Health surveillance
Health surveillance involves on-going health checks designed to detect ill-health effects from specific identified hazards using a risk assessment process. Health and safety law requires health surveillance when workers remain exposed to health risks even after controls have been put in place. This is because control measures may not always be reliable, despite appropriate checking, training, and maintenance. Health risks which require health surveillance include noise, vibration, and substances hazardous to health.
At Essex, health surveillance is likely to be required when there is a high risk from exposure to:
- Respiratory sensitisers, e.g. minerals, oils, wood dust, solder fumes, chemicals, biological agents.
- Skin sensitisers such as substances that may cause dermatitis, e.g. latex and wet work.
- Sustained periods of loud noise
- Regular use of vibrating tools or machinery
- Night working
Health records relating to health surveillance should be kept for 40 years under the Control of Substances Hazardous to Health (COSHH) Regulations, as per the Occupational Health retention schedule.
Health surveillance
Objectives of Health Surveillance:
- To proactively screen to detect early signs of work affecting employees' health.
- To protect the health of employees by detecting ill-health effects as early as possible.
- To assess the effectiveness of measures to control exposure.
Health surveillance is conducted by one of the Occupational Health Advisers, usually on a yearly or two-yearly basis except for skin surveillance, where supervisors may carry out these checks following appropriate training from Occupational Health. Health surveillance can take the form of questionnaire screening and physical tests such as hearing tests and lung function tests.
Assessing need for health surveillance
A specific risk assessment must be used to identify any need for health surveillance. The person who undertakes the risk assessment for the work is responsible for identifying the need for health surveillance.
Workplace Health, Safety and Wellbeing (WHSW) can support and advise managers in completing the risk assessment (especially when specific measurements are required, for example, of noise levels) and to identify employees exposed to specific health hazards requiring health surveillance.
Once those requiring health surveillance have been identified, the manager must make Occupational Health aware and provide the risk assessments and COSHH assessments already in place to manage the identified hazards. Relevant employees will then be contacted by OH to complete a questionnaire and/or attend an appointment.
Manager/Department responsibilities
With the support of the HSLO/DBSO and/or Health and Safety Adviser, managers/departments should:
- Undertake suitable and sufficient risk assessments and inform OH if the potential need for health surveillance has been identified.
- Ensure that all people working with or intending to work with substances requiring health surveillance are identified by the managers and registered on the appropriate health surveillance programme.
- Record and maintain all health surveillance results (health records) confidentially which are to be kept for 40 years in line with the COSHH Regulations.
- Ensure prompt referral to OH if a member of staff reports ill health symptoms that could be related to their working environment, e.g. Respiratory/skin problems.
- Ensure that where reasonably practicable any recommendations from OH are implemented where recommendations are not able to be made OH should be informed.
Types of health surveillance
Hearing
The Control of Noise at Work Regulations 2005 ensure that workers' hearing is protected from excessive noise at their place of work which could cause them to lose their hearing and/or to suffer from tinnitus (permanent ringing in the ears). Hearing tests are carried out to check if employees might be suffering from early signs of hearing damage and provides the opportunity to prevent further damage.
Who may require surveillance:
- Employees who are regularly exposed to noise at the upper exposure action levels (daily or weekly exposure of 85dB, peak sound pressure of 137dB)
- Those who are at increased risk for any reason e.g. they already suffer from hearing loss or are particularly sensitive to damage.
Examples of teams (not exhaustive):
- Maintenance
- Grounds
What it involves:
- Questionnaire
- Hearing test
Frequency: On employment, annually for the first two years then two-yearly.
Further information: HSE guidance on noise.
Respiratory
The Control of Substances Hazardous to Health (COSHH) Regulations require adequate control of exposure to materials in the workplace that cause ill health. Respiratory surveillance is carried out to check for any damage to the lungs as a result of breathing in hazardous substances.
Who may require surveillance:
- Employees who are exposed to substances or processes where occupational asthma is a known problem.
- Those working with respiratory irritants or sensitizers as defined by COSHH.
Examples of teams (not exhaustive):
- Maintenance
- Cleaners
What it involves:
- Questionnaire
- Spirometry (lung function) test, which requires measuring height and weight.
Frequency: Annually
Further information: HSE guidance on COSHH health surveillance
Hand/arm vibration (HAV)
Hand-arm vibration is vibration transmitted from work processes into workers' hands and arms. It can be caused by operating hand-held power tools, such as road breakers, and hand-guided equipment, such as powered lawnmowers, or by holding materials being processed by machines, such as pedestal grinders. Hand-arm vibration can cause a range of conditions collectively known as hand-arm vibration syndrome (HAVS), as well as specific diseases such as carpal tunnel syndrome.
Who may require surveillance:
- Employees who are likely to be regularly exposed to vibration above the action value of 2.5 m/s2 A(8) – the level at which specific measures must be taken to eliminate or reduce exposure.
- Employees likely to be exposed occasionally above the action value and where the risk assessment identifies that the frequency and severity of vibration exposure may pose a risk to health.
- Employees already diagnosed with HAVS, even if exposure is below the action value. This is to continue to monitor for worsening of symptoms.
Examples of teams (not exhaustive)
- Maintenance
- Grounds
What it involves
- Questionnaire
- Physical examination and further testing (if required)
Frequency: Annual questionnaire and additional testing where indicated.
Further information: HSE guidance on Hand-arm vibration
Skin
The Control of Substances Hazardous to Health (COSHH) Regulations require adequate control of exposure to materials in the workplace that cause ill health. Skin surveillance is carried out to check for any damage to the hands as a result of handling hazardous substances.
Who may require surveillance: Those who are working with skin irritants or sensitisers as defined by COSHH.
Examples of teams (not exhaustive):
- Cleaners
- Food service workers
- Laboratory workers
What it involves
- Questionnaire
- Visual inspection
If a supervisor has received training from Occupational Health, they will request a questionnaire on skin health be completed annually by their employees and complete 3 monthly visual inspections. If any skin problems are noted, the employee should be referred immediately to Occupational Health for further assessment.
Frequency: 3 monthly visual checks and annual questionnaire
Occupational Health can advise on glove use and other personal protective equipment. They can also advise on hand care products used in the workplace for any worker experiencing any issues.
Further information: HSE guidance on COSHH health surveillance
Biological agents
The Control of Substances Hazardous to Health (COSHH) Regulations require adequate control of exposure to materials in the workplace that cause ill health. This can include biological agents used in research experiments, as listed on the Approved List of Biological Agents.
Who may require surveillance: Employees involved in projects involving pathogens or genetically modified organisms in Hazard Group 2 or human blood or tissue samples that may contain Group 2 pathogens.
What it involves
- Questionnaire, appointment if deemed necessary
Frequency: Annually
Night workers
The Working Time Regulations 1999 provide workers with certain entitlements. These include special protection for night workers who must be offered free and confidential health assessments before starting work, on a regular basis, or as appropriate to the individual.
Who may require surveillance:
Those who undertake at least three hours of night work (11pm-6am) on a regular basis. This is primarily Security staff.
What it involves:
- Questionnaire.
- Follow up assessment (if needed).
The health questionnaire is voluntary but enables the employee to report any health concern or medical condition that is difficult to manage or made worse by working night-time hours. The health questionnaire remains confidential to Occupational Health. Medical details will not be passed on to managers other than a simple statement of fitness to continue with night working.
Adjustments:
If a worker has a medical condition that may require work adjustments, an appointment will first be made with the Occupational Health Adviser, to discuss the health problem and agree on recommendations to be made to the manager and Employee Relations.
Frequency: Annual.
Further information: HSE guidance on managing shift work
