11.3 Managing occupational health

Question 1

Occupational health focuses on three main objectives:

Answer 1

 The maintenance and promotion of workers’ health and working capacity.
 The improvement of working environment and work to become conducive to
safety and health.
 The development of work organizations and working cultures in a direction which
supports health and safety at work and in doing so also promotes a positive
social climate and smooth operation and may enhance productivity of the
undertakings.

Question 2

In complex organisations with a spectrum of occupational health hazards a multi-
faceted team of professionals may be required to help manage the risks.

The key professionals are likely to be an occupational physician and occupational
health nurse / adviser. Other professionals who may have a key role to play include: 6

Answer 2

  Toxicologists 
  Physiotherapists 
  Ergonomists 
  Microbiologists 
  Psychologists  
  Health physicists.

Question 3

There are currently three levels of qualification in occupational medicine for doctors:

Answer 3

 Diploma in Occupational Medicine (DOccMed) (recommended minimum standard
of qualification).
 Associate membership of the Faculty of Occupational Medicine (AFOM).
 Membership of the Faculty of Occupational Medicine (MFOM).

Question 4

Nurses who carry out occupational health surveillance should, as a minimum, be
registered with

Answer 4

the Nursing and Midwifery Council (NMC). They may also hold an
occupational health qualification at Certificate, Diploma or Degree level. If the nurse
does not have an occupational health qualification then they should work under the
supervision of an appropriately qualified clinician (doctor or nurse).

Question 5

Generally the distinction between assessment and surveillance is the same as the
distinction between

Answer 5

measuring and monitoring

Question 6

There are many activities that can be done to measure or monitor the health of
employees that should not be confused with health surveillance. Examples include
measures necessary to comply with legal duties such as:

Answer 6

 Pre-placement and annual medical examinations to assess an individual’s
fitness for work, under the Ionising Radiations Regulations 1999.
 Health screening such as eye and eyesight testing under the Health and Safety
(Display Screen Equipment) Regulations 1992.
 Assessments of fitness to drive or operate cranes within dock premises
under the Docks Regulations 1988.
 Fitness for work health assessments offered to night workers under the Working
Time Regulations 1998.

Question 7

Health surveillance is about

Answer 7

putting in place systematic, regular and appropriate
procedures to detect early signs of work-related ill health among employees exposed
to certain health risks. It is also about acting on the results to prevent any
progression of work-related ill health.

Question 8

Health surveillance offers a range of potential benefits for the employer and
employees, including: 5

Answer 8

 Detecting harmful health effects at an early stage, protecting workers and helping
to keep them fit for work.
 Checking the on-going effectiveness of control measures.
 Providing data by health records to help detect and evaluate health risks.
 Providing an opportunity to train and instruct employees further in safe and
healthy working practices.
 Giving employees a chance to raise concerns about the effect of work on health.

Question 9

Health surveillance may be appropriate where

Answer 9

a risk cannot be reduced or controlled

to such a level that it will not be harmful to health.

Question 10

The following conditions should be met for health surveillance to be appropriate: 4

Answer 10

 The work is known to damage health in some particular way.
 There are valid ways to detect the disease or condition. To be effective health
surveillance has to be able to reliably show that damage to health is starting to
happen or becoming likely. The technique must be accurate, safe and practical.
 Damage to health must be likely under the particular conditions at work.
 Surveillance should benefit the employee in some way.

Question 11

Health surveillance action guide 8

Answer 11

1. Involve employees and their
representatives
2. Obtain specialist advice if
appropriate
3. Identify the most suitable health
surveillance procedure
Consider the type of hazard, degree
of risk, likely health effects, affected
employees, relevant procedure(s),
whether in-house expertise exists
4. Design system, put
someone in charge
5. Set up the programme
6. Carry out procedures/
feedback information
7. Keep records
8. Monitoring, action and evaluation
Protect individuals at risk
Review your risk assessment
Improve risk control
Discuss grouped results with
employee representatives

Question 12

The range of techniques available

Answer 12

Self-checks

A responsible
person making
basic checks for
signs of disease

Enquiries about 
symptoms, 
inspection and 
examination by a 
qualified person 

Clinical
examinations

Biological
monitoring and
biological effect
monitoring

Question 13

When health surveillance shows that an employee’s health is being affected by work,
the following steps should be taken: 4

Answer 13

 Prevent further harm by temporarily removing them from exposure to the hazard,
or reducing their exposure.
 Refer the individual for further examination and/or treatment by an occupational
health doctor.
 Re-examine the relevant risk assessment(s) to determine what further action
may need to be taken to protect the rest of the workforce or to extend
surveillance.
 Improve control measures as necessary, seeking specialist advice (from
occupational hygienists, for example), as necessary.

Question 14

Health surveillance results can be used in two ways:

Answer 14

(1) Individual assessments should aim to improve the protection of the employees
covered.
(2) Analysis of group data provides an insight into how well the health risk control
programmes are working.

Question 15

Legal requirements for health surveillance

Answer 15

Control of Substances
Hazardous to Health
Regulations 2002
(CoSHH)

Control of Noise at Work 
Regulations 2005 (CNWR) 

Control of Vibration at
Work Regulations 2005
(CVWR)

Health and Safety
(Display Screen
Equipment) Regulations
1992

Question 16

Legal requirements for medical surveillance

Answer 16

Control of 
Substances 
Hazardous to 
Health Regulations  
2002 (CoSHH) 

Control of Lead at
Work Regulations
2002 (CLAW)

Control of Asbestos
Regulations 2012
(CAR)

Ionising Radiation
Regulations 1999
(IRR99)

Question 17

Health surveillance programmes should include keeping a health record for each
individual. These are important because they provide: 3

Answer 17

 an historical record of jobs involving exposure to substances or processes
requiring health surveillance
 a record of the outcome of previous health surveillance procedures (in terms of
fitness for work, restrictions required etc)
 information for HSE or local authority inspectors to show that health surveillance
has been carried out.

Question 18

Health records are different from clinical records in that

Answer 18

they do not contain
confidential clinical details and can therefore be kept securely with other confidential
personnel records

Question 19

Length of retention of health records

Answer 19

As a general rule, employee’s individual health records should be kept for as long as
they are under health surveillance.

CoSHH1998, CAR 2012, and the Work in Compressed Air Regulations 1996 all
require that records are ‘kept in a suitable form for at least 40 years from the date of
the last entry made in it.’ The guidance to CLAW 2002 also recommends keeping
records for 40 years.

IRR99 requires that records are kept:
… until the person to whom the record relates has or would have attained
the age of 75 years but in any event for at least 50 years from the date of
the last entry made in it.

CNWR 2005 and CVWR 2005 merely require that a suitable record is made and
maintained.

Question 20

The Data Protection Act 1998 requires those who hold information on health and
medical records to

Answer 20

tell those on whom records are held that a record is being kept,
its purpose and that they have a right to see the information and correct it.