
R
Drug and Alcohol Screening
(Company Policy)
General Health/Lifestyle
K
Workplace Stress /
Mental Health Assessment
J
Biological Monitoring
I
Colour Vision
H
Visual Acuity
G
Mid Range Acuity (DSE users)
F
Urinalysis
E
Blood Pressure
D1 D2 D3 D4
Vibration Health Check
C
Respiratory Health Check
B
Audiometry Health Check
A
Skin Health Check
HEALTH ASSESSMENT MATRIX
Musculoskeletal
Questionnaire/Assessment
Health Assessment Matrix
Compressed Air
Ionising Radiation
Lead
Asbestos
Safety Critical Workers - Fitness
For Task Assessments
Pre-Placement Health
Assessment/Medical
Pre-Placement Questionnaire
Statutory Medicals (Appointed Doctor)
SECTION 1: JOB ROLE/TASK
ADMINISTRATOR (site)
ASBESTOS LICENSED WORKER
C
BRICKLAYER
CARPENTER/JOINER/SHOP FITTER
CONCRETE SPRAYER
CONSTRUCTION SITE OPERATIVE - GENERAL
CONSTRUCTION SITE OPERATIVE - SPECIALIST (risk assessment)
DIVER (refer to standards)
C
DEMOLITION OPERATIVE
ELECTRICIAN - FITTER/ENGINEER
FORM WORKER
GEOTECHNICAL
C
GLAZIER/GLASS FITTER/WINDOW INSTALLER
INDUSTRIAL CLEANER
LGV/HGV DRIVER
C
MARITIME OPERATIVE GENERAL (refer to standards)
MARITIME OPERATIVE SPECIALIST (refer to standards)
C
PAINTER/DECORATOR
PILING OPERATIVE
PIPE FITTER
PLANT OPERATOR - GENERAL
C
PLANT OPERATOR - CRANE DRIVER
C
PLANT OPERATOR - MOBILE MACHINE DRIVER
C
PLASTERER/DRY LINER
PLUMBER/GAS/HEATING/VENTILATION ENGINEER
PROFESSIONAL
ROAD CONSTRUCTION - ASPHALTER/PAVER
ROOFER - SLATER/THATCHER/TILER
SCAFFOLDER/RIGGER
C
SITE FOREMAN/SUPERVISOR
SITE MANAGER
SLINGER/SIGNALLER/BANKSMAN/TRAFFIC MARSHALL
C
STEEL ERECTOR STRUCTURAL/FABRICATOR
C
STEEPLEJACK
C
STONEMASON
TUNNEL BORING GANG
C
WALL TILER/FLOOR TILER
WELDER
SECTION 2: HAZARDS TABLE
ASBESTOS (short duration)
BIOLOGICAL
CEMENT/CONCRETE
CHEMICAL - RESPIRATORY (sensitisers)
CHEMICAL - SKIN (sensitisers)
COMPRESSED AIR
CONFINED SPACE
C
IONISING RADIATION
LEAD
LONE WORKING
MANUAL HANDLING
NOISE
NIGHT WORK (and annual assessment)
RAIL TRACKSIDE (refer to standards, PTS or equivalent)
ROADSIDE (high speed)
C
SILICA
TUNNELLING (Hyperbaric and/or confined space only)
C
VIBRATION
C
SECTION 3: SAFETY CRITICAL WORKERS - All workers must be assessed for safety critical worker status
HEALTH CHECKS INCLUDED IN ASSESSMENT
KEY TO CODING:
HEALTH SURVEILLANCE/MANDATORY HEALTH CHECK (Dependant on worker risk exposure - risk assessment required)
C
SAFETY CRITICAL - CBH classes this as an ESSENTIAL health check requirement in construction
ASSESSMENT OF HEALTH (BEST PRACTICE) (Strongly recommended - risk assessment required)
NOT LEGALLY REQUIRED - GOOD BUSINESS SENSE
Prevention is better than cure.
Matrix2/1152/1111/©CBH
WORKING AT HEIGHT (control measures not practicable)
This Matrix is not to be used in isolation, refer to the
CBH Industry Standards for Workplace Health in UK Construction
NATIONAL INDUSTRY SCHEME
FOR WORKPLACE
HEALTH MANAGEMENT
Helpline: 0845 873 7726
www.cbhscheme.com
Fig 4
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Section 1 - Job Roles
It is important that the correct job role is used when setting up employees onto the
electronic database. Different roles require different health checks. In order to limit the
size and complexity of the health assessment matrix, job roles have been grouped into
the following categories.
Fig 3: Job Roles/task within the Health Assessment Matrix
ADMINISTRATOR (SITE)
ASBESTOS LICENSED WORKER
BRICKLAYER
CARPENTER/JOINER/SHOP FITTER
CONCRETE SPRAYER
CONSTRUCTION SITE OPERATIVE - GENERAL
CONSTRUCTION SITE OPERATIVE - SPECIALIST (RISK ASSESSMENT)
DIVER (REFER TO STANDARDS)
DEMOLITION OPERATIVE
ELECTRICIAN - FITTER/ENGINEER
FORM WORKER
GEOTECHNICAL
GLAZIER/GLASS FITTER/WINDOW INSTALLER
LGV/HGV DRIVER
MARITIME OPERATIVE (GENERAL) REFER TO STANDARDS
MARITIME OPERATIIVE (SPECIALIST) REFER TO STANDARDS
PAINTER/DECORATOR
PILING OPERATIVE
PIPE FITTER
PLANT OPERATOR - GENERAL
PLANT OPERATOR - CRANE DRIVER
PLANT OPERATOR - MOBILE MACHINE DRIVER
PLASTERER/DRY LINER
PLUMBER/GAS/HEATING/VENTILATION ENGINEER
PROFESSIONAL
ROAD CONSTRUCTION - ASPHALTER/PAVER
ROADSIDE (HIGH SPEED)
ROOFER - SLATER/THATCHER/TILER
SCAFFOLDER/RIGGER
SITE FOREMAN/SUPERVISOR*
SITE MANAGER*
SLINGER/SIGNALLER/BANKSMAN/TRAFFIC MARSHALL
STEEL ERECTOR STRUCTURAL/FABRICATOR
STEEPLEJACK
STONEMASON
TUNNEL BORING GANG (LOCO DRIVER, SIGNALLER, MINERS ETC)
WALL TILER/FLOOR TILER
WELDER
*Roles are not “hands on” - If undertaking manual tasks add another job role
e.g. construction site operative for a dual role.
More information regarding job roles is available from CBH
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How to Use the Matrix:
Section 1 - Job Role/Task
1. Select the job role for an employee. If in doubt about which job role is appropriate
contact Constructing Better Health for advice.
2. Follow the line along to find the types of health checks required for the job role.
3. The employer has a choice to make and is able to select:
RED
– Legal compliance only (minimum required)
AMBER + C
– Safety critical workers - CBH classes this as essential health check
requirements in construction
AMBER
– Evidence based or best practice programme
GREEN
– Wellbeing programme (health promotion and education)
Or a combination of any (but must include all RED)
Section 2 - Hazards
Hazards associated with any jobs are listed here. The hazards section can be used
where there is an added task that is not normally part of a role but has been identified
as applicable by the risk assessment process, e.g. plumber who works as a lone worker.
Each health assessment in the matrix has an allocated Fitness Standard code (A-R) which
the occupational health service providers will use as a guide for each element of the
health checks undertaken.
Once the type of health checks have been identified and chosen from the matrix by the
employer, the OHSP should be invited to provide the most appropriate occupational
health service that fits in with the health risks and the requirements of the hiring
company. The OHSP will work to the CBH fitness for task standards
In situations where there are many risks or complex projects, the OHSPs should be
invited to visit sites and undertake a needs assessment prior to being selected as the
chosen provider.
The following fitness standards set out the health requirements of each health check
and provide evidence based or best practice guidance to follow. It should be noted that
health issues are not always straight forward and although the employer has access to
the standards, in case of doubt the fitness standards should be applied by a competent
OHSP.
Results of health checks will be categorised as in Fig 5
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Fig 5: Key to the Outcomes from Health Checks and Interpretation
Fitness Categories will be marked as category 1, 2, 3 or 4 in feedback forms
CATEGORY
FITNESS STANDARD
INTERPRETATION
1
Fit for work without
restriction
Passed assessment
2
Fit for work, with
some restrictions and
recommendations
Assessment indicates need to advise
job/worker restrictions and/or
recommendations to prevent worsening of
health issues and/or re occurrence of health
issues and/or to promote safety of self and
others
3
Temporarily does not
meet fitness
standards
• An employee may present with symptoms
that could have implications for their job
but the diagnosis is not clear. Each
situation will need to be assessed
individually with consideration of the
probability of serious disease particularly
where this may affect safety critical tasks
• Assessment of health history may require
further investigation/tests and operational
risk assessment. Outcome may include
modifications to work/job role as above
• Generally workers who present with
symptoms of a potentially serious
condition should be classified Category 3
until condition can be adequately assessed.
May be fit for alternative duties. Consider
implications of the Equality Act
4
Unable to meet the
fitness for work
standard
• Requires individual case assessment based
on health issue and job requirement by OH
Physician
• Operational risk assessment and liaison/
case conference with management
required to discuss appropriate
consideration for SCW
transfer/redeployment to non safety
critical/ reduced risk work environments
and duties/ capability process/Ill health
retirement
• Management to make final decision on
future employment in accordance with
relevant employment legislation/Equality
Act
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Summary of Frequency of Health Checks
The following table provides ‘at a glance’ guidance on the frequency that health
assessments and surveillance should be undertaken as a minimum.
Fig 6: Frequency of Health Checks
HEALTH CHECKS
FREQUENCY
Pre-placement health questionnaire
Before starting with a new employer and
when undertaking a new job role
Pre-placement health assessment
Before starting a new role if necessary, based
on response to questionnaire, or if a SCW or
for statutory medicals
Baseline health assessment
Pre-exposure to workplace identified hazards
Blood pressure
3 yearly as part of FFT assessment if SCW
Routine urine testing
Vision Tests
Vision Tests for computer users
2 yearly
Colour Perception
Pre-placement then every 3 years
Respiratory
Pre-placement, 6 weeks (for high risk/
exposure), 12 weeks and repeated annually
Hearing
Pre-placement, annually for the first 2 years
then 3 yearly intervals
Hand arm vibration assessments
Level 1
Pre-placement, then annually
Skin health checks
Monthly by a responsible person (can be less
frequent depends on substances and risk
assessment)
Annual skin questionnaire
Musculoskeletal questionnaire
Annual
Statutory Medicals
Lead
Asbestos
Ionising radiation
Compressed air
As required in Approved Code of Practice
(ACOP) under relevant Regulations
Work-place stress assessment -
Following risk assessment or symptom
reporting
Drug and alcohol testing
Pre placement and for cause testing post
accident. (See CBH recommended policy for
testing)
Safety critical workers (SCW)
Pre-placement and then 3 yearly. Also after
absence or health incidents likely to affect
the health status of an individual. Age
factors or health deterioration may
necessitate more frequent assessments.
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Industry Standards A - R
A B - Pre-Placement Health/Baseline Assessment
The purpose of pre-placement/baseline health check is:
1. To ensure that the prospective employee is medically fit to fulfill the duties and
responsibilities of the post, with a view to making such adjustments as may be
necessary
2. To assess whether the proposed post may adversely affect the prospective
employee’s health and make recommendations to reduce the risk if necessary
3. To record health information as a starting point for monitoring exposure to health
hazards e.g. a hearing test on an employee working in a noise hazard area. This
type of test is called a baseline test as it is establishing health levels before exposure
4. For some specific work activities there is a legal duty to carry out pre-placement
assessments of an individual’s fitness for work, for example, those working with
lead or compressed air. Although not legally designated as such, for the purposes of
the CBH standards it is recommended that workers classified as ‘safety critical
workers’ require pre-placement screening also
The Equality Act makes it clear that employers have to be very careful about asking
health related questions either prior to or in interview. This is due to the fact that there
remains some prejudice and ignorance about health conditions and the effect on work
especially in relation to mental health. The pre-placement health screening process can
now only be undertaken AFTER a job offer has been made. Failure to comply with this
could result in charges of discrimination if the candidate is subsequently not offered a
post.
After the job offer employers can use 3 methods of assessing pre-placement health:
1. A basic ‘open’ questionnaire which asks 4 general questions and acts as a
pre-screening device and serves to ‘fast track’ those who have no health issues likely
impact on work or the employee (category 1 and 2 above, not appropriate for
category 3 and 4). Any health issues identified with a ‘yes’ on the questionnaire
should trigger a confidential pre-placement questionnaire to be completed and
sent directly to Occupational Health by the employee. Pre-screening questionnaires
may be checked by non qualified medical staff if suitably trained and the applicant
is aware of the process
2. A confidential pre-placement questionnaire for screening by an occupational health
service provider for those in any category but specifically for categories 3 and 4.
The completed questionnaire should be sent directly to the OHSP for screening as
appropriate. The OHSP, on receipt of a completed questionnaire, will conduct
enquiries into health issues that may affect work or prove difficult for the
prospective employee due to health issues. The first step is usually a telephone
discussion where information received will clarify the situation and enable the
OHSP to provide management information back to the employer. Occasionally a
report may be required from the prospective employees’ GP, in which case written
consent must be given by the prospective employee
3. A full health check which would incorporate completing risk specific questionnaires,
discussion, examination by OHSPs to gather baseline information and to undertake
medical tests e.g. drug and alcohol testing
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OHSP Process
In order to make a fully informed assessment, OHSPs will consider:
• The job requirements (it may be necessary to see a copy of the job description and
obtain further clarification about details of the post from the manager or HR)
• A relevant medical history which may include information from:
• The health questionnaire
• Consultation with the prospective employee (usually over the telephone,
occasionally in person)
• Further information (with informed written consent) from the prospective
employee's GP, hospital specialist or previous employer
Determining the Outcome
A professional judgement will be made by the OHSP on the suitability of the applicant
to the proposed post by reviewing the questionnaire, making an assessment of the
potential employee’s health and functional capacity based on the information provided,
ensuring there is a clear understanding of pertinent medical conditions, in line with the
potential job tasks/demands, working environment and fitness to work issues. If the
OHSP is unable to determine the suitability of the applicant for the proposed post or
the applicant has declared a condition that requires a medical examination, a face to
face consultation with an OH Physician may be required.
The OHSP should also establish any requirements for baseline health surveillance or
whether a health check is required due to the nature of the role, i.e. safety critical
worker.
Advice to Employee
If any health condition is highlighted which causes concern for work purposes, the
employee should be advised of the process of informing the employer of the outcome.
Should anything that requires specific recommendation be identified, the individual
should be advised by the OHSP i.e. regarding use of personal protective equipment.
Individuals may also require information sheets or tool box talks which are available
from CBH.
Advice to Employer
Subject to the arrangement between the OHSP and the employer, a fitness for work
certificate should be supplied; this will not include any clinical information unless
specific consent has been obtained from the employee, but generally the fitness of the
individual for the proposed work and whether any restrictions or adjustments are
recommended.
Baseline health checks e.g. for hearing will provide the opportunity for starting the
health record and this should accompany the fitness for work notification.
Pre-placement health checks by the OHSP will be based on objective, informed
assessment of all the available relevant information. It will be carried out in line with
the requirements of the Equality Act 2010 and good occupational health practice.
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FITNESS STANDARD A:
PRE-PLACEMENT HEALTH QUESTIONNAIRE
Frequency: Pre-placement
CATEGORY
INTERPRETATION
1
Fit: No medical conditions or past medical history declared that
would in any way affect ability to do or be made worse by
proposed job
2
A medical condition or past medical history declared that having
obtained further information or medical evidence indicates need
to advise job/worker restrictions and/or recommendations to
prevent exacerbation of health issues and/or re-occurrence of
health issues and/or to promote safety of self and others
May be covered by Equality legislation
3/4
A medical condition declared that required assessment with an
OHP, who may/may not have obtained further information and/or
medical evidence, that indicated that exposure to hazards
identified in proposed job role could exacerbate the medical
condition or pose a safety risk to self or others
FITNESS STANDARD B:
PRE-PLACEMENT HEALTH ASSESSMENT/MEDICAL
Frequency: Pre-placement
CATEGORY
INTERPRETATION
1
Fit: No medical conditions or past medical history declared that
would in any way affect ability to do or be made worse by
proposed job. All baseline health checks within normal or
acceptable ranges
2
A medical condition/past medical history declared that having
obtained further information or medical evidence, and/or baseline
health surveillance indicates need to advise job/worker restrictions
and/or recommendations to prevent exacerbation of health issues
and/or re occurrence of health issues and/or to promote safety of
self and others
3/4
A medical condition declared/or baseline health surveillance that
required assessment with an OHP, who may/not have obtained
further information and/or medical evidence, that indicated that
exposure to hazards identified in proposed job role could
exacerbate the medical condition or pose a safety risk to self or
others
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C - Safety Critical Worker
Vehicles and equipment operating on and around construction sites can include
specialised lifting gear, cranes, lift trucks, heavy goods vehicles, dumpers, specialised
vehicles or plant. Often there is significantly more danger from vehicles in the
workplace than on the public highway since the operating conditions are different.
Therefore, the employer needs take into account the individual employee’s fitness both
in respect of activities where an employee’s fitness may be likely to affect personal
health and safety and where it may affect others.
In the Construction Industry CBH recommends that job roles are divided into high risk
and termed ‘safety critical’, this is where the ill health of an individual may compromise
their ability to undertake a task defined as safety critical, thereby posing a significant
risk to the health and safety of others; or employees who only have responsibilities to
themselves (non safety critical workers). Whilst the use of professional judgment would
help to ensure that an individual is fit to perform a task effectively and without risk to
self or others health and safety; it is likely that only those exposed to safety critical
work would need be subjected to a full medical assessment. In this situation the medical
fitness standards for the rail industry (Railtrack PLC 2000) may be broadly applicable to
safety critical work in the Construction Industry:
For safety critical workers, health standards would need to be of the higher standard
whilst non safety critical employees would undergo health checks as decided by risk
assessment processes.
The risk assessment that identifies an activity as ‘safety critical’ in the Construction
Industry should distinguish between the risk of harm to the individual worker and from
that to other employees and third parties.
Employees should not be suffering from medical conditions, or be taking medical
treatment likely to cause:
• Sudden loss of consciousness
• Impairment of awareness or concentration
• Sudden incapacity
• Impairment of balance or co-ordination
• Significant limitation of mobility
In construction the following have been defined as ‘safety critical’:
• Asbestos licensed worker
• Driver
• Geotechnical
• LGV/HGV Driver
• Maritime Operative (Specialist)
• Plant Operators
• Scaffolder/Rigger
• Slinger/Signaller/Banksman/Traffic Marshall
• Steel Erector Structural/Fabricator
• Steeplejack
• Tunnel Boring Gangs
• Roadside (high speed)
• Tunnelling
• Confined Space workers
• Working at Height where control measures not practicable
• Others as identified by the risk assessment process
If there is doubt about fitness, the examining occupational health professional should
undertake all necessary objective medical tests that are available, or by referring the
candidate for further assessment.
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Sleep Disorders
Excessive daytime sleepiness (EDS) may be described as a tendency to fall asleep at
inappropriate times while intending to stay awake. Non-medical causes of EDS include
irregular sleep schedules (e.g. shift work), disturbed sleep, insufficient sleep or sleep
deprivation. Fatigue management strategies often include measures to control the risks
related to EDS due to non-medical causes.
EDS may also be a feature of a number of medical conditions, especially sleep disorders,
of which there are many. The most relevant to SCW is obstructive sleep apnoea (OSA),
present in about 4% of males. The prevalence of sleep apnoea in lorry drivers is
approximately 28%, much higher than that of the general male population.
Obstructive sleep apnoea is characterised by repeated episodes of complete or partial
upper airways obstruction occurring during sleep, causing a sleep-wake cycle which may
occur hundreds of times a night. The symptoms that are suggestive of OSA are EDS,
loud habitual snoring and sudden gasping for air usually reported by spouses or others.
Formal diagnosis and treatment requires referral to a specialist sleep clinic.
FITNESS STANDARD C:
SAFETY CRITICAL WORKERS
Frequency:
Assessment of fitness for SCW is every set at 3 yearly, unless otherwise advised by
relevant legislation. Review can be more frequently for any substantial change in
health circumstances. Such an assessment need only address the specific change in
health circumstances with full re-assessment when next scheduled
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HEALTH ASSESSMENT
REQUIRED STANDARD
Health Questionnaire
No evidence of ill health reported that would affect safety
of self or others. Refer to specific medical conditions below
Blood pressure
Must be below 180/100 in order to continue safety critical
work (otherwise fail).
• Between 160/95 and 180/100, the examining physician
shall require the examinee visit their GP for advice and
treatment. Pass, with a review at 6 months.
• Between 140/90 and 160/95 – pass - advice given
regarding lifestyle
• 140/90 and below – considered normal blood pressure
Individuals, who are experiencing symptoms of low blood
pressure (90/60mmHg) due to medication, should not work
in safety critical roles or environments until the condition is
stabilised. Peripheral vascular insufficiency might affect the
ability to move or react quickly to a place of safety if the
person’s limit of exercise tolerance has been reached by
physical exertion
Hearing
Hearing loss should not exceed 30dB averaged over
frequencies of 0.5, 1 and 2 kHz in either ear.
No evidence of a health condition likely to cause a sudden
or unpredictable change in hearing
Provided the standard is met without the use of a hearing
aid, a hearing aid may be used to improve hearing further
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Respiratory Health
FEV1% greater than 70% of predicted value. No evidence
of respiratory symptoms on questionnaire
Visual acuity
6/9 in better or 6/12 in the other eye. Also uncorrected
acuity must be at least 3/60
Colour perception
(where required
through risk
assessment process)
Achieves a pass, red/green using Ishihara test plates
Mental Health
No evidence of mental ill health which is likely to impact on
ability and safety to self and others
Urinalysis
Testing for glucose is mandatory. Testing for protein and
blood is recommended as best practice.
Normally the urine test should be negative for glucose. If
the urine is also tested for blood and protein the result
should also be negative. However, if any positive results are
found they should be investigated appropriately. If the
investigations indicate that the positive result does not
indicate an underlying disease and the person is well then
this is acceptable
Mobility and co
ordination assessment
No evidence/reporting of musculoskeletal or neurological
disorder that could affect safety of self or others
Drug and Alcohol
Screening
Pass test result. No evidence of over-the-counter or
prescribed medication likely to cause symptoms.
See standard Q for Drug and Alcohol limits
D – Statutory medicals
For serious health risks there is a system of mandatory health surveillance; overseen by a
doctor recommended by the HSE and designated as an Appointed Doctor.
Appointed Doctors (AP) are specialist doctors who advise on specific serious health
issues which could arise when working with substances or in certain situations e.g. lead
or compressed air. AP’s have to attend training and keep up to date with the
regulations relating to the health risk e.g. Control of Lead at Work Regulations (CLAW).
Doctors in this category have duties to the employee, employer and to the HSE and
must have full understanding of work processes to be able to apply their knowledge.
In the Construction Industry these are as follows:
D1 - Asbestos
Past exposure to asbestos is the largest single cause of work-related fatal disease and ill
health in the UK. Almost all asbestos related deaths and ill health are from exposures
several decades ago, but asbestos is still around in many forms, so the risk remains.
Asbestosis is a serious, long-term lung disease caused by inhaling asbestos dust and is
one of a number of conditions that can be caused by asbestos, but there are other
associated diseases such as cancer.
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A licence is not required to work with asbestos under the following conditions:
• Short duration work (within any 7-day period a single job lasts less than one hour per
worker or two hours in total)
• Undertaking air monitoring
• Collecting bulk samples to identify asbestos
• Undertaking clearance inspections
Although a licence may not be needed to carry out a particular job; any work will need
to comply with the general rules detailed under the Control of Asbestos Regulations
2006 to prevent exposure to asbestos. This may include a health check.
It should be noted for most jobs, it is an offence to work with asbestos insulation,
asbestos coating or asbestos insulating board without a licence.
The health checks required for licensed asbestos workers are set out in The Control of
Asbestos Regulations 2006 and require that a Doctor (recommended by the HSE) must
be appointed to undertake the health check every two years – to assist with efficiency it
is suggested that the safety critical health check be undertaken at the same time.
For further information visit: http://www.hse.gov.uk/asbestos/index.htm
D2 - Lead
Any work which produces lead dust, fume or vapour can affect construction workers
health most notably in the following;
• Blast removal and burning of old lead paint
• Stripping of old lead paint from doors, windows etc
• Hot cutting in demolition and dismantling operations
• Painting of buildings
• Working with metallic lead and alloys containing lead, e.g. soldering
• Using pigments, colours and ceramic glazes.
Lead enters the body when items containing lead are processed, worked, or recovered
from scrap or waste. The dust created can be absorbed when:
• Breathing in lead dust, fume or vapour
• Swallowing any lead, e.g. during eating, drinking or smoking, biting nails without
washing hands and face
Any lead absorbed will circulate in the blood; some will be expelled naturally, but some
will stay in the body, stored mainly in bones and, remaining there for many years
without any adverse effects.
If the level of lead gets too high, it can cause:
• Headaches
• Tiredness
• Irritability
• Constipation
• Nausea
• Stomach pains
• Anaemia
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• Loss of weight
Continued uncontrolled exposure could cause more serious symptoms such as:
• Kidney damage
• Nerve and brain damage
• Infertility
NB: These symptoms can also have causes other than lead exposure.
An unborn child is at particular risk from exposure to lead, especially in the early weeks
before a pregnancy becomes known. Women of child bearing age must follow good
work practices and have a high standard of personal hygiene.
Doctors appointed by the HSE should monitor those considered to be at risk from lead
and will undertake biological monitoring (taking blood and urine samples) to check
lead levels.
D3 - Radiation
There are two main kinds of radiation relevant to the Construction Industry; ionising
(that which requires statutory health surveillance) and non-ionising, both of which may
cause negative health effects.
IONISING RADIATION:
Can occur in:
• Naturally occurring radon gas from the ground; some areas have higher levels of
radon than others
• Radiography or from thickness measuring gauges
Excess doses of ionising radiation can cause burns, sickness and have other adverse
health effects.
See Ionising Radiations Regulations 1999 for advice on health surveillance required.
NON-IONISING RADIATION:
• Lasers can cause burns and damage the eye
Ultra-Violet (UV) radiation (e.g. from the sun) can damage the skin and lead to skin
cancer, particularly relevant in summer when hot work warrants the removal of
clothing. Too much sunlight is harmful to the skin. A tan is a sign that the skin has been
damaged by UV rays in sunlight. Some medicines can also make skin more sensitive to
sunlight.
Longer term problems from sun exposure can increase the chance of developing skin
cancer. Skin cancer is the most common kind of cancer in the UK with over 40,000 new
cases diagnosed each year. Workers should be encouraged to check their skin regularly
for unusual spots or moles that change size, shape or colour and to seek medical advice
if there are concerns.
Construction workers should be encouraged to wear a hat, use a sunscreen with a sun
protection factor of 15 or more and to keep shirts on in sunny weather.
Further advice available from: www.sunsmart.org.uk
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D4 - Compressed Air
There are various types of health problems which can be caused by working in
compressed air. The most common are:
• Decompression sickness
• Barotrauma principally affecting the the ears and sinuses
• Dysbaric osteonecrosis, which is a long-term, chronic condition damaging the long
bone (hip or shoulder) joints
The Work in Compressed Air regulations 1996 provides a framework for the
management of health and safety risks by those undertaking tunnelling and other
construction work in compressed air. As well as the standard safety provision there is a
duty on employers to provide health surveillance via an Appointed Doctor to provide
occupational health advice on all aspects of the work in compressed air.
FITNESS STANDARD D:
STATUTORY MEDICALS
Frequency: As required under the relevant approved code of practice (ACOP)
TYPE
ASBESTOS
Asbestos medicals are required under Regulation 22 of The
Control of Asbestos Regulations (CoAaW) 2006 and shall be
carried out by an appointed Doctor. Refer to ACOP
LEAD
Under the Control of Lead at Work Regulations (CLAW)
2002 each employee who is likely to be exposed to lead at
work requires assessment by a doctor. Where this exposure
is 'significant' as defined by the Lead at Work regulations,
the doctor must be an appointed Doctor
Refer to ACOP
IONISING RADIATION
Employees who are likely to receive an effective dose of
more than 6mSv per year, or an equivalent dose which
exceeds three-tenths of any relevant dose limit should be
designated 'classified persons' under The Ionising Radiation
Regulations 1999
Classified workers must have health surveillance by an
appointed doctor. The detailed requirements can be found
in the Health and Safety Executive (HSE) approved code of
practice and guidance L121 'Work with Ionising Radiation'
COMPRESSED AIR
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The Work in Compressed Air regulations 1996 provides a
framework for the management of health and safety risks
by those undertaking tunneling and other construction
work in compressed air. As well as the standard safety
provision there is a duty on employers to provide health
surveillance via an Appointed Doctor to provide
occupational health advice on all aspects of the work in
compressed air
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E - Musculoskeletal
Musculoskeletal disorders (MSD’s) are health issues affecting the muscles, tendons,
ligaments, nerves or other soft tissues and joints. MSD’s are the most common
occupational illness in the UK. The areas most affected are the back, joints and
repetitive strain injuries of various sorts. Injury can happen while doing any activity that
involves movement of the body ranging from heavy lifting to typing.
There are certain tasks and factors in the Construction Industry that increase the risk
such as:
• Repetitive and heavy lifting
• Bending and twisting
• Repeating an action too frequently
• Uncomfortable working position
• Exerting too much force
• Working too long without breaks
• Adverse working environment (e.g. hot, cold)
• Stress pressures e.g. high job demands and time pressure
• Whole body vibration
There are no specific health checks to predict that MSD’s are developing, however,
symptoms can be regularly monitored in order to detect symptoms early and ensure the
worker gets appropriate advice and treatment and importantly, modifying the work
where practicable. Schemes for making physiotherapy available have been shown to be
successful.
For further information visit: http://www.hse.gov.uk/msd/index.htm
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FITNESS STANDARD E:
MUSCULOSKELETAL HEALTH (MSD), MOBILITY AND CO-ORDINATION
Frequency:
• 3 yearly for SCW or sooner if required i.e. symptoms reported
• Pre-placement for new employees whose work will include a significant amount of
handling or repetitive movement, a pre-placement “fitness for work” assessment
should be conducted to determine any MSD’s already present which may preclude
the intended employment
• Employees should be encouraged to report symptoms of any MSD’s to a nominated
person at any time. Employees attending for other health surveillance should
discuss any symptoms of MSD’s which have not previously been reported. When a
problem is detected a full assessment of all possible causes should be undertaken
CATEGORY
FITNESS STANDARD INTERPRETATION
1
Fit: No evidence or reporting of musculoskeletal/nervous disorder
2
Musculoskeletal/nervous disorder identified that does not render
individual unable to perform work but requires job/worker
restrictions and/or recommendations to prevent exacerbation of
health issues and/or re-occurrence of health issues and/or to
promote safety of self and others. For example it may be
recommended individual does not lift above a certain weight, or is
unable to work in confined spaces. Advice should be provided on
an individual basis following functional assessment
3/4
Musculoskeletal: Does not have full movement of the trunk, neck,
upper and lower limbs. Chronic pain or restriction of joint
movement interferes with mobility. Employees with limb
prosthesis may still be able to operate machinery but this should
be based on an individual functional assessment with an OH
professional, manager and operator
Nervous system: Vertigo, giddiness and balance disorders are a bar
to SCW, lack of muscle coordination, double vision, significant
tremor, paralysis, generalized or localized muscular weakness, and
disorders or diseases of the nervous system are all a bar to
machinery/SCW
Employees who have had a stroke or fainting fits should be
restricted until assessed by an OH Physician
Identifiable long term/current medical problem which restrict
capability and ability to stand, walk sit for periods, and may affect
safety of self or others
Operational risk assessment indicated. Equality legislation may
apply
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F – Skin Health
Occupational skin disease can be caused by exposure to a physical, chemical, or
biological agent or a repetitive mechanical force. Skin disease is often labelled as work
related dermatitis or eczema and forms 80% of all occupational skin diseases.
There are different types of substances which can harm the skin – some irritate the skin
and others can cause permanent damage. For the Construction Industry the main skin
hazard is from the exposure to cement dust; often mixed with sand or other aggregates
to make mortar or concrete. Treatment by creams and avoidance of the hazardous
substance will resolve the irritation but if exposure continues the condition may go on
to cause a more serious skin condition - allergic dermatitis. This can result in large areas
of skin becoming severely inflamed from tiny exposures and work in the area becomes
untenable for health reasons.
A risk assessment needs to establish known substances that can cause skin allergy and
identify measures to be put in place to protect the worker. Reference to hazard data
sheets can highlight substances which are known to cause skin problems. Health checks
may also be required as a means of monitoring skin in the workplace. CBH accredited
OHSPs are able to assist the employer on what level of health surveillance may be
required.
It is recommended that all employees exposed to certain substances (see CBH matrix)
undergo an initial skin assessment. This provides an opportunity to inform the
employee of the hazards of exposure to certain substances as well as establish baseline
data.
For further information visit: http://www.hse.gov.uk/skin/index.htm and the CBH
website www.cbhscheme.com
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FITNESS STANDARD F:
SKIN HEALTH ASSESSMENTS
Frequency:
• Prior to placement if potential employee at risk of contracting allergic contact
dermatitis (e.g. those with a history of atopic eczema or a past history of
work-related skin disorders)
• Within two weeks of employment if employee working in an environment where
there is exposure to possible occupational skin irritants/allergens
• A ‘responsible person’ to carry out regular (monthly) skin checks and annually to
use a brief skin questionnaire
• Employees should be educated to examine their own skin on a regular basis
in-between these intervals
• When an employee informs their manager and/or occupational health of any skin
symptom which may be occupational
• Employees at risk of developing occupational dermatitis and/or skin disorders seen
annually by an OHNA
CATEGORY
INTERPRETATION
1
Fit: No evidence or reporting of skin problems- e.g. dermatitis
2
Skin disorder identified that does not render individual unable to
perform work but requires job/worker restrictions and/or
recommendations to prevent exacerbation of health issues and/or
re-occurrence of health issues and/or to promote safety of self and
others. For example it may be recommended that an individual
with irritant contact dermatitis may need to avoid contact with
the particular agent that caused irritation whilst skin heals, but
can work normally with that restriction in place. Could then return
to normal duties with adequate control measures in place
Advice should be provided on an individual basis following
assessment
3/4
Skin disorder identified that renders individual unable to perform
a certain task either on a temporary or permanent basis. Advice
should be provided on an individual basis following assessment by
OHSP
Skin disease is not usually a reason to bar from safety critical work
unless a sign of underlying disease or illness which could exclude
SCW.
Dermatitis needs to be reported as a case of disease for the
purposes of RIDDOR if confirmed by a Doctor
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G - Respiratory Health Checks
Work related lung diseases include a number of health conditions, the most well known
being occupational asthma.
Respiratory diseases amongst construction workers may include:
• Silicosis or asbestos exposure (see above)
• Asthma and other allergic reactions (e.g. due to two-pack (isocyanate) paint or resin
exposure)
• Chronic obstructive pulmonary disease (COPD)
Smoking may contribute to the chest problems and increase the risk of some allergic
responses. Asbestos workers who smoke increase the negative effects of exposure.
Risk assessment processes should establish if employees are liable to be exposed to a
substance hazardous to breathing or lung health, check hazard data sheets for phrases
such as respiratory irritant or sensitiser. From the risk assessment it should be
determined whether health surveillance is required. CBH accredited OHSPs are able to
assist the construction employer as to the level of health surveillance required.
Where there is a danger of damage to the lungs or breathing the OHSP will undertake
a programme of health checks which can include asking workers to complete a health
questionnaire and, in some cases, perform a lung function test (spirometry) on an
on-going basis.
Respirable Crystalline Silica (RCS)
RCS is one of the major components of soil, rock, granite and many other minerals
found in the earth’s crust. Exposure to RCS can occur during work such as concrete
removal, demolition work, tunnel construction, concrete or granite cutting, drilling,
sanding and grinding.
Exposure to RCS can cause silicosis, chronic obstructive pulmonary disease (COPD), lung
cancer, and some connective tissue disorders.
Scientific measurements of silica levels should be taken by accredited hygiene
professionals to ensure the levels do not exceed more than 0.1 mg per cubic metre over
an 8 hour shift. Health checks which include a respiratory questionnaire and lung
function testing should be undertaken. The requirement for mandatory chest X-rays are
still under discussion at the time of publication of these standards, any future
advice/guidance will be reviewed and incorporated into these standards.
Source: http://www.hse.gov.uk/pubns/cis36.pdf where further, more detailed
information can be obtained.
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Occupational Asthma
Occupational Asthma (OA) is asthma that has been caused due to work by a substance
which has be designated as a respiratory sensitiser; as with ordinary asthma it can have
serious implications for both affected individuals and employers. For the affected
individual, continued exposure to the harmful dust or fume usually leads to
deteriorating asthma and the risk of severe, or on rare occasion’s fatal asthma attacks.
Even if exposure ceases, the more severely affected may still be left with persistent
asthma and chronic disability.
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a common chronic chest disease which
is mainly caused by smoking. It is a lung condition that includes chronic bronchitis
(regular phlegm production) and emphysema (damage to the air sacs in the lung).
As well as smoking, COPD may be caused by long term exposures to certain substances
in the workplace such as coal dust, silica, wood dust, metal fumes, and irritating gases
such as nitrogen oxides and sulphur dioxide. In particular construction work, welding
and stonemasonry are associated with COPD.
COPD involves a slowly progressive irreversible decline in lung function which would be
detected by breathing tests. The main emphasis for the individual is to stop smoking
and elimination or reduction of exposures to causative substances in the workplace.
Where there is a strong evidence base for a link between specific health hazard
exposures and COPD then health checks in the form of spirometry will be appropriate.
Source http://www.hse.gov.uk/copd/index.htm where more details can be obtained.
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FITNESS STANDARD G:
RESPIRATORY HEALTH CHECK
Frequency:
• At pre-placement on occupations known to involve exposure to respiratory hazards
at work and/or who wear respiratory protection
• Health surveillance should include assessments by questionnaire and spirometry,
then 6 weeks and three months after starting work with hazardous substance if
considered a high risk of exposure to respiratory sensitisers
• Surveillance for chronic obstructive pulmonary disease should be annually
• Yearly review thereafter provided there are no problems identified
• Symptoms of allergy to work substances can be the first signs that occupational
asthma may be developing
• On any employee who notifies occupational health of respiratory or allergy
symptoms which may or may not be occupationally related
• Respiratory health surveillance will cease when the employee is not longer exposed
to hazards requiring surveillance or when employment is terminated. Close
proximity to respiratory sensitisers may still require continued surveillance and
should be decided by risk assessment
• Employees who fail to produce results within the normal range and/or have
respiratory symptoms should be referred to an OH Physician in order for a full
investigation to take place. Referral to their GP may also be necessary in order that
treatment can be considered
• Procedures should be in place to enable employees to report any symptoms that
occur between tests
CATEGORY
STANDARD INTERPRETATION
1
Fit: Normal spirometry results. No evidence of respiratory illness
likely to have a negative impact on employment
2
Further investigation required/referral to Occupational Health
Physician if employee has ;
• Abnormal spirometry: a drop of 20% from predicted VC and FVC
• FEV1/FVC ratio of less than 70%
• Any individual diagnosed asthmatic with impaired lung
function
• Any individual diagnosed with impaired lung function related
to a respiratory disease or where it is likely lung function may
deteriorate as part of the natural disease process
• Any individual with a history of workplace respiratory
sensitisation (asthma/rhinitis)
3/4
Respiratory disorders may affect ability to perform SCW, partly
because of the exertion required to work safely; difficulty
breathing and sudden drastic respiratory failure would be a bar to
SCW
Clinical judgement required by OH professional on a case by case
basis. Workers should be excluded from SCW until a clear
diagnosis is made
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H – Hearing Health Check
Exposure to industrial noise at work can permanently damage hearing. Therefore
health surveillance is a requirement under The Control of Noise at Work Regulations
(2005) for those workers regularly exposed to noise over 85 dB(A). Employers should
undertake regular noise monitoring of work areas to ensure noise levels are controlled
so far as reasonably practicable.
Other workers may be eligible for hearing tests if the noise levels are sufficient and the
individual is sensitive to noise. Health surveillance for employees exposed to noise
involves regular hearing tests and the maintenance of health records.
The medical check should incorporate health information and informing workers about
how noise affects hearing and being shown the proper fitting, cleaning and
maintenance of hearing protection used.
The Health and Safety Executive (HSE) has published a guide on how to manage noise
and interpret hearing tests; there are 4 categories: (HSE guidance L108) decided by the
OH professional after the hearing test has been completed:
• Category 1: acceptable hearing
• Category 2: mild hearing impairment
• Category 3: poor hearing
• Category 4: rapid hearing loss
The OHSP will be able to provide information on what action is required for employees
in categories 2 - 4. For further information visit: http://www.hse.gov.uk/noise/index.htm
Safety Critical Workers – due the nature of the work and the potential for injury and
harm due to poor hearing, have a higher level of hearing requirement which will be
applied by the OHSP.
FITNESS STANDARD H:
HEARING HEALTH CHECK
Frequency: A hearing programme should start with a baseline audiogram to use as a
comparison for future. All subsequent hearing tests should be before exposure to
noise (for at least 16-24 hours). The schedule of audiometric testing should include
annual tests for the first two years of employment and at three yearly intervals after
if no abnormalities noted
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CATEGORY
STANDARD INTERPRETATION
1
HSE Category 1. Acceptable hearing limits for lower frequencies
and upper frequencies. Continue with proper use of PPE and
monitoring as per risk assessment/health matrix. Provided that the
standard H1 is met without the use of a hearing aid, a hearing aid
may be used (i.e. at work) to improve hearing further
2
HSE Category 2 indicates a warning i.e. there is evidence of mild
hearing impairment/noise induced hearing loss. Emphasise to be
made to maintenance/good use of PPE and increased frequency of
audiometric monitoring
For safety critical roles hearing loss should not exceed 30dB
averaged over frequencies of 0.5, 1 and 2kHz in either ear (see
safety critical standard C)
If it is difficult to determine the ability of a worker to hear safety
instructions and auditory warning signals a functional assessment
may be appropriate to determine an employee’s safety and the
safety of others in the workplace. Drivers/Operators must be able
to hear instructions and warning signals. The use of a hearing aid
is not a bar to fork lift truck operation
The functional assessment would be conducted by a manager or
safety professional familiar with health and safety issues in the
employee’s working environment
If noise-induced hearing loss is deemed to be stable, continuing
exposure to noise will usually be acceptable where adequate
hearing protection is used and where residual hearing ability is
not so poor as to make the risk of further hearing loss
unacceptable
Meticulous use of PPE advised, particularly where noise cannot be
removed at source
Further investigation required with OH Physician
Repeat/more frequent audiometry indicated. And GP/Specialist
referral/report may be required
3/4
Where employee has not met criteria 1 and/or 2, for example
• evidence from previous audiometric testing of rapid/reduced
hearing loss in higher and/or lower frequencies
• unilateral hearing loss
• presence of a medical condition - likely to cause unpredictable
fluctuation in hearing levels or permanent reduced levels of
hearing
It is the employer who makes the decision whether an employee
should continue working in a noise hazard area. The role of the
OH practitioner is to provide the employer with a competent
assessment of an employee’s hearing in relation to the job and
work environment. A competent assessment of an individual with
significant hearing loss would include advice from a hearing
specialist. The Equality Act may apply
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I – Vibration Health Check
HAND ARM VIBRATION (HAV) is vibration transmitted to an individual’s hands and arms
when using hand-held powered tools. Regular and frequent exposure to vibration can
lead to a disabling condition called hand-arm vibration syndrome (HAVS) and carpal
tunnel syndrome (CTS).
HAVS and carpal tunnel syndrome can be caused by operating hand-held power tools
(such as road breakers), hand-guided equipment (such as compactors), or by holding
materials being processed by machines (such as pedestal grinders). Damage occurs from
long term vibration effecting the tiny blood vessels, nerves and muscles of the hand and
fingers. Occasional exposure is unlikely to cause ill health. The severity of the HAVS
increases with more usage of hand held tools and is an irreversible process. The most
commonly seen health issue is vibration white finger, which can cause severe pain and
disability in the affected fingers.
Identifying the signs and symptoms at an early stage is crucial to preventing serious
long-term health effects.
The Control of Vibration at Work Regulations (COVWR, 2005) sets out the requirements
for health surveillance for HAVS and is linked to the level of exposure to vibration over
an eight hour working day,
For further information about HAVS:
http://www.hse.gov.uk/vibration/hav/advicetoEmployers/index.htm
WHOLE BODY VIBRATION: Back pain can be caused or aggravated by vibration from a
vehicle or machine. Whole body vibration is defined as shaking or jolting of the human
body through a supporting surface (usually the seat or floor), for example when driving
or riding on a vehicle on an unmade road, operating earth-moving machinery or
standing on a structure attached to a large, powerful, fixed machine which is impacting
or vibrating.
There are specified limits to the amount of vibration over a working day of:
1.15m/s2 A(8)- exposure limit value – must not be exceeded
0.5 m/s2 A(8) – exposure action value – employer must take action to reduce risk
There is no prescribed health check for whole body vibration and the HSE suggests the
establishment of a symptom monitoring programme by a suitably trained responsible
person. Those complaining of back pain thought to be associated to whole body
vibration should be referred to OHSP
For further information: www.hse.gov.uk/pubns/indg242.pdf
FITNESS STANDARD I:
VIBRATION HEALTH CHECK
Frequency: HAVS assessments should be provided
• At pre-placement – Level 1 assessment if there is a risk of vibration exposure
• Newly-exposed workers should be reviewed 6 months after commencing work with
vibrating tools or earlier if there is any indication of HAVS developing
• HAVS screening questionnaire should be carried out annually. This may be done by
a competent responsible person. If signs or symptoms arise at this stage, the
employee must referred to an occupational health professional
• Every third year (whether symptoms have been reported or not) the employee
should be assessed by a qualified person (OH Professional) (HSE Tier 3)
• Additionally, if an employee consults occupational health/management
complaining of symptoms which could be associated with HAVS
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CATEGORY
INTERPRETATION
1
Fit: No signs or symptoms of HAVS
2
Stage 1 symptoms
• Advise the employer to review the risk assessment, and to
reduce further exposure to a level that is as low as reasonably
practicable. Advise a change work practices to eliminate
exposure to vibration and where there is a residual risk despite
control measures, consider job rotation to reduce an exposure
• If there is a suggestion that the disease is progressing rapidly,
then a review at 6 months rather than 1 year may be indicated
• Stage 2 symptoms: exposure must be reassessed, close
monitoring for symptom progression and worsening functional
impairment
• The OH Physician needs to consider whether the individual is fit
to continue to be exposed to hand transmitted vibration (HTV)
Normally the individual will only become unfit if reached late
stage 2. Tier 5 testing may confirm the severity of symptoms. It is
important to recognise that the tests are not necessarily precise,
and therefore the decision as to whether a case is late stage 2
will always be based on clinical judgement
• Management of current cases at Stages 2-3 might be different,
as the disease progression may be clearer. If the employee is
approaching retirement age, continued fitness to work may be
acceptable, particularly if further exposure can be limited, and
there is regular health surveillance. The situation and risks need
to be explained fully to the employee
3/4
• Stage 3 symptoms. Normally individuals with Stage 3 HAVS will
be unfit for further exposure to HTV. If this stage is diagnosed, a
meeting should be arranged for the individual, management,
Trades Union and possibly company legal representative.
• Unfit for further exposure. If the OH Physician recommends
that exposure to HTV ceases, the employer needs to consider
what action to take. This might include redeployment to an
alternative role. Consideration given to whether the employee
symptoms of reduced grip strength and/or manual dexterity may
implicate safety of self or others
• Carpal Tunnel Syndrome (CTS) - the individual should be
removed from further exposure and referred to the GP for
specialist treatment. Recommendations about returning to work
need to be made on an individual basis, and the employee must
be advised about the risk of developing further symptoms
• Cases of HTVS or CTS caused by HAV are RIDDOR reportable
once the diagnosis has been confirmed by an OH Physician.
• Specialist testing may be indicated. Employee should cease
working with vibrating tools until further notice
• The Equality Act may be applicable
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FITNESS STANDARD J:
BLOOD PRESSURE
Frequency: 3 yearly as part of FFT assessment if SCW or more frequently where
symptoms or history of high blood pressure has been reported
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CATEGORY
INTERPRETATION
1
Fit: Normal blood pressure is below 140/90mmHg (140 systolic and
90 diastolic).
Safety critical workers BP should not be above 180/100 – see
standard C for more detail
No cardiac symptoms presented or reported
2
Asymptomatic and stable conditions e.g.:
• fully recovered after heart attack (myocardial infarct) or well
controlled and uncomplicated by hypertension
• arrhythmia if symptoms are controlled and cardiac function is
satisfactory
• a single, uncomplicated myocardial infarction
• Angina, unless symptoms are brought on by work duties and/or
medication produces side effects which may interfere with work
duties
The above are not considered a bar to SCW
3/4
The following are a bar to safety critical work :
• Uncontrolled hypertension (180/100) likely to cause health
symptoms and/or sudden collapse, which could potentially
endanger the safety of others
• Syncope, transient ischaemic attacks and complete heart block
unless successfully treated with a pacemaker and follow-up is
satisfactory
• A second or complicated myocardial infarction - employee
should be referred to an OH Physician
• Conditions which limit exercise tolerance or which are likely to
lead to syncope are incompatible with work in SCW, as are
symptomatic arrhythmias which distract the patient or cause
temporary incapacity
• A stress ECG should be conducted using the Bruce protocol
(treadmill test). The exercise capacity should be > a 90% of the
age/sex predicted capacity. Reaching a level of Stage 3 of the
Bruce Protocol without ECG changes would be acceptable.
When a stress ECG is positive, or clinical assessment indicates,
referral to a cardiologist should be made for further assessment
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FITNESS STANDARD K:
URINALYSIS
Frequency: 3 yearly as part of FFT assessment if SCW or more frequently where
symptoms/history have been reported
CATEGORY
INTERPRETATION
1
Fit: Normally the urine test should be negative for glucose. If the
urine is also tested for blood and protein the result should also be
negative.
2
Any positive results should be investigated appropriately. If the
investigations indicate that the positive result does not indicate an
underlying disease and the person is well then this would be
acceptable
Requires case management via the employees GP
3/4
Is diagnosed with/receiving treatment for a medical condition
which is not under control and may influence safety of self or
others.
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FITNESS STANDARD L:
VISUAL ACUITY
Frequency: 3 yearly as part of FFT assessment if SCW and/or sooner if
• Prior to placement for drivers/safety critical tasks
• Complaints of eyestrain, focusing difficulties, headaches or similar conditions
CATEGORY
INTERPRETATION
1
Fit:
Safety Critical Workers standard :
Corrected visual acuity at least 6/9 one eye and 6/12 in the other
Uncorrected visual acuity - at least 3/60 in each eye
Near vision = N8
Visual field: No pathological defect
Corrected visual acuity
Non-safety critical standard
6/18= is considered sufficient to undertake normal duties
If dependent on contact lenses to meet vision requirements,
spectacles of an equivalent prescription shall be carried when in
critical safety roles. (This is so that, if, for any reason, the contact
lenses have to be removed, the person is still able to achieve the
necessary visual performance to continue working safely.) The
order of testing vision should be – unaided – with spectacles – with
contact lenses. No pathological condition of the eyes likely to
cause visual impairment should be present. The use of tinted or
photo chromic prescription spectacles is prohibited. To prevent
adverse effects on colour discrimination and on general vision in
areas of strong contrast between light and shade, only sunglasses
which conform to BS EN 1836, shade 2.5 are permitted
2
Has not met the criteria above
Monocular vision must be assessed on an individual basis
Uncontrolled double vision and binocular field defects would be a
bar to fork lift truck operation
Those who have not met the above standards should not be
allowed to return to driving duties/safety critical duties until
satisfied that vision has been corrected/ improved
An occupational health reassessment is required following referral
to optician
3/4
Has a pathological condition of the eyes likely to cause visual
impairments, which cannot be corrected with the use of spectacles
and/or contact lenses. The Equality Act is likely to apply
M – Mid Range Acuity (Display screen equipment users)
Working at a screen does not cause eye damage, but many users experience temporary
eye strain or stress. This can lead to reduced work efficiency or taking time off work.
Workstation assessments and eyesight testing are part of the statutory requirement for
display screen workers.
Many optometrists now offer corporate schemes to companies with significant
discounts available.
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FITNESS STANDARD M:
MID RANGE ACUITY (DISPLAY SCREEN EQUIPMENT) USERS
Frequency:
Visual acuity testing should be undertaken for DSE users:
• As soon as possible after employment commences
• At two yearly intervals or when requested by the employee i.e. reports eyestrain,
focusing difficulties, headaches or similar conditions
CATEGORY
INTERPRETATION
1
Fit: Employee has satisfactory visual acuity for intermediate
distance with or without spectacles/contact lenses. For those with
spectacles and/or contact lenses the current prescription applies
2
Employee has a medical condition or visual impairment that
indicates need to advise job/worker restrictions and/or
recommendations to prevent exacerbation of condition or visual
impairment and/or re occurrence of condition or visual
impairment, i.e. large monitor, frequent changes of activity.
Consideration should be given to obligations under the Equality
Act
3/4
Employee has a medical condition or visual impairment which
needs further specialist assessment, which may/not require further
information and/or medical evidence which indicate that use of
display screen equipment could exacerbate the medical condition
or visual impairment.
Consideration should be given to obligations under the Equality
Act
N – Colour Vision
FITNESS STANDARD N:
COLOUR VISION
Frequency:
3 yearly or sooner if required i.e. symptoms reported
CATEGORY
1
Fit: Has passed Ishihara (24) plates/City test standard for colour
perception, no colour deficiency noted. Employee identified as
potentially safe with milder degrees of anomalous trichromatism
2
Employee has poor colour discrimination (dichromats and severe
anomalous trichromats) and is unable to distinguish from Red/
Green. Employees who fail Ishihara test or City University tests will
require an operational risk assessment: to test the extent to which
their visual defect impacts upon safe working
3
SCW should be excluded from aspects of safety critical work where
colour perception red/green is a key requirement
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O - Biological Monitoring
Biological monitoring may be required if exposure to chemical hazards is identified
during the risk assessment process.
It is difficult to detail every situation where monitoring is necessary. The decision should
be taken on an individual basis
FITNESS STANDARD O:
BIOLOGICAL MONITORING
The following list, which is not definitive, gives a general idea of where biological
monitoring is required and the type of sample, however further guidance can be
obtained from CBH/OHSP
Biological sample
Examples of parent compounds
Urine
Heavy metals e.g. organic lead, mercury, cadmium,
chromium, cobalt
Metalloids e.g. arsenic
Ketones
Blood
Heavy metals
Aromatic compounds e.g. toluene, benzene
Chlorinated solvents e.g. trichloroethylene
Breath
Aromatic compounds
Chlorinated solvents
Hair and nail
Arsenic
Mercury
Fat
Polychlorinated biphenyls
Frequency: On exposure to hazard
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CATEGORY
1
Fit: No abnormalities detected
2/3/4
Case by case assessment of each individual
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P – Workplace Stress/Mental Health Assessment
One in six workers experiences depression, anxiety or unmanageable stress. A further
one in six experience symptoms of mental ill health such as sleep problems and fatigue,
yet mental health is still taboo in the workplace. Many employees keep quiet about
their mental distress, for fear of discrimination from managers or colleagues. This
means problems spiral and often not identified until too late, exacerbating the business
and human costs, as well as placing added strain on colleagues.
Workplace Stress
Pressure is part of everyday life, but excessive pressure can lead to stress, which
undermines performance, is costly to employers and can make people ill.
HSE defines work-related stress as:
‘The adverse reaction people have to excessive pressure or other types of demand
placed on them.’
Stress at work can be tackled in the same way as any other risk to health. A recent
survey identified the top five most stressful issues in the Construction Industry as:
• Having too much work to do in the time available
• Travelling or commuting
• Being responsible for the safety of others at work
• Working long hours
• Having a dangerous job
• With management, road maintenance staff, designers and administration staff
reporting more stress than other job roles of labourers and operatives.
Employers have duties to undertake risk assessment for stress the same as other health
hazards.
For further information go to:: http://www.hse.gov.uk/stress/index.htm
Mental Health Fitness
Mental health problems can affect anyone at any age regardless of race, gender, or
social background. Disorders can take many different forms and affect people in
different ways. Depression, schizophrenia and bipolar disorder are all examples of
mental health issues.
Mental distress can affect how people think, feel and act. As a result, people suffering
from mental ill health may behave, communicate or respond in unexpected ways that
may be at odds with a given situation. In some cases, mental health conditions can
affect people’s ability to do their jobs
For those undertaking safety critical work it is important to identify any serious mental
health problem which could have the potential to affect personal safety or that of
others, for this reason it is important to assess mental health as part of the safety critical
health check
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Mental Health in the Workplace
Organisations need to understand the impact that work can have on an individual who
may be recovering or suffering from a mental health/or work related stress by
considering the following:
• Having workloads that match employees’ abilities and experience
• Ensuring reasonable and agreed deadlines for work completion
• Consider reducing repetitive duties within workloads
• Review the working environment (consider noise, office lighting, equipment)
• Ensure there are clearly defined roles and duties in a job
• Involve employees in the planning of work
• Allow freedom for employees to express any concerns regarding the compromise of
personal or professional standards
• Introduce employee training and development programmes.
For more information of mental health in the workplace go to http://www.mind.org.uk/
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FITNESS STANDARD P:
WORKPLACE STRESS/MENTAL HEALTH FITNESS
Frequency:
As identified through risk assessment process or symptoms reported
CATEGORY
1
Fit: No evidence of mental ill health which is likely to impact on
ability to work in a safety critical environment
2
Has shown evidence/reported of one or more of the following:
• Deterioration in behaviour
• Changes in relationships with colleagues
• Irritability/sudden mood swings/hypermania
• Reduced performance
• Inability to make decisions or pay attention to detail
• Altered perception/short-term memory or concentration
• Currently undergoing psychiatric assessment
• Current symptoms of stress related illnesses
• Very low mood
• Significant intellectual impairments
Maintenance therapy which is not causing side effects will usually
be compatible with unrestricted SCW duties provided that the
individual remains asymptomatic.
Depression: this will be dependent on effects on concentration
and mental alertness and any medication side-effects.
Case by case assessment required
3
Symptoms as detailed above, but more severe.
Case by case assessment is required by an Occupational Health
Physician
4
Confirmed long term and unstable mental disorders or medication
causing one or more of the following are incompatible with some
employment, and in particular safety critical environments:
• Deterioration in behaviour
• Changes in relationships with colleagues
• Irritability/sudden mood swings/hyper mania
• Reduced performance
• Unable to make decisions or pay attention to detail
• Altered perception/short-term memory or concentration
• Currently undergoing psychiatric assessment
• Current symptoms of stress related illnesses.
• Very low mood/reclusive behaviour
• Significant intellectual impairments
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Q – Drugs and Alcohol
The misuse of drugs and alcohol is a serious problem in the workplace, not only for the
misusers but also for employers, colleagues and the public. The possession of some
drugs is illegal; other prescribed drugs and over-the-counter medicines can have side
effects which could affect safety.
Alcohol too can affect productivity, performance and a team morale leading to bad
behaviour and poor discipline. Both drugs and alcohol (D & A) are known to affect
concentration and physical co-ordination which can lead to highly dangerous
behaviours. This is particularly relevant when considering the safety critical nature of
specific jobs within the Construction Industry and the potential for catastrophic events.
Alcohol or drug problems should always be treated primarily as a health problem rather
than a reason for immediate dismissal. Employers should encourage employees who
show signs of developing such problems to seek help.
Definition:
Drug and alcohol misuse is defined as:
• Alcohol dependence, excessive alcohol consumption and/or inebriation in the
workplace
• Taking or possessing illegal drugs
• Misuse of legal substances such as prescribed medicines
• Solvent misuse e.g. inhalation of gases or glues
Legal Position for Drug and Alcohol Management
• There is a general duty under the Health & Safety at Work etc. Act to look after the
health, safety and welfare of employees
• There is a duty to assess health and safety risks to employees under the Management
of Health and Safety Regulations
• The Construction (Design and Management) Regulations 2007 (CDM) sets out specific
duties for clients, contractors and workers in relation to health, safety and welfare of
those involved in construction projects.
• The principal contractor must prepare, develop and implement a written plan and
site rules for health and safety; the relevant parts are to be given to contractors.
The site drug and alcohol policy would be such a document to share
• Contractors should co-operate with principal contractor, consult with the workers
and keep to the site rules
• Workers should ensure the health and safety of construction workers and others
who may be affected by the work and report obvious risks
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• Under the Road Traffic Act and the Transport and Works Act, drivers of road vehicles
must not exceed certain statutory limits so as to be under the influence of drugs or
alcohol while driving, attempting to drive or when they are in charge of a vehicle. For
certain rail, tram and other guided-transport system workers must not be unfit
through drugs or alcohol while working on the system
• The Misuse of Drugs Act states that:
• It is unlawful to be in possession of a controlled drug
• The occupier of a premises is committing an offence if it is known that producing,
supplying (or attempting to supply), or the preparation and smoking of controlled
drugs is taking place on those premises
• Companies must take action if illegal drug activity is discovered
• The Human Rights Act aims to ensure that the rights of the individual as well as that
of the community are protected. This means that one individual’s rights may have to
be balanced against another’s. Article 8 covers the individual’s right to private life
and family. A drug and alcohol policy is justified where public safety is concerned.
The Act also makes allowances for interferences where the aim is for the protection
of the health of others as determined by other relevant legislation
• The Data Protection Act sets out principles of confidentiality and legal ways of
processing information. Companies should ensure the principles are applied across
the whole area of testing, training and results. Special care must be taken to inform
employee’s of the terms of a drug and alcohol policy and the consequences if testing
is found to be positive
Why Have a Drug and Alcohol Policy?
The construction and associated industries can benefit from setting out a company’s
stance on alcohol and drug misuse. Many large companies already have such policies
and regularly undertake testing to ensure that workers are not under the influence of
alcohol and/or drugs. It is also considered to be ‘due diligence’ given the environment
in which the employees work.
Other benefits include:
• Cost saving from training and recruiting new employees
• Reducing the cost of absence or decreased productivity
• Reducing the risk of accidents
• Improving the health of the workforce by provision of local advice and support
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Types of Drug and Alcohol Policy
Every employee should be covered by the general terms of a drug and alcohol policy in
the contract of employment. CBH recommends that consideration should be given to
the type of work undertaken and the associated risks and hazards for all workplaces
within the construction sector. The risk assessment process should identify safety critical
issues and any need for extensive testing procedures, taking into account issues as set
out above.
A drug and alcohol policy can range from a general statement regarding drug and
alcohol use to the comprehensive provisions for an employer who undertakes full drug
and alcohol testing on a regular basis
As part of its continuing commitment to improving health in the Construction Industry,
CBH’s Industry Standard for all Construction Sectors is that there is, as a minimum, a
written drug and alcohol policy or statement.
The contents of a D & A policy should be discussed and agreed with employees, Trade
Unions and workers representatives. In larger organisations, good practice would be to
set up a working party led by a senior manager to look at the issue of drug and/or
alcohol misuse as it affects business. Occupational health service providers, who are
accredited by Constructing Better Health (CBH), should also be involved.
Due the nature of construction work, drug and alcohol testing can be implemented
throughout the supply chain – often the employers policy may differ from that of a
contractor with different drugs being tested for or different levels of alcohol being
acceptable. It must be made clear to new starters and those visiting other sites what
the drug and policy testing policy is on sites and the requirements of each.
Consequences of positive test results may result in disciplinary action and being sent
home.
A sample drug and alcohol policy which can be adapted is available from CBH. The
sample document also provides a framework for policy and guidance on
implementation.
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FITNESS STANDARD Q:
DRUG & ALCOHOL SCREENING
(DEPENDANT ON EMPLOYERS POLICY)
Frequency:
Pre placement, 3 yearly and for cause testing post accident in SCW. Screening for
illicit drugs may be required for pre-placement or change of risk category health
assessments depending on local legislative requirements and organisational practices.
Screening may also be required by management at a triggered health assessment
CATEGORY
INTERPRETATION
1
Fit: No evidence of substance or alcohol misuse/abuse
2/3/4
Evidence of substance misuse / impairment due to illegal/
prescription or OTC medication using chain of custody procedures.
Control level: The current level for alcohol and drugs is:
• The presence of drugs for which there is no legitimate medical
need or very raised levels of prescribed drugs or
• Road Traffic Act Standard
• Railway Standard
Alcohol/drug dependence should be a bar from SCW until a period
of freedom from dependence (e.g. 3 years) is verified by a GP
report and further medical assessment/testing
May be fit for duty subject to review. Requires reference to
company drug and alcohol policy for further guidance and
management. The severity of the addiction, response to treatment
and the working requirements need to be taken into account. May
be suitable for alternative duties
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R - General Health/Lifestyle Checks
Whilst there is no legal requirement for general health checks such as measurements of
cholesterol or weight as part of a health promotion or wellbeing campaign; it is
considered best practice to look at overall health issues (rather than just work related
health matters) in order to improve workers wellbeing and to change health behaviour
such as smoking, overeating etc.
The government has expressed concerns at levels of obesity in the UK and that
everyone should aim to achieve a healthy weight to improve health and reduce the risk
of diseases associated with overweight and obesity. Health problems such as coronary
heart disease, type 2 diabetes, osteoarthritis and some cancers.
Employees and employers will benefit from taking part in health campaigns aimed at
changing behaviour not associated with work risks. Programmes such as blood pressure
checks, healthy eating, cholesterol testing.
FITNESS STANDARD R:
GENERAL HEALTH ASSESSMENT/LIFESTYLE
General health assessments can include blood pressure, urinalysis, cholesterol, height,
weight, body mass index (BMI), and health promotion/education. The following are
guidelines which can be followed to determine the type of advice/health promotion
Frequency: 3 yearly for SCW ‘Fitness for Work’ assessment
76
CATEGORY
Blood Pressure
See Fitness Standard J
Urinalysis
See Fitness Standard K
Cholesterol
The National Institute for Health and Clinical Excellence (NICE) and
Department of Health cholesterol guidelines are:
• Total cholesterol: less than 5.0mmol/l
• LDL cholesterol: less than 3.0mmol/l
Helpline: 0845 873 7726
www.cbhscheme.com
Height/Weight
BMI
Waist
Measurement
26/1/12
11:27
Page 77
Body mass index (BMI) is calculated by dividing weight (kgs) by the
square of height in metres (kg/m2) and can be used as a measure
of overweight in adults but needs to be interpreted with caution
because it is not a direct measure of adiposity
Classification
BMI
Healthy weight
18.5 – 24.9
Overweight
25 – 29.9
Obesity I
30 – 34.9
Obesity II
35 – 39.9
Obesity III
40 or more
Waist measurement can be used in addition to BMI for those who
have a BMI less than 35kg/m2. The assessment of health risks
associated with overweight should be based on the following
table:
BMI Classification
Waist Circumference
Low
High
Very High
Overweight
No increased Increased
Risk
Risk
Very High
Risk
Obesity I
Increased
Risk
Very High
Risk
High
Risk
For men, waist circumference of less than 94 cm is low, 94 –
102 cms is high and more than 102 cm is very high
For women, waist circumference of less than 80 cm is low, 80 –
88 cms is high, and more than 88 cm is very high
History taking
The past medical and family history can indicate the likelihood of
recurrence or the likely risk of developing a medical condition
Health
Promotion/
Education
In line with Government strategies, health promotion/education
activities can empower an individual to improve their lifestyle and
promote well being. Any advice given should be evidence based
‘Fitness for work’ standards for specific medical conditions
The table shown overleaf is intended as general guidance only on a number of serious
health conditions. Occupational health professionals can recommend fitness for work
or task taking into account the proposed role.
When considering fitness for work and any obligations under the Equalities Act, such as
adjustments and restrictions to working; safety considerations should take precedence.
Any decision, taken by the employer should be based on risk assessment and specialist
medical evidence, and not on assumptions.
It is possible that decisions taken may have to be defended in court.
77
CONDITION
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Page 78
RATIONALE/
RISK BASIS
COMMENTS
SAFETY
CRITICAL/
NONSAFETY
CRITICAL
Gastro
intestinal
Risk of infection to
others, acute
disability (e.g.
absence from post
for toilet breaks)
May be relevant
after holidays
abroad
3 whilst
symptomatic
1 non-catering
3 catering (may
need
bacteriological
clearance of
faecal specimens
Other
infection
Risk of infection to
others, acute
incapacity
Use public
health
guidelines
3 until resolved
1
HIV
Progression to
AIDS, may affect
the ability to
perform Safety
Critical Work due
to impairment of
mental function or
other affects on
the body
Advice on safe
sex and risk to
others
1 HIV if no side
effects from
treatment
1
Acute
complications e.g.
risk to self from
bleeding or to
others from fits
Advice on sun
exposure,
smoking,
control of
asbestos
exposure.
Screening for
breast, cervical
or bowel cancer
3 pending
assessment of
progress,
prognosis and
measure of
disability and
specialist
report.
Treatments may
be disabling
3 pending
assessment of
progress,
prognosis and
measure of
disability and
specialist report
3 until
treatment in
hand. Case by
case with
specialist advice
if uncertainty
about prognosis
or side effects
of treatment
1 Case by case
with specialist
advice if
uncertainty
about prognosis
or side effects of
treatment
INFECTIONS
CANCERS/
TUMOURS
Malignant
neoplasms
ENDOCRINE
AND
METABOLIC
Endocrine
(thyroid,
adrenal,
pituitary,
ovaries,
testes)
78
Risk of disability or
complications
Helpline: 0845 873 7726
www.cbhscheme.com
26/1/12
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CONDITION
RATIONALE/
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Diabetes –
non-insulin
treated(diet
or oral
medication)
Progression to
insulin use, of
visual, neurological
and cardiac
problems
Screening at
pre-placement
and periodic
health checks
1 when
stabilized in the
absence of
complications,
the employee
has an
awareness of
(sensation of)
hypoglycaemia/
diary of blood
sugars is
recorded/
absence of end
organ effects
that may affect
work as per
standards.
Annual health
screening
1 when
stabilized in the
absence of
complications
Diabetes –
insulin using
Safety-critical risk
from
hypoglycaemia.
Risk to self or
others from loss of
control
May be classed
fit if there is
sufficient
evidence that
condition is
well controlled.
The employee
has an
awareness of
(sensation of)
hypoglycaemia/
diary of blood
sugars is
recorded/
absence of end
organ effects
that may affect
work as per
standards
4 If criteria not
met
3 from start of
treatment until
stabilized,
depending on
individual
assessment
Obesity
Accident to self,
reduced mobility
and exercise
tolerance in
routine and
emergency duties.
Too heavy for
seating provided
Dietary and
lifestyle advice
2/3 consider as
IHD risk factor
79
CONDITION
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RATIONALE,
RISK BASIS
Page 80
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
BLOOD
DISORDERS
Blood
forming
organs
Varied – recurrence
of abnormal
bleeding. Acute
disability
2 coagulation
disorders
1 Case by case
judgment
Anaemia
Reduced exercise
tolerance, acute
disability
3 until
investigated
and treated
1 Case by case
judgment
Splenectomy
of certain
infections
1 Case by case
judgment
1 Case by case
judgment
4 for minimum
of 3 years.
Specialist report
on prognosis
and risk of side
effects of
treatment
3 until
investigated and
stabilised
Antibiotic
prophylaxis
MENTAL
DISORDERS
80
Psychosis
(acute)
schizophreni
a, bipolar
disorder
Recurrence,
accidents, erratic
behaviour, safety
performance
Alcohol
abuse
(dependency)
Recurrence,
accidents, erratic
behaviour, safety
performance
Advice on safe
drinking.
Policies on
alcohol use
3 until
investigated
and stabilized
with normal
blood
parameters for
3 years
4 if persistent
and affecting
health
Subject to
tailored
random testing
to check
compliance
3 until
investigated and
stabilized
4 if persistent
and affecting
health
Drug
dependence/
persistent
substance
abuse
Recurrence,
accidents, erratic
behaviour, safety
performance
Advice. Policies
on drug use
4 if history in
last 3 years
Subject to
tailored
random testing
to check
compliance
after
3 until
investigated and
stabilized
4 if persistent
and affecting
health
Neurosis
Poor performance
Personal and
organizational
advice on stress
management
3 while under
investigation or
acute. Consider
effects of
medication
1 case by case
assessment
Helpline: 0845 873 7726
www.cbhscheme.com
CONDITION
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RATIONALE/
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Organic
nervous
disease e.g.
Parkinson’s
disease,
multiple
sclerosis
Limitations on
muscular power,
balance,
co-ordination and
mobility
May have side
effects from
treatments
3 whilst under
investigation
and until stable.
Case by case
assessment
informed by
specialist advice
and based
on job
requirements
2/3 Case by case
assessment
informed by
specialist advice
and based
on job
requirements
Epilepsy
Risk to self and
others from
seizures
Consider lone
working
implications
and night work
– due to
medication.
Importance of
being aware of
a fit or absence
occurring
1 if free from
fits for 10 years,
no
anti-epileptic
treatment for
10 years, and
no continuing
liability to
seizures.
Normal EEG.
Withdrawal
from anti
epileptic
treatment not
considered
compatible
with SCW
unless cleared
by Neuro
consultant
2 no working at
heights until 1
year after fit or
1 year after end
of treatment.
Hand held
power tools may
be a hazard if
they can be
fixed in the ‘on’
position
Cranial
surgery
(including
treatment of
vascular
anomalies or
significant
traumatic
brain
damage)
Of epilepsy.
Defects in
cognitive, motor or
sensory function
3 for one year
1 case by case
assessment
Migraine
(frequent
attacks
causing
incapacity)
Risk of disabling
recurrences
3 until
investigated
and stabilized
Consider 4 if
persistent
1 case by case
assessment
DISEASES
OF THE
NERVOUS
SYSTEM
81
26/1/12
CONDITION
RATIONALE/
RISK BASIS
Syncope and
other
disturbances
of
consciousness
11:28
Page 82
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Recurrence causing
injury to self or
others through loss
of control
3 until
investigated
and specific
neurological or
cardiovascular
causes excluded
(for minimum 3
months).
4 if persistent
3 until
investigated and
stabilised
2 (no working at
heights) if
persistent
Menière’s
disease
Inability to balance
causing immobility
and nausea
3 during acute
phase
1 if completely
symptom-free
for 1 year
4 if frequent
and
incapacitating
2 (no working at
heights) if
frequent and
incapacitating
Narcolepsy/
Cataplexy/
Sleep apnoea
Recurrence causing
injury to self or
others through loss
of control
4
2 no working at
heights until
symptoms
controlled
Encephalitis/
Meningitis
Acutely disabled
3 until fully
recovered
3 until fully
recovered
Intracranial
haematoma
Of epilepsy.
Defects in
cognitive, motor or
sensory function
3 with specialist
assessment
when epilepsy
risk less than
2%
2 no working at
heights for 1
year
Diagnosis and
treatment via a
sleep clinic
CARDIOVASCULAR
SYSTEM
82
Heart –
congenital
and valve
disease
Limit on exercise,
risk of bacterial
endocarditis.
Advice on
prophylaxis
4 if
symptomatic
3 for 1 year
after cerebral
embolism
1
Hypertension
Risk factor for IHD,
stroke, eye or
kidney damage
Screening at
medical. Early
treatment
3 until
stabilized then
1 with annual
medical
2 (no working at
heights) until
stabilized, then
1
Helpline: 0845 873 7726
www.cbhscheme.com
26/1/12
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Page 83
CONDITION
RATIONALE,
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Cardiac
event
(myocardial
infarction,
ECG evidence
of old MI,
newly
diagnosed
Left bundle
branch block,
angina,
cardiac
arrest, CABG,
angioplasty)
Risk of recurrence
leading to sudden
loss of capability,
reduced exercise
tolerance
Risk factor
screening,
lifestyle advice,
smoking
cessation advice
3 until
investigated
and stabilized
and successful
completion of
Bruce protocol
without
ischaemic
changes.
Annual review
1/2 no working
at heights for 6
weeks
Cardiac
arrhythmias
(and
conduction
defects,
including
those with
pacemakers)
Risk of recurrence
and sudden loss of
capability, exercise
limitation.
Pacemaker activity
affected by strong
electromagnetic
fields
4
2 (no working at
heights) until
stabilized, then
1
Other heart
disease e.g.
cardiomyopa
thies,
pericarditis,
heart failure
Risk of sudden loss
of capability,
exercise limitation
4 if
symptomatic
and no
ischaemia
noted in
completed
Bruce protocol
2 (no working at
heights) until
stabilized, then
1
Ischaemic
cerebrovascular
disease
Risk of sudden loss
of capability,
mobility limitation.
Risk of other
circulatory disease
causing loss of
capability
Risk factor
screening,
lifestyle advice,
smoking
cessation advice
3 for 1 year
after TIA or
stroke,
provided fully
recovered and
no significant
risk factors
4 if not fully
recovered/
remaining risk
factors
2 (no working at
heights) for at
least 1 month,
until stabilized,
then 1
Intermittent
claudication
Mobility limitation.
Risk of other
circulatory disease
causing loss of
capability
Risk factor
screening,
lifestyle advice,
smoking
cessation advice
1 provided no
ischaemia on
successfully
completed
Bruce protocol
1
Deep vein
thrombosis
or
pulmonary
embolus
Risk of sudden loss
of capability from
embolus,
temporary
limitation of
mobility
3 until treated
and stable
4 if recurrent
3 until treated
and stable
83
CONDITION
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Page 84
RATIONALE,
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Chronic
bronchitis
and
emphysema
COPD
Reduced exercise
tolerance and
disabling
symptoms
Advice on
smoking
cessation
Case by
case assessment
1
Asthma
Unpredictable
episodes of severe
breathlessness.
May be
occupational
disease
Early detection
of occupational
and other
remediable
causes. Keep
inhalers close
3 until stable
2 restrictions if
occupational
cause
2 restrictions if
occupational
cause
Pneumothorax
spontaneous
/traumatic
Acute disability
from recurrence
4 if recurrent
unless
pleurectomy
performed for
spontaneous
3 until resolved
for traumatic
3 until resolved
Stoma
Site of stoma
relevant to PPE
Case by case
assessment
Case by case
assessment
Cirrhosis of
liver
Liver failure,
bleeding
4 if severe or
complicated by
ascites or
oesophageal
varices
Case by case
assessment
Pancreatitis
Recurrence
4 if recurrent or
alcohol related
Case by case
assessment
RESPIRATORY
SYSTEM
DIGESTIVE
SYSTEM
84
Advice on safe
drinking.
Policies on
alcohol use
Helpline: 0845 873 7726
www.cbhscheme.com
CONDITION
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RATIONALE,
RISK BASIS
11:28
Page 85
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
3 Until
investigated
and causes
resolved
Case by case
assessment
GENITOURINARY
CONDITIONS
Protein,
Glucose or
Blood in
urine
Indicator of renal
or other diseases
SKIN
Infections
Exacerbation, risk
to others
Advice on
hygiene and
use of PPE
Case by case
assessment
Case by case
assessment
Eczema,
dermatitis
Consider
occupational
causes
Advice to
individual and
employer on
occupational
allergens and
irritants. Advice
on skin care
1 If not
occupational
2 If
occupational
1 If not
occupational
2 If occupational
MUSCULOSKELETAL
Osteoarthritis,
other joint
diseases and
subsequent
joint
replacement
Pain and limitation
of mobility reduce
capability. Risk of
dislocation of
replaced joints
Case by case
assessment,
based on
history and job
requirements
Case by case
assessment,
based on history
and job
requirements
Recurrent
instability of
shoulder or
knee joints
Sudden disabling
loss of mobility
with pain
3 Until
satisfactorily
treated
Case by case
assessment
Limb
prosthesis
Mobility limitation
Case by case
assessment,
based on
history and job
requirements
Case by case
assessment,
based on history
and job
requirements
85
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Page 86
CONDITION
RATIONALE,
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Back pain
Mobility limitation,
risk of
exacerbation
Manual
handling
advice. Early
intervention
and
rehabilitation
to reduce risk
of chronicity.
Refer for
physiotherapy
3 If
incapacitating
3 If
incapacitating
Case by case
assessment
based on defect
and job
requirements
Case by case
assessment
based on defect
and job
requirements
SENSORY
Speech
defect
Limits to
communications –
may be safety
critical
Recurrent
ear
infections
Risk to others
Hearing
protection may
cause issues
1 Provided
hearing is
adequate
2 (no food
handling)
Deafness
Limits to routine
and emergency
communication,
may be safety
critical. May be
occupational noise
induced hearing
loss
Advice to
individual and
employer about
noise reduction
1 If to HSE
category 1 or 2
Case by case
assessment
based on defect
and job
requirements
Safety critical loss
of visual
information
Provision of
appropriate
correction
safety glasses
Eyesight
86
Helpline: 0845 873 7726
See safety
critical standard
for details
4 If standards
not met
3 For 3 months
after laser
refractive
surgery
1 With
surveillance for
specific
conditions (e.g.
glaucoma)
where
standards are
met
www.cbhscheme.com
4 If standards
not met
CONDITION
26/1/12
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Page 87
RATIONALE,
RISK BASIS
COMMENTS
SAFETY
CRITICAL
NONSAFETY
CRITICAL
Pregnancy
Should not be a
bar to SCW but
case by case
assessment in cases
of fainting/
hyperemesis
gravidarum,
hypertension, post
caesarean section
Should be
based on ‘New
and Expectant
Mothers’ risk
assessment
Caution
regarding SCW
dependant on
severity of
symptoms.
Assessment
required. 3
4 if standards
not met/
evidence of
increased risk to
mother and
unborn child.
Prescribed
medication
Lowered
performance, other
side effects,
Policy for
reporting
medicine use,
advice on
restrictions.
Side effects on
patient
information
leaflet
3 For duration
of medication if
package notes
indicate risk
when driving/
operating
machinery or
other relevant
side effects
Case by case
assessment
based on side
effects and job
requirements
Transplants
Risk of rejection,
side effects of
medication
Case by case
assessment
Case by case
assessment
GENERAL
Conditions
not
specifically
listed
Progressive
conditions
that are
currently
within
standards
Use analogy
with related
conditions as a
guide. Consider
excess risk of
sudden
incapacity, or
limitations on
performing
normal or
emergency
duties
Varied – e.g.
Huntington’s
chorea including
family history,
keratoconus,
Multiple Sclerosis
May have
increased levels
of absence
Consider
Equality Act
Case by case
assessment with
specialist
advice. Such
conditions do
not bar if
harmful
progression
before next
medical is
judged to be
unlikely
87
26/1/12
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Page 88
References
• Access to Medical Reports Act 1988
• Agriculture (Tractor cab) Regulations 1974
• Asthmagen? Critical assessments of the evidence for agents implicated in
occupational asthma ISBN 0 7176 1465 4, HSE Books
• At a glance guide to the current medical standards of fitness to drive, issued by the
DVLA
• Blueprint for UK Construction Skills 2007-2011 (Construction Skills Network Model,
2006; Experian)
• Clinical Testing and Management of Individuals exposed to Hand Transmitted
Vibration: An Evidence Review. FOM April 2004
• Control of Lead at Work Regulations 2002 (ISBN 0-7176-2565-6)
• Control of Noise at Work Regulations (2005)
• Control of Vibration at Work Regulations 2005 Management of Health & Safety at
Work Regulations 199
• Cook R (1996) Urinalysis: ensuring accurate urine testing. Nursing Standard. 10, 46,
49-54
• Equalities Act 2010
• Fitness for Work, The Medical Aspects, 4th Edition edited RAF Cox
• Employment Law and Occupational Health, Joan Lewis and Greta Thornbury
• Guidance notes for ADs CLAW 2002
• Hand Arm Vibration at Work. HSE www.hse.gov.uk/vibration/hav/index.htm
• HAVS nomogram http://www.hse.gov.uk/foi/internalops/fod/inspect/havs.pdf
• HAVS Screening Limited www.Whitefinger.co.uk
• Health & Safety (Display Screen Equipment) Regulations 1992
• Health and Safety at Work Act 1974
• HSE guidance note MS26
• HSE Guidance Series L108
• Management of Health and Safety at Work Regulations 1999
• Manual of Clinical Practices. Core Elements of Care: Diagnostic Interventions.
Edinburgh, RIE
• Mechanical vibration. Measurement and assessment of human exposure to
hand-transmitted vibration. BS EN ISO 5349-2:2002
• Medical and occupational evidence for recruitment and retention in the Fire and
Rescue Service, Office of the Deputy Prime Minister
• Medical aspects of occupational asthma MS25, HSE
• NICE Guidelines on Obesity (2006)
• Nice Guidelines on Management of Long Term Sickness Absence and Incapacity for
Work (2009)
88
Helpline: 0845 873 7726
www.cbhscheme.com
26/1/12
11:28
Page 89
• Occupational Contact Dermatitis and Urticara, BOHRF
• Occupational Health Standards in the Construction Industry CWH/07/04 HSL
http://www.hse.gov.uk/research/rrhtm/rr518.htm
• Proposals for new Control of Vibration at Work Regulations (Northern Ireland) 2005.
HSENI (Health and Safety Executive for Northern Ireland)
www.hseni.gov.uk/legislation/
• PUWER Regulations 1998
• RIDDOR Regulations 1995
• Royal Infirmary of Edinburgh NHS Trust (1997)
• RSSB, Recommendations for Train Movement, Staff Suitability and Fitness, GO/RC3561
• Supply of Machinery (Safety) Regulations 1992
• The Control of Vibration at Work Regulations 2005. Guidance on Regulations. HSE.
HSE Books
• Thompson J (1991) The significance of urine testing. Nursing Standard. 5, 25, 39-40
Acknowledgements
We would like to thank Dr Ray Quinlan and Dr Martin Philips of RPS Business
Healthcare, Dr Geoff Davies, Wendy Stimson and Jane Coombs; also the HSE for their
contribution to the Industry Standards for Workplace Health in the UK Construction
Industry.
89

CBH National Industry Standards

Transcription

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