We all know that a key element of successful health and safety management is risk assessment. We work through the process under consideration, thinking about the hazards, how they can be controlled etc. But what do we do when we get to the question of ‘Is health surveillance required?’

Many people find this part of the ‘journey’ quite difficult.

The requirement for health surveillance is to be found in a number of pieces of legislation, but I’m going to concentrate here on the Control of Substances Hazardous to Health Regulations 2002 – or COSHH as we tend to refer to it.

It’s no ‘accident’ that the Regulations are ordered in the way they are, known as the ‘hierarchy of control’:

To remind ourselves of this process - we are required to identify the substance being used, consider whether another substance can be used, if not, arrange for potential worker exposure to be controlled in some way, by enclosure, extraction ventilation or protective clothing – usually a combination of all 3 of these.

Once the protective arrangements have been put in place, a system of monitoring is usually needed to ensure that the arrangements are working – e.g. environmental or personal hygiene monitoring.

Following this comes the requirement for health surveillance – we are now at Regulation 11  in the Regulations as you may be aware

In the initial guidance for Regulation 11 the criteria for when health surveillance should be initiated is outlined, it’s useful to remember this on all occasions when considering the requirement for health surveillance, so quoting this precisely here:

‘Health surveillance shall be treated as being appropriate where the exposure of the employee to a substance hazardous to health is such that:

  1. an identifiable disease or adverse health effect may be related to the exposure;
  2. there is a reasonable likelihood that the disease or effect may occur under the particular conditions of his work; and
  3. there are valid techniques for detecting indications of the disease or effect’

It should be noted that just prior to the above, reference is made to the specific substances in Schedule 6 and related processes and health surveillance. These are only relevant in regard to the specific substances mentioned and industries.

If we consider for example isocyanate: In widespread use in vehicle painting etc. A known respiratory sensitiser, or more simply – a substance that can cause occupational asthma.  This has just described a) above – ‘identifiable disease or adverse health effect.’  The product safety information should point you in the direction of identifying diseases and adverse health effects.

Now to the ‘reasonable likelihood’…. etc under the particular conditions of work.

If the process were to be completely enclosed – with no worker present in the enclosure, then there would be virtually no likelihood that the ‘adverse health effect’ would occur under these working conditions.

However, we know that in most cases this work is undertaken by a worker in a paint spray booth, using a ‘mask’ i.e. respiratory protective equipment. Whilst the booth should be inspected (maintenance, examination and testing of control measures – Regulation 9 of COSHH) and the ‘mask’ should be face fitted to ensure a protective fit., as a fully enclosed system is not being used, there could be potential for the worker to be exposed to the substance in question.

There are ‘valid techniques’ for ‘detecting indications of the disease or effect’ – respiratory symptom questionnaires, and possibly lung function tests. A urine test for detecting the presence of isocyanate can also be used. Advice on the appropriateness of any of these ‘techniques’ can be obtained from an occupational health provider. A specialist occupational health nurse or doctor would be considered ‘competent’ to provide this advice under the Management of Health and Safety Regulations 1999 and can assist you with setting up and running a programme of health surveillance. A health professional isn’t always needed to undertake the ‘valid techniques’ – e.g. where a substance is being used that can cause skin problems, a member of the workforce can be trained to do this, with assistance from an occupational health nurse or doctor, also acting as a referral point for any identified problems.

The above is merely intended as a guide to start the assessment process so that health surveillance can at least be initially considered as part of the overall risk assessment and control measures for the substance and process.

There are specific regulations covering lead and asbestos, also noise so these should be considered separately referring to the relevant health and safety guidance.

Health surveillance should be used to monitor the effectiveness of the control measures and assure workers that their health is not being compromised by their work. It assists the employer in complying with their duties under health and safety law.

Melanie Phillips is a Specialist Occupational Health Nurse and Chartered Health and Safety Practitioner

Link - HSE Is Health Surveillance required in my workplace?

Link - HSE Set up and Design health surveillance according to need

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