Controlling Workplace Health Issues

International Diploma for Occupational Health
and Safety Management Professionals
Unit ID2 : Do – Controlling Workplace

Health Issues (International)
Unit ID2: Do – Controlling Workplace Health Issues (International)

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GWG - NEBOSH IDIP Textbook - Version 1 (June 2021)
Specification Date: July 2020
NEBOSH Syllabus Publication Date: April 2021

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Acknowledgements and Disclaimer
Green World Safety & Security Consultancies LLC is thankful to National Examination Board in
Occupational Safety and Health (NEBOSH) for allowing us to reproduce extracts from their
documents including Syllabus guide, examiner reports and past exam papers available on their
website.
We also acknowledge the permission given by the following bodies to allow the use of their
publically available material:
• Health and Safety Executive HSE-UK

• International Labour Organization (ILO)
• National Institute for Occupational Safety and Health (NIOSH)-USA
• Occupational Safety and Health Administration (OSHA)-USA
• Safe Work Australia
• Worksafe Victoria
• European Agency for Safety and Health at Work
• Worksafe New Zealand
We’d like to express a gratitude of thanks to the authors of this book.
- Mr. Shanker Srikumar – Dip. RSA, Grad IOSH, M.Sc, MBA (UK), SIIRSM
- Mr. Manikandan Gobinath - Dip. RSA, Grad IOSH, MBA (UK), MIIRSM
- Mr. Dilip Madurai – MET (General Emphasis - US), IDip NEBOSH, Grad IOSH, Lead Auditor
- Mr. Logananthan Ramachandran – Grad IOSH, B.Tech, MS (Sweden), MBA
- Mr. Varun Vignesh – M.Tech HSE, Grad IOSH

Contents
9.1 Occupational health services, Equality in the workplace ................................................................... 7
The basic principles of the bio-psychosocial model and how it relates to the health of individuals ... 7
Why it is important to make ‘reasonable adjustments’ for workers with physical and mental ill-
health .................................................................................................................................................... 8
The role and benefits of ‘pre-placement’ assessment ......................................................................... 8
Managing long-term sickness absence and capability .......................................................................... 9
The meaning of vocational rehabilitation ........................................................................................... 10
The benefits of vocational rehabilitation within the context of the worker and the employer ........ 10
Possible barriers to the effective rehabilitation of workers ............................................................... 11
What needs to be considered in a risk assessment prior to return to work ...................................... 12
Liaison with other disciplines in assessing and managing fitness for work ........................................ 14
The role of agencies that can support employers and workers ......................................................... 15
The roles of typical occupational health specialists............................................................................ 16
Typical activities offered by an occupational health service .............................................................. 19
9.2 Mental ill-health, Wellbeing, Workplace violence, Lone working .................................................... 20
Occupational circumstances that could lead to workplace mental ill-health issues .......................... 20
The impact of chronic pain on a worker’s mental health ................................................................... 21
Depression and anxiety ....................................................................................................................... 22
The effects of fatigue on mental health ............................................................................................. 23
The meaning of work-related stress and its relationship to mental health conditions...................... 25
The causes of work-related mental ill-health relating to organisation, job and individual ................ 25
Non work-related factors effecting mental health ............................................................................. 28
Recognition that common mental health problems found within the workplace are rarely entirely
due to work-related factors but are a combination of a number of factors ...................................... 29
Why health and safety professionals, occupational health services (where relevant) and the
organisation’s HR department should work together to manage workers’ mental ill-health
conditions............................................................................................................................................ 30
Recognition that most people with mental health problems can continue to work effectively and
how this can be facilitated/supported by employers ......................................................................... 33
The identification and assessment of work-related mental ill-health at individual and organisational
level ..................................................................................................................................................... 34

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The types of interventions for mental ill-health ................................................................................. 35

How workers with mental ill-health conditions can be managed in the workplace .......................... 36
The benefits of good nutrition, exercise and sleep on mental ill-health conditions .......................... 36
The British HSE stress management standards and their role in assessing and managing work
related stress....................................................................................................................................... 40
The relationship between wellbeing and mental health .................................................................... 41
How health and wellbeing workplace strategy can help to improve workers’ health ....................... 42
The link between health and wellbeing and safety culture ................................................................ 43
Why line managers must be trained on wellbeing strategies and initiatives ..................................... 43
The meaning of work-related violence ............................................................................................... 46
What is harassment? .......................................................................................................................... 46
The physical and psychological effects ............................................................................................... 46
The factors likely to increase the risk of work-related violence ......................................................... 47
Four stages for effectively managing work-related violence.............................................................. 48
What is a lone worker? ....................................................................................................................... 52
How general risk assessments can be used to avoid and control risks to lone workers .................... 53
The impact on risk to lone workers .................................................................................................... 54
Particular problems facing lone workers ............................................................................................ 54
Alternatives, precautions and safe working procedures for lone working......................................... 55
9.3 Health Surveillance ........................................................................................................................... 57
The distinction between general health assessment and health surveillance ................................... 57
The elements of the British HSE’s health surveillance cycle............................................................... 58
Noise health surveillance .................................................................................................................... 59
Vibration health surveillance .............................................................................................................. 63
Keeping health records and medical records confidential ................................................................. 63
Biological monitoring .......................................................................................................................... 65
Why health assessments should be offered to shift/night workers ................................................... 66
Forms of health surveillance that are a good idea to carry out although there is no legal
requirement ........................................................................................................................................ 68
How to establish and maintain an alcohol/drugs policy and tie in with other relevant policies/
procedures .......................................................................................................................................... 68
The benefits of pre-employment health screening ............................................................................ 73

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When testing for alcohol/drugs should be carried out....................................................................... 74

The disadvantages of alcohol/drugs testing ....................................................................................... 76
9.4 Hazardous Substances ...................................................................................................................... 78
The structure and function of human anatomical systems ................................................................ 78
The concept of target organs and target systems in relation to attack by hazardous substances .... 89
The body’s defensive responses with particular reference to the respiratory system ...................... 93
The distinction between inhalable and respirable dust ..................................................................... 98
9.5 Health risks from hazardous substances .......................................................................................... 99
The aims of REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) ............. 99
The purpose of classification and the role of hazard and precautionary statements for hazardous
substances........................................................................................................................................... 99
EC Regulation 1272/2008 Classification, Labelling & Packaging of Substances and Mixture (CLP) . 102
Health hazard classes ........................................................................................................................ 104
Information on substances or preparations/mixtures which have the potential to cause harm to be
communicated to users .................................................................................................................... 105
What should be considered in the assessment of risks to health from hazardous substances ....... 112
Review of risk assessment ................................................................................................................ 112
The prevention and control of exposure to hazardous substances ................................................. 113
9.6 Epidemiology and toxicology .......................................................................................................... 114
Human epidemiological investigations ............................................................................................. 114
The role of toxicological testing ........................................................................................................ 116
The meaning of dose-response relationship, NOAEL, LD50, LC50 .................................................... 121
9.7 Asbestos and lead ........................................................................................................................... 122
Identification of types of asbestos .................................................................................................... 122
Typical locations where asbestos can be found ............................................................................... 122
The control measures for the specific case of asbestos ................................................................... 123
Use of specialist contractors for removal and disposal of asbestos ................................................. 125
Additional control measures for working with lead with typical workplace examples .................... 126
Health surveillance for those workers who regularly undertake work where asbestos or lead are
likely to be present ........................................................................................................................... 127
9.8 Ventilation and PPE......................................................................................................................... 129
The uses and limitations of dilution ventilation ............................................................................... 129

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The purpose of the typical components of an LEV and their function ............................................. 130
Source strength and capture zones .................................................................................................. 134
Thorough examinations of LEV ......................................................................................................... 135
The types of PPE for use with hazardous substances ....................................................................... 138
Respiratory protective equipment (RPE) .......................................................................................... 139
Skin and eye protection .................................................................................................................... 144
The storage and maintenance of PPE ............................................................................................... 146
The need for training in the correct use of PPE ................................................................................ 147
9.9 Hazardous substances monitoring .................................................................................................. 148
The concept of exposure standards .................................................................................................. 148
The meaning of Exposure Limits for airborne harmful substances .................................................. 149
The significance of short- and long-term exposure limits (STEL, LTEL) and calculation of
timeweighted average (TWA) values ................................................................................................ 150
International examples of exposure limits ....................................................................................... 151
Monitoring ........................................................................................................................................ 152
Interpreting a hygienist’s report ....................................................................................................... 158
9.10 Biological agents ........................................................................................................................... 160
The main types of biological agent ................................................................................................... 160
The special properties of biological agents....................................................................................... 162
The special properties of Zoonotic/Vector-borne diseases .............................................................. 163
Additional control measures that may be required for general/incidental exposure to biological
agents ................................................................................................................................................ 171
9.11 Noise ............................................................................................................................................. 173
The basic concepts of sound pressure, sound intensity, frequency, the decibel scale .................... 173
The physical and psychological effects on the individual ................................................................. 180
Noise risk assessment and planning for control ............................................................................... 182
The use of noise calculators to determine mixed exposure ............................................................. 186
The hierarchy of noise control .......................................................................................................... 186
9.12 Vibration ....................................................................................................................................... 195
The basic concepts ............................................................................................................................ 195
The groups of workers at risk and effects of Hand-arm vibration (HAV) & Whole-body vibration
(WBV) ................................................................................................................................................ 197

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The use of vibration calculators to determine mixed exposures ..................................................... 203

Vibration risk assessment and planning for control ......................................................................... 203
Practical control measures to prevent or minimise exposure .......................................................... 204
9.13 Radiation ....................................................................................................................................... 206
The distinction between ionising and non-ionising radiation........................................................... 206
The electromagnetic spectrum ......................................................................................................... 207
Particulate radiation properties........................................................................................................ 212
Non-ionising radiation ...................................................................................................................... 217
Sources of non-ionising radiation ..................................................................................................... 217
Routes and effects of exposure ........................................................................................................ 219
Radiation risk assessment to consider .............................................................................................. 221
Control measures to prevent or minimise the exposure .................................................................. 221
Ionising radiation .............................................................................................................................. 225
Sources of ionising radiation ............................................................................................................. 225
Routes and effects of exposure ........................................................................................................ 227
Radiation risk assessment to consider .............................................................................................. 229
Control measures to prevent or minimise the exposure .................................................................. 230
9.14 Musculoskeletal issues, Manual handling .................................................................................... 232
Human musculoskeletal system ....................................................................................................... 232
The types of injury and ill-health conditions resulting from repetitive physical activities, manual
handling and poor posture ............................................................................................................... 238
Types of ill-health conditions resulting from sitting for long periods and how these can be
controlled/managed ......................................................................................................................... 245
The principles of ergonomic design as applied to the control of musculoskeletal risks .................. 248
When a manual handling risk assessment is required...................................................................... 250
How the simple filters (from L23) can be used to decide if a manual handling risk assessment is
required............................................................................................................................................. 250
Risk assessment ................................................................................................................................ 252
How to decide if a more detailed assessment should be used......................................................... 257
The circumstances when the assessment tools should be used ...................................................... 257
Practical control measures................................................................................................................ 264
9.15 Workplace temperature, Welfare arrangements ......................................................................... 267

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The importance of maintaining heat balance in the body................................................................ 267

The effects of working in high and low temperatures and humidity ............................................... 268
The meaning of thermal comfort ...................................................................................................... 270
Parameters affecting thermal comfort ............................................................................................. 271
The purpose of the heat stress index WBGT .................................................................................... 272
The practical control measures to minimise the risks when working in extreme thermal
environments .................................................................................................................................... 273
Facilities for pregnant women and nursing mothers, together with the practical arrangements ... 275

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9.1 Occupational health services, Equality in the workplace

The basic principles of the bio-psychosocial model and how it relates to the health of
individuals
The bio-psychosocial model of health and illness is a framework that states that interactions between
biological, psychological, and social factors determine the cause, appearance, and outcome of wellness
and disease.
Historically, it was suggested that any one of these factors was sufficient to change the course of
development. The biopsychosocial model argues that any one factor is not sufficient; it is the interplay
between people's genetic makeup (biology), mental health and behavior (psychology), and social and
cultural context that determine the course of their health-related outcomes.
Biological Influences on Health: Biological influences on health include an individual's genetic makeup
and history of physical trauma or infection. Many disorders have an inherited genetic vulnerability. The
greatest single risk factor for developing schizophrenia, for example is having a first-degree relative with
the disease (risk is 6.5%). If one parent is affected the risk is about 13%; if both are affected the risk is
nearly 50%.
It is clear that genetics have an important role in the development of schizophrenia, but equally clear is
that there must be other factors at play. Certain non-biological (i.e., environmental) factors influence the
expression of the disorder in those with a pre-existing genetic risk.
Psychological Influences on Health: The psychological component of the biopsychosocial model seeks to
find a psychological foundation for a particular symptom or array of symptoms (e.g., impulsivity,
irritability, overwhelming sadness, etc.). Individuals with a genetic vulnerability may be more likely to
display negative thinking that puts them at risk for depression; alternatively, psychological factors may
exacerbate a biological predisposition by putting a genetically vulnerable person at risk for other risk
behaviors. For example, depression on its own may not cause liver problems, but a person with depression
may be more likely to abuse alcohol, and, therefore, develop liver damage. Increased risk-taking leads to
an increased likelihood of disease.
Social Influences on Health: Social factors include socioeconomic status, culture, technology, and
religion. For instance, losing one's job or ending a romantic relationship may place one at risk of stress and
illness. Such life events may predispose an individual to developing depression, which may, in turn,
contribute to physical health problems. The impact of social factors is widely recognized in mental
disorders like anorexia nervosa (a disorder characterized by excessive and purposeful weight loss despite
evidence of low body weight). The fashion industry and the media promote an unhealthy standard of
beauty that emphasizes thinness over health. This exerts social pressure to attain this "ideal" body image
despite the obvious health risks.

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Why it is important to make ‘reasonable adjustments’ for workers with physical and mental
ill-health
Adjustments are steps you can take, specific to a particular employee, so that employee can continue
doing their job. Reasonable adjustments in the workplace are ones that are effective for the employee
and but are also reasonable and not too costly or disruptive to the business.
Legal responsibilities:
Employers have a legal duty under the Equality Act 2010, to implement reasonable adjustments in the
workplace. Under the legislation, employers must make reasonable adjustments where disabled staff
would otherwise be put at a substantial disadvantage compared with non-disabled colleagues. Employers
cannot legally justify a failure to comply with a duty to make a reasonable adjustment.
It’s important that employers take appropriate steps to removing, reducing or preventing any barriers
that may negatively impact on disabled colleagues and job applicants.
Importance of making reasonable adjustments in the workplace:
Workplace adjustments can make an organisation a more attractive place to work and can contribute to
the development of inclusive working environments and cultures by:
• Helping disabled staff to feel more valued and supported in their work and in working towards
their career aspirations.
• Improving employee engagement and staff experience, which in turn will increase staff retention.
• Providing higher levels of productivity and reducing levels of sickness absence.
• Reducing levels of harassment, bullying and abuse (disabled staff experience greater levels
compared to non-disabled staff).
• Increasing understanding amongst senior leaders, managers and colleagues about disability
equality and inclusion in the workplace, which in turn, will help improve patient care and
outcomes.
The role and benefits of ‘pre-placement’ assessment

The purpose of any pre-placement examination is to fit the worker to the job and the job to the worker.
The objective is to identify any pre-existing medical conditions that may be of importance in hiring and
job-placement-either at the time of hire or in the instance of a job transfer- while taking care to consider
local laws regarding discriminatory practices. This examination can also provide baseline data that can be
used to measure functional, pathological, or physiological changes in workers over time, thus, facilitating
future epidemiological studies related to health effects. Of particular importance is the identification of
pre-existing medical conditions in target organs that potentially might be affected by nickel and its
compounds (notably the respiratory system and skin, but also reproductive and renal systems).
The benefits of conducting pre-employment medical assessments include:
• A safer working environment

• Reduction in workplace injuries
• Minimised downtime

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• Reduction in Workcover claims and insurance costs

• Matching the capacity of the employee with the role
• Overall recruitment cost and risk reduction
Procedures for pre-placement health examinations are well defined but may in practice vary from country
to country and between industries and occupations.
There are a number of clinical tests that may be performed to characterize the baseline data more
efficiently. Selection of appropriate types of tests will depend on the nature of the job, hazards involved
and potential health effects. These tests include:
• Height, weight, body mass index (BMI)

• Cardiovascular examination (heart check, blood pressure, pulse)
• Full musculoskeletal examination including comprehensive range of movement
• Central nervous system examination
• Examination for hernias and other abdominal abnormalities
• Urinalysis for diabetes or kidney / bladder disorders
• A detailed history of previous diseases and occupational exposures. The focus should be on
exposure to toxins such as silica, asbestos, irritant gases, etc.
• Past or present history of any allergies, including asthma
• Identification of personal habits (smoking, hygiene, alcohol consumption, fingernail biting) that
may be relevant to work. Histories should be sufficiently detailed. For example, for smoking, the
type of smoking, duration, amount smoked, and age of onset of smoking should be recorded.
• Complete physical examination with special attention to respiratory, dermal, and, possibly, renal
problems
• Specific to women, reproductive questionnaires and/or examinations with special emphasis on
pregnant or lactating female workers who may potentially be exposed to harmful agents
• Chest X-ray
• Lung function tests using classical spirometry
• Audiometric testing
• Vision testing including colour blindness
Managing long-term sickness absence and capability

Long-term sickness absence is sometimes defined as an absence lasting more than 2 weeks, but in
guideline guidance NG146 produced by the UK’s National Institute for Health and Care Excellence
(NICE), it is defined as 4 or more weeks. Recurring long-term sickness absence has been defined as more
than 1episode of long-term sickness absence, with each episode lasting more than 4weeks. The
recommendations given below from sections 1.1 and 1.3 to 1.7 of NG146 are for employers, senior
leadership, managers and human resources personnel.
• Workplace culture and policies: Ensure that all employees know the workplace policies or
procedures for notifying and managing sickness absence, and for return to work. Make this part

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of the induction process for new employees and ensure that they know the sickness absence
reporting system is confidential.
• Statement of fitness for work: When a statement of fitness for work ('fit note') is received
indicating that someone is not fit for work, start and maintain a confidential record.
• Making workplace adjustments: When any work adjustments have been agreed with a person
returning from sickness absence arrange additional risk assessments if needed.
• Keeping in touch with people on sickness absence: Ensure that the organisation regularly keeps
in touch with people who are 'not fit for work' during periods of sickness absence, including
people with a chronic health condition or a progressive illness or disability covered by the
Equality Act 2010.
• Early intervention: In organisations that offer access to early interventions (such as
rehabilitation, counselling or an employee assistance programme) ensure that all employees are
aware of their availability, remit and confidentiality.
• Sustainable return to work and reducing recurrence of absence
o Sustainable return to work for people with a musculoskeletal condition.
o Reducing recurrence of absence for people with a common mental health condition
mental health condition.
The meaning of vocational rehabilitation

Vocational rehabilitation is a set of services offered to individuals with mental or physical disabilities.
These services are designed to enable participants to attain skills, resources, attitudes, and expectations
needed to compete in the interview process, get a job, and keep a job. Services offered may also help an
individual retrain for employment after an injury or mental disorder has disrupted previous employment.
The benefits of vocational rehabilitation within the context of the worker and the employer
The following services may be provided by Vocational Rehabilitation Centers (VRC):
• Comprehensive rehabilitation evaluation to determine abilities, skills, interests, and needs

• Vocational counseling and rehabilitation planning
• Employment services such as job-seeking skills, resume development, and other work readiness
assistance
• Assistance finding and keeping a job, including the use of special employer incentives
• On the Job Training (OJT), apprenticeships, and non-paid work experiences
• Financial assistance for post-secondary training at a college, vocational, technical or business
school
• Supportive rehabilitation services including case management, counseling, and referral
• Independent living services
Employee benefits Employers benefits

After a rehabilitation plan is developed and Vocational rehabilitation will provide employers
signed, the services outlined in the plan will be with a variety of useful services and resources at

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provided to the worker in order to achieve no cost. VRC’s ability to provide pre-screened,
suitable employment and/or an increase in job-ready applicants can save employers time
independent living skills. The Vocational and money during their recruitment processes.
Rehabilitation center will provide ongoing State owned/operated Vocational centers can
counseling, assistance, and coordination of serve as a key starting point in the hiring process
services. These should include tutorial by providing a pool of motivated applicants
assistance, job-seeking skills training, already connected to job supports that can
adjustment counseling, payment of training ensure employment success. It also offers
allowance, and other services as required to financial incentives, tax credits and various on-
help the service member achieve a career and going workforce development services to
live as independently as possible. businesses and organizations open to hiring
people with disabilities. While employees with
disabilities offer a wide array of skills and talents,
they might need training, specialized equipment
and/or ongoing supports to maintain their jobs.
Much of these costs will be covered by VRC.
Possible barriers to the effective rehabilitation of workers

Following barriers to vocational success need to be considered:
• The complexities and characteristics of the injury/ ill-health sustained: Essentially, the challenge for
vocational rehabilitation rests with individuals with mild and moderate injuries; those with severe
injuries are often unable to pursue a vocational course at all after injury. It is import for the VR
counselor to know that no two individuals with an injury will have had the same history, interests and
abilities before injury and will not display the same post-injury deficits or implications for daily living.
• Services — not available or inappropriate if available: People with disabilities rely upon the state-
federal VR system to help them become employed. Aspects of this system, along with the lack of other
services and programs, may inhibit successful vocational outcomes. More specifically:
o The VR system is a time-limited service provider that does not meet the long-term needs of
many individuals
o Large caseloads prevent concentrated delivery of services and discourage the pursuit and
adoption of innovative approaches to service
o Counselors may not be specifically trained to be ‘experts’ in effective approaches to
rehabilitation
o Delayed referral to VR results in delayed services, but too early a referral may result in a
determination of ineligibility for services. Timeliness of referral is fundamental!
o Vocational programs adapted to the special needs of people with more complex injuries are
rare. Long-term supported employment programs may also not be available.
• Restraints within the community and society: Within the individual’s immediate and societal worlds,
many barriers to successful vocational outcomes exist, for example, inadequate housing, inaccessible
transportation and lack of social supports. Within the service system, no coordinated system of care
for community reentry exists. The absence of community resource linkages to provide pre- and post-
vocational support is also clearly problematic

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• Potential loss of benefits associated with vocational placement: Because some benefits will be
withdrawn under certain circumstances when the individual start to earn money, the risk of losing
benefits can inhibit vocational progress. To minimize this disincentive, the individual must evaluate
his or her ‘portfolio’ of benefits to determine what will be affected and what protected, and under
what circumstances.
• Consumer barriers: Successful placement also depends on whether the consumer fully understands
how working will have a positive impact on his or her financial and benefit status and makes a decision
that it is worthwhile to engage in employment. Job clubs are helpful in promoting appropriate work
behavior and increasing knowledge about employment options. Peer support can be a powerful force
in assisting consumers through the training and employment process.
What needs to be considered in a risk assessment prior to return to work

Returning to work after time off can be difficult, so once reasonable adjustments have been identified, a
Return to Work Plan must be developed. Risk assessment and safe system of work must be reviewed at
this stage to ensure that adjustments have been made where required; in order for the concerned
employee not be at risk and not create additional hazards.
If an employee is suffering from back or joint pain, adjustments to ergonomic factors may be required like
working posture, use of muscle force for gripping and handling, the type of equipment used, the working
environment, the pace of production and the spacing of rest breaks. For some people with mental health
conditions, appropriate adjustments may include building up to normal workloads over a period of time,
and regular meetings with line managers and colleagues to support and encourage the employee. It is
important to talk to the employee concerned about the kind of support and adjustments they may need
and take expert advice if necessary.
If the mental health condition arises from stress at work, the management system need to be reviewed
and how it could be altered to avoid pressures building up. Ill health or injury is sometimes traceable to a
specific event in or out of the workplace such as an accident, excessive lifting, acute or regular exposure
to hazardous substances, or traumatic occasions. Much more often it results from a combination of factors
such as increased workloads, lack of control over work, failure to take breaks, or pressures and activities
outside work. Pain and discomfort feel more acute when there are other difficulties to deal with at the
same time, so it pays to consider the job in the round. For instance in the case of back pain, consider
management and work systems as well as working positions, awkward movements and seating.
Employees will readjust more easily and gain confidence to cope with, e.g. lingering pain, or depression
brought about by events outside work, if they feel supported at work, demands are reasonable and tasks
are satisfying.
Here are some examples of adjustments that could be introduced temporarily while the employee regains
strength, mobility or capacity to work, or they could form reasonable adjustments on a permanent basis
to allow disabled employees to continue to work.
• Provide new or modify existing equipment and tools

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• Modify workstations, furniture, movement patterns

• Modify instructions or reference manuals
• Modify work patterns or management systems and styles to reduce pressures and give the
employee more control
• Arrange telephone conferences to reduce travel, or if face-to-face meetings cause anxiety
• Provide supervision
• Provide alternative work.
• Allow a phased return to work to build up strength, e.g. building up from part time to full-time
hours over a period of weeks
• Change individuals’ working hours to allow travel at quieter times, or allow flexible working to
ease their work-life balance
• Provide help with transport to and from work, e.g. organising lifts to work or for a disabled
employee
• Allow the employee to be absent during working hours for rehabilitation assessment or treatment
• Make alterations to premises, e.g. providing a ramp for people who find steps difficult, improving
lighting where sight-impaired employees work, providing clear visual signs and alerts for deaf
employees
A sample risk assessment form in relation to a Return to Work is given below:
Name of Employee: ____________________________ Name of Reviewer:__________________________

What is the What is the Identified Modification/s Who will action When will the Agreed
impact of impact on risks agreed to identified modifications be review
the the (including, if remove/minimise modification/s? made? date/s
condition on employee’s appropriate, risks identified
what the ability to in relation to
employee undertake other
can/cannot their role? colleagues)
do?
e.g. avoid e.g. e.g. dropping e.g. introducing e.g. Line e.g. is it possible e.g. Daily,
lifting temporarily equipment aids i.e. trolleys to Manager, immediately/time Weekly,
weights over unable to may increase manoeuvre heavy colleague, to order Fortnightly,
5kg lift/move risk to weights, identify returning aids/adjust monthly
equipment in employee colleagues able to employee environment?
excess of and others undertake such
that weight work temporarily,
adjust shelving
levels
Date: _____________________________ Reviewer’s Signature: _____________________________ Employee’s

Signature:_______________________

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Liaison with other disciplines in assessing and managing fitness for work
The primary purpose of fitness to work health assessments is to make sure that an individual is fit to
perform their work and designated tasking effectively and without risk to their own or others’ health and
safety. Fitness to work is relevant where illnesses or injuries reduce performance, or affect health and
safety in the workplace. It may also be specific to certain hazardous tasks for which medical standards
exist.
The British Equality Act 2010 provides a legislative framework to protect the rights of individuals and
advance equality of opportunity for all. One of the central duties for employers under the Act is to make
reasonable adjustments to the workplace for employees who suffer a disability of any kind.
Invariably, the question becomes one of how much ought a person to disclose of their previous medical
history. Many conditions do not manifest as an impairment or abnormality that can be detected through
simple examination, and it is only through the medical history that the assessor becomes aware of the
need to examine in more depth.
Medical practitioners, occupational health nurses and other health professionals carrying out medical
examinations of any sort are encouraged not to ask the traditional 'medical history' type of question which
are based on body system review. Instead they should reorientate their question protocol towards the
conditions and tasks that must be carried out in a workplace, or would affect the person's working life in
the near future, and, therefore, what the individual is capable of doing rather than detection of
abnormality. It should be clearly understood that when someone attends a doctor or nurse, or other
health professional, for an examination in relation to their employment, that some information might
need to be discussed with the employer
Since Human Rights legislation forbids unreasonable discrimination in employment, it is unlawful to ask
any potential employee about any matters not directly related to the requirements of the job. It is usually
inappropriate, for example, to ask about pregnancy and childbirth history, marital or family status,
religious and ethnic beliefs, national or ethnic origins, or disability not directly related to performing the
job or ensuring the employee's own or others' safety.
In the face of these prohibited grounds of discrimination, the examining physician is restricted to asking
the following questions:
• Whether the prospective employee has any condition which could adversely affect the
productivity, or quality of the job, or the safety of themselves or others. Avoid an inclusive list of
diseases, which may not be relevant to the job. Some specific enquiries may be allowed, for
example, uncontrolled epilepsy in heavy commercial vehicle drivers, certain communicable
diseases in food handlers. These must be based on a careful job analysis or, in certain cases, in
accordance with specific legislation.
• Any past or present injury likely to be aggravated by the proposed job.
• Any requirement for job or workplace modification to enable them to carry out the job
adequately and safely.

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The role of agencies that can support employers and workers

Typical services provided by state vocational rehabilitation agencies include:
Type of service Description
Assessment Services provided and activities performed to determine an individual's

eligibility for vocational rehabilitation services, to assign an individual
to a priority category of a state vocational rehabilitation agency that
operates under an order of selection, and/or to determine the nature
and scope of vocational rehabilitation services to be included in the
individual plan for employment; trial work experiences and extended
evaluation may also be included
Diagnosis and This includes diagnosis and treatment of mental and emotional
treatment of disorders
impairments
Vocational Discrete therapeutic counselling and guidance services necessary for an

rehabilitation individual to achieve an employment outcome, including personal
counselling and adjustment counselling; counselling that addresses medical, family, or
guidance social issues; vocational counselling; and any other form of counselling
and guidance necessary for an individual with a disability to achieve an
employment outcome. This service is distinct from the general
counselling and guidance relationship that exists between the
counsellor and the individual during the entire rehabilitation process
On-the-job training Training in specific job skills by a prospective employer; generally the
individual is paid during this training and will remain in the same or a
similar job upon successful completion; this category also includes
apprenticeship training programmes conducted or sponsored by an
employer, a group of employers, or a joint apprenticeship committee
representing both employers and a union
Job readiness training Training to prepare an individual for the world of work (e.g. appropriate
work behaviours, methods for getting to work on time, appropriate
dress and grooming, methods for increasing productivity)

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Type of service Description
Disability-related Service includes, but is not limited to, orientation and mobility,
augmentative skills rehabilitation teaching, training in the use of low-vision aids, Braille,
training speech reading, sign language, and cognitive training/retraining
Job search assistance Job-search activities that support and assist a consumer in searching
for an appropriate job; may include help in preparing resumes,
identifying appropriate job opportunities, and developing interview
skills, and may include making contacts with companies on behalf of
the consumer
Job placement A referral to a specific job resulting in an interview, whether or not the
assistance individual obtained the job
On-the-job support Support services provided to an individual who has been placed in
employment in order to stabilize the placement and enhance job
retention; such services include job coaching, follow-up and follow-
along, and job retention services
Rehabilitation The systematic application of technologies, engineering

technology methodologies, or scientific principles to meet the needs of, and
address the barriers confronted by, individuals with disabilities in
areas that include education, rehabilitation, employment,
transportation, independent living, and recreation; includes
rehabilitation engineering services, assistive technology devices, and
assistive technology services
The roles of typical occupational health specialists

Occupational health is primarily a prevention-orientated activity, involved in risk assessment, risk
management and pro-active strategies aimed at promoting the health of the working population.
Therefore the range of skills needed to identify, accurately assess and devise strategies to control
workplace hazards, including physical, chemical, biological or psychosocial hazards, and promote the
health of the working population is enormous. No one professional group has all of the necessary skills to
achieve this goal and so co-operation between professionals is required. Occupational health is not simply
about identifying and treating individuals who have become ill, it is about taking all of the steps which can
be taken to prevent cases of work related ill health occurring. In some cases the work of the occupational
hygienist, engineer and safety consultant may be more effective in tackling a workplace health problem
than the occupational health nurse or physician. The multi-professional occupational health team can

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draw on a wide range of professional experience and areas of expertise when developing strategies, which
are effective in protecting and promoting the health of the working population.
Occupational health provision will depend on the size of the organisation. It can be provided by a nurse
with occupational health training and a part-time doctor, or through a range of specialists, including:
• Occupational health physician

• Occupational health nurse
• Occupational health adviser
• Occupational health technician
Advice and expertise of other professionals may be required including:
• Physiotherapists
• Hygienists
• Psychologists
• Ergonomic experts
• Occupational therapists
Role of key professionals include:
• Occupational health physician: Occupational health physicians are specialists in the field of
occupational medicine which focuses on prevention, identification, management and treatment
of health conditions and rehabilitation. An occupational physician can operate at a level beyond
the individual worker and can consider potential impacts across a workplace population, the
holistic work environment and the “health” of the company. Occupational physicians are able to
help an employer significantly reduce the risks and thus assist with optimising productivity whilst
reducing costs related to health. They do this by minimising the impacts of health risks to the
business:
o Identifying the legacy of impairment/disease in new employees and establishing at
employment the ‘baseline’ of health
o Ensuring employers are aware of adjustments required to comply with the Disability
Discrimination Act.
o Identifying work-related disease at the earliest point, to facilitate early intervention and
treatment, enable cost containment and avoid legal challenge
o Advising on preventing/minimising work-related illness
o Complying with health surveillance, and, where required, advising on statutory reporting
of work-related disease
o Assessing fitness for work during and after illness/disease onset – recommending
adjustments and restrictions (mostly temporary) to reduce absence costs
o Training managers to manage attendance, prevent /mitigate physical or mental illness,
including stress

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• Occupational health nurse: The occupational health nurse may fulfil several, often inter related
and complimentary, roles in workplace health management, including: Clinician, Specialist,
Manager, Coordinator, Adviser, Health educator. Counsellor, Researcher etc. According to WHO,
there are at least three types of ‘nurses’ commonly found working in occupational health services.
Nursing assistants: The nursing assistant or nursing aid is a person without a professional
nursing qualification who works as an assistant to, and under the supervision of, a
qualified nurse. Nursing assistants are often involved in delivering basic nursing care,
under supervision, and can play an important role in supporting nurses.
Registered nurses: The Registered Nurse is a fully trained nurse, with a professional
qualification, but without specialist training in occupational health. These nurses, by
virtue of their general nurse education, training and clinical experience can play a valuable
part in the delivery of nursing services within the clinical setting. However, it would be
beyond the level of competence that could be expected of these nurses to offer advice
on issues that are, for example, related to working conditions, occupational exposure or
employment legislation, without them having had the opportunity to undergo the
necessary training and education to perform this role safely.
Specialist occupational health nurses The Specialist Occupational Health Nurse is a fully
trained Registered Nurse who, in addition to their general nursing education and training,
will have undertaken an additional period of formal study in occupational health, leading
to a recognized specialist qualification in occupational health nursing, most often at
University degree level. The role of the specialist occupational health nurse is primarily
orientated towards:
a) The prevention of occupational injury and disease through a comprehensive pro-active

occupational health and safety strategy
b) The promotion of health and work ability, by focusing on non-occupational, workplace

preventable conditions that, whilst not caused directly by work, may affect the employees
ability to maintain attendance or performance at work, through a comprehensive
workplace health promotion strategy
c) Improving environmental health management, by reducing risk to the working

population and the wider community, which contributes to the wider public health
agenda
• Occupational health adviser: Role of occupational health adviser in workplace health

management is to advise management and staff on the development of workplace health policies
and practices by participating in, for example, health and safety committee meetings, health
promotion meetings, and may be called upon to provide independent advice to managers or
workers who have specific concerns over health related risks.

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• Occupational health technician: Occupational health and safety technicians collect data on the
health and safety conditions of the workplace. Technicians work with occupational health and
safety specialists in conducting tests and measuring hazards to help prevent harm to workers,
property, the environment, and the general public.
Typical activities offered by an occupational health service

There are a number of services listed in the ILO Convention 161, which may typically be offered by the
occupational health service and these are summarized hereunder:
• Health promotion: Providing advice, information, training and education, on occupational health,
safety and hygiene and on ergonomics and protective equipment as well as lifestyle (diet,
exercise, smoking etc.)
• Health assessment: Identification and assessment of the risks from health hazards in the
workplace. This involves surveillance of the factors in the working environment and working
practices which may affect workers' health. It also requires a systematic approach to the analysis
of occupational "accidents", and occupational diseases. The services specially include fitness for
work, pre-placement/employment, return to work, job-related medical screening, pregnant
workers
• Advice to management: Advising on planning and organisation of work and working practices,
including the design of work-places, and on the evaluation, choice and maintenance of equipment
and on substances used at work, input to risk assessments, no-smoking policy, absence
management etc. In so doing, the adaptation of work to the worker is promoted. Contributing to
occupational rehabilitation and maintaining in employment people of working age, or assisting in
the return to employment of those who are unemployed for reasons of ill health or disability
• Treatment services: Organising first aid and emergency treatment, counselling, physiotherapy,
other rehabilitation services. The occupational health service has a role and function in all of the
areas of action mentioned above. However, it is necessary to notice that the employer has the
responsibility for the actions at the workplace, and without employees’ full participation, any
action in maintenance of work ability is not likely to be successful. The occupational health service
can motivate, activate and support work ability activities at workplace, it can promote, follow and
assess work ability and health at individual, team and organizational levels, it can participate in
design, assessment and development of safe and healthy work environment and processes, and
it can follow and report development in health, safety and wellbeing to the management.
• Medical and health surveillance: Surveillance of workers' health in relation to work. Occupational
health surveillance is distinct from general health screening and health promotion. It involves
watching out for early signs of work-related ill health in employees exposed to certain health risks.
Such risks could be exposure to noise, vibration, ionising radiation, asbestos, lead, fumes, dusts,
biological agents, solvents or any other substances that could be hazardous to health.
Health surveillance is necessary when:
o There is an identifiable disease or adverse health effect associated with the exposure to
the substance/s in the workplace, for example, dermatitis, cancer or asthma
o It is possible to detect the disease/adverse health effect
o The techniques for detecting the disease/adverse health effect pose no risk to employees.

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9.2 Mental ill-health, Wellbeing, Workplace violence, Lone working

Occupational circumstances that could lead to workplace mental ill-health issues
Few of us want to work two jobs. But sometimes we have to. Maybe you’re getting your own business
started from home while you work a full-time job elsewhere, or maybe you’re working a day shift and a
night shift to make ends meet. Whatever your reason for holding down multiple jobs, you no doubt feel
as if you need to. The question is: Is your extra work hurting your mental health?
Experts in industrial and organizational psychology (I-O psych) have looked into this very question. While
the issue is complex, working a lot does appear to have some real, negative consequences. These include:
Depression
A study on long work hours has found that those who work more than 11 hours a day are 2.5 times more
likely to develop depression than those who work regular hours. This is likely because most people who
are working a lot are doing so out of a sense of obligation. They would rather not be working and this
causes serious psychological stress. Interestingly, those in upper management positions do not suffer
increased rates of depression with increased time at work. This, too, seems to come down to an issue of
control. Top-level workers have more control over what they do and when they do it. They’re also better
rewarded, which can play a role in easing psychological stress. As such, working two jobs could be fine for
your mood as long as you feel as if you’re in control of your decision to work.
Heart Disease
Can poor mental health lead to poor heart health? It can when stress is involved. In fact, the stress of
working 3–4 hours of overtime for a prolonged period of time can increase your risk of heart disease by
60%. While the disease is presumably caused by stress-related high blood pressure, the symptoms are
often missed as the higher pressure typically occurs at work and not at the doctor’s office. This means
that when working extended hours, you should closely monitor your heart health.
Sleep Problems
Not only can stress cause us to sleep poorly, but working a night shift of any kind can also lead to poor
sleep. This is because working nights interrupts our natural circadian rhythms. A lack of sleep and its
resulting can negatively affect our mood, impair our judgement, weaken our defenses against disease,
and increase our chances of heart disease and even cancer. If you’re adding a night shift to your daily
work, you should keep these potential consequences in mind.
Higher Incidence of Mistakes
We all know that when we aren’t clear-headed, we’re more likely to make mistakes. And working a lot is
one of the things that can make us less than clear-headed. In fact, people who report being overworked
are 20% more likely to say they make lots of mistakes on the job than people who don’t feel overworked.
This can be dangerous for those who work physically demanding jobs. But it can also cause problems for

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those who are simply sitting at a desk. If you’re going to work two jobs, you need to be on guard for
making the kinds of mistakes that may lose you one—or both—of those jobs.
The impact of chronic pain on a worker’s mental health

The relationship between work, productivity and chronic pain is an issue that is drawing increasing
attention in the United States. The yearly costs of lowered worker productivity due to pain, ranged from
$299 billion to $335 billion in 2010.
Chronic pain can appear after an accident, surgery, or as the result of a chronic disease. Millions of people
suffer silently and are affected financially, socially and psychologically by their pain.
Chronic pain and lost productivity
Chronic pain is long-term pain that lasts for more than three to six months. Known causes can be a trauma
resulting in an injury such as a herniated disc or an illness such as diabetes. This type of pain can persist
long after an injury has apparently healed. It can also start without a known injury or illness and outlast
what is considered a normal healing time.
Chronic pain can interfere with your concentration and ability to work. A study from the Department of
Health Policy at Johns Hopkins evaluated the impact of pain in the US.
It found that:
• In 2008, about 100 million adults suffered from chronic pain, including joint pain or arthritis.
• The yearly costs of pain associated with lower worker productivity due to pain ranged from $299-
$335 billion.
• The yearly cost of pain was greater than the costs of heart disease ($309 billion), cancer ($243
billion), and diabetes ($188 billion).
Types of pain that affect productivity
Any type of pain, if severe enough, can affect productivity. However, a recent study looked at how certain
types of pain can interfere with daily activities, more than others. The study was based on interviews with
over 500 adults suffering from chronic pain (2).
It found that:
• Pain at several sites in the body (multisite pain) is more likely to impair daily activities. The painful
body sites included a mix of three or more areas such as the head/face/jaw or the neck/back or
the abdomen/pelvis/genitals or the arm/leg.
• Patients with neuropathic pain (a pain condition arising from nerve damage or a disease of the
nervous system) also had more trouble with daily activities.
• One-third of patients with chronic pain suffered from depression as a result of their pain. This
could impact their productivity.
• Most patients made an effort to attend their work, yet had a reduced performance despite trying
to be present.

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• The average reported reduction in work productivity was roughly 2.4 hours per week for adults
with joint pain. It was roughly 9.8 hours per week for adults with multisite chronic pain.
Pain in the workplace
Some types of pain, arise as a result of your workplace. According to the Bureau of Labor Statistics,
musculoskeletal problems represented up to 33% of all worker injuries and illness cases in 2013.
Musculoskeletal pain affects the muscles, nerves, ligaments, and tendons. Workers in industries that
require heavy lifting, reaching overhead, pushing and pulling, are at increased risk. Meatpacking industry
workers, assembly line workers, and construction workers are at high risk for musculoskeletal injuries and
chronic pain.
However, office jobs also place workers at high risk for musculoskeletal pain. In the office, pain results
from working in awkward postures, spending long hours sitting, and repeating the same task (typing).
Some examples of some musculoskeletal disorders related to work:
• Headaches due to strain in the cervical neck or base of the head

• Headaches caused by eye strain
• Carpal tunnel syndrome
• Tendinitis
• Rotator cuff injuries (causes pain in the shoulder)
• Epicondylitis (causes pain in the elbow)
• Trigger finger
• Muscle strains and low back injuries
Depression and anxiety

Depression: Depression is a feeling of low mood that lasts for a long time and affects the everyday life. It
can make one feel hopeless, despairing, guilty, worthless, unmotivated and exhausted. It can affect self-
esteem, sleep, appetite, sex drive and, sometimes, physical health. In its mildest form, depression doesn’t
stop you leading a normal life, but it makes everything harder to do and seem less worthwhile. At its most
severe, depression can make feel suicidal, and be life-threatening.
There are also some common specific forms of depression, such as:
• Postnatal depression (PND) – depression that can develop from between two weeks to up to two
years after becoming a parent. It's usually diagnosed in mothers, but can affect partners too.
• Seasonal affective disorder (SAD) – depression that is related to day length and usually (but not
always) occurs in the winter.
Anxiety: Anxiety refers to strong feelings of unease, worry and fear. Because occasional anxiety is a
normal human experience, it's sometimes hard to know when it's becoming a mental health problem –
but if the feelings of anxiety are very strong, or last for a long time, they can be overwhelming. One might
experience:

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• Constant worrying about things that are a regular part of everyday life, or about things that aren’t
likely to happen.
• Unpleasant physical symptoms such as sleep problems, panic attacks, an increased heartbeat, an
upset stomach, muscle tension or feeling shaky.
• A specific anxiety disorder, such as generalized anxiety disorder (GAD), panic disorder, a phobia,
obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)
The effects of fatigue on mental health

Fatigue is a feeling of constant tiredness or weakness and can be physical, mental or a combination of
both. It can affect anyone, and most adults will experience fatigue at some point in their life.
Each year, around 1.5 million Australians see their doctor about fatigue. Fatigue is a symptom, not a
condition. For many people, fatigue is caused by a combination of lifestyle, social, psychological and
general wellbeing issues rather than an underlying medical condition.
Although fatigue is sometimes described as tiredness, it is different to just feeling tired or sleepy. Everyone
feels tired at some point, but this is usually resolved with a nap or a few nights of good sleep. Someone
who is sleepy may also feel temporarily refreshed after exercising.
If you are getting enough sleep, good nutrition and exercising regularly but still find it hard to perform
everyday activities, concentrate or be motivated at your normal levels, you may be experiencing fatigue
that needs further investigation.
Causes of fatigue
The wide range of causes that can trigger fatigue include:
• Medical causes – unrelenting exhaustion may be a sign of an underlying illness, such as a thyroid
disorder, heart disease or diabetes.
• Lifestyle-related causes – alcohol or drugs or lack of regular exercise can lead to feelings of fatigue.
• Workplace-related causes – workplace stress can lead to feelings of fatigue
• Emotional concerns and stress – fatigue is a common symptom of mental health problems, such
as depression and grief, and may be accompanied by other signs and symptoms, including
irritability and lack of motivation.
Medical causes of fatigue
There are a number of diseases and disorders which trigger fatigue. If you experience prolonged bouts of
fatigue, consult your doctor.
Lifestyle-related causes of fatigue
Common lifestyle factors that can cause fatigue include:
• Lack of sleep – typically adults need about eight hours of sleep each night. Some people try to get
by on fewer hours of sleep.

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• Too much sleep – adults sleeping more than 11 hours per night can lead to excessive daytime
sleepiness.
• Alcohol and drugs – alcohol is a depressant drug that slows the nervous system and disturbs
normal sleep patterns. Other drugs, such as cigarettes and caffeine, stimulate the nervous system
and can cause insomnia.
• Sleep disturbances – disturbed sleep may occur for a number of reasons, for example, noisy
neighbours, young children who wake in the night, a snoring partner, or an uncomfortable
sleeping environment such as a stuffy bedroom.
• Lack of regular exercise and sedentary behaviour – physical activity is known to improve fitness,
health and wellbeing, reduce stress, and boost energy levels. It also helps you sleep.
• Poor diet – low kilojoule diets, low carbohydrate diets or high energy foods that are nutritionally
poor don’t provide the body with enough fuel or nutrients to function at its best. Quick fix foods,
such as chocolate bars or caffeinated drinks, only offer a temporary energy boost that quickly
wears off and worsens fatigue.
• Individual factors – personal illness or injury, illnesses or injuries in the family, too many
commitments (for example, working two jobs) or financial problems can cause fatigue.
• Workplace-related causes of fatigue
Common workplace issues that can cause fatigue include:
• Shift work – the human body is designed to sleep during the night. This pattern is set by a small
part of the brain known as the circadian clock. A shift worker confuses their circadian clock by
working when their body is programmed to be asleep.
• Poor workplace practices – can add to a person’s level of fatigue. These may include long work
hours, hard physical labour, irregular working hours (such as rotating shifts), a stressful work
environment (such as excessive noise or temperature extremes), boredom, working alone with
little or no interaction with others, or fixed concentration on a repetitive task.
• Workplace stress – can be caused by a wide range of factors including job dissatisfaction, heavy
workload, conflicts with bosses or colleagues, bullying, constant change, or threats to job security.
• Burnout – can be described as striving too hard in one area of life while neglecting everything
else. ‘Workaholics’, for example, put all their energies into their career, which puts their family
life, social life and personal interests out of balance.
• Unemployment – financial pressures, feelings of failure or guilt, and the emotional exhaustion of
prolonged job hunting can lead to stress, anxiety, depression and fatigue.
Psychological causes of fatigue
Studies suggest that psychological factors are present in at least 50 per cent of fatigue cases. These may
include:
• Depression – this illness is characterised by severe and prolonged feelings of sadness, dejection
and hopelessness. People who are depressed commonly experience chronic fatigue.
• Anxiety and stress – a person who is chronically anxious or stressed keeps their body in overdrive.
The constant flooding of adrenaline exhausts the body, and fatigue sets in.

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• Grief – losing a loved one causes a wide range of emotions including shock, guilt, depression,
despair and loneliness.
The meaning of work-related stress and its relationship to mental health conditions
One in four people in the UK will have a mental health problem at some point. While mental health
problems are common, most are mild, tend to be short-term and are normally successfully treated, with
medication, by a GP.
Mental health is about how we think, feel and behave. Anxiety and depression are the most common
mental health problems. They are often a reaction to a difficult life event, such as bereavement, but can
also be caused by work-related issues.
Work-related stress and mental health problems often go together and the symptoms can be very similar.
Work-related stress can aggravate an existing mental health problem, making it more difficult to control.
If work-related stress reaches a point where it has triggered an existing mental health problem, it becomes
hard to separate one from the other.
Common mental health problems and stress can exist independently – people can experience work-
related stress and physical changes such as high blood pressure, without having anxiety, depression or
other mental health problems. They can also have anxiety and depression without experiencing stress.
The key differences between them are their cause(s) and the way(s) they are treated.
Stress is a reaction to events or experiences in someone's home life, work life or a combination of both.
Common mental health problems can have a single cause outside work, for example bereavement,
divorce, postnatal depression, a medical condition or a family history of the problem. But people can have
these sorts of problems with no obvious causes.
The causes of work-related mental ill-health relating to organisation, job and individual
Organisation of work
o Job interdependence: The more interdependence between a person’s tasks and the tasks of
others, the more potential stress there is. Autonomy, on the other hand tends to reduced stress
o Pays and benefits: The financial rewards associated with a job are important in terms of lifestyle.
They are also often perceived to be an indication of an individual's worth and value to the
organisation. Although financial reward may not be a prime motivator, it could become a factor
if there are other negative aspects of the job.
o Unemployment: Losing your job or not being able to find work can also add to your stress level.
o Work patterns: including working hours, long hours, shift work, unpredictable hours, changes in
working hours
o Organization’s Life Cycle: Organisations go through a cycle. They are established; they grow,
become mature and eventually decline. An organization’s life cycle creates different problems
and pressures for the employees. The first and the last stage are stressful. The establishment

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involves a lot of excitement and uncertainty, while the decline typically requires cutback, layoffs
and a different set of uncertainties. When the organisation is in the maturity stage, stress tends
to be the least because uncertainties are lowest at this point of time.
Workplace culture
o Communications: When you work for a company that is typically transparent, but that
transparency suddenly disappears, this can lead to understandable speculation about what is
going on. A lack of communication becomes a cause of stress, breeds office paranoia, and provides
grist for the rumor mill. Before you know it, the whole company is packing up and moving
overseas, and a twenty-person office staff is fighting over ten career postings on a job site.
o Unrealistic expectations. No one is perfect. If you expect to do everything right all the time, you're
destined to feel stressed when things don't go as expected.
o Organizational Change: Change is difficult for an institution and for its employees. There is
uncertainty about the future, about what the organization will “look like,” and how the employees
feel they will fit into the new structure. While some individuals embrace change, most simply
accept it—and with widely varying degrees of willingness. There are those, however, who refuse
to change. The subsequent rejection of cooperative progress puts increased stress on supervisors,
colleagues, and the institution as a whole.
o Changes in Roles and Tasks: Many organizations are finding it necessary to examine the ways in
which business is conducted. Whether seen as positive or negative, many organizations are
reexamining processes and services, as well as staffing, and are taking on more “businesslike”
approaches to how work is accomplished. This may mean streamlining or greater use of
technology (including less in-person contact and more online interactions). It generally requires
that employees learn new skills and commit to continuous learning. While exciting for some, and
taken in stride by many, it is resented or rejected by a percentage of employee populations. As
roles and tasks change, there is the potential for stress-producing ambiguity, placing increased
emphasis on the importance of adequate and timely communication. Clarity of job descriptions,
reporting relationships, and performance standards are critical in combating the potential stress
caused by changes in role and/or tasks.
o Organisational Leadership: These factors represent the managerial style of the organization’s
senior managers. Some managers create a culture characterised by tension, fear and anxiety. They
establish unrealistic pressures to perform in the short run impose excessively tight controls and
routinely fire employees who fail to turn up
o Unrealistic expectations. No one is perfect. If you expect to do everything right all the time, you're
destined to feel stressed when things don't go as expected.
o Organizational Change: Change is difficult for an institution and for its employees. There is
uncertainty about the future, about what the organization will “look like,” and how the employees
feel they will fit into the new structure. While some individuals embrace change, most simply
accept it—and with widely varying degrees of willingness. There are those, however, who refuse
to change. The subsequent rejection of cooperative progress puts increased stress on supervisors,
colleagues, and the institution as a whole.
o Organisational Leadership: These factors represent the managerial style of the organization’s
senior managers. Some managers create a culture characterised by tension, fear and anxiety. They
establish unrealistic pressures to perform in the short run impose excessively tight controls and
routinely fire employees who fail to turn up

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Working environment
o Work environment: Jobs where temperatures, space, light, noise or other working conditions are
dangerous or undesirable can increase anxiety. Similarly, working in an overcrowded room or
invisible location where interruptions are constant, can also lead to stress.
o Surrounding environment: Unsafe neighborhoods, crime-ridden cities, and other safety concerns
may lead to chronic stress.
Job content and Job role
o Role Conflict: Role conflict occurs when two or more persons have different and sometimes
opposing expectations of a given individual. Thus, there are two or more sets of pressures on the
individual so that it is not possible to satisfy all of them. Role conflict takes place when
contradictory demands are placed upon an employee simultaneously. For example, an advertising
manager may be asked to produce a creative ad campaign while on the other hand, time
constraint is put upon him, both roles being in conflict with each other
o Role Ambiguity: Stresses from job ambiguity arise when an employee does not know what is
expected of him or her or how to go about doing the job. For example, if an employee who joins
an organisation is left to himself to figure out what he is supposed to be doing and nobody tells
him what the expectations of him or his role are, the newcomer will face a high level of role
ambiguity.
o Workload: Another task demand stressor is workload. Overload occurs when a person has more
work to do than he can handle. The overload can be either quantitative (the individual has too
many tasks to perform or too little time in which to perform them) or qualitative (the person
believes that he lacks the ability to do the job). On the other hand, the opposite of overload is
also undesirable. It can result in boredom and apathy just as overload can cause tension and
anxiety. Thus, a moderate degree of work related stress is optimal because it leads to high level
of energy and motivation.
o Time pressure: i.e. pressure to finish the job with tight deadlines. For example, finishing a
construction project where excessive rains have severely disturbed the progress already.
Relationships
o Bullying and harassment including verbal/physical abuse: Bullying results in strong feelings of
fear, shame, embarrassment, and guilt, which are encouraged by the bully to keep their target
quiet. Work colleagues often withdraw their support and then join in with the bullying, which
increases the stress and consequent psychiatric injury. Workplace bullying can take various forms,
including:
- Shouting or swearing at an employee
- Verbal abuse targeted at an employee
- Being singled out for unjustified criticism or blame
- Being excluded; social isolation
- Excessive micro-managing or being given unrealistic deadlines
- Having your work or contributions purposefully ignored

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- Language or actions that embarrass or humiliate

- Practical jokes, especially repeatedly-occurring to the same person
Home-work interface: travel to/from work, childcare issues, relocation, etc.
o Discrimination: Feeling discriminated against can cause long-term stress. For example, you may
experience discrimination on the basis of your race, ethnicity, gender, or sexual orientation. Some
people face discrimination and the stress it causes nearly every day.
o Balance in Work and Life: As technology increases, we are witnessing a struggle—not just with
continuous learning and the expectation that work will be accomplished more quickly, but also
with a quality dilemma. For those who provide a service rather than a product, there is stress
inherent in balancing process efficiencies with customer expectations for quality and personal
hands-on assistance. Another significant contributing factor to organizational stress is the “24/7”
expectation in an increasing number of jobs. Many employees express concerns that they do not
have a “life outside of work” anymore. Office-related e-mails infringe on employees’ evenings and
weekends. With the abundance of laptop computers, the expectation seems to be growing that
we can work wherever we go. Employees risk becoming resentful and are vulnerable to burnout.
Some cease to have the energy and the enthusiasm they had in the past. As they lose their spark
and creativity, the organization loses a major resource.
Non work-related factors effecting mental health

Increasingly, the demands on the individual in the workplace reach out into the homes and social lives of
employees. Long, uncertain or unsocial hours, working away from home, taking work home, high levels of
responsibility, job insecurity, and job relocation all may adversely affect family responsibilities and leisure
activities. This is likely to undermine a good and relaxing quality of life outside work, which is an important
buffer against the stress caused by work. Such adverse working environment can impact on employee
mental health. There is no work environment or type of trauma that automatically leads to mental illness
in all people. The non-work factors also contribute and impact performance at work. Any suggestion of
simple cause and effect relationships between work and mental health are likely to be inaccurate. Factors
outside of the workplace that may be important include:
• Conflicting demands between work and home life

• Stressful life events
• Childcare responsibilities
• Financial worries
• Bereavement
• Housing problems
• Health
• Relationships
• Beliefs
Thus, a vicious cycle is set up in which the stress caused in either area of one's life, work or home, spills
over and makes coping with the other more difficult.

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Women are especially likely to experience these sources of stress, since they still carry more of the burden
of childcare and domestic responsibilities than men. In addition, women are concentrated in lower paid,
lower status jobs, may often work shifts in order to accommodate domestic responsibilities, and may
suffer discrimination and harassment.
Recognition that common mental health problems found within the workplace are rarely
entirely due to work-related factors but are a combination of a number of factors
The vast majority of workers with mental illness succeed in their chosen career while managing their
mental illness. Some workers will choose to disclose their mental illness if they require workplace support.
Others may choose not to disclose their illness if they feel they do not require any workplace support or
fear an adverse reaction. As a manager, you have a responsibility to assist workers with mental illness by
providing changes which will enable them to perform their duties more effectively in the workplace (these
are known as ‘Reasonable Adjustments’).
With the exception of certain safety-sensitive industries (airlines being one of them), employers cannot
discipline, dismiss or otherwise discriminate against employees with illnesses or disabilities, whether overt
or perceived, and they must attempt to accommodate them instead.
Reasonable Adjustments for mental health are generally simple, practical and cost-effective. Some
examples are listed here. This is not an exhaustive list – employers should explore with the individual their
specific needs and be as creative as possible when thinking about how to address these issues.
• Flexible hours or change to start/finish time. For shift workers not working nights or splitting up
their days off to break up the working week can also help
• Change of workspace – e.g. quieter, more/ less busy, dividing screens
• Working from home (although it’s important to have regular phone catch ups so people remain
connected and don’t feel isolated)
• Changes to break times
• Provision of quiet rooms
• Light-box or seat with more natural light for someone with seasonal depression
• Return-to-work policies e.g. phased return – reduced hours gradually building up
• Relaxing absence rules and limits for those with disability-related sickness absence
• Agreement to give an employee leave at short notice and time off for appointments related to
their mental health, such as therapy and counselling
• Reallocation of some tasks or changes to people’s job description and duties
• Redeployment to a more suitable role
• Training and support to apply for vacancies and secondments in other departments
• Increased supervision or support from manager. For example, some people can take on too much
so may need their manager to monitor their workload to prevent this and ensure they’re working
sensible hours
• Extra training, coaching or mentoring
• Extra help with managing and negotiating workload
• More positive and constructive feedback
• Debriefing sessions after difficult calls, customers or tasks
• Mentor or ‘buddy’ systems (formal or informal)

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• Mediation can help if there are difficulties between colleagues

• Mental health support group or disability network group
• Self-referral to internal support available
• Identifying a ‘safe space’ in the workplace where the person can have some time out, contact
their buddy or other sources of support and access self-help
• Provision of self-help information and sharing approaches and adjustments that have proven
effective at supporting others
• Encourage people to work on building up their resilience and doing things that support good
mental health such as exercise, meditation or eating healthily
• Encourage people to be more aware of their mental state and reflect on what factors affect it in
the workplace
• Provide regular opportunities to discuss, review and reflect on people’s positive achievements –
this can help people to build up positive self-esteem and develop skills to better manage their
triggers for poor mental health.
Why health and safety professionals, occupational health services (where relevant) and the
organisation’s HR department should work together to manage workers’ mental ill-health
conditions
The Role of HR in Office Safety and Well-Being
Optimal workplace safety should always be a standard for any company. Not only are your employees
your most valuable asset, but your reputation could suffer considerable damage by neglecting
occupational safety requirements. As technology advances and the social and political climate changes,
the definition of a safe working environment is in flux. I’ll show you how your Human Resources can play
an essential, vigilant role in dealing with new concepts and new circumstances regarding employee safety.
Your human resources department is working hard. There’s hardly any part of a business that HR is not
involved with.
You’re in a unique position within the company. You know all the workings of the business itself, and
you’re familiar with all employees. You know most of the company procedures and your team is often the
front line between employers and management. Because of this, HR plays an essential role when it comes
to the health and safety of employees.
There are plenty of ways that Human Resource Management can effectively maintain and improve
workplace safety.
1. Make Improving Health and Safety a Vital Part Of Your Work Culture
One of the major functions of HR managers is the recruitment and hiring process. This is a perfect time to
specify your commitment to the wellbeing of employees. For instance, by outlining your commitment
following health and safety procedures, adequate breaks and time off.
Designate a health and safety person or committee inside the company, whose job it is to handle
scheduling safety training, drills, and filing emergency and accident reports. Show your dedication to

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physical and mental fitness as a company, with an interoffice fitness program or even regular
competitions. Team-building drills can help reassert a company-wide commitment to a healthy and
engaged workforce.
2. Regular Safety Training
Proper training is essential for avoiding accidents. Regular safety training drills are one way to keep your
employees safe. Team building exercises can help build a rapport. Getting co-workers familiar with safety
procedures helps prevent panic, or worse when a real emergency arises.
As well as training specifically for safety, the HR team should be aware of an employee's individual safety
certifications. If you’re working with hazardous materials, ensure everyone on the team is WHMIS
certified. Keep records of who has first aid training, and ensure everyone stays up to date.
Finally, to maintain the safest environment for everyone, make sure they are trained on new procedures,
new equipment, and other potential dangers. Performing regular equipment checks should also be part
of your safety training. In addition, post signs and safety procedures throughout the office (for example,
lift techniques posted in a storeroom). This will keep everyone up to date and gives them access to safety
information when and where they need it.
Safety training should go beyond CPR drills and planning for accidents. Employees should know that the
company cares about safety and peace of mind. Scheduling regular sensitivity and anti-harassment
training programs can help reinforce workplace policies, and encourage anyone who may be victimized
into coming forward.
Many offices are also implementing mental health initiatives that can make a huge difference to the health
and work culture in your office.
3. Keep Updated Records
The best way to prevent accidents is to have a plan in place when they happen. Above regular safety and
emergency training, it’s vital to keep track of records.
Records do more than prevent future injury or accident. They help you deal with problems faster, and can
sometimes even help you spot issues before they happen. Keeping track can help reduce mental health
risks. It also helps bolster confidence in your employees. Not only will they know there’s a plan in place
should something go wrong. They know that their HR team and management will keep on top of any
injury, insurance, or ongoing health claims.
Having records you can look back on, can help prevent worse problems in the future. Updated records
also mean you stay on top of any needed upgrades to office equipment, training techniques and new
technologies, which can impact health and safety procedures.
Finally, having a written and actionable health and safety plan that everyone is aware of and has access
to, makes life easier for both employees and management, and improves communication.

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4. Keep an Open Dialogue
Mental health concerns have become every bit as important as threats to physical health in the workplace.
In fact, 54% of employees reported they do not feel safe reporting unfair work practices. This is where the
position of Human Resources can make a real impact.
Updated records mean keeping track of safety concerns and accidents. But it also means being aware of
the health concerns of your employees. It’s true that an office workspace is less prone to industrial
accidents or injury through falls. But mental health issues have devastating impacts on your employees'
overall health and their loved ones.
Stress caused by harassment in the workplace, financial difficulty, or overworking to hit a deadline can
cause long-term health problems, like insomnia, chronic pain, and even lead to heart problems.
An open-door policy when it comes to emotional and physical complaints helps to keep you aware of any
ongoing issues when it comes to health and morale. A good HR department can facilitate that.
5. An HRM System That Allows for Transparency
Along with an open dialogue, using a cloud-based Human Resource Management system allows for
transparency in the workplace. It’s easier to schedule for holidays, time off, and even medical leave. But
ease of access also means everyone in the office has the same information when it comes to everything
safety-related. Including:
- Training dates
- Operating procedures for equipment
- Dates of safety inspections, equipment updates, and other important safety-related concerns.
An HRM system that is simple to use and works across multiple departments also makes it easier to keep
to reasonable schedules, avoiding burnout, exhaustion, and the risks that come with it. Requesting time
off is as simple as pushing a button, and your HR department can more easily respond with the appropriate
information.
6. Ergonomics and Office Tech
Ensuring the safety of your team may be as simple as getting the right office setups. Work with
management and design your office to avoid stress disorders, backaches, and other health problems.
As well as keeping up to date with the latest ergonomic office furniture, to allow working in comfort, be
sure to provide employees with the right protective gear when they need it.
7. Keep Things Tidy

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There’s more than ergonomics at play when it comes to your office. Make sure there’s ample space to
move around, and do the work that needs to be done.
Even though you’re in an office space, you should still have room for traffic, especially in a shared space.
An uncluttered workspace makes trips and falls less likely. That cuts down on one of the biggest causes of
workplace accidents. Use your scheduling software to keep on top of deliveries, and stay organized.
8. Knowing When to Get Help
Finally, don’t leave out your safety inspections. No matter your work environment, you want your office,
your staff, and your equipment to be up to code. Knowing the safety procedures won’t help you if there’s
a serious fault in the structure of the building, faulty wiring in your server room, or you’ve misfiled
important safety information.
Regular three to six-month health inspections ensure your workplace stays safe. There are plenty of ways
to find an accredited safety inspector who can give you the expertise you’re looking for. By conducting
regular safety inspections, you’ll avoid expensive and dangerous problems later on.
HR can then translate the inspection results into actionable plans and guidelines that every department
will easily understand and implement. As they know the specific workload and other workplace details,
they can cater to the information exactly to each recipient.
Your Human Resource department is the “spider” in the web of your organization. In addition to knowing
all the operating procedures in a company, the HR department knows employees' circumstances often
better than management. When HR is proactively involved in workplace safety, beyond hanging up some
safety posters, your chance of injuries and other problems will dramatically decrease. Which will have a
positive effect on your bottom line and boost your company’s reputation?
Recognition that most people with mental health problems can continue to work effectively
and how this can be facilitated/supported by employers
The vast majority of workers with mental illness succeed in their chosen career while managing their
mental illness. Some workers will choose to disclose their mental illness if they require workplace support.
Others may choose not to disclose their illness if they feel they do not require any workplace support or
fear an adverse reaction. As a manager, you have a responsibility to assist workers with mental illness by
providing changes which will enable them to perform their duties more effectively in the workplace (these
are known as ‘Reasonable Adjustments’).
With the exception of certain safety-sensitive industries (airlines being one of them), employers cannot
discipline, dismiss or otherwise discriminate against employees with illnesses or disabilities, whether overt
or perceived, and they must attempt to accommodate them instead.
Reasonable Adjustments for mental health are generally simple, practical and cost-effective. Some
examples are listed here. This is not an exhaustive list – employers should explore with the individual their
specific needs and be as creative as possible when thinking about how to address these issues.

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• Flexible hours or change to start/finish time. For shift workers not working nights or splitting up
their days off to break up the working week can also help
• Change of workspace – e.g. quieter, more/ less busy, dividing screens
• Working from home (although it’s important to have regular phone catch ups so people remain
connected and don’t feel isolated)
• Changes to break times
• Provision of quiet rooms
• Light-box or seat with more natural light for someone with seasonal depression
• Return-to-work policies e.g. phased return – reduced hours gradually building up
• Relaxing absence rules and limits for those with disability-related sickness absence
• Agreement to give an employee leave at short notice and time off for appointments related to
their mental health, such as therapy and counselling
• Reallocation of some tasks or changes to people’s job description and duties
• Redeployment to a more suitable role
• Training and support to apply for vacancies and secondments in other departments
• Increased supervision or support from manager. For example, some people can take on too much
so may need their manager to monitor their workload to prevent this and ensure they’re working
sensible hours
• Extra training, coaching or mentoring
• Extra help with managing and negotiating workload
• More positive and constructive feedback
• Debriefing sessions after difficult calls, customers or tasks
• Mentor or ‘buddy’ systems (formal or informal)
• Mediation can help if there are difficulties between colleagues
• Mental health support group or disability network group
• Self-referral to internal support available
• Identifying a ‘safe space’ in the workplace where the person can have some time out, contact
their buddy or other sources of support and access self-help
• Provision of self-help information and sharing approaches and adjustments that have proven
effective at supporting others
• Encourage people to work on building up their resilience and doing things that support good
mental health such as exercise, meditation or eating healthily
• Encourage people to be more aware of their mental state and reflect on what factors affect it in
the workplace
• Provide regular opportunities to discuss, review and reflect on people’s positive achievements –
this can help people to build up positive self-esteem and develop skills to better manage their
triggers for poor mental health
The identification and assessment of work-related mental ill-health at individual and

organisational level
Major mental illnesses such as schizophrenia or bipolar disorder rarely appear “out of the blue.” Most
often family, friends, teachers or individuals themselves begin to recognize small changes or a feeling that
“something is not quite right” about their thinking, feelings or behavior before one of these illnesses
appears in its full-blown form.

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Learning about developing symptoms, or early warning signs, and taking action can help. Early
intervention can help reduce the severity of an illness. It may even be possible to delay or prevent a major
mental illness altogether.
If several of the following are occurring, it may useful to follow up with a mental health professional.
• Withdrawal — Recent social withdrawal and loss of interest in others

• Drop in functioning — An unusual drop in functioning, at school, work or social activities, such as
quitting sports, failing in school or difficulty performing familiar tasks
• Problems thinking — Problems with concentration, memory or logical thought and speech that
are hard to explain
• Increased sensitivity — Heightened sensitivity to sights, sounds, smells or touch; avoidance of
over-stimulating situations
• Apathy — Loss of initiative or desire to participate in any activity
• Feeling disconnected — A vague feeling of being disconnected from oneself or one’s
surroundings; a sense of unreality
• Illogical thinking — Unusual or exaggerated beliefs about personal powers to understand
meanings or influence events; illogical or “magical” thinking typical of childhood in an adult
• Nervousness — Fear or suspiciousness of others or a strong nervous feeling
• Unusual behavior – Odd, uncharacteristic, peculiar behavior
• Sleep or appetite changes — Dramatic sleep and appetite changes or decline in personal care
• Mood changes — Rapid or dramatic shifts in feelings
The types of interventions for mental ill-health

Prevention and mental health
Preventing the onset of mental health problems before they occur, and supporting people to stay well, is
an important approach to improving mental health in our communities.
In England, around one in six adults met criteria for a common mental health problem such as anxiety and
depression, and one in eight 5-19-year-olds met criteria for a mental health problem.
How does prevention link to mental health?
Mental health prevention, or ‘public mental health’, is often used to refer to efforts to stop mental health
problems before they emerge. However, it's important to note that it can also be used to refer to work
that supports people with and without mental health problems to stay well.
There are several different types of preventative approaches, which can be applied together to enable
communities to protect everyone as well as give targeted support to those most at-risk. The different
kinds of prevention approaches can be defined as:
Primary prevention: stopping mental health problems before they start

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Stopping mental health problems before they occur and promoting good mental health for all. Often
primary prevention work is ‘universal’ in that it targets and benefits everyone in a community, for example
anti-stigma campaigns such as Mental Health Awareness Week or mental health literacy programs.
Secondary prevention: supporting those at higher risk of experiencing mental health problems
Supporting those at higher risk of mental health problems (either because of biological characteristics
they are born with or experiences they have had) by providing targeted help and support. This type of
prevention is often called “selective” or “targeted” prevention. Examples include programs which support
those who have experienced trauma or been victims of hate crime.
Tertiary prevention: helping people living with mental health problems to stay well
Supporting those with mental health problems to stay well and have a good quality of life. These types of
programs often focus on those already affected by mental health problems and can aim to reduce
symptoms that can be disabling, limit complications, and empower people experiencing problems to
manage their own symptoms as much as possible. Tertiary prevention is seen as distinct, but
complementary to treatment for mental health problems and is often carried out in community, rather
than clinical, settings.
How workers with mental ill-health conditions can be managed in the workplace
• speaking to workers as soon as it is recognised that there may be an issue
• use routine management tools to identify and tackle issues eg, appraisals, scheduled meetings
• support for workers who become emotionally distressed at work
• support for workers with on-going mental health conditions e.g., flexibility in work patterns to
suit the worker’s needs.
• encourage workers to develop coping strategies to help manage their condition
• use of ‘advance statements’
• ensure that the worker knows where to get help and support for their mental ill-health
condition outside of the workplace.
The benefits of good nutrition, exercise and sleep on mental ill-health conditions
Clinical Depression affects an estimated 17 million Americans each year. Depression is one of the most
treatable mental disorders. There are many treatment options now available for those suffering with
Depression. Over the past 40 years, we have made great advances in developing anti-depressant
medications to treat the illness of Depression. Studies have shown that antidepressant medications
relieve the symptoms of depression in as many as 80% of those who take them. But medication alone
may not be enough for those who suffer from Depression. Psychotherapy has been another important
and effective tool in the treatment of Depression. Psychotherapy has been used in the treatment of
Depression long before medications were available, and new and more effective therapy approaches are
being developed and utilized all the time. Numerous studies have shown that the best way to treat
Depression is with both antidepressant medications and psychotherapy provided simultaneously.

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But, as with many other illnesses, there is still more we can do for ourselves to improve our health and
wellbeing. For example, somebody with Diabetes would be quick to tell you that managing the symptoms
of their illness requires more than just taking their medication or insulin. To best manage the symptoms
of Diabetes, one has to follow the appropriate balanced diet, exercise regularly, and get adequate rest.
Likewise, nutrition, exercise, and sleep play a vital role in managing and preventing the illness of
Depression. The mind and body are connected. If you want to feel your best mentally, take good care of
your body. So often people who feel stressed, fatigued, and mentally “down” are under-exercised,
undernourished, and under-rested. Often, they assume that tending to the body takes too much time or
is too difficult. The point is important enough to restate: You can’t ignore your body and expect to feel
good. Time invested in physical health is a wise investment. Exercise, proper nutrition, and adequate sleep
are very important in overcoming Depression and in preventing Depression. The objective of this bulletin
and its sequel in March is to help you set up and execute a simple plan for optimal physical and mental
health in three areas: exercise, nutritional practices, and sleep hygiene.
Exercise
Exercise improves self-esteem and general mental health. Research has shown that exercise is an
effective, but often underused, treatment for mild to moderate Depression. Regular exercise has been
proven to reduce stress and anxiety as well as improve sleep. There’s no evidence that any one kind of
exercise choice has a greater impact on Depression than others. It appears that any form of exercise can
help Depression. Please check with your healthcare provider before starting any exercise program. This is
particularly important for people with a medical condition and people who have not exercised much in
the past.
To get the most benefit, you should exercise at least 20 to 30 minutes a day, three days a week.
Current studies suggest that four or five times a week is best. If you are a beginner, exercise for 20 minutes
and build up to 30 minutes. But remember, any amount of exercise is better than none. Even a 10 minute
“energy walk” has been found to increase energy and lift the mood. Start your exercise gently, and build
up gradually. If you can eventually work up to 30 minutes a day, five days a week, great! If not, do what
you can to start. Here are some tips for getting started:
Choose an activity you enjoy. Exercising should be fun, not a chore.
• Walking is an easy choice to make as you begin your Depression and exercise plan. It carries little
potential for injury and requires no special equipment.
• Initially, due to the isolation that accompanies your Depression, it may be important to team up
with someone, or even a group.
• When it’s nice outside consider outdoor activities. Sunshine can be a “pick-me-up”, both
psychologically and literally. Twenty minutes of sunshine a day stimulates the natural production
of serotonin in the brain.
• Schedule regular exercise into your daily routine, write it in your planner, or on your calendar.
• Add a variety of exercises so that you don’t get bored.

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• Look into scheduled exercise classes at your local community center, school, or church. In Alma,
for example, foul weather walkers take advantage of HIS Place, the Alma High School hallways
after dinner, and the Stone Center track at Alma College.
• Exercise does not have to put a strain on your wallet. Avoid buying expensive equipment or health
club memberships unless you are certain you will use them regularly.
• If you have trouble falling asleep, try exercising before dinner, or earlier.
• Stick with it. Set goals for yourself and reward yourself for reaching your goals. If you exercise
regularly, it will soon become part of your lifestyle.
• Depression is a treatable and manageable illness. Anti-depressant medications and
psychotherapy are the foundation of treatment, but there is more we can do to defeat and
prevent Depression.
• We have discussed the role of exercise as a technique to help in the battle against
• Depression. The next “Mental Health Matters” will explore the role of nutrition and sleep. Start
now with a simple, written plan for optimal physical and mental health. It’s not always easy, but
you can do it if you put your mind to it.
Nutrition
While many people understand the connection between nutrition and a physical disease state, fewer
people are aware of the connection between nutrition and depression. Depression is more typically
thought of as strictly emotional or biochemical. Nutrition, however, can play a key role in the onset,
severity, and duration of depression, including daily mood swings. Many of the same food patterns that
precede depression are the same food patterns that occur during depression. These patterns may include
skipping meals, poor appetite, and a desire for sweets. People who follow extremely low carbohydrate
diets also run the risk of feeling depressed or blue, because the brain chemicals that promote a feeling of
well-being, tryptophan and serotonin, are triggered by carbohydrate rich foods.
A number of studies have found that vitamin deficiencies are more prevalent among subjects with
depression compared to normal individuals. Vitamin deficiencies that have been found include vitamin
B1, vitamin B6, vitamin B12, and folate deficiency. Beside some of the other functions of these vitamins,
they also play important roles in neurotransmitter metabolism. Folic acid deficiency can cause personality
change and depression. Vitamin B12, at just marginally low levels, can contribute to depression and
memory problems. Folic acid deficiency is one of the most common vitamin deficiencies in the United
States. Not only is it easily destroyed by cooking, but is most abundant in leafy green vegetables – an often
under consumed food group. As we age, Vitamin B12 may not be absorbed as readily, even if the
recommended daily requirement is met through the diet. Minerals that play a role in the development or
prevention of depression, irritability, and mood swings include calcium, iron, magnesium, selenium, and
zinc.
• The bottom line is that proper nutrition plays a key role in maintaining mental health:
• Foods to eliminate or eat in moderation include sugar and sugary foods, and caffeine.
• Get into the habit of eating at least three meals a day, including breakfast.
• Replace sweets with fruit and whole grain carbohydrates.
• Eat lean sources of protein several times a day.

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• Drink plenty of water (at least six 8 oz glasses per day).

• Focus on a well-balanced diet, including various foods from each section of the food guide
• Eat plenty of leafy greens for folic acid.
• Eat bananas, avocado, chicken, greens, and whole grains for Vitamin B6.
• If you’re concerned about getting enough of some of the key nutrients, consult your physician or
dietitian before supplementing.
Sleep
For optimal physical and mental health, most people need about 6-9 hours of sleep per day, at regular
times. But many people have difficulties with sleep. There is definitely a connection between sleep
problems, particularly insomnia, and depression. We frequently find insomnia in patients diagnosed with
clinical depression; in fact, sleep disturbance is one of the core Symptoms of clinical depression. More
than 80% of those suffering from depression experience insomnia or some type of sleep disturbance. But
this is truly a two-way street because sleep deprivation and insomnia can also increase a person’s risk of
developing depression or experiencing a recurrence of depression.
The psychological symptoms of sleep deprivation include mood swings, irritability, impatience, anxiety,
depression, fatigue, decreased alertness and concentration, impaired memory, and impaired judgment.
Many people feel that there is little we can do to improve our sleep…we are either going to sleep or we’re
not. However, this is not the case. There are many things we can do to improve our chances of getting
good sleep by learning to practice more effective sleep hygiene techniques. Here are some good sleep
hygiene techniques:
• Go to bed at the same time every night and get up at the same time every day. Plan to allow for
8 hours of sleep per night. For example, go to bed at 11 p.m. and wake up at 7 a.m.
• Decrease the stimulus in your home at least one hour before going to bed; turn down the lights,
turn down the volume, turn down the activities, etc.
• If you take medication to help you sleep, take your medication about 1 hour before bed. For most
people, these medications take about 30 minutes to 1 hour to start working.
• Find an activity that is relaxing to you and do that activity in the hour before bed. Some examples
include; reading, listening to relaxing music or nature sounds, knitting, working on a hobby,
writing in a journal, taking a warm bath, etc.
• Make a mental list of all the things you have to be thankful for.
• Write about your worries in a journal, or mentally set them aside. Plan to think about them
another time.
• Avoid caffeine 4-6 hours before bedtime.
• Avoid alcohol, a depressant which may induce sleep but which will disrupt it later.
• Avoid consuming a heavy meal just before bedtime. A light carbohydrate snack is fine. Don’t go
to bed too full or too hungry.

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• Regular exercise during the day has been proven to improve your ability to fall asleep faster, stay
asleep longer, and have better quality sleep. But, avoid exercising too close to bedtime (within
three hours).
• Select a comfortable mattress, pillow, sheets, and clothing.
• Keep the room temperature moderate.
• Keep the bedroom quiet; wear ear plugs. Use a white noise machine, like a fan, to block other
Unplug the telephone.
• Remove the clock from your view.
Depression is a treatable and manageable illness. Anti-depressant medications and psychotherapy are the
foundation of treatment, but there is more we can do to defeat depression. We have discussed many
healthy techniques to help in the battle against depression, not all of them may be right for you. Your job
now is to find those that work for you and stick with them. Develop a simple, written plan for optimal
physical and mental health. Individuals suffering from depression need to eat a balanced diet of healthy
and nutritious food, exercise regularly, and get enough rest and sleep to overcome depression. It’s not
always easy, but you can do it if you put your mind to it.
The British HSE stress management standards and their role in assessing and managing
work related stress
The Management Standards define the characteristics, or culture, of an organisation where the risks from
work related stress are being effectively managed and controlled.
The Management Standards cover six key areas of work design that, if not properly managed, are
associated with poor health and well-being, lower productivity and increased sickness absence. In other
words, the six Management Standards cover the primary sources of stress at work. These are:
Demand: Employees often become overloaded if they cannot cope with the amount of work or type
of work they are asked to do. This includes issues such as workload, work patterns and the work
environment. Pay attention to the way the job is designed, training needs and whether it is possible
for employees to work more flexible hours
Control: Employees can feel disaffected and perform poorly if they have no say over how and when
they do their work. Think about how employees are actively involved in decision making, the
contribution made by teams and how reviewing performance can help identify strengths and
weaknesses
Support: Levels of sick absence often rise if employees feel they cannot talk to managers about issues
that are troubling them. This includes the encouragement, sponsorship and resources provided by the
organisation, line management and colleagues. Give employees the opportunity to talk about the
issues causing stress, provide a sympathetic ear and keep them informed
Relationships: A failure to build relationships based on good behaviour and trust can lead to problems
related to discipline, grievances and bullying. This may happen due to threat of violence, harassment,
etc. (threats to personal safety), lack of trust, lack of systems in workplace available to report and deal
with unacceptable behaviour. This includes promoting positive working to avoid conflict and dealing

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with unacceptable behaviour. Check the organisation’s policies for handling grievances, unsatisfactory
performance, poor attendance and misconduct, and for tackling bullying and harassment
Role: Employees will feel anxious about their work and the organisation if they don’t know what is
expected of them. It may involve role conflict (conflicting job demands, multiple
supervisors/managers), role ambiguity (lack of clarity about responsibilities, expectations, etc.) or
level of responsibility. Review the induction process, work out an accurate job description and
maintain a close link between individual targets and organisational goals
Change: Change needs to be managed effectively or it can lead to huge uncertainty and insecurity.
Plan ahead so change doesn’t come out of the blue. Consult with employees so they have a real input,
and work together to solve problems
The relationship between wellbeing and mental health

Mental health is a positive concept related to the social and emotional wellbeing of individuals and
communities.
Having good mental health, or being mentally healthy, is more than just the absence of illness, rather it’s
a state of overall wellbeing.
The concept is influenced by culture, but it generally relates to:
• Enjoyment of life
• Having the ability to cope with and ‘bounce back’ from stress and sadness
• Being able to set and fulfil goals
• Having the capability to build and maintain relationships with others.
Influences on mental health and wellbeing
Mental health is influenced by several biological, psychological, social and environmental factors which
interact in complex ways. These include:
Structural factors such as safe living environments, employment, education, freedom from discrimination
and violence, and access to economic resources
Community factors such as a positive sense of belonging, community connectedness, activities to highlight
and embrace diversity, social support, and participation in society
Individual factors such as the ability to manage thoughts and cope with stressors and having
communication and social skills to support connection with others.
Tips for mental health and wellbeing
We all know that to keep a car going, we have to fill it with petrol, check the oil and water regularly and
give the tires some air. To see a bank balance grow, we need to make steady deposits. But how often do
we take the time to reflect on whether we are giving ourselves what we need to flourish and live well?

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It can be so easy for us to take our mental health for granted; to prioritise other things; to put it off until
next week. It can also seem too big and too hard. But it’s not. There are some things everyone can do. The
following are some tips to get you started,
• Get enough sleep and rest. Sleep affects our physical and mental health, but can be the first thing
we trade in when we get busy or stressed
• Take time out for things you enjoy. Balance in life is important, so taking time out for things you
enjoy can make a difference to how you think and feel
• Be active and eat well. Our physical and mental health is closely linked, so adding exercise and
nutritious food every day can make us feel better
• Nurture relationships and connect with others. Our connection to others is what builds us up and
keeps us strong
• Learn to manage stress. If you have trouble winding down or managing thoughts you may find
relaxation, yoga or writing your feelings down helpful
• Get involved and join in. Being part of a group with common interests provides a sense of
belonging so find out about sporting, music, volunteer or community groups locally
• Build your confidence. Learning improves your mental fitness and taking on a new challenge can
build confidence and give you a sense of achievement
• Be comfortable in your own skin. Everyone is unique and should be celebrated. Know who you
are and what makes you happy.
• Set realistic goals and deal with tasks one at a time. It is good to be specific when you set a goal
to help keep you on track
• Reach out for help when you need it. Everyone needs support from time to time. Talking to a
family member, a friend, your doctor or one of the many services available can make all the
difference.
How health and wellbeing workplace strategy can help to improve workers’ health
• benefits to the organisation of well-being strategies ie, costs of initiatives vs costs of lost working
time due to preventable ill-health conditions, absenteeism, presenteeism and employee
retention; happier, healthier and more engaged workforces leading to higher productivity
• support from top management for initiatives; appointment of board level well-being champions
• types of well-being initiatives that could improve ill-health (mental or physical) eg, subsidised gym
membership; free fruit; employee assistance programmes; mindfulness/meditation sessions; free
access to medical support such as treatment for mental ill-health conditions, physiotherapy;
medical screening; financial education
• the role of education and support programmes in promoting well-being in the workforce
• why well-being initiatives need to be relevant to the majority of workers
• working with partners to improve health and well-being eg, occupational health services (internal
or external to the organisation)
• involving and empowering all workers eg, appointing workforce well-being champions to get
involved in well-being initiatives, use of health assessments to empower workers to manage their
own well-being
• how monitoring, reviewing and communicating the health and well-being strategy can positively
influence the workforce

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The link between health and wellbeing and safety culture

There is a two way relationship between wellbeing and health: health influences
• wellbeing and wellbeing itself influences health

• Health is one of the top things people say matters for wellbeing
• Both physical and mental health influence wellbeing, however mental health and wellbeing are
independent dimensions, mental health is not simply the opposite of mental illness.
The World Health Organisation (WHO) states that “wellbeing exists in two dimensions, subjective and
objective. It comprises an individual’s experience of their life as well as a comparison of life circumstances
with social norms and values”. Examples of life circumstance include health, education, work, social
relationships, built and natural environments, security, civic engagement and governance, housing and
work-life balance. Subjective experiences include a person’s overall sense of wellbeing, psychological
functioning and affective states
• Health is one of the top things people say matters to wellbeing

• Both physical health and mental health can influence wellbeing . Recent acute health problems
affect wellbeing most but longer-term chronic ill health also has an effect on wellbeing.
• The relationship between health and wellbeing is not just one-way – health influences wellbeing
and wellbeing itself influences health. There are a number of correlations between wellbeing and
physical health outcomes, improved immune system response, higher pain tolerance, increased
longevity, cardiovascular health, slower disease progression and reproductive health .
• The effect of wellbeing on health is substantial (but variable) and comparable to other risk factors
more traditionally targeted by public health such as a healthy diet.
• Wellbeing and mental illness are correlated with depression and anxiety, which are associated
with low levels of wellbeing.
• Mental illness and wellbeing are independent dimensions; mental health is not simply the
opposite of mental illness. It is possible for someone to have a mental disorder and high levels of
wellbeing. It is also possible for someone to have low levels of wellbeing without having a mental
disorder. Most associations are only moderately altered by adjusting for severity of mental
disorder.
• Good health is also correlated with higher life satisfaction.
• Wellbeing is a shared government objective. It can also provide a shared objective around which
to engage to deliver health benefits. For example, promoting physical activity has benefits for
health but it also has a benefit for wellbeing. In addition, strengthening social networks and time
spent socialising benefit wellbeing as well as improving mental health in particular.
Why line managers must be trained on wellbeing strategies and initiatives

Employees are affected by a multitude of pressures, both at work and in their personal lives. Line
managers, given their position within an organisation, are often best placed to spot the signs of poor
mental health in the workplace and – if equipped with the right skill set – can manage issues effectively
before they reach crisis point. Their actions and behaviour also have a direct impact on employee
wellbeing: a good line manager will foster the kind of working environment that makes employees feel
valued, respected and supported, and will act as a ‘gatekeeper’ protecting them from any working

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conditions that present risks to their mental wellbeing. Conversely, a bad line manager can aggravate and,
in some cases, even be the cause of stress, anxiety and depression.
Management Today and the Institution of Occupational Safety and Health (IOSH) set out to examine the
role line managers play in promoting positive mental health in the workplace. We conducted a survey of
more than 400 employees from a variety of businesses across the UK to get a clearer picture of what is
being done in the workplace to support those with mental health problems. Our sample was split into two
groups to enable us to evaluate the results from each group appropriately: one group comprised
managers who have employees reporting directly to them, the other comprised managers without any
direct reports.
KEY FINDING: Line managers lack support and training
Worryingly, 62% of line managers that took part in our survey say they don’t get enough help from their
organisation to support the mental wellbeing of their staff. If line managers are to be effective
in promoting positive mental health in the workplace, it is vital they understand how to manage
fluctuations in workers’ mental health, what the causes of ill-health can be, how to recognize when
employees may be unwell, and how to advise on where to access further support. Armed with this
knowledge, they can shape the work environment to be conducive to positive mental health and
wellbeing. These are all things that can be achieved through proper training, but as our survey results
show, many businesses are failing to adequately educate their line managers. Only 31% of respondents
say they feel they have been sufficiently trained to recognise the signs of poor mental health in their direct
reports. More than half (57%) say their organisation offers no mental health and wellbeing training and/or
support for managerial staff. Those that do have training and support in place within their organisation
report in most cases it is optional (79%) rather than mandatory (22%). Taking into account that businesses
have both a legal and moral duty to ensure the health, safety and welfare of their employees, training
senior staff to deal with mental health issues should be a top priority. Employers are already required by
law to provide proportionate advice or training on health and safety . Line managers can be a key asset in
creating healthier, happier and more productive workforces and helping their employers comply with the
law, providing they are equipped with the relevant skills.
KEY FINDING: A reactive approach
Results indicate businesses are not being proactive enough when it comes to tackling poor mental health
in the workplace. Less than half of managers in both sample groups (45% of line managers with direct
reports and 49% of managers without) say their organisation is proactive in support of the mental health
of its employees. When questioned on the types of services in place within their organisation to support
staff, reactive measures such as counselling and Mental Health First Aid (MHFA) featured highly, with
fewer participants referring to proactive measures such as stress risk assessments and mental resilience
techniques.
While counselling and MHFA can offer a great deal to someone experiencing mental health problems,
what they do not address is the need to create a culture which prevents physical or mental ill health from

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occurring in the first place. they should form part of a more comprehensive, prevention-first programme
that empowers line managers to create the types of working environment that promote positive mental
health and wellbeing. As with many workplace problems, a proactive approach is far more effective, and
prevention is always better than cure.
Adopting a proactive approach also makes good business sense. Creating an environment where positive
wellbeing is actively encouraged and behaviours and policies that inhibit positive mental health called out
as unacceptable reduces the potential costs of mental-health-related sickness, absence and presenteeism
– when staff turn up to work but are unproductive when they get there.
KEY FINDING: Still a taboo
Much has been done to improve the stigma of mental health in the workplace in recent years. Many UK
companies have taken positive steps to providing caring workplaces and changing negative attitudes and
behaviours. However, our results show the pace of change is too slow. A staggering 80% of respondents
say they would be reluctant to discuss their mental health with their line manager for fear of being seen
as incapable in their role. A further 30% express concern it would lead to them being treated differently
and receiving special treatment. Workers comment they have been diagnosed with anxiety and
depression but never admitted to it at work for fear of being stigmatized.
Equally, managers can be reluctant to bring up the subject, often for fear of saying or doing the wrong
thing – 33% of line managers in our survey say they ‘rarely’ (22%) or even ‘never’ (11%) discuss mental
health and wellbeing with their direct reports, while 48% say they discuss the issue only ‘occasionally’. In
fact, our results highlight that more employees would feel comfortable discussing their own mental health
with their colleagues (25%), a confidential support service (25%), or a independent service outside of work
(24%), than with their line manager (18%).
It is clear much more work still needs to be done on creating the kinds of workplace environments and
company cultures where employees are able to divulge any issues, they might have without fear of
harming their career prospects or being stigmatised. With the right knowledge in how to deal with these
types of scenarios, line managers can confidently address issues head on and have conversations with
their staff to help them deal with their difficulties. Staying silent and doing nothing only makes things
worse.
CONCLUSION:
The results from our survey show line managers have a fundamental role to play in the promotion of
positive mental health in the workplace. The positive impact they can have on the wellbeing of their direct
reports is huge, therefore it is vital they receive the best possible support from their organisations to
empower them to champion positive mental health within the workplace. Our findings evidence that
much more work needs to be done from the top. Organisations need to take a more proactive approach
to building and maintaining a positive, supportive workplace culture – early action can make a vast
amount of difference in helping avert any issues or nip them in the bud before they escalate. Businesses
also need to work hard to break down the taboos surrounding mental health and create more open lines

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of communication. They need to support their managers to fulfil their role by equipping them with the
skills and knowledge to promote positive mental health, but without placing unrealistic expectations on
them. In return, they will reap the rewards of happier, healthier, more engaged and productive
employees.
The meaning of work-related violence

ILO Code of Practice, Workplace Violence in Services Sectors and Measures to Combat This Phenomenon,
in their section 1.3 defines Workplace violence as,
Any action, incident or behaviour that departs from reasonable conduct in which a person is
assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work.
• Internal workplace violence is that which takes place between workers, including
managers and supervisors.
• External workplace violence is that which takes place between workers (and
managers and supervisors) and any other person present at the workplace.
What is harassment?
The European agreement defines harassment and violence as unacceptable behaviour by one or more
individuals that can take many different forms, some of which may be more easily identifiable than others.
Harassment occurs when someone is repeatedly and deliberately abused, threatened and/or humiliated
in circumstances relating to work. Violence occurs when one or more worker or manager is assaulted in
circumstances relating to work. Both may be carried out by one or more manager, worker, service user or
member of the public with the purpose or effect of violating a manager’s or worker’s dignity, affecting
his/her health and/or creating a hostile work environment.
The European agreement recognises that harassment and violence can:
• Be physical, psychological, and/or sexual;

• Be one off incidents or more systematic patterns of behaviour;
• Be amongst colleagues, between superiors and subordinates or by third parties such as clients,
customers, patients, pupils, etc;
• Range from minor cases of disrespect to more serious acts, including criminal offences, which
require the intervention of public authorities.
The physical and psychological effects

For the victim there may be both immediate and long term effects.
• Physical: The result may be an injury which may need First Aid treatment such as pressure to stop
bleeding, swelling or pain and/or hospital referral. As with all ill-health and accidents violent hazards
can increase costs due to absenteeism, employer’s liability premiums and compensation payments.
• Psychological: Experiencing violence often results in loss of self-confidence and increase in fear and
feelings of insecurity, loss of control and even panic. For those who haven’t directly experienced the
violence but who work in the area or who have been witnesses to it, similar effects can exist. Violence
at work lowers morale in the ‘whole workforce and may make it difficult to recruit and retain staff.
This, if not adequately treated, may further develop into behavioural problems for those in fear,

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including illness such as anxiety or depression. Post-traumatic stress disorder can also develop in
severe cases.
The factors likely to increase the risk of work-related violence

Experience has shown that workers engaged in the following activities are at higher risk:
• Providing care, advice or training

o Healthcare e.g. ambulance crews, psychiatric nurses, casualty department staff and
community social workers
o Social welfare staff and those engaged with the public in similar circumstances
o Teachers
o Local authority housing staff
• Working with mentally disturbed

o Mental health workers
• Working with drunk populations or drug addicts

o Prison officers
o Public house and hotel staff
o Voluntary workers in shelters
o Health care staff
• Carrying out enforcement or inspection duties

o Traffic wardens
o Police
o Door attendants at discos, rock concerts and clubs
o Park keepers and attendants
• Handling money and valuables

o Bank, building society and post office staff
o Security staff
o Transport workers, e.g. bus and taxi drivers
o Shop assistants
o Petrol station workers
• Working alone
o Taxi drivers
o Home visitors such as domestics, milkmen, meter readers
o Nightwatchmen
o Estate agents

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Following factors can also cause of worsen the situation
Alcohol and Drugs: Alcohol is a factor in many assaults e.g. casualty departments, discos and public
transport. However, premises that operate at times when drunken customers can be expected should
take this into account when doing the risk assessment for the Safety Statement.
Job Location: This can affect an employee’s risk of becoming a victim of assault as certain areas may have
higher rates of violent crime. Employees who are mobile should be aware of locations which have a history
of violent incidents. Known high risk areas should be identified to employees.
Waiting: Employees who provide a public service often deal with persons who have been waiting in a
queue for some time, with rising frustration.
Time: There are certain times of the day which are more dangerous than others, such as after pubs close
or when opening or closing premises in which cash is kept.
Cultural change: Culture stress occurs when there is a change to a different way of living in a new culture.
Culture-stress can arise not only because of differences of national or religious values, but also because
of differences of corporate, social, family and personal values.
Racial discrimination, particularly in combination with gender and ethnicity, is also a strong influence on
work stress.
Four stages for effectively managing work-related violence

• Stage 1 Finding out if you have a problem
• Stage 2 Deciding what action to take
• Stage 3 Take action
• Stage 4 Check what you have done
It is important to remember that these four stages are not a one-off set of actions. If stage 4 shows there
is still a problem then the process should be repeated again. Stages 1 and 2 are completed by carrying out
a risk assessment.
Stage 1 Finding out if you have a problem
The first step in risk assessment is to identify the hazard. You may think violence is not a problem at your
workplace or that incidents are rare. However, your employees’ view may be very different.
A major petrol company was not aware of the size of the problem faced daily by forecourt employees,
until it sought their views during a series of meetings. Filling station employees believed strongly that
increased customer violence was the most serious threat to their personal health and safety.
Ask your staff - do this informally through managers, supervisors and safety representatives or use a short
questionnaire to find out whether your employees ever feel threatened. Tell them the results of your
survey so they realise that you recognise the problem.

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Keep detailed records - it is a good idea to record incidents, including verbal abuse and threats. You may
find it useful to record the following information:
• an account of what happened;

• details of the victim(s), the assailant(s) and any witnesses;
• the outcome, including working time lost to both the individual(s) affected and to the organisation
as a whole;
• the details of the location of the incident.
For a variety of reasons some employees may be reluctant to report incidents of aggressive behaviour
which make them feel threatened or worried. They may for instance feel that accepting abuse is part of
the job. You will need a record of all incidents to enable you to build up a complete picture of the problem.
Encourage employees to report incidents promptly and fully and let them know that this is what you
expect.
Classify all incidents - use headings such as place, time, type of incident, potential severity, who was
involved and possible causes. It is important that you examine each incident report to establish whether
there could have been a more serious outcome. Here is an example of a simple classification to help you
decide how serious incidents are:
• fatal injury;
• major injury;
• injury or emotional shock requiring first aid, out-patient treatment, counselling, absence from
work (record number of days);
• feeling of being at risk or distressed.
It should be easy to classify ‘major injuries’ but you will have to decide how to classify ‘serious or persistent
verbal abuse’ for your organisation, so as to cover all incidents that worry staff.
You can use the details from your incident records along with the classifications to check for patterns.
Look for common causes, areas or times. The steps you take can then be targeted where they are needed
most.
A survey by a trade union after 12 separate shop robberies found that each incident occurred between 5
and 7 o’clock in the evening. This finding could have useful security lessons for late night opening of stores
and shops.
Try to predict what might happen - do not restrict your assessment to incidents which have already
affected your own employees. There may be a known pattern of violence linked to certain work situations.
Trade and professional organisations and trade unions may be able to provide useful information on this.
Articles in the local, national and technical press might also alert you to relevant incidents and potential
problem areas.
Stage 2 Deciding what action to take

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Having found out that violence could be a problem for your employees you need to decide what needs to
be done. Continue the risk assessment by taking the following steps to help you decide what action you
need to take.
Decide who might be harmed, and how
Identify which employees are at risk - those who have face-to-face contact with the public are normally
the most vulnerable. Where appropriate, identify potentially violent people in advance so that the risks
from them can be minimised.
Evaluate the risk
Check existing arrangements, are the precautions already in place adequate or should more be done?
Remember it is usually a combination of factors that give rise to violence. Factors which you can influence
include:
• the level of training and information provided;

• the environment;
• the design of the job.
Consider the way these factors work together to influence the risk of violence.
Training and information
Train your employees so that they can spot the early signs of aggression and either avoid it or cope with
it. Make sure they fully understand any system you have set up for their protection.
Provide employees with any information they might need to identify clients with a history of violence or
to anticipate factors which might make violence more likely.
The environment
Provide better seating, decor, lighting in public waiting rooms and more regular information about delays.
Consider physical security measures such as:
• video cameras or alarm systems;

• coded security locks on doors to keep the public out of staff areas;
• wider counters and raised floors on the staff side of the counter to give staff more protection.
The design of the job
Use cheques, credit cards or tokens instead of cash to make robbery less attractive.
Bank money more frequently and vary the route taken to reduce the risk of robbery.
Check the credentials of clients and the place and arrangements for any meetings away from the
workplace.

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Arrange for staff to be accompanied by a colleague if they have to meet a suspected aggressor at their
home or at a remote location.
Make arrangements for employees who work away from their base to keep in touch.
Maintain numbers of staff at the workplace to avoid a lone worker situation developing.
The threat of violence does not stop when the work period has ended. It is good practice to make sure
that employees can get home safely. For example where employees are required to work late, employers
might help by arranging transport home or by ensuring a safe parking area is available.
Employees are likely to be more committed to the measures if they help to design them and put them
into practice. A mix of measures often works best. Concentrating on just one aspect of the problem may
make things worse in another. Try to take an overall view and balance the risks to your employees against
any possible reaction of the public. Remember that an atmosphere that suggests employees are worried
about violence can sometimes increase its likelihood.
In one housing department it was found that protective screens made it difficult for staff and the public
to speak to each other. This caused tension on both sides. Management and safety representatives agreed
a package of measures including taking screens down, providing more comfortable waiting areas and
better information on waiting lists and delays. This package of measures reduced tension and violent
incidents.
Record your findings
Keep a record of the significant findings of your assessment. The record should provide a working
document for both managers and employees.
Review and revise your assessment
Regularly check that your assessment is a true reflection of your current work situation. Be prepared to
add further measures or change existing measures where these are not working. This is particularly
important where the job changes. If a violent incident occurs, look back at your assessment, evaluate it
and make any necessary changes.
Stage 3 Take action
Your policy for dealing with violence may be written into your health and safety policy statement, so that
all employees are aware of it. This will help your employees to co-operate with you, follow procedures
properly and report any further incidents.
Stage 4 Check what you have done
Check on a regular basis how well your arrangements are working, consulting employees or their
representatives as you do so. Consider setting up joint management and safety representative
committees to do this. Keep records of incidents and examine them regularly; they will show what

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progress you are making and if the problem is changing. If your measures are working well, keep them up.
If violence is still a problem, try something else. Go back to Stages 1 and 2 and identify other preventive
measures that could work.
What about the victims?
If there is a violent incident involving your workforce you will need to respond quickly to avoid any long-
term distress to employees. It is essential to plan how you are going to provide them with support, before
any incidents. You may want to consider the following:
debriefing- victims will need to talk through their experience as soon as possible after the event.
Remember that verbal abuse can be just as upsetting as a physical attack;
time off work- individuals will react differently and may need differing amounts of time to recover. In
some circumstances they might need specialist counselling;
legal help- in serious cases legal help may be appropriate;
other employees- may need guidance and/or training to help them to react appropriately.
The Home Office leaflet Victims of crime gives more useful advice if one of your employees suffers an
injury, loss or damage from a crime, including how to apply for compensation. It should be available from
libraries, police stations, Citizens Advice Bureaux and victim support schemes. Further help may be
available from victim support schemes that operate in many areas. Your local police station can direct you
to your nearest one.
What is a lone worker?

A lone worker is ‘someone who works by themselves without close or direct supervision’. They exist in all
sectors and include those who:
• work alone at a fixed base, for example in shops, petrol stations, factories, warehouses or leisure
centres;
• work separately from other people on the same premises or outside normal working hours, for
example security staff, cleaners, maintenance and repair staff;
• work at home;
• work away from a fixed base, such as:
o health, medical and social care workers visiting people’s homes etc;
o workers involved in construction, maintenance and repair including engineers, plant
installation and cleaning workers;
o engineers, assessors and delivery drivers of equipment and supplies who attend
construction projects;
o service workers, including postal staff, taxi drivers, engineers, estate agents, and sales or
service representatives visiting domestic and commercial premises;
o delivery drivers including HGV drivers, van driver/couriers and car/bike-based couriers;
o agricultural and forestry workers;

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• are volunteers carrying out work on their own, for charities or voluntary organisations
(fundraising, litter-picking etc).
How general risk assessments can be used to avoid and control risks to lone workers
The law says that employers must assess and control the risks in their workplace. You must think about
what might cause harm to people and decide whether you are doing enough to prevent that harm. If you
employ five or more workers, you must write down what you’ve found.
That record should include:
• the hazards (things that may cause harm);

• how they may harm people;
• what you are already doing to control the risks.
You must review and update this record, for example if anything changes.
There is no legal requirement to conduct a specific, separate risk assessment for lone workers. However,
you have a duty to include risks to lone workers in your general risk assessment and take steps to avoid
or control risks where necessary. This must include:
• involving workers when considering potential risks and measures to control them;
• taking steps to ensure risks are removed where possible, or putting in place control measures, for
example by carefully selecting work equipment to ensure the worker can perform what is required
safely;
• instruction, training and supervision;
• reviewing risk assessments periodically and updating them after any significant changes, such as
new staff, processes or equipment;
• when the lone worker is working at another employer’s workplace, consulting with that employer
to identify any risks and required control measures. Risk assessment should help you decide on
the right level of supervision for lone workers. There are some high-risk activities where at least
one other person may need to be present. Examples include working:
• in a confined space, where a supervisor may need to be present, along with someone dedicated
to the rescue role;
• near exposed live electricity conductors;
• in diving operations, vehicles carrying explosives or fumigation.
You should take account of normal work and foreseeable emergencies such as fire, equipment failure,
illness and accidents. Consider how to control the risks by thinking about who will be involved, where the
work will happen and what triggers might be more of an impact for lone workers.
The lone worker and other people
You should consider the lone worker, the people they may come into contact with, the work they are
carrying out, and how this may impact on the risk:
• How experienced is the worker in their role and in working alone?

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• Has the worker received relevant training?

• Are there any reasons why the worker might be more vulnerable, for example are they young,
pregnant, disabled or a trainee?
Environment and equipment
Consider the environment the worker is in and the equipment they are using:
• Does the workplace present a specific risk to the worker, such as operating equipment alone or
lifting objects too large for one person?
• Is the work in a rural or isolated area?
• Is the worker going into someone else’s home or premises?
• Is there a safe way in or out for one person working outside normal hours?
• Does the worker have adequate and reliable means of communication and a way to call for help?
How could the work trigger an incident?
Consider the activity being carried out by a lone worker and how it might trigger an incident:
• Is the work a security role, for example having authority over customers and enforcing rules?
• Does the work involve handling cash, asking for payment or removing goods or property?
The impact on risk to lone workers

• worker issues: vulnerability, experience and training
• violence
• mental health issues (including stress/mental health and well-being)
• worker’s medical conditions (suitable for working alone)
• workplace e.g., is it isolated, other people’s premises etc
• high-risk work activities i.e. confined space working that requires supervision
• communication where English is not a worker’s first language
• emergency situations
• specific issues relating to home working: minimal supervision, support for when things go wrong,
working conditions (set up of a suitable workstation), managing mental health conditions that
may arise from feeling isolated, recognition that home working will not suit all workers.
Particular problems facing lone workers

Medical conditions: Check that lone workers have no medical condition that would make them unsuitable
for working alone, seeking medical advice if necessary. Employers should seek medical advice if necessary.
Consider both routine work and foreseeable emergencies that may impose additional physical and mental
burdens on an individual.
Training: Training is particularly important where there is limited supervision to control, guide and help
in uncertain situations. Training may also be crucial in enabling people to cope in unexpected
circumstances and with potential exposure to violence and aggression. Lone workers are unable to ask
more experienced colleagues for help, so extra training may be appropriate. They need to be sufficiently

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experienced and fully understand the risks and precautions involved in their work and the location that
they work in. Employers should set the limits to what can and cannot be done while working alone. They
should ensure workers are competent to deal with the requirements of the job and are able to recognise
when to seek advice from elsewhere.
Supervision: The extent of supervision depends on the risk and the ability of the lone worker to identify
and handle health and safety issues. Employees new to a job may need to be accompanied until
competencies are achieved. Supervisors may periodically visit to observe the work being done.
• There should be regular contact by radio, telephone or mobile phone
• Automatic warnings should be activated if specific signals are not received at base
• Other warnings that raise the alarm in the event of an emergency should be devised
• Check that the lone worker has returned to base, or home, on completion of the work.
Emergency procedures: Your assessment of the risks should identify foreseeable events. Emergency
procedures should be established and employees trained in them. Information regarding emergency
procedures should be given to lone workers. Your risk assessment may indicate that mobile workers
should carry first-aid kits and/or that lone workers need first-aid training. They should also have access to
adequate first-aid facilities.
Lifting objects that are too heavy for one person: Before starting the lift, take some time to examine the
object that you will move. A small size does not always mean a light load. Test the item's weight by picking
up one corner of the item, or push it with your foot to gauge if you need another person, dolly or other
form of equipment to pick up the object. How easy it moves tells you how heavy it is. Will it be too heavy
for you to lift without help?
More than one person needed to operate essential controls or transport: Persons may be prohibited
from working alone in certain situations. Following are example of types of work where presence of at
least two employees might be required:
• Confined space entry

• Working on energized electrical conductor or equipment
• Power line hazards: Use of a vehicle, crane, or similar equipment near a live power line where it
is possible for any part or the equipment or its load to make contact with the live power line
• View obstruction: A vehicle, crane, mobile equipment, or similar material handling equipment
where the operator does not have full view of the intended path of travel
• Use of supplied air respiratory equipment or self-contained breathing apparatus
• Risk of drowning
• Welding operation where a fire watcher is required
• Tasks which, based on the risk assessment; are deemed to require more than one person
Alternatives, precautions and safe working procedures for lone working
Safe working arrangements for lone workers are no different to Organising the safety of other employees:

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• It must be identified if the lone worker can adequately control the risks of the job
• Precautions must be in place for both normal work and for emergencies such as fire, equipment
failure or sudden illness.
Other considerations:
• Does the lone worker have a safe way in and out of the workplace?
• Can one person handle temporary access equipment, plant, goods or substances?
• Is there a risk of violence?
• Are women especially at risk?
• Do young people work alone?
Environmental design – workplaces and their surrounds can be designed to reduce the likelihood of
violence. Environmental design features include:
• Controlling access through installing effective barriers

• Layout of client consultation rooms
• Increased visibility
• Monitored CCTV.
Design solutions need to be tailored to the specific workplace.
Buddy system: A second person is assigned to work with the first, because the job cannot be done safely
alone.
Communications: Telephones and walkie-talkies can be a lifeline in some cases.
Electronic and visual monitors: If introduced through proper negotiation these can offer some protection.
Personal alarm security systems (PASS) can also help.
Alarms: Many counter, service and care workers have access to panic buttons. A range of other
emergency, personal distress and violent attack alarms are available.
Movement records: knowing where workers are expected to be can assist in managing risks. Examples
are call in systems with supervisors or colleagues or using whiteboards at a base.
Training: Workers who deal with potentially violent clients alone need appropriate training. Workers in
remote locations also need training in first aid.
Knowledge sharing: Local, industry or client specific knowledge on where hazards and risks may arise can
assist with good OHS planning. Flagging systems, briefings and log books can all help in making sure that
knowledge is shared between employers and workers.

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9.3 Health Surveillance

The distinction between general health assessment and health surveillance
A general health assessment is a plan of care that identifies the specific needs of a person and how those
needs will be addressed by the healthcare system. Health assessment is the evaluation of the health status
by performing a physical exam after taking health history. It is done to detect diseases early in people that
may look and feel well.
Occupational health involves watching out for early signs of work-related ill health in employees exposed
to certain health risks. Such risks could be exposure to noise, vibration, ionizing radiation, asbestos, lead,
fumes, dusts, biological agents, solvents or any other substances that could be hazardous to health.
Health surveillance is important for:
• Detecting ill-health effects at an early stage, so employers can introduce better controls to
prevent them getting worse
• Providing data to help employers evaluate health risks
• Enabling employees to raise concerns about how work affects their health
• Highlighting lapses in workplace control measures, therefore providing invaluable feedback to the
risk assessment
• Providing an opportunity to reinforce training and education of employees (e.g. on the impact of
health effects and the use of protective equipment)
Health surveillance is necessary when:
• There is an identifiable disease or adverse health effect associated with the exposure to the
substance/s in the workplace, for example, dermatitis, cancer or asthma
• It is possible to detect the disease/adverse health effect
• The techniques for detecting the disease/adverse health effect pose no risk to employees
• The conditions in the workplace make it likely that the disease will appear
Health surveillance is a process; it may be a regular planned assessment of one or more aspects of a
worker's health, for example: lung function or skin condition. However, it is not enough to simply carry
out suitable tests, questionnaires or examinations. Employers must then have the results interpreted and
take action to eliminate or further control exposure. It may be necessary to redeploy affected workers if
necessary. Health surveillance may need to be completed by an occupational health service physician
(doctor or nurse). If a GP offers the service, it must be ensured that they are competent in occupational
medicine.

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The elements of the British HSE’s health surveillance cycle

The diagram below provides an overview of the HSE-UK health surveillance cycle. The employer has a
central role in every aspect with involvement from employees to ensure effective implementation.

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Noise health surveillance

The purpose of health surveillance is to:
• Warn employers when employees might be suffering from early signs of hearing damage
• Give employers an opportunity to do something to prevent the damage getting worse
• Check that control measures are working.
According to ILO CoP, ‘Ambient Factors in the Workplace’, appropriate health surveillance should be
conducted for all workers whose noise exposures reach a certain level prescribed by national laws and
regulations or by national or internationally recognized standards above which health surveillance should
be carried out.
Workers’ health surveillance may include:
• A pre-employment or pre-assignment medical examination to:

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o Determine any contraindication to exposure to noise

o Detect any sensitivity to noise
o Establish a baseline record useful for later medical surveillance
• Periodical medical examinations at intervals prescribed as a function of the magnitude of the exposure
hazards to:
o Detect the first symptoms of occupational disease
o Detect the appearance of any unusual sensitivity to noise and signs of stress due to noisy
working conditions
• Medical examinations prior to resumption of work after a period of extended sickness or in case of
conditions as may be specified in national legislation or internationally recognized standards;
• Medical examinations performed on cessation of employment to provide a general picture of the
eventual effects of exposure to noise;
• Supplementary and special medical examinations when an abnormality is found and it requires
further investigation.
The use of audiometry to measure hearing and hearing loss:
Employers must make the necessary arrangements for workers to have hearing checks carried out by a
competent medical practitioner. They also need to consult trade union safety representative, or employee
representative and the employees concerned before introducing health surveillance. It is important that
employees understand that the aim of health surveillance is to protect their hearing and introduce an
effective Hearing Conservation Program consisting of following basic parts:
o Noise Monitoring
o Hearing Protection
o Hearing Tests
o Training
The purpose of Audiometric testing is to provide an early diagnosis of any hearing loss due to noise and
to assist in the preservation of hearing. Larger companies may have access to in-house occupational health
services who may be able to carry out the programme. Where there are no facilities in-house you will
need to use an external contractor.
Audiometry should be conducted according to ISO 6189. The person’s response to a ‘barely audible’ tone
forms the basis of the test, so it is ‘subjective’; this can be unsatisfactory if he/she is not participating fully
-either because of inadequate instructions, noisy conditions, inattention or medico-legal factors affecting
test compliance.

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Audiometry assessment works in cooperation with the three main parts of our ear (outer, middle and
inner ears). It helps perceive if the patient has any defect to the nerve or cochlea (sensorineural hearing
loss) or damage to the eardrum or tiny bones of the ear: incus, malleus and stapes (conductive hearing
loss).
To illustrate, the outer ear collects and centralizes audible sound to the eardrum. The sound causes a
vibration of the eardrum, which is passed to the incus, malleus and stapes of middle ear. This causes the
vibration of the cochlea, and eventually the fluid and hair cells of the cochlea start vibrating. As the hair
cells tremble, nerve signals are delivered to the brain. The brain will consequently perceive it as sound.
Audiogram
During the test, the patient puts on headphones connected to the audiometer. The audiometer sends a
series of sounds that differ according to their pitch (frequency) and loudness to the headphones or bone
conductor. The loudness, or sound intensity, is measured in decibels (dB). Each ear of the patient will be
assessed individually. Every time the patient hears a tone, he presses a button to notify the audiologist of
hearing the sound. To exemplify, the audiologist controls the volume of the sound delivered and
decreases it until the patients hears nothing. The examiner will display a technically louder sound so that
the patient would be able to hear again. The process will be repeatedly carried on and on with sounds at
a high frequency each time to accurately determine the patient’s threshold of hearing at various
frequencies.
A suitably soundproofed setting must be provided for testing. Persons must be correctly instructed and
monitored during the test to ensure continued attention and compliance. Many audiometers have a
facility for talking via microphone and headphones to the person in the test booth. This should be used if
responses to audiometric tones seem exceptionally poor or are inconsistent.

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These recommendations and subsequent actions include, but are not limited to:
i. Normal Audiogram: - no further action required

ii. Improvement in Audiogram: - new audiogram is judged more representative and, therefore,
adopted as new baseline audiogram.
iii. Possible Invalid Audiogram: - Employee will be retested.
iv. Invalid Audiogram: - Employee will be retested.
v. Specific Employee Recommendations: - will be handled on an individual basis.
vi. Standard Threshold Shift (STS): If the comparison of the annual audiogram to the baseline
audiogram indicates an STS has occurred, the employee will be informed of this fact in writing.
A physician or audiologist will evaluate the employee and determine if the STS is work-related
or aggravated by occupational noise exposures. If the physician determines the STS is not
work related or aggravated by occupational noise exposure, the employee will be referred to
his or her family physician. If the physician determines STS may be work related, the physician
will refer the employee for an audiological or otological evaluation. Change in job
responsibilities or administrative controls may be necessary to reduce exposure.
Advantages of audiometry programmes: Disadvantages of audiometry programmes:

• Legal compliance • It’s a reactive approach and only tells us
• Prevention of noise-induced hearing loss about hearing loss that has happened
(NIHL) • Result accuracy is effected by many factors
• Prevention of NIHL reduced the risk of
workers compensation payments
• Effective programme can also detect
hearing losses that may be due to causes
other than workplace noise and might
otherwise go untreated
• Temporary hearing loss and tinnitus can also
be reduced or eliminated, as well as some
noise-related safety hazards
• Employees are less likely to feel fatigued and
annoyed, and the possibility of stress-
related illness can also be reduced
• Decreased likelihood of antisocial behavior
resulting from annoyance and stress
Analysing the results of the health surveillance for groups of workers can give an insight into how well the
programme to control noise risks is working. Use the results to target noise reduction, education and

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compliance practices more accurately. Make this information available to employee or safety
representatives.
Vibration health surveillance

A pre-employment medical examination should examine candidates for jobs affected by hand-arm
vibration for Raynaud’s phenomenon of non-occupational origin and for hand-arm vibration syndrome
(HAVS) from previous employment. Where these symptoms are diagnosed, such employment should not
be offered unless vibration has been satisfactorily controlled.
If a worker is exposed to hand-transmitted vibration, the occupational health professional responsible for
health surveillance should:
(a) examine the worker periodically, as prescribed by national laws and regulations, for HAVS and ask the
worker about symptoms;
(b) examine the worker for symptoms of possible neurological effects of vibration, such as numbness and
elevated sensory thresholds for temperature, pain, and other factors.
If it appears that these symptoms exist and may be related to vibration exposure, the employers should
be advised that control may be insufficient. The employer should review the assessment in accordance
with section 3.2 of this code, and in particular control the causative vibration.
Because of possible association of back disorders with whole-body vibration, workers exposed should be
counselled during health surveillance about the importance of posture in seated jobs, and about correct
lifting technique.
Keeping health records and medical records confidential

Under the COSHH Regulations, employees must ensure that a health record, containing particulars
approved by the HSE, in respect of each of his employees who have been or may have been exposed to
substances hazardous to health, is made and maintained. That record, or a copy thereof, must be kept
available in a suitable form.
However, apart from the duty to maintain health records under the COSHH Regulations, there is clearly a
case for maintaining health records of all employees.
Not only is it possible for the occupational health practitioner to obtain useful information on unidentified
health risks form accumulated records, but a health record could well be important evidence where an
individual may be taking a civil action for negligence against the organisation many years later, or where
the enforcement agency may be taking action under health and safety legislation.
The following records on individual employees may need to be maintained:
• Pre-employment and subsequent health questionnaires submitted by employees

• Details of pre-employment and subsequent health examinations and screening tests undertaken
by an occupational health nurse
• Relevant medical and occupational history, smoking habits, disabilities and handicaps

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• Injuries resulting from occupational and non-occupational accidents

• Illness occurring at work or on the way to or from work
• History of sickness absence
• Details of occupational diseases and conditions diagnosed
• Care and treatment provided
• Advice give, recommendations and work limitations imposed
• Referrals made to other medical specialists or agencies
• Correspondence relating to the health of individual employees
• Dispersal of cases following emergencies and treatment
• On subsequent occasions, record must also be maintained for the patient’s progress, findings on
examination, monitoring and follow-up arrangements, details of telephone consultations, details
about chaperones present, and any instance in which the patient has refused to be examined or
comply with treatment. It is also important to record your opinion at the time regarding, for
example, diagnosis.
Medical records can cover a wide range of

material including:
• Handwritten notes
• Computerised records
• Correspondence between health
professionals
• Laboratory reports
• Imaging records, including x-rays
• Photographs
• Video and other recordings
• Printouts from monitoring
equipment Patient medical record sheet
• Text or email communication with
patients.
There are strict laws and regulations in UK to ensure health records are kept confidential and can only be
accessed by health professionals directly involved in the care. There are a number of different laws that
relate to health records, the two most important laws are:
• Data Protection Act (1998)

• Human Rights Act (1998)
It is a criminal offence to breach the Data Protection Act (1998) and doing so can result in imprisonment.
The Human Rights Act (1998) also states that everyone has the right to have their private life respected.
This includes the right to keep your health records confidential.
Here are some guidelines being followed in UK regarding maintaining and access to medical records:
• Your medical record is a history of your healthcare, including treatments, medication, allergies,
test results, X-rays and scans. You have a legal right to apply for access to your medical records. A
request for your medical records should be made directly with the healthcare provider that

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provided the treatment. This is known as a Subject Access Request (SAR), as set out by the Data
Protection Act of 1998
• Health records are confidential so you can only access someone else's records if you’re authorized
to do so. To access someone else's health records, you must:
o Be acting on their behalf with their consent, or
o Have legal authority to make decisions on their behalf, or
o Have another legal basis for access
• If a person does not have the mental capacity to manage their own affairs and you are their
attorney, you will have the right to apply for access
• A person with parental responsibility will usually be entitled to access the records of a child who
is under 16. However, the best interests of the child will always be considered. If the healthcare
provider is confident that the child can understand their rights, then it will respond to the child
rather than the parent.
• If you want to see the health records of someone who has died, you can apply in writing to the
record holder under the Access to Health Records Act (1990).
• Under the terms of the Act, you will only be able to access the deceased’s health records if you
are either:
o A personal representative (the executor or administrator of the deceased person's estate)
o Someone who has a claim resulting from the death (this could be a relative or another
person)
Biological monitoring
The role of biological limits: Evaluation of the over-all hazard presented by the working environment
should be based on the results from the group of workers exposed to a given level of the harmful
substance, in order to offset the effect of individual biological variability. Any worker for whom the
findings exceed the biological limits should undergo further and repeated biological and medical
investigations.
When interpreting biological monitoring data, the physician must take into consideration factors that
contribute to individual variation in response to the exposure. Two workers will likely have differences in
pulmonary function, hemodynamics, body composition, efficacy of excretory organs, and activity of
enzyme systems that mediate metabolism of the chemical. Other factors to consider include personal
factors (age, sex, pregnancy, medications, state of health), lifestyle choices (smoking, drug use, eating
habits, and personal hygiene), and environmental exposures outside the workplace. It is possible to
exceed the BEIs and not experience adverse health effects. Authorised company physician must carefully
evaluate personal profile and integrate all necessary information into the interpretation of biological
monitoring results.
The relative advantages and disadvantages: Biological monitoring offers numerous advantages over
environmental monitoring and in particular permits assessment of:
o Exposure over an extended time period

o Exposure as a result of worker mobility in the working environment
o Absorption of a substance via various routes, including the skin
o Overall exposure as a result of different sources of pollution, both occupational and non-
occupational

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o The quantity of a substance absorbed by the subject depending on factors other than the
degree of exposure, such as the physical effort required by the job, ventilation, or climate
o The quantity of a substance absorbed by a subject depending on individual factors that
can influence the toxicokinetic of the toxic agent in the organism; for example, age, sex,
genetic features, or functional state of the organs where the toxic substance undergoes
biotransformation and elimination.
In spite of these advantages, biological monitoring still suffers today from considerable limitations, the
most significant of which are the following:
o The number of possible substances which can be monitored biologically is at present still
rather small.
o In the case of acute exposure, biological monitoring supplies useful information only for
exposure to substances that are rapidly metabolized, for example, aromatic solvents.
o The significance of biological indicators has not been clearly defined; for example, it is not
always known whether the levels of a substance measured on biological material reflect
current or cumulative exposure (e.g., urinary cadmium and mercury).
o Generally, biological indicators of internal dose allow assessment of the degree of
exposure, but do not furnish data that will measure the actual amount present in the
critical organ
o Often there is no knowledge of possible interference in the metabolism of the substances
being monitored by other exogenous substances to which the organism is simultaneously
exposed in the working and general environment.
o There is not always sufficient knowledge on the relationships existing between the levels
of environmental exposure and the levels of the biological indicators on the one hand,
and between the levels of the biological indicators and possible health effects on the
other.
o The number of biological indicators for which biological exposure indices (BEIs) exist at
present is rather limited. Follow-up information is needed to determine whether a
substance, presently identified as not capable of causing an adverse effect, may at a later
time be shown to be harmful
Why health assessments should be offered to shift/night workers

To be sure workers are fit for night work, employers must offer a free health assessment to anyone who
is about to start working nights and to all night workers on a regular basis. A night worker cannot opt-out
of the night work limit. Where a night worker’s work involves special hazards or heavy physical or mental
strain, there is an absolute limit of eight hours on the worker’s working time each day – this is not an
average.
How shift working can be managed with reference to the British HSE’s HSG256
Effective management of the risks associated with shift work requires commitment from senior
management. It is vitally important to make sure senior management (ie those who make the business
decisions, allocate funds and create a drive for change) are included in the development of, and/or
modification of, shift working arrangements.

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Developing clear policies and procedures for managing shift-working arrangements ensures that people
throughout the organisation, no matter how large or small, are aware that preventing or limiting the risks
of shift working needs to be considered at all levels of planning.
What is fatigue ?
More than 3.5 million people are employed as shift workers in the UK. They work in a wide variety of
industries including the emergency services, healthcare, the utilities, transport, manufacturing (including
oil, gas & chemical industries), entertainment and retail. Poorly designed shift-working arrangements and
long working hours that do not balance the demands of work with time for rest and recovery can result
in fatigue, accidents, injuries and ill health.
Fatigue refers to the issues that arise from excessive working time or poorly designed shift patterns. It is
generally considered to be a decline in mental and/or physical performance that results from prolonged
exertion, sleep loss and/or disruption of the internal clock. It is also related to workload, in that workers
are more easily fatigued if their work is machine-paced, complex or monotonous.
Managing fatigue
• Fatigue needs to be managed, like any other hazard.

• It is important not to underestimate the risks of fatigue. For example, the incidence of accidents
and injuries has been found to be higher on night shifts, after a succession of shifts, when shifts
are long and when there are inadequate breaks.
• The legal duty is on employers to manage risks from fatigue, irrespective of any individual's
willingness to work extra hours or preference for certain shift patterns for social reasons.
Compliance with the Working Time Regulations alone is insufficient to manage the risks of fatigue.
• Changes to working hours need to be risk assessed. The key considerations should be the
principles contained in HSE's guidance. Risk assessment may include the use of tools such as HSE's
'fatigue risk index'.
• Employees should be consulted on working hours and shift patterns. However, note that
employees may prefer certain shift patterns that are unhealthy and likely to cause fatigue.
• Develop a policy that specifically addresses and sets limits on working hours, overtime and shift-
swapping, and which guards against fatigue.
• Implement the policy and make arrangements to monitor and enforce it. This may include
developing a robust system of recording working hours, overtime, shift-swapping and on-call
working.
• Problems with overtime and shift-swapping may indicate inadequate resource allocation and
staffing levels.
• There are many different shift work-schedules and each schedule has different features. This
sheer diversity of work and workplaces means that there is no single optimal shift system that
suits everyone. However, a planned and systematic approach to assessing and managing the risks
of shift work can improve the health and safety of workers.
• There are a number of key risk factors in shift schedule design, which must be considered when
assessing and managing the risks of shift work. These are the workload, the work activity, shift
timing and duration, direction of rotation and the number and length of breaks during and

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between shifts. Other features of the workplace environment such as the physical environment,
management issues and employee welfare can also contribute to the risks associated with shift
work.
• Sleep disturbances can lead to a 'sleep debt' and fatigue. Night workers are particularly at risk of
fatigue because their day sleep is often lighter, shorter and more easily disturbed because of
daytime noise and a natural reluctance to sleep during daylight.
Forms of health surveillance that are a good idea to carry out although there is no legal
requirement
• workers with known mental ill-health conditions (especially work-related stress)
• workers who will be working at height
• driving occupations e.g., fork-lift truck drivers
• alcohol/substance abuse at work
How to establish and maintain an alcohol/drugs policy and tie in with other relevant
policies/ procedures
Drug and Alcohol Policy
Purpose
In compliance with the Drug-Free Workplace Act of 1988, the company has a longstanding commitment
to provide a safe, quality-oriented and productive work environment. Alcohol and drug abuse poses a
threat to the health and safety of the company’s employees and to the security of the company’s
equipment and facilities. For these reasons, the company is committed to the elimination of drug and
alcohol use and abuse in the workplace.
Scope
This policy applies to all employees and all applicants for employment of the company. The human
resource (HR) department is responsible for policy administration.
Employee Assistance
The company will assist and support employees who voluntarily seek help for drug or alcohol problems
before becoming subject to discipline or termination under this or other company’s policies. Such
employees will be allowed to use accrued paid time off, placed on leaves of absence, referred to treatment
providers and otherwise accommodated as required by law. Employees may be required to document
that they are successfully following prescribed treatment and to take and pass follow-up tests if they hold
jobs that are safety-sensitive or require driving, or if they have violated this policy previously. Once a drug
test has been initiated under this policy, unless otherwise required by the regional laws, the employee
will have forfeited the opportunity to be granted a leave of absence for treatment, and will face possible
discipline, up to and including discharge.

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Employees should report to work fit for duty and free of any adverse effects of illegal drugs or alcohol.
This policy does not prohibit employees from the lawful use and possession of prescribed medications.
Employees must, however, consult with their doctors about the medications’ effect on their fitness for
duty and ability to work safely, and they must promptly disclose any work restrictions to their supervisor.
Work Rules
1.Whenever employees are working, are operating any company vehicle, are present on company
premises or are conducting company-related work offsite, they are prohibited from:
• Using, possessing, buying, selling, manufacturing or dispensing an illegal drug (to include
possession of drug paraphernalia).
• Being under the influence of alcohol or an illegal drug as defined in this policy.
• Possessing or consuming alcohol.
2.The presence of any detectable amount of any illegal drug, illegal controlled substance or alcohol in an
employee’s body system, while performing company business or while in a company facility, is prohibited.
3.The company will also not allow employees to perform their duties while taking prescribed drugs that
are adversely affecting their ability to safely and effectively perform their job duties. Employees taking a
prescribed medication must carry it in a container labeled by a licensed pharmacist or be prepared to
produce the container if asked.
4.Any illegal drugs or drug paraphernalia will be turned over to an appropriate law enforcement agency
and may result in criminal prosecution.
Required Testing
Pre-employment
Applicants being considered for hire must pass a drug test before beginning work or receiving an offer of
employment. Refusal to submit to testing will result in disqualification of further employment
consideration.
Reasonable suspicion
Employees are subject to testing based on (but not limited to) observations by at least two members of
management of apparent workplace use, possession or impairment. HR, the plant manager or the director
of operations should be consulted before sending an employee for testing. Management must use the
Reasonable Suspicion Observation Checklist to document specific observations and behaviors that create
a reasonable suspicion that an employee is under the influence of illegal drugs or alcohol. Examples
include:
• Odors (smell of alcohol, body odor or urine).

• Movements (unsteady, fidgety, dizzy).
• Eyes (dilated, constricted or watery eyes, or involuntary eye movements).

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• Face (flushed, sweating, confused or blank look).

• Speech (slurred, slow, distracted mid-thought, inability to verbalize thoughts).
• Emotions (argumentative, agitated, irritable, drowsy).
• Actions (yawning, twitching).
• Inactions (sleeping, unconscious, no reaction to questions).
When reasonable suspicion testing is warranted, both management and HR will meet with the employee
to explain the observations and the requirement to undergo a drug and/or alcohol test within two hours.
Refusal by an employee will be treated as a positive drug test result and will result in immediate
termination of employment
Under no circumstances will the employee be allowed to drive himself or herself to the testing facility. A
member of management must transport the employee or arrange for a cab and arrange for the employee
to be transported home.
Post-accident
Employees are subject to testing when they cause or contribute to accidents that seriously damage a
company vehicle, machinery, equipment or property or that result in an injury to themselves or another
employee requiring offsite medical attention. A circumstance that constitutes probable belief will be
presumed to arise in any instance involving a work-related accident or injury in which an employee who
was operating a motorized vehicle (including a company forklift, pickup truck, overhead crane or
aerial/man-lift) is found to be responsible for causing the accident. In any of these instances, the
investigation and subsequent testing must take place within two hours following the accident, if not
sooner. Refusal by an employee will be treated as a positive drug test result and will result in immediate
termination of employment.
Under no circumstances will the employee be allowed to drive himself or herself to the testing facility. A
member of management must transport the employee or arrange for a cab and arrange for the employee
to be transported home.
Collection and Testing Procedures
Employees subject to alcohol testing will be transported to a company-designated facility and directed to
provide breath specimens. Breath specimens will be tested by trained technicians using federally
approved breath alcohol testing devices capable of producing printed results that identify the employee.
If an employee’s breath alcohol concentration is .04 or more, a second breath specimen will be tested
approximately 20 minutes later. The results of the second test will be determinative. Alcohol tests may,
however, be a breath, blood or saliva test, at the company’s discretion. For purposes of this policy, test
results generated by law enforcement or medical providers may be considered by the company as work
rule violations.
Applicants and employees subject to drug testing will be transported to a company -designated testing
facility and directed to provide urine specimens. Applicants and employees may provide specimens in
private unless they appear to be submitting altered, adulterated or substitute specimens. Collected

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specimens will be sent to a federally certified laboratory and tested for evidence of marijuana, cocaine,
opiates, amphetamines, PCP, benzodiazepines, methadone, methaqualone and propoxphane use. (Where
indicated, specimens may be tested for other illegal drugs.) The laboratory will screen all specimens and
confirm all positive screens. There must be a chain of custody from the time specimens are collected
through testing and storage.
The laboratory will transmit all positive drug test results to a medical review officer (MRO) retained by
company, who will offer individuals with positive results a reasonable opportunity to rebut or explain the
results. Individuals with positive test results may also ask the MRO to have their split specimen sent to
another federally certified laboratory to be tested at the applicant’s or employee’s own expense. Such
requests must be made within 72 hours of notice of test results. If the second facility fails to find any
evidence of drug use in the split specimen, the employee or applicant will be treated as passing the test.
In no event should a positive test result be communicated to the company until such time that the MRO
has confirmed the test to be positive.
Consequences
Applicants who refuse to cooperate in a drug test or who test positive will not be hired and will not be
allowed to reapply/retest in the future.
Employees who refuse to cooperate in required tests or who use, possess, buy, sell, manufacture or
dispense an illegal drug in violation of this policy will be terminated. If the employee refuses to be tested,
yet the company believes he or she is impaired, under no circumstances will the employee be allowed to
drive himself or herself home.
Employees who test positive, or otherwise violate this policy, will be subject to discipline, up to and
including termination. Depending on the circumstances, the employee’s work history/record and any
state law requirements, the company may offer an employee who violates this policy or tests positive the
opportunity to return to work on a last-chance basis pursuant to mutually agreeable terms, which could
include follow-up drug testing at times and frequencies determined by the company for a minimum of
one year but not more than two years as well as a waiver of the right to contest any termination resulting
from a subsequent positive test. If the employee either does not complete the rehabilitation program or
tests positive after completing the rehabilitation program, the employee will be immediately discharged
from employment.
Employees will be paid for time spent in alcohol or drug testing and then suspended pending the results
of the drug or alcohol test. After the results of the test are received, a date and time will be scheduled to
discuss the results of the test; this meeting will include a member of management, a union representative
(if requested), and HR. Should the results prove to be negative, the employee will receive back pay for the
times/days of suspension.
Confidentiality

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Information and records relating to positive test results, drug and alcohol dependencies, and legitimate
medical explanations provided to the MRO will be kept confidential to the extent required by law and
maintained in secure files separate from normal personnel files. Such records and information may be
disclosed among managers and supervisors on a need-to-know basis and may also be disclosed when
relevant to a grievance, charge, claim or other legal proceeding initiated by or on behalf of an employee
or applicant.
Inspections
The company reserves the right to inspect all portions of its premises for drugs, alcohol or other
contraband; affected employees may have union representation involved in this process. All employees,
contract employees and visitors may be asked to cooperate in inspections of their persons, work areas
and property that might conceal a drug, alcohol or other contraband. Employees who possess such
contraband or refuse to cooperate in such inspections are subject to appropriate discipline, up to and
including discharge.
Crimes Involving Drugs
The company prohibits all employees, including employees performing work under government contracts,
from manufacturing, distributing, dispensing, possessing or using an illegal drug in or on company
premises or while conducting company business. The company employees are also prohibited from
misusing legally prescribed or over-the-counter (OTC) drugs. Law enforcement personnel may be notified,
as appropriate, when criminal activity is suspected.
The company does not desire to intrude into the private lives of its employees but recognizes that
employees’ off-the-job involvement with drugs and alcohol may have an impact on the workplace.
Therefore, the company reserves the right to take appropriate disciplinary action for drug use, sale or
distribution while off company premises. All employees who are convicted of, plead guilty to or are
sentenced for a crime involving an illegal drug are required to report the conviction, plea or sentence to
HR within five days. Failure to comply will result in automatic discharge. Cooperation in complying may
result in suspension without pay to allow management to review the nature of the charges and the
employee’s past record with the company.
Definitions
“Company premises” includes all buildings, offices, facilities, grounds, parking lots, lockers, places and
vehicles owned, leased or managed by the company or any site on which the company is conducting
business.
“Illegal drug” means a substance whose use or possession is controlled by federal law but that is not being
used or possessed under the supervision of a licensed health care professional. (Controlled substances
are listed in local laws)
“Refuse to cooperate” means to obstruct the collection or testing process; to submit an altered,
adulterated or substitute sample; to fail to show up for a scheduled test; to refuse to complete the

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requested drug testing forms; or to fail to promptly provide specimen(s) for testing when directed to do
so, without a valid medical basis for the failure. Employees who leave the scene of an accident without
justifiable explanation prior to submission to drug and alcohol testing will also be considered to have
refused to cooperate and will automatically be subject to discharge.
“Under the influence of alcohol” means an alcohol concentration equal to or greater than .04, or actions,
appearance, speech or bodily odors that reasonably cause a supervisor to conclude that an employee is
impaired because of alcohol use.
“Under the influence of drugs” means a confirmed positive test result for illegal drug use per this policy.
In addition, it means the misuse of legal drugs (prescription and possibly OTC) when there is not a valid
prescription from a physician for the lawful use of a drug in the course of medical treatment (containers
must include the patient’s name, the name of the substance, quantity/amount to be taken and the period
of authorization).
Enforcement
The HR director is responsible for policy interpretation, administration and enforcement.
The benefits of pre-employment health screening

When job seekers apply for a job, they may be required to be screened for drug and alcohol use. In some
cases, employers make this a necessary condition for applying to the job position. This drives home the
importance of drug and alcohol testing as a pre-employment process aimed towards ensuring that
prospective employees are fit for the job. Typical drugs that are usually screened for in blood tests include
amphetamines, cocaine, marijuana, methamphetamines, opiates, nicotine, and alcohol.
This goes to show that having a comprehensive workplace and drug testing program, whether during pre-
employment or on-the-job, benefits both the employer and the employee in numerous ways. The benefits
of Drug and Alcohol Testing to an organization are numerous but here are six pertinent advantages.
1. It Promotes a Safer Working Environment
Safer workplace is perhaps the single biggest advantage of workplace drug testing because it promotes
workplace health and safety. This is especially true for safety-sensitive jobs involving handling hazardous
chemicals, operating heavy machinery, or driving vehicles for your company (as seen in the oil and gas,
manufacturing and construction industry). If any of them work while impaired by their drug of choice,
whether it’s ice or alcohol, the risks of a workplace accident are significantly increased. However,
regardless of the industry, any workplace accident can lead to significant losses, injuries and even deaths.
When that happens, it’s going to expose your company to a whole array of liabilities and public relations
issues.
2. Increased Safety Leads to Better Productivity
Drug testing leads to reduced accidents, which is a pretty good indicator that a workplace has indeed a
safe working environment. That can only motivate employees to become more productive, knowing that

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their employers are doing everything they can to keep everyone safe while at work. Companies with a
comprehensive workplace drug testing program have consistently reported an overall improvement in job
performance as well as employee morale.
3. Pre-employment Drug Testing Can Screen Drug Users Before Hiring Them
Some employers see pre-employment drug testing as an unnecessary cost on their part. However, when
considering the potential cost of dealing with a drug user among your staff, you quickly see the value. At
what point would you find out that a person in your company is using illicit drugs? It is better to screen
prospective employees before they are employed.
4. Improves Staff Morale
Drug abuse in the workplace is often synonymous to trouble for everyone in it. When employees see that
a drug testing program is being strictly implemented, it impresses upon them how committed their
employer is to provide a safe working environment for everyone. That raises morale among staff, which
is always a good thing for any organization.
5. Reduces Potential Workplace Conflict/Violence
Drug abusers tend to behave a little more aggressively, particularly those who are hooked on stimulant
drugs such as ice or cocaine. With the implementation of a drug testing program, the organization will be
able to pinpoint and deal with drug abusing employees before any incidents of conflict and violence ever
take place.
6. It Creates A Healthier Workplace
Drug abuse carries with a number of health risks. The deterrent effect of drug testing at work, combined
with the education of employees on these health risks, can significantly contribute to make the workplace
a healthier one.
When testing for alcohol/drugs should be carried out

Pre-Employment: Pre-employment testing is conducted to prevent hiring individuals who illegally use
drugs. It typically takes place after a conditional offer of employment has been made. Applicants agree
to be tested as a condition of employment and are not hired if they fail to produce a negative test.
However, it is possible for employees to prepare for a pre-employment test by stopping their drug use
several days before they anticipate being tested. Therefore, some employers test probationary
employees on an unannounced basis. Some states, however, restrict this process. Furthermore, the
Americans with Disabilities Act (ADA) of 1990 prohibits the use of pre-employment testing for alcohol use.
Reasonable Suspicion: Reasonable suspicion testing is similar to, and sometimes referred to, as
“probable-cause” or “for-cause” testing and is conducted when supervisors document observable signs
and symptoms that lead them to suspect drug use or a drug-free workplace policy violation. It is extremely
important to have clear, consistent definitions of what behavior justifies drug and alcohol testing and any
suspicion should be corroborated by another supervisor or manager. Since this type of testing is at the

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discretion of management, it requires careful, comprehensive supervisor training. In addition, it is advised

that employees who are suspected of drug use or a policy violation not return to work while awaiting the
results of reasonable suspicion testing.
Post-Accident: Since property damage or personal injury may result from accidents, testing following an
accident can help determine whether drugs and/or alcohol were a factor. It is important to establish
objective criteria that will trigger a post-accident test and how and by whom they will be determined and
documented. Examples of criteria used by employers include fatalities; injuries that require anyone to
be removed from the scene for medical care; damage to vehicles or property above a specified monetary
amount; and citations issued by the police. Although the results of a post-accident test determine drug
use, a positive test result in and of itself cannot prove that drug use caused an accident. When post-
accident testing is conducted, it is a good idea for employers not to allow employees involved in any
accident to return to work prior to or following the testing. Employers also need to have guidelines to
specify how soon following an accident testing must occur so results are relevant. Substances remain in
a person’s system for various amounts of time, and it is usually recommended that post-accident testing
be done within 12 hours. Some employers expand the test trigger to incidents even if an accident or injury
was averted and hence use term “post-incident.”
Random: Random testing is performed on an unannounced, unpredictable basis on employees whose

identifying information (e.g., social security number or employee number) has been placed in a testing
pool from which a scientifically arbitrary selection is made. This selection is usually computer generated
to ensure that it is indeed random and that each person of the workforce population has an equal chance
of being selected for testing, regardless of whether that person was recently tested or not. Because this
type of testing has no advance notice, it serves as a deterrent.
Periodic: Periodic testing is usually scheduled in advance and uniformly administered. Some employers
use it on an annual basis, especially if physicals are required for the job. Such tests generally are more
accepted by employees than unannounced tests, but employees can prepare them by stopping their drug
use several days beforehand.
Return-to-Duty: Return-to-duty testing involves a one-time, announced test when an employee who has
tested positive has completed the required treatment for substance abuse and is ready to return to the
workplace. Some employers also use this type of testing for any employee who has been absent for an
extended period of time.
Other: Other types of tests are also used by some employers. For example, follow-up testing or post-
rehabilitation testing is conducted periodically after an employee returns to the workplace upon
completing rehabilitation for a drug or alcohol problem. It is administered on an unannounced,
unpredictable basis for a period of time specified in the drug-free workplace policy. Another type of
testing, blanket testing, is similar to random testing in that it is unannounced and not based on individual
suspicion; however, everyone at a worksite is tested rather than a randomly selected percentage. Other
types of testing include voluntary, probationary, pre-promotion and return-after-illness testing.

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The disadvantages of alcohol/drugs testing

Random drug testing is not in real time
A positive drug test reveals only a potential past condition and not necessarily a present one. This is not
helpful when the purpose of drug tests is to dissuade drug use and intoxication while on the job.
Timing is especially important when testing for cannabis. Unlike alcohol, which is water-soluble and whose
presence in the blood more accurately reflects current intoxication, the chemical compounds in cannabis
can be present in body fluids long after they have been metabolized and long after the psychoactive
effects have worn off. This issue has commonly prevented DUI-cannabis charges to lead to successful
convictions.
So, urine or blood testing for cannabis use are ineffective in revealing intoxication, preventing accidents,
and dissuading drug use while at work. Instead, the strongest indicators of real-time cannabis impairment
are behavioral and cognitive measures.
Unsurprisingly, cannabis is the most common cause of positive drug tests in the workplace. And it’s
positivity rate is increasing across all workforces. Between 2014 and 2018, it’s increased by 24% in the US
general workforce. At the same time, the positivity rates for opiates in the general workforce are
declining--a 37% decrease between 2015 and 2018.
This means that companies are spending increasing amounts of money on tests that measure the effects
of a drug consumed within a wide time-frame, and thus may have no implications on workers’ actual level
of impairment while at work.
Random drug testing is not a safety measure
The fact that workplace drug tests do not measure impairment in real-time also make it impossible for
them to be considered a safety measure.
When drug tests are taken before work, they obviously do not detect drug use while actually on the job,
nor do they dissuade drug users from taking drugs after the test is done. Thus, they do not improve safety.
Instead, job applicants merely take a break from using drugs so they are clean for the pre-employment
drug screen.
When drug tests are taken after an accident, their purpose as a safety measure is moot. At that point, the
test is a matter of course in investigating the accident’s causes, not to reduce the victim’s safety risk. Too
little, too late.
And especially too little when you get a false positive!
Random drug tests are not always accurate
Here are 20 common medications known to cause false positives:
i. Amitriptyline (Amitril): An antidepressant.

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ii. Bupropion (Wellbutrin): An antidepressant.

iii. Dextromethorphan (Robitussin, Delsym): Found in many over-the-counter cough
suppressants.
iv. Diltiazem (Cardizem): Used to treat hypertension (high blood pressure) or to slow heart
rate.
v. Diphenhydramine (Benadryl): An antihistamine found in allergy medications or sleep aids.
vi. Ibuprofen (Motrin, Advil) and naproxen (Aleve): Over-the-counter anti-inflammatory pain
medications.
vii. Metformin (Glucophage): A common oral medication for diabetes.
viii. Fluoxetine (Prozac) and trazodone: Used to treat depression.
ix. Pseudoephedrine (Sudafed): Used for sinus and nasal congestion.
x. Labetalol (Trandate): Used for blood pressure control.
xi. Methylphenidate (Ritalin): Used to treat ADHD.
xii. Doxylamine: Found in over-the-counter sleep aids.
xiii. Sertraline (Zoloft): An antidepressant.
xiv. Tramadol (Ultram): Used for pain treatment.
xv. Quetiapine (Seroquel): An antidepressant.
xvi. Phentermine (Adipex-P): Weight loss medication.
xvii. Oxaprozin (Daypro): Anti-inflammatory medication used to treat arthritis.
xviii. Venlafaxine (Effexor XR): An antidepressant.
xix. Proton pump inhibitors (omeprazole, esomeprazole, pantoprazole): Used to treat
gastroesophageal reflux disease (GERD) and heartburn symptoms.
xx. Quinolone antibiotics (levofloxacin, ofloxacin): Used to treat urinary tract infections,
pneumonia, sinus infections, and more.
So, the presence of a substance detected in body fluid is not necessarily an indicator of impairment while
at work.
Random drug tests are not sensitive to change
The legalization or decriminalization of cannabis in various countries, especially for medicinal purposes,
has left many companies in a pickle.
With quickly changing laws and conflicting state and federal regulations, the right policies regarding
cannabis in the workplace aren’t always obvious.
In such a time of social change and developing scientific research on cannabis use, penalizing workers for
having consumed cannabis at some point, for either medical or recreational purposes, often results in a
lawsuit.
The possibility of positives and the growing use of medical marijuana further contribute to employee
grievances and pushback against workplace drug testing.
Random drug tests are not good for workplace safety culture

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Employee's general dislike of random and pre-employment drug tests stems from the fact that they are
focused on catching and punishing wrongdoing. Such a negative and reactive approach to workplace
safety typically results from poor management and leadership. When the only recognition for safety
performance in a workplace is in the form of reprimand, communication and rapport between front-line
workers and management tends to be poor.
Random drug tests are not comprehensive
Workplace drug testing overlooks other forms of impairment, such as those caused by alcohol, fatigue,
illness, and even emotional distress. Alcohol tests at work are not as common as drug tests, although
many employees who are randomly tested for drugs may also drink regularly or to excess. Further, the
effects of alcohol linger long after an alcohol test would be able to detect its presence. For example,
although a worker may not be acutely or visibly drunk at work, they may be hungover and neither a
random drug test nor an alcohol test will prevent them from undertaking safety-sensitive work.
Drug testing these employees cannot identify any heightened safety risks they pose before they become
apparent in lagging indicators. But pre-task or pre-shift impairment testing can do this, and thus allow
intervention by supervisors when such circumstances arise.
Random drug testing makes it harder to hire qualified workers
More than half of Americans say they have tried marijuana and 55 million use marijuana weekly.
That's a lot. And drug tests that disqualify candidates (or discourage them from even applying) based on
if they've had marijuana sometime in the recent past make finding a qualified job candidate a lot more
difficult for employers.
And it's not just cannabis users that are penalized. Stories of workers being fired for using prescription
medicine while at work are not uncommon. Ironically, in many cases, these prescription medicines are
actually meant to enhance the worker's ability to remain focused and productive.
For example, ten years ago, The New York Times reported on the story of a woman who was fired from
her job of 22 years after testing positive for a painkiller that her doctor prescribed. (Business Insider, 2015)
The situation is especially lamentable when companies have to fire dedicated and valuable employees in
an effort to remain compliant with regulations that do not necessarily improve safety.
Meanwhile, candidates impaired by alcohol, whether currently or in the past, are not subject to the same
scrutiny.
9.4 Hazardous Substances

The structure and function of human anatomical systems
Human body is made of ten different systems. All the systems require support and coordination of other
systems to form a living and healthy human body. If any one of these systems is damaged, human body
will become unstable and this lack of stability will ultimately lead to death. The instability caused by

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damage of one system cannot be stabilized by other systems because functions of one system cannot be
performed by other systems.
A system of human body means a collective functional unit made by several organs in which the organs
work in complete coordination with one another. Organs cannot work alone because there are certain
needs of every organ that need to be fulfilled and the organ itself cannot fulfill those needs. So all organs
of human body need the support of other organs to perform their functions and in this way an organ
system is formed.
Human body systems
A brief introduction to all the systems of human body is given in the table below.
Name: Components Role
Strength, Support, Shape,

Skeletal System Bones, associated cartilages, Joints Protection, Leverage, Cell
Production
Muscles (Skeletal Muscles, Smooth muscles, Motor power for

Muscular System
Cardiac Muscles) movements of body parts.
Control and Coordination of

Nervous System Brain, Spinal Cord, Nerves, Nerve Endings all body functions (Nervous
coordination)

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Respiratory Lungs, Nose, Trachea, Bronchi, Bronchioles,

Gaseous exchange
System Alveolar sacs, Alveoli
Cardiovascular Heart, Blood vessels (Arteries, Veins and Flow of blood (and
System Capillaries), Blood nutrients) throughout body
Lymphatic Lymph vessels, Central lymphoid tissue, Peripheral

Drainage and Protection
System Lymphoid Organs, Lymphocytes
Endocrine glands (Pituitary gland, Thyroid gland,

Parathyroid glands, Adrenal glands, Pancreas Regulation of body functions
Endocrine System
(endocrine part), Testes (endocrine part), Ovary (Chemical coordination)
(endocrine part), Liver (endocrine part))
Alimentary Canal (Oral Cavity, Esophagus, Stomach,

Digestion and absorption of
Digestive System Small Intestine, Large Intestine, Anus), Liver,
food
Pancreas, Salivary glands, Teeth, Tongue
Regulation of body’s internal

environment, and
Urinary System Kidneys, Ureters, Urinary bladder, Urethra
production and excretion of
urine
Male Formation of sperms and

Reproductive Penis, Testes semen, and fertilizing the
System female
Female Formation of eggs and

Reproductive Uterus, Ovaries, Vulva, Labia, Clitoris bearing the fetus during
System development
For the purpose of this course; only respiratory, digestive, circulatory, nervous system and the special sensory organs
(skin, eyes and nose) will be discussed in more detail.
Respiratory system
Components: Functions:
Gaseous exchange: Main function of
respiratory system is gaseous exchange.

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Nose: The most external organ, air is inhaled and Through respiratory system new air is
exhaled through nose, has different mechanisms for always brought into the body and used air
cleaning and condensing the inhaled air is expelled out. In this way oxygen is gained
Larynx: Also known as sound box, formed of cartilages, and carbon dioxide is lost by the body.
connects the trachea to the laryngopharynx Excretion of carbon monoxide: Respiratory
Trachea: Tubular structure with about 1 inch diameter, system is the major system for excretion of
composed of 15-20 C shaped cartilages that keep it carbon dioxide from the body. Carbon
dilated dioxide is produced as a result of metabolic
Bronchi: Left and Right divisions of trachea, enters the break down of carbohydrates in body and
lungs and divide into secondary bronchi must be eliminated quickly. Carbon dioxide
Lungs: Main organs of respiration where gaseous is brought to the lungs by blood and is lost
exchange take place. Two in number (one on each side from the lungs through gaseous exchange
of heart) Conical in shape, divided into lobes. Lungs are with fresh air in lungs.
soft, spongy and very elastic. Oxygenation of blood: Oxygen is required
Respiratory passages: Respiratory passages or air-ways by the body for breakdown of food and
are the conducting portions of human respiratory must be continuously supplied for
system. Here no exchange of gases take place, but they continuous supply of energy. Supply of
guide the air to go to the lungs and not anywhere else in oxygen is maintained by respiratory
the body. Conducting portion of the human respiratory system.
system consists of; Traches, Bronchi, Bronchioles,
Alveolar sacs and Alveoli.
Respiratory system
Digestive system

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Oral cavity: It is the cavity of mouth, irregular in shape, Digestive system is the food processing
contains tongue, teeth and salivary glands, system of human body. The food taken by
Esophagus: Muscular tube passing the food from human beings is digested into simpler
pharynx to stomach molecules that can be absorbed into the
Stomach: Muscular, hollow and dilated part of blood and utilized for various functions of
alimentary canal, involved in both mechanical and human body. As the digestive system is the
chemical digestion of food, secretes strong acid and only route of intake of nutrients (in normal
enzymes to aid in digestion of food conditions), therefore necessarily all the
Small intestine: Lies between stomach and large nutrient requirements of human body are
intestine, majority of digestion and absorption takes fulfilled by this system alone. If the
place here, About 5 meters in length digestive system is impaired for some
Large intestine: Second-to-last part of alimentary canal, reason, health of the affected individual
main function is to absorb water from indigestible food. will seriously decline.
Anus: Last part of alimentary canal, opens to outside for
digestion of food, Controls the expulsion of feces
Liver: Produces bile for emulsification of fats
Pancreas: Secretes pancreatic juice containing different
digestive enzymes into the small intestine
Teeth: Chewing and mastication of food
Tongue: Rolling and lubrication of food

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Digestive system
Circulatory/Cardiovascular system
Heart: Hollow muscular organ providing the force for Perfectly functioning Cardiovascular
flow of blood throughout human body system is so important for human body,
Blood vessels: Pathways of blood flow in human body, that if it stops for a minute, rapid death will
hollow tubes, of 3 types occur. The flow of blood is necessary for
Arteries: Carry blood away from heart to other existence of life. If the flow of blood is
body parts, very muscular and elastic stopped, life will stop. Heart is the main
Capillaries: Microscopic blood vessels where organ of cardiovascular system and it is
exchange of nutrients with tissues take place responsible for distributing blood all over
Veins: Carry blood towards the heart from other human body.
body parts, their walls are thinner as compared
to corresponding arteries.

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Blood: Blood is a specialized tissue of body that exists in

fluid form. Blood consists of two major portions: Blood
cells and Plasma. Plasma is the watery portion of blood
that makes it a fluid. 90% of blood plasma is water and
remaining 10% are proteins, inclusions and waste
products etc. Blood cells are of three main types: Red
Blood Cells (RBCs), White Blood Cells (WBCs) and
Platelets.
Circulatory system
Nervous system
Brain: Central part of nervous system, Controls all body Control of all body functions: Nervous
functions system is the master system of human
Spinal cord: long and thin bundle of nervous tissue body. It controls the activity of all other
extending from lower part of brain, transmits neural systems in such a way that all the systems
signals between brain and rest of the body collectively make a human being. Without
Nerves: A bundle of peripheral axons enclosed by a controlling system, there is no concept of
connective tissue. Carries nervous signals from nervous life because in such case there will be no
system to body and from body to nervous system. coordination between different body

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Nerves are of two types; Spinal nerves and Cranial functions and they will all act separately.
Nerves. Nervous system not only controls the
Spinal Nerves: Spinal nerves arise from the voluntary functions of human body that are
spinal cord. There are 31 pairs of spinal nerves directed by human will, but it also controls
in human body. those functions that are below the level of
Cranial Nerves: Cranial nerves arise from the consciousness of human beings. Control of
brain. There are 12 pairs of cranial nerves in a function means that the intensity of that
human body. function can be increased or decreased
Nerve ending: Motor and sensory neurons end in according to the demands of human body.
special type of structures depending on their function. Coordination of different body organs:
These structures are called nerve endings Nervous system not only produces
coordination between different systems,
but also between different organs of a
system. To form an organ system, role of
the component organs must also be
coordinated. So nervous system is not only
important for formation of an organism by
different organ systems, but also for
formation of a system by different organs
of human body.

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Nervous system
Sensory organs (skin, eyes and nose)

The sense organs — eyes, ears, tongue, skin, and nose — help to protect the body. The human sense
organs contain receptors that relay information through sensory neurons to the appropriate places
within the nervous system.
The skin: The skin protects the internal organs of the body from the outside environment. Its outer
layer is composed of hardened, dead cells which make the skin resistant to daily wear and tear. Sweat
glands cool the body when the environment is hot. Sebaceous glands produce oils which repel water.

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Skin
A network of small blood vessels, or capillaries, plays a key role in controlling body temperature. These
capillaries open when it is hot, radiating heat outward into the air, and constrict when it is cold,
conserving heat in the body. The skin also has a protective layer of oils and proteins which helps to
prevent injury or penetration by harmful substances. A substance may be absorbed and travel to
another part of the body, or it may cause damage at the point of entry (the skin), and start the disease
process. Such substances are usually identified in an MSDS with a notation “skin” along with their
exposure limits, indicating that the exposure can occur through the skin, mucous membranes, or eyes,
or may damage the skin itself.
Eyes: The eye is the organ of vision. It has a complex structure consisting of a transparent lens that
focuses light on the retina. The retina is covered with two basic types of light-sensitive cells-rods and
cones. The cone cells are sensitive to color and are located in the part of the retina called the fovea,
where the light is focused by the lens. The rod cells are not sensitive to color, but have greater
sensitivity to light than the cone cells. These cells are located around the fovea and are responsible for
peripheral vision and night vision. The eye is connected to the brain through the optic nerve. The point
of this connection is called the "blind spot" because it is insensitive to light.
The brain combines the input of our two eyes into a single three-dimensional image. In addition, even
though the image on the retina is upside-down because of the focusing action of the lens, the brain
compensates and provides the right-side-up perception.

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Human eye
The range of perception of the eye is phenomenal. In the dark, a substance produced by the rod cells
increases the sensitivity of the eye so that it is possible to detect very dim light. In strong light, the iris
contracts reducing the size of the aperture that admits light into the eye and a protective obscure
substance reduces the exposure of the light-sensitive cells. The spectrum of light to which the eye is
sensitive varies from the red to the violet. Lower electromagnetic frequencies in the infrared are
sensed as heat, but cannot be seen. Higher frequencies in the ultraviolet and beyond cannot be seen
either, but can be sensed as tingling of the skin or eyes depending on the frequency.
Nose: The nose is the organ responsible for the sense of smell. The cavity of the nose is lined with
mucous membranes that have smell receptors connected to the olfactory nerve. The smells
themselves consist of vapors of various substances. The smell receptors interact with the molecules
of these vapors and transmit the sensations to the brain. The smell receptors are sensitive to seven
types of sensations that can be characterized as camphor, musk, flower, mint, ether, acrid, or putrid.
The sense of smell is sometimes temporarily lost when a person has a cold.

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Anatomy of nose
Our other senses touch and taste may seem less critical, but they still make valuable contributions to
our rich sensory experiences.
Taste is important not only because it allows us to enjoy the food we eat, but even more crucial,
because it leads us toward foods that provide energy (sugar, for instance) and away from foods that
could be harmful. Together with the sense of smell, taste helps us maintain appetite, assess potential
dangers (such as the odor of a gas leak or a burning house), and avoid eating poisonous or spoiled
food.
Our ability to taste begins at the taste receptors on the tongue. The tongue detects six different taste
sensations. The skin, the largest organ in the body, is the sensory organ for touch. The skin contains a
variety of nerve endings, combinations of which respond to particular types of pressures and
temperatures. When different parts of the body are touched, it will be found that some areas are more
ticklish, whereas other areas respond more to pain, cold, or heat. The thousands of nerve endings in
the skin respond to four basic sensations: Pressure, hot, cold, and pain.
The concept of target organs and target systems in relation to attack by hazardous
substances
The effects of exposure to workplace safety hazards are sometimes immediate, painful, and obviously
damaging, but it is not always easy to observe when and how the body’s cells are attacked by hazardous
materials in the workplace. Many of the most serious diseases do not occur until 10 to 30 years after
exposure.
Because the body only has a certain number of responses to chemical and biological stressors, it is a
complicated business sorting out the signs and symptoms and determining the actual cause of human
disease or illness. In many cases, it is impossible to determine whether an illness was caused by chemical
exposure or by a biological agent (like a flu virus). A history of exposure to a chemical is one important
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that the chemical was the cause. To establish this cause/effect relationship, it is important that the
chemical be detected in the body (such as in the blood stream), at levels known to cause illness. If the
chemical produces a specific and easily detected biochemical effect (like the inhibition of the enzyme
acetyl cholinesterase), the resulting biochemical change in the body may be used as conclusive evidence.
Category System affected Common symptoms

Respiratory Nose, trachea, lungs Irritation, coughing, choking,
tight chest
Gastrointestinal Stomach, intestine Nausea, vomiting, diarrhea
Renal Kidneys Back pain, urinating more or
less than usual
Neurological Brain, spinal cord Headache, dizziness, behavior
confusion, depression, coma,
convulsions
Hematological Blood Anemia (tiredness, weakness)
Dermatological Skin, eyes Rashes, itching, redness,
swelling
Reproductive Ovaries, testis, fetus Infertility, miscarriage
Hazardous substances may cause local effects. Acute local effects may include corrosive injuries from acids
and bases or lung injuries from inhaled gases such as ozone, phosgene and nitrogen oxides.
Many other gases cause adverse effects only after they have been inhaled repeatedly over a long time
period. Low concentrations of a gas may also act in this way. A persistent irritation of the respiratory
system can arise from exposure to gases such as sulphur oxides, hydrogen fluoride and hydrogen chloride.
Once the hazardous substance has entered the blood circulation, it may be distributed to all parts of the
body. It will reach the liver, which is the most important detoxication organ of the body. The liver attempts
to convert the toxic agents to a less toxic ones or to the ones useful to the body. This process is called
metabolism. Some substances such as alcohol and carbon tetrachloride can damage the liver.
The body excretes unwanted chemicals. The kidneys filter them from blood circulation, which is the main
way that the body excretes poisons, but in doing this, the kidneys can be damaged by toxic substances,
such as carbon tetrachloride, ethylene glycol and carbon disulphide. Cadmium causes permanent
damages to kidneys.
Other means of excretion are via feces, sweat and through lung exhalation.
The nervous system is sensitive to chemicals. The adverse effects may be on the central nervous system
or on the nerves that transport impulses to other parts of the body. Organic solvents are commonly used

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at work and are known to be able to affect the nervous system. An example is tetraethyl lead, a gasoline
additive, which causes skin effects at the contact site. Then it is absorbed and transported into the body
causing typical effects on the central nervous system and on other organs. Many other substances may
behave in the same way, such as carbon disulphide, mercury, lead, manganese and arsenic.
The degree of the toxic effect is not the same in all organs. Usually there are one or two organs which are
most affected. These are referred to as target organs of toxicity of the particular substance. The central
nervous system is the target organ of toxicity most frequently involved in systemic effects. The blood
circulation system, liver, kidneys, lungs and skin follow in frequency. Muscle and bones are the target
organs for a few substances. The male and female reproduction systems are vulnerable to many
substances.
Human organs; health and illness
The liver The nervous system

The liver is the chemical factory of the body. The To stay alive, we must breathe continuously, our
cells which make up the liver contain enzymes heart must pump constantly, and all the other
which can convert certain toxic substances into organs must function. We also think and
forms that are more easily handled by the body. respond to emotions and sensations. All these
But the liver itself may be damaged if it is functions performed by the mind and body are
overwhelmed by toxic substances. The liver may controlled by the nervous system

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become inflamed, producing the condition The central nervous system is the control centre.
known as hepatitis. This disease may be caused The spinal cord connects the brain to the
by a virus or by chemicals like alcohol, carbon nervous system. Part of the nervous system
tetrachloride, and other chlorinated reaches the outer areas and is called the
hydrocarbons. Repeated bouts of hepatitis may peripheral nervous system.
lead to liver scarring and a disease called Most injuries of the central nervous system are
cirrhosis of the liver. Generally speaking, it permanent, although damage to the peripheral
means that there are not enough normal liver nervous system can sometimes be reversed.
cells remaining to detoxify body chemicals. Exposure to metals like lead and mercury may
Overexposure to chemicals like acrylonitrile, interfere with nerve impulses and result in
benzene, carbon tetrachloride, DDT, tremors and loss of reflexes or feeling.
chloroform, phenol, styrene, tetrachloroethane, Central nervous system depression covers
and tetrachloroethylene may also cause liver effects such as headache, lightheadedness,
damage. Vinyl chloride, a substance used in the drowsiness, and unconsciousness. The organ
production of plastics, has been linked to a rare affected is the brain and the result is depressed
and deadly form of liver cancer called performance. Many solvents such as toluene,
angiosarcoma. Some substances that may cause xylene, ether, and acetone produce this effect if
liver damage include Antimony, Arsine, the vapour concentration is high enough.
Benzene, Hydrazine, Beryllium, Methyl Alcohol, Workers exposed to these chemicals in cleaning
Carbon Tetrachloride, Methyl Chloride, solvents, paints, thinners, and degreasers may
Cadmium, Chlorinated Benzenes, Copper, have experienced these effects.
Chloroform and more The brain needs a constant supply of oxygen.
Some toxic chemicals interfere with the
functioning of the central nervous system and
disrupt the oxygen supply. The first warning
signs are dizziness and drowsiness. Warning
signs should be heeded immediately and
appropriate action taken. For example,
immediately leave the area and seek medical
assistance. The operations of the nervous
system are very complicated. It is a delicately
balanced system and several chemicals can
damage it, such as: Acetates, Alcohols,
Brominated chemicals, Chlorinated chemicals,
Ethers, Ketones, Carbon disulfide, Hydrogen
cyanide, Hydrogen sulfide, Asphyxiating gases
and Carbon monoxide etc.
Healthy Liver and Cirrhosis
Kidneys and bladder The reproductive system

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The kidneys act as a filter for substances in the Workplace hazards affect the worker, but the
blood. Each kidney contains over a million small problem reaches into the workers home as well.
filters. These filters clean the blood, removing a The reproductive organs—the testes in men and
number of impurities which they deposit in the the ovaries in women—produce the cells that
urine. The urine then passes to little tubes which allow us to reproduce. Any damage to these cells
monitor the levels of acid and the amount of can have disastrous consequences. Deformities
water in the body, and keep them balanced. in children may result or the developing embryo
From these tubes, the urine moves to the may be so severely damaged that it is unable to
bladder, which stores it until it is released from survive and is miscarried.
the body. Since the kidneys act as filters, they Some chemicals cause miscarriages or birth
can be seriously injured by toxic substances defects by attacking the genetic material of cells
passing through the body. Kidney disorders may or the systems which control its functions.
result in high or low blood pressure, which in Similar damage may also be involved in cancer—
turn may cause heart strain or heart failure. cancer-causing substances are often the cause
Kidney malfunction may also upset the body’s of birth defects and miscarriages.
delicate chemical balance, resulting in further
harm to the body.
Just as the lungs are vulnerable to hazardous
materials because they are a major route of
entry, the kidneys and bladder are vulnerable
because they are a major route of exit.
Some of the suspected causes of kidney damage

include:
Lead, Mercury, Carbon Tetrachloride, Cadmium,
Chromates, Carbon Monoxide, Copper, Gasoline
Vapours, Uranium, Beryllium, Arsenic, Oxalic
Acid etc.
The body’s defensive responses with particular reference to the respiratory system
From a functional perspective, the immune system consists of innate immunity and adaptive immunity,
two separate, but interacting and overlapping defensive systems that provide an additional array of
defensive weapons. In addition, innate immunity and adaptive immunity are activated by recognition of
molecular shapes that are "foreign" to our body. By distinguishing between "self" and "non-self" these
systems are (normally) able to identify, destroy, and remove foreign cells, infectious agents, and large
foreign molecules without directly attacking our own cells and tissues.
Innate (Natural) Immunity: Many bacteria, viruses, and protozoa have glycoproteins and glycolipids on
their surface that have distinctive shapes (referred to as "pathogen-associated molecular patterns" or
PAMPS) on their surface that enable them to be recognized in a non-specific way as "non-self" by the
innate immune system. There are perhaps 100-200 of these PAMPs that have remained unchanged over

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the course of evolution, and they are molecular shapes that are not present in our tissues. The innate
immune system has certain "sentinel cells (monocytes, macrophages, and specialized macrophages called
a dendritic cells) that have so-called toll-like receptors that bind to PAMPs, triggering rapid cellular
responses directed against the pathogens. The responses include:
• Phagocytosis and intracellular killing by dendritic cells, monocytes, and macrophages.

• Recruitment of other inflammatory cells by secreting cytokines that activate other defensive cells
and attract them to the site of invasion.
• Communication with the adaptive immune system by presenting fragments of the pathogenic
antigens to lymphocytes in order to activate them.
• Triggering an inflammatory response
• Triggering activation of the complement system
It is possible for a given PAMP to be present on a number of different types of pathogen, and the innate
system will respond to them in the same way without distinguishing among them. Consequently, the
innate system is non-specific in how it recognizes and responds to pathogens. And this system is referred
to as innate or natural immunity, because the sentinel cells in the innate system will recognize a PAMP
and respond to it on the first encounter.
Immune system

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Adaptive (Acquired) Immunity: Cells of the lymphatic (or lymphoid) system provide adaptive immunity,
which, unlike innate immunity, is highly specific in its ability to recognize and defend against specific
foreign agents using both cellular weapons (e.g., cytotoxic T-lymphocytes) and humoral weapons
(antibodies manufactured by plasma cells). The lymphatic system is distinct from the arterial and venous
systems, but like them, it consists of a complex network of vessels (lymphatic ducts), and the distribution
of the lymphatic network often runs in parallel with the arterial and venous systems. Along the lymphatic
vessels, there are intermittent lymph nodes, which filter lymph and also house many defensive cells
(leukocytes or "white blood cells") and provide a site where the various leukocytes can communicate with
one another. When fighting an infection, nearby lymph nodes often become enlarged due to aggregation
and increased production of leukocytes and removal of foreign material. Filtered lymph eventually is
emptied into the subclavian vein where it mixes with blood and contributes to the plasma fraction of
blood. The thymus and the spleen are also important components of the lymphatic system. The lymphatic
system, thymus, and spleen play important roles in immune function, but cellular elements of the immune
system are the real "soldiers" in the battle against foreign agents.
Skin: The largest organ in the human body (~1.5-2 m2 in area) provides a protective cover to the body
organs. The skin consists essentially of two layers, a thin, outermost layer called the epidermis and a much
thicker under layer called the dermis. The epidermis consists of several layers of flat, rather tightly-packed
cells which form a barrier against infections, water, and some chemicals. This barrier is the external part
of the epidermis. It is called the keratin layer, and is largely responsible for resisting water entry into the
body. It can also resist weak acids but is much less effective against organic and some inorganic chemicals.
The keratin layer contains fat and fat- like substances which readily absorb chemicals which are solvents
for fat, oil, and grease.
But skin can allow permeation of chemicals if the load is excessive. Chemicals which pass through the skin
are nearly always in liquid form. Solid chemicals and gases or vapours do not generally pass through the
skin unless they are first dissolved in moisture on the skin's surface. Many substances can infiltrate
through the skin and find its way to the hematological system, for example phenol, which may even lead
to fatality in the event of heavy exposure. Most common forms of skin disorders that may occur due to
chemical contact are: eczemas, irritation and local inflammation. This condition can be either a non-
allergic or allergic reaction to exposure to chemical substances. Examples of common contact allergens
are several colorants and dyes, nickel, chromium, cobalt and their salts, organomercuric compounds,
acrylate and methacrylate monomers, rubber additives and pesticides. Chemical skin injury may also be
influenced by extreme levels of humidity and heat.
In some instances, chemicals may enter the body by accidental injection through the skin. This situation
may occur in hospital settings or in industrial hole-punching or injection processes. Once in the blood
stream, these chemicals can be transported to any site or organ of the body where they may exert their
effects.
Eyes: Although eye splashes or eye contamination by workplace chemicals is fairly common, chemicals
usually do not enter the body this way. Small amounts of chemicals may enter by dissolving in the liquid
surrounding the eyes, and larger, but probably not significant amounts, may enter the eyes if they are
splashed with chemicals.
The eyes are richly supplied with blood vessels and many chemicals can penetrate the outer tissues and
pass into the veins. The eye may or may not be damaged during this process, depending on the corrosive
nature of the chemical and its ability to penetrate the outer tissues.

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Ingestion system: Chemicals can enter the stomach either by swallowing contaminated mucus which has
been expelled from the lungs, or by eating and drinking contaminated food. Food and drink are most
frequently contaminated by contact with unwashed hands, gloves or clothing, or by being left exposed in
the workplace. Nail-biting and smoking can also contribute to exposure.
Once inside the mouth, chemicals pass down the esophagus and then into the stomach. Some chemicals,
such as alcohols, may pass across the stomach wall and enter the blood stream here, but most chemicals
move from the stomach into a long, twisting tube known as the small intestine. The inside of the small
intestine has many hundreds of tiny finger-like projections called villi. The villi have very thin walls and are
filled with tiny blood vessels. This formation allows some ingested chemicals to pass from the small
intestine across the walls of the villi and enter the veins. The chemical is then carried around the body by
the blood stream.
Some chemicals, which are not soluble or whose basic units (molecules) are too big to pass across the villi
walls, will stay in the gut and pass out of the body in the feces without being absorbed into the blood
stream to any extent.
Some acids, bases and organics may cause severe "burn" damage to the digestive system if swallowed in
high concentrations
Digestive system
Respiratory system: Over an 8-hour working day, more than 2,800 litres of air will be breathed in and out
of the lungs. In conditions of hard physical work, up to 10,000 litres may be exchanged. Air breathed in
through the nose is filtered by the nasal hairs so that large, solid particles in the atmosphere are prevented
from going any further. Inside the nose there are small bones and cartilages that cause the inhaled air to

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swirl around. This swirling air can cause some large contaminating particles to be deposited in the nose
and trapped by the moisture of the mucus lining.
Air coming in from the nose and the mouth reaches the back of the throat and enters an area known as
the pharynx. The pharynx, which is the entrance to the airways, divides into two tubes, one called the
esophagus, which carries food to the stomach, and one called the trachea, which leads down towards the
lungs. Contaminated air passes into the trachea which itself divides into two large tubes; each called a
bronchus. Each bronchus enters a lung. Once inside its lung, each bronchus starts to branch. The tubes of
the bronchus get thinner and thinner as they spread, rather like the branches of a tree. Eventually, the
tiniest tubes, which are called bronchioles, end in thin-walled air sacs. Each of these sacs is called an
alveolus. Collectively, they are called alveoli and there are many thousands of these alveoli in each lung.
The walls of the alveoli are very thin and are richly supplied with tiny blood vessels (capillaries).
Oxygen in the inhaled breath crosses the alveolar walls to enter the blood. Once oxygen has become
attached to the blood inside the veins, it is then distributed throughout the body. Chemical vapours, gases,
and mists which reach the alveoli in the lungs can also pass into the blood and be distributed around the
body.
Sometimes, the concentration of chemicals reaching the alveolar air sacs is lower than in the workplace
air. This difference in concentration occurs because the airways contain a lining of sticky, thick fluid called
mucus. Tiny hairs, known as cilia, on the inside of the tubes constantly carry this mucus upwards towards
the back of the throat. In some instances, a portion of the gases, vapours and mists may be dissolved in
this mucus before they reach the alveolar sacs.
Solid, visible particles (found in dusts, fumes, and smoke) that have escaped the filtering mechanisms of
the nose may also be trapped by the mucus. The mucus is propelled by the tiny cilia hairs until it reaches
the back of the throat where it is either expelled through the mouth or swallowed and passed to the
stomach. If it passes into the stomach, the chemical will enter the body in the same way as contaminated
food or drink. This route of exposure is dealt with in more detail in the section below on swallowing
(ingestion).
Much smaller particles (so small that they cannot be seen by the eye) may not be stopped by the mucus
in the trachea and bronchiole tubes. They travel through the various branches of the airways and
eventually reach the alveoli. Solid particles which cannot pass through the thin wall of the air sacs may
lodge and stay where they are. Some may dissolve, and others may be attacked and destroyed by the
scavenger cells of the body's defence system. Others may prove too big or too insoluble to be disposed of
in this way and simply stay in the air sacs. Some of these particles, if they are present only in small
quantities, do no apparent harm. Other types of dusts may damage the surrounding alveolar walls. The
damage may be permanent and may cause scars, which eventually interfere with the lung's ability to pass
oxygen into the blood stream.

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Respiratory system
Some acids, bases, or organic chemicals, when inhaled in sizable amounts, can cause serious and
irreparable "burn" damage to the mouth, nose, trachea, bronchi and lungs.
The distinction between inhalable and respirable dust

Most industrial dusts contain particles of a wide range of sizes. The behaviour, deposition and fate of any
particular particle after entry into the human respiratory system and the body response that it elicits,
depend on the nature and size of the particle. HSE distinguishes two size fractions for limit-setting
purposes termed ‘inhalable’ and ‘respirable’. A distinction is also given in BS EN 481:1993
Inhalable dust is that fraction of a dust cloud that can be breathed into the nose or mouth. Examples of
dusts for which any inhalable particle is of concern include certain hardwood dusts (which may cause
nasal cancer), and dusts from grinding lead containing alloys (which can be absorbed and cause systemic
poisoning).
Respirable dust is that fraction of inhaled airborne particles that can penetrate beyond the terminal
bronchioles into the gas-exchange region of the lungs. Examples of dusts for which the respirable fraction

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offers greatest hazard include quartz and other dusts containing free crystalline silica; cobalt-containing
and other hard metal dust produced by grinding masonry drill bits; and many others.
9.5 Health risks from hazardous substances

The aims of REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals)
• To provide a high level of protection of human health and the environment from the use of
chemicals.
• To make the people who place chemicals on the market (manufacturers and importers)
responsible for understanding and managing the risks associated with their use.
• To promote the use of alternative methods for the assessment of the hazardous properties of
substances e.g. quantitative structure-activity relationships (QSAR) and read across.
The purpose of classification and the role of hazard and precautionary statements for
hazardous substances
The GHS is a system for harmonizing hazard classification criteria and chemical hazard communication
elements worldwide. The GHS is not a regulation; rather it is a framework or guidance for classifying and
labeling hazardous chemicals. The purpose of classification under the GHS is to provide harmonized
information to users of chemicals with the goal of enhancing protection of human health and the
environment.
Many countries already have regulatory systems in place for chemical classification and hazard
communication. These systems may be similar in content and approach, but their differences are
significant enough to require multiple classifications, labels, and safety data sheets (SDS) for the same
product. This leads to inconsistent protection for those potentially exposed to the chemicals, as well as
creating extensive regulatory burdens on companies producing chemicals.
The GHS document (referred to as “The Purple Book”) establishes agreed hazard classification and
communication provisions with explanatory information on how to apply the system. Regulatory
authorities in countries adopting the GHS will take the agreed criteria and provisions, and implement them
through their own regulatory process and procedures. The GHS document provides countries with the
regulatory building blocks with which to develop or modify existing national programs that address
classification of hazards and transmittal of information about those hazards and associated protective
measures.
There are three major hazard groups:
• Physical hazards.
• Health hazards.
• Environmental hazards
Physical hazards Health hazards Environmental hazards

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• Explosives • Acute Toxicity • Hazardous to the aquatic

• Flammable Gases • Skin Corrosion/Irritation environment
• Flammable Aerosols • Serous Eye Damage/Eye o Acute aquatic
• Oxidizing Gases Irritation toxicity
• Gases Under Pressure • Respiratory or Skin o Chronic aquatic
• Flammable Liquids Sensitization toxicity
• Flammable Solids • Germ Cell Mutagenicity • Hazardous to the ozone
• Self-Reactive Substances • Carcinogenicity layer.
• Pyrophoric Liquids • Reproductive Toxicology
• Pyrophoric Solids • Target Organ Systemic
• Self-Heating Substances Toxicity – Single Exposure
• Substances which, in • Target Organ Systemic
contact with water, emit Toxicity – Repeated
flammable gases Exposure
• Oxidizing Liquids • Aspiration Toxicity
• Oxidizing Solids
• Organic Peroxides
• Corrosive to Metals
Within each of these hazard groups there are classes and categories. Each of these parts is called a building
block. Each country can determine which building blocks of the GHS it will use in their different sectors
(workplace, transportation, consumers). Once the building blocks are chosen, the corresponding GHS
rules for classification and labels must be used.

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GHS symbols
There are many benefits to global implementation of the GHS. It is anticipated that application of the GHS
will:
• Enhance the protection of human health and the environment by providing an internationally
understood system
• Provide a recognized framework to develop regulations for those countries without existing
systems
• Facilitate international trade in chemicals whose hazards have been identified on an international
basis
• Reduce the need for testing and evaluation against multiple classification systems
Benefits to companies include:
• A safer work environment and improved relations with employees

• An increase in efficiency and reduced costs from compliance with hazard communication
regulations
• Application of expert systems resulting in maximizing expert resources and minimizing labor and
costs

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• Facilitation of electronic transmission systems with international scope

• Expanded use of training programs on health and safety
• Reduced costs due to fewer accidents and illnesses
• Improved corporate image and credibility
Benefits to workers and members of the public include:
• Improved safety for workers and others through consistent and simplified communications on
chemical hazards and practices to follow for safe handling and use
• Greater awareness of hazards, resulting in safer use of chemicals in the workplace and in the
home
EC Regulation 1272/2008 Classification, Labelling & Packaging of Substances and Mixture

(CLP)
European Regulation (EC) No 1272/2008 on classification, labelling and packaging of substances and
mixtures came into force on 20 January 2009 in all EU Member States. It is known by its abbreviated form,
‘the CLP Regulation’ or just plain ‘CLP’. The CLP Regulation adopts the United Nations’ Globally
Harmonised System on the classification and labelling of chemicals (GHS) across all European Union
countries.
As GHS is a voluntary agreement rather than a law, it has to be adopted through a suitable national or
regional legal mechanism to ensure it becomes legally binding. That’s what the CLP Regulation does. GHS
was heavily influenced by the old EU system; the CLP Regulation is very similar in many ways. The duties
on suppliers are broadly the same: classification, labelling and packaging.
Chemical suppliers must classify, label and package their substances and mixtures in accordance with the
CLP Regulation. Their obligations depend upon their role in the supply chain.
Suppliers may have one or more of these roles:
• Manufacturer of substances or mixtures

• Importer of substances or mixtures
• Producer of specific articles
• Downstream user, including formulator and re-importer
• Distributor, including retailer
If they place a hazardous substance on the market, they must notify ECHA of its classification and labeling
within one month of placing the substance on the market for the first time. For importers, the one month
is counted from the day when a substance, on its own or contained in a mixture, is physically introduced

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in the customs territory of the EU. If required by REACH, manufacturers and importers also need to classify
substances which are not placed on the market, such as on-site isolated intermediates, transported
intermediates or substances for product and process-orientated research and development (PPORD).
Suppliers must label a substance or mixture contained in packaging according to CLP before placing it on
the market either when:
• A substance is classified as hazardous.

• A mixture contains one or more substances classified as hazardous above a certain threshold.
CLP defines the content of the label and the organisation of the various labelling elements. The label
includes:
• The name, address and telephone number of the supplier

• The nominal quantity of a substance or mixture in the packages made available to the general
public (unless this quantity is specified elsewhere on the package)
• Product identifiers
• Where applicable, hazard pictograms, signal words, hazard statements, precautionary statements
and supplemental information required by other legislation.
Chemical label

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The CLP Regulation does not apply to the following chemicals:
• Radioactive substances and mixtures

• Substances and mixtures subject to customs supervision
• Non-isolated intermediaries
• Substances and mixtures for scientific research and development which are not placed on the
market and are only used in controlled conditions
• Waste
The CLP Regulation does not apply to the following chemicals which are in the finished state intended for
the final user:
• Medicines
• Medical devices
• Veterinary medicines
• Cosmetics
• Food
• Feeding stuffs (i.e. food additive; food flavouring; feeding stuffs used in animal nutrition)
Health hazard classes

As given in chapter 3 of GHS, chemicals can be divided into following categories bases upon their adverse
health effect:
Acute toxicity: It refers to those adverse effects occurring following oral or dermal administration of a
single dose of a substance or multiple doses given within 24 hours or an inhalation exposure of 4 hours.
Acute toxicity values are expressed as LD50 (oral, dermal) or LC50 (inhalation) values.
Skin corrosion: Skin corrosion means the production of irreversible damage to the skin following the
application of a test substance for up to 4 hours. Substances and mixtures in this hazard class are assigned
to a single harmonized corrosion category.
Skin irritation: Skin irritation means the production of reversible damage to the skin following the
application of a test substance for up to 4 hours. Substances and mixtures in this hazard class are assigned
to a single irritant category.
Serious eye damage: It means the production of tissue damage in the eye, or serious physical decay of
vision, following application of a test substance to the front surface of the eye, which is not fully reversible
within 21 days of application.
Eye irritation means changes in the eye following the application of a test substance to the front surface
of the eye, which are fully reversible within 21 days of application

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Respiratory sensitization means a substance that induces hypersensitivity of the airways following
inhalation of the substance.
Skin sensitization means a substance that will induce an allergic response following skin contact. The
definition for “skin sensitizer” is equivalent to “contact sensitizer”
Germ cell mutagenicity: Mutagen means an agent giving rise to an increased occurrence of mutations in
populations of cells and/or organisms.
Carcinogenicity: Carcinogen means a chemical substance or a mixture of chemical substances which

induce cancer or increase its incidence
Reproductive toxicity: Reproductive toxicity includes adverse effects on sexual function and fertility in
adult males and females, as well as developmental toxicity in offspring
Specific target organ toxicity (single and repeated exposure): The GHS distinguishes between single and
repeat exposure for Target Organ Effects. Some existing systems distinguish between single and repeat
exposure for these effects and some do not. All significant health effects, not otherwise specifically
included in the GHS, that can impair function, both reversible and irreversible, immediate and/or delayed
are included in the nonlethal target organ/systemic toxicity class. Narcotic effects and respiratory tract
irritation are considered to be target organ systemic effects following a single exposure. The guidance
values and ranges for single and repeated doses are intended only for guidance purposes. This means that
they are to be used as part of the weight of evidence approach, and to assist with decisions about
classification. They are not intended as strict demarcation values. The guidance value for repeated dose
effects refer to effects seen in a standard 90-day toxicity study conducted in rats. They can be used as a
basis to extrapolate equivalent guidance values for toxicity studies of greater or lesser duration.
Aspiration hazard: Aspiration toxicity includes severe acute effects such as chemical pneumonia, varying
degrees of pulmonary injury or death following aspiration. Aspiration is the entry of a liquid or solid
directly through the oral or nasal cavity, or indirectly from vomiting, into the trachea and lower respiratory
system. Some hydrocarbons (petroleum distillates) and certain chlorinated hydrocarbons have been
shown to pose an aspiration hazard in humans.
Information on substances or preparations/mixtures which have the potential to cause

harm to be communicated to users
Any workplace that works consistently with chemicals is required to educate workers on the various
aspects of these dangerous chemicals. Workers need to be able to understand and identify various
chemicals throughout the workplace and know how to work with them safely. Not only does this eliminate
accidents and gives workers a greater sense of confidence and peace of mind while working, but this
education is also a legal requirement and is also known as Worker’s Right to Know.
Chemical manufacturers and importers are required to evaluate the hazards of the chemicals they
produce and distribute. The information about the hazards and associated protective measures is

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required to be disseminated on container labels and safety data sheets (SDS). All employers with exposed
employees are required to provide access to the labels and SDS, and to train workers. The three ways to
achieve the same include:
• Chemical Labels
• Safety Data Sheets and
• Chemical Safety Assessments/Reports
Chemical Labels:
According to GHS, labels for a hazardous chemical must contain following 6 pieces of information:
1- Manufacturer Information: Name, Address and Telephone Number of the chemical manufacturer,
importer or other responsible party.
2- Product Name or Identifiers: Is how the hazardous chemical is identified. This can be (but is not
limited to) the chemical name, code number or batch number. The manufacturer, importer or
distributor can decide the appropriate product identifier. The same product identifier must be both
on the label and in the SDS.
3- Signal Words: These are used to indicate the relative level of severity of the hazard and alert the
reader to a potential hazard on the label. Examples of words used as signal words, “Danger” and
“Warning.” Within a specific hazard class, “Danger” is used for the more severe hazards and
“Warning” is used for the less severe hazards. There will only be one signal word on the label no
matter how many hazards a chemical may have. If one of the hazards warrants a “Danger” signal word
and another warrants the signal word “Warning,” then only “Danger” should appear on the label.
4- Hazard Statements: It describe the nature of the hazard(s) of a chemical, including, where
appropriate, the degree of hazard. For example: “Causes damage to kidneys through prolonged or
repeated exposure when absorbed through the skin.” All of the applicable hazard statements must
appear on the label. Hazard statements may be combined where appropriate to reduce redundancies
and improve readability. The hazard statements are specific to the hazard classification categories,
and chemical users should always see the same statement for the same hazards no matter what the
chemical is or who produces it.
5- Symbols/Pictograms: The GHS symbols have been incorporated into pictograms for use on the GHS
label. Pictograms include the harmonized hazard symbols plus other graphic elements, such as
borders, background patterns or colors which are intended to convey specific information. For
transport, pictograms will have the background, symbol and colors currently used in the UN
Recommendations on the Transport of Dangerous Goods, Model Regulations. For other sectors,
pictograms will have a black symbol on a white background with a red diamond frame. A black frame
may be used for shipments within one country. Where a transport pictogram appears, the GHS
pictogram for the same hazard should not appear.
GHS Pictograms and Hazard Classes

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Oxidisers Flammables Explosives

Self Reactives Self Reactives
Pyrophorics Organic Peroxides
Self-Heating
Emits Flammable Gas
Organic Peroxides
Carcinogen
Respiratory Sensitizer
Corrosives Gases Under Pressure Reproductive Toxicity
Target Organ Toxicity
Mutagenicity
Aspiration Toxicity
Irritant
Dermal Sensitizer Environmental Toxicity Acute toxicity (severe)
Acute toxicity (harmful)
Narcotic Effects
Respiratory Tract Irritation
Transport “Pictograms”
Flammable Liquid Flammable solid Pyrophorics Compressed Gases

Flammable Gas Self-Reactive (Spontaneously
Flammable Aerosol Substances Combustible)
Self-Heating
Substances

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Substances, which in Oxidizing Gases Acute Toxicity Corrosive

contact with water, Oxidizing Liquids (Poison): Oral, Dermal,
emit flammable gases Oxidizing Solids Inhalation
(Dangerous When
Wet)
Explosive Explosive Division 1.5 Explosive Division 1.6

Explosive Division 1.4
Divisions 1.1, 1.2, 1.3
Marine Pollutant
Organic Peroxides
6- Precautionary Statements: Precautionary information supplements the hazard information by briefly

providing measures to be taken to minimize or prevent adverse effects from physical, health or
environmental hazards. First aid is included in precautionary information. The GHS label should
include appropriate precautionary information. Annex 3 of the GHS Purple Book includes
precautionary statements and pictograms that can be used on labels. Annex 3 includes four types of
precautionary statements covering: prevention, response in cases of accidental spillage or exposure,
storage, and disposal. The precautionary statements have been linked to each GHS hazard statement
and type of hazard. The goal is to promote consistent use of precautionary statements.
7- Supplemental Information: Supplemental label information is non-harmonized information on the

container of a hazardous product that is not required or specified under the GHS. In some cases this
information may be required by a Competent Authority or it may be additional information provided
at the discretion of the manufacturer/distributor. The GHS provides guidance to ensure that
supplemental information does not lead to wide variation in information or undermine the GHS
information. Supplemental information may be used to provide further detail that does not contradict
or cast doubt on the validity of the standardized hazard information. It also may be used to provide
information about hazards not yet incorporated into the GHS. The labeler should have the option of
providing supplementary information related to the hazard, such as physical state or route of
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The GHS hazard pictograms, signal word and hazard statements should be located together on the label.
The actual label format or layout is not specified in the GHS. National authorities may choose to specify
where information should appear on the label or allow supplier discretion.
When labelling small packages:
• All applicable GHS elements should appear on the immediate container of the hazardous
substance
• Where it’s not possible to put all label information on immediate container itself (due to shape,
size, or form of container; or due to need for label elements to be in different languages), other
methods of providing the full hazard information should be used as appropriate
• Where the volume of the substance is low and supplier has data to demonstrate that there is no
likelihood of harm to human health or environment, the competent authority may allow certain
elements to be omitted from the immediate container.
Many commercial chemical substances and products occur as natural or formulated mixtures of
chemicals. This means that typical exposure is not to one but to several chemicals simultaneously. The
potential health risk resulting from handling a mixture is defined by a number of factors, such as the
toxicity of the individual constituents, their concentration in the mixture, the volatility (or particle size) of
the various components and possible interactions between them. The following options for interactions
may exist:
• Substances with different modes of action and without any mutual interaction
• Substances with the same mode of action where the response is additive
• Substances with the same mode of action where the response is antagonistic
• Substances with synergistic or potentiating interactions
Safety Data Sheets:
One of the key aspects of a chemicals hazard communication program is the Safety Data Sheet (SDS) of
the chemicals involved. These sheets are designed to inform workers of everything they need to know
about particular chemicals. By reading the SDS, workers should be able to determine:
• Any and all health hazards relating to any chemical they are working with or will be exposed to.
• The flammability of the product that they are working with. They will also be able to determine
the temperature the product will ignite at.
• How reactive the particular chemical is and how it will react with other chemicals and agents. This
will let them know if they could be dealing with a potential explosion or similar behavior when
working with specific chemicals.
• The Personal Protective Equipment (PPE) they will need to protect themselves from the chemicals
and products they will be working with.
Along with the above information, workers need to also be able to know, answer, and remember the
following:
• Where the SDSs are kept for the chemicals, they will be working with and exposed to.

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• What kind of threats, hazards, and dangers they will experience should they improperly use any
chemicals?
• The steps and emergency procedures to follow should there be a spill or accident.
• How to correctly and fully inspect their PPE to ensure that it is working and functioning properly.
In accordance with the REACH Regulation, a SDS should be supplied with any hazardous chemical. Safety
data sheets provide useful information on chemicals, describing the hazards the chemical presents, and
giving information on handling, storage and emergency measures in case of an accident.
A Safety Data Sheet must be:
• Prepared by a competent person

• In an official language(s) of Member State where the chemical is being placed on the market
• In the required 16 heading format
• Specific to the chemical
• Clear and understandable
• Provided free of charge, either on paper or electronically
• Provided no later than at the time of first delivery
• Updated when new information on the chemical becomes available or when an authorization is
granted or refused or a relevant restriction is imposed under REACH
• Provided to everyone who has received the chemical during the previous 12 months upon update
or revision
• Dated and the pages numbered.
The Safety Data Sheet must contain the following 16 sections:
Section 1: Contains contact details of the person/company responsible for

Identification of the supplying the chemical, the uses of the chemical, as well as the
substance/mixture and of the telephone number to contact in case of an emergency.
company/undertaking
Section 2: Gives details on the hazards of the chemical and the potential
Hazards identification effects and symptoms resulting from use. This will help in the
assessment of the risks to health, the health of workers and the
environment. The information in this section must be consistent
with the information on the label.
Section 3: If the chemical is a mixture, this section will give information on the
Composition/information on hazards of each of the individual substances in the mixture.
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Section 4: Describes the necessary first aid measures to be taken in case of an

First aid measures accident. Important symptoms ad effects and immediate medical
attention and special treatment if required.
Section 5: Fire-fighting Gives specific information on fighting a fire caused by the chemical,
measures including the most suitable extinguishing media and protective
equipment.
Section 6: Accidental release Describes what actions need to be taken if there is an accidental
measures release of the chemical.
Section 7: Handling and storage Contains details on how to handle and store the chemical safely
including precautions for safe handling and conditions for safe
storage and any incompatibilities (if exists).
Section 8: Exposure Gives details of the steps needed to reduce exposure, e.g.
controls/personal protection ventilation and the personal protective equipment (PPE) necessary
to protect health
Sections 9: Physical and Including appearance, odour, boiling point, melting pint, freezing
chemical properties point, flash point, vapour pressure, flammability and explosive
range.
Section 10: Stability and Contains details of any hazardous reactions that may occur if the
reactivity chemical is used under certain conditions. Include advice on
conditions to avoid, incompatible materials and hazardous
decomposition products.
Section 11: Toxicological Various toxicological health effects and the available data used to
information identify those effects including likely routes of exposure, symptoms,
acute and chronic effects and exposure limits etc.
Section 12: Ecological Provides echo toxicity, mobility in soil, persistence and
information degradability and other adverse effects.
Section 13: Disposal Explains how the chemical should be disposed of correctly.
considerations
Section 14: Transport Contains information relating to the transportation of the chemical
information including UN number, transport hazard class, UN shipping name.
Section 15: Regulatory Contains details on relevant EU/national legislation.
information
Section 16: Other information Gives any other information relevant to the chemical e.g. training
advice, full text of hazard statements etc.
Chemical Safety Assessments/Reports:

A Chemical Safety Assessment (CSA) is a mandatory requirement for all substances that are manufactured
or imported in volumes equal to or greater than 10 tonnes per year and by downstream users if their uses
are not addressed by their supplier.

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The purpose of a CSA is to ensure that the risks related to the substance are controlled and is designed to
address the manufacture of a substance and it’s intended uses
The chemical safety assessment of a substance comprises the following steps:

• Assessment of the human health hazard
• Human health hazard assessment of physicochemical properties
• Assessment of the environmental hazard
• Persistent, bio accumulative and toxic (PBT) and very persistent and very bio-accumulative (vPvB)
assessment
What should be considered in the assessment of risks to health from hazardous substances
As the first stage of the assessment, the employer should inspect the workplace and obtain
information on,
• hazardous substances that are present or likely to occur, along with other hazardous ambient
factors (ionizing and non-ionizing radiation, hazardous optical radiation, electric or magnetic
fields, noise and vibration, and extremes of temperature and humidity, including the work
organization)
• activities that take place
• any hazardous substances or processes that may easily be eliminated
• Consideration should be given to obtaining information on
o the intrinsic hazards of the raw materials, products and byproducts according to the
physical states (e.g. solid, liquid, gas) in which they occur or are produced
o the ambient conditions (e.g. barometric pressure, temperature, etc.) under which the
hazardous substances are used or produced
o the impact of either the change in phase of the hazardous substances (e.g. solid to liquid
phase) or fluctuations in the ambient conditions on the health of workers exposed, the
public and the environment.
• When obtaining information for assessment, employers should take account of specific work
situations where workers are likely to be exposed, for example, to
o hazardous fumes as by-products (e.g. welding)
o hazardous substances and/or oxygen deficiency in confined spaces
o prolonged periods (such as during overtime) with the risk of accumulation of higher
doses
o higher concentrations due to fluctuations in ambient conditions (e.g. hot environments
where vapour pressures of hazardous substances may be elevated)
o absorption through multiple routes (inhalation, ingestion, absorption through the skin)
o hazardous substances that may be present even in concentrations below exposure limits
while performing arduous tasks.
Review of risk assessment

The assessment should be reviewed whenever there is reason to suspect that it is no longer valid or where
there has been a significant change in the work to which the assessment relates.

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The assessment may be shown to be no longer valid because of, for example:
• The results of periodic thorough examinations and tests of engineering controls

• The results of monitoring exposure at the workplace, the results of health or medical
surveillance, or a confirmed case of occupationally induced disease
• New information on health hazards
A significant change in the work may consist of:
• A change in the substances used or their source

• Plant modification, including engineering controls
• A change in the process or methods of work
• A change in the volume or rate of production
The prevention and control of exposure to hazardous substances

ILO Code of Practice, Ambient Factors in the Workplace, in their chapter 4.3 requires,
Where the assessment of hazards or risks shows that control measures are inadequate or likely to
become inadequate, risks should be:
• eliminated by ceasing to use such hazardous substances or replacing them with less hazardous
substances or modified processes;
• minimized by designing and implementing a programme of action;
• reduced by minimizing the use of toxic substances, where feasible.
Control measures for implementing such a programme could include any combination of the
following
• good design and installation practice

o totally enclosed process and handling systems
o segregation of the hazardous process from the operators or from other processes;
o plants, processes or work systems which minimize generation of, or suppress or
contain hazardous dusts, fumes, etc., and which limit the area of contamination in
the event of spills and leaks;
o partial enclosure, with local exhaust ventilation;
o local exhaust ventilation;
o sufficient general ventilation;
• work systems and practices
o reduction of the numbers of workers exposed and exclusion of non-essential access;
o reduction in the period of exposure of workers;
o regular cleaning of contaminated walls, surfaces, etc.;
o use and proper maintenance of engineering control measures;
o provision of means for safe storage and disposal of substances hazardous to health;
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o where the above measures do not suffice, suitable personal protective equipment
should be provided until such time as the risk is eliminated or minimized to a level
that would not pose a threat to health;
o prohibition of eating, chewing, drinking and smoking in contaminated areas;
o provision of adequate facilities for washing and changing and for storage of clothing
(everyday clothing separated from work clothing), including arrangements for
laundering contaminated clothing;
o use of signs and notices;(v)adequate arrangements in the event of an emergency.
9.6 Epidemiology and toxicology

Human epidemiological investigations
Case-Control studies
Case-Control studies are usually retrospective. A study that compares two groups of people: those with
the disease or condition under study, and a very similar group of people who do not have the disease or
condition (controls). Researchers study the medical and lifestyle histories of the people in each group to
learn what factors may be associated with the disease or condition.
In essence, the investigators jump back in time to identify a useful cohort which was initially free of
disease and 'at risk.' They then use whatever records are available to determine each subject's exposure
status at the beginning of the observation period, and they then ascertain what subsequently happened
to the subjects in the two (or more) exposure groups. Retrospective cohort studies are also 'longitudinal,'
because they examine health outcomes over a span of time. The distinction is that in retrospective cohort
studies all of the cases of disease have already occurred before the investigators initiate the study. In
contrast, exposure information is collected at the beginning of prospective cohort studies before any
subjects have developed any of the outcomes or interest, and the 'at risk' period begins after baseline
exposure data is collected and extends into the future.
Retrospective cohort studies are particularly useful for unusual exposures or occupational exposures. For
example, if an investigator wanted to determine whether exposure to chemicals used in tire
manufacturing was associated with an increased risk of death, one might find a tire manufacturing factory
that had been in operation for several decades. One could potentially use employee health records to
identify those who had had jobs which involved exposure to the chemicals in question (e.g., workers who
actually manufactured tires) and non-exposed coworkers (e.g., clerical workers or sales personnel in the
same company or, even better, workers also involved in manufacturing operations but with jobs that
didn't involve exposure to the chemicals). One could then ascertain what had happened to all the subjects
and compare the incidence of death in the exposed and non-exposed workers.
Retrospective cohort studies like this are very efficient because they take much less time and cost much
less than prospective cohort studies, but this advantage also creates potential problems. Sometimes
exposure status is not clear when it is necessary to go back in time and use whatever data was available,
because the data being used was not designed to be used in a study. Even if it was clear who was exposed
to tire manufacturing chemicals based on employee records, it would also be important to take into
account (or adjust for) other differences that could have influenced mortality (confounding factors). For
example, in a study comparing mortality rates between workers exposed to solvents used in tire
manufacture and an unexposed comparison group, it might be important to adjust for confounding factors

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such as smoking and alcohol consumption. However, it is unlikely that a retrospective cohort study would
have accurate information on these other risk factors.
The following notes relate case-control to cohort studies:
• Outcome is measured before exposure

• Controls are selected on the basis of not having the outcome
• Good for rare outcomes
• Relatively inexpensive
• Smaller numbers required
• Quicker to complete
• Prone to selection bias
• Prone to recall/retrospective bias
Cohort studies
A cohort study is a study in which subjects who presently have a certain condition, and/or receive a
particular treatment are followed over time and compared with another group who are not affected by
the condition under investigation. For research purposes, a cohort is any group of individuals who are
linked in some way or who have experienced the same significant life event within a given period. The
subjects are followed into the future in order to record the development of any of the outcomes of
interest. The follow up can be conducted by mail questionnaires, by phone interviews, via the Internet, or
in person with interviews, physical examinations, and laboratory or imaging tests. Combinations of these
methods can also be used.
Cohort studies are usually prospective. Prospective investigation is required to make precise estimates of
either the incidence of an outcome or the relative risk of an outcome based on exposure. Typically, the
investigators have a primary focus, for example, to learn more about cardiovascular disease or cancer,
but the data collected from the cohort over time can be used to answer many questions and test many
possible determinants, even factors that they hadn't considered when the study was originally conceived.
The investigators first identify a cohort (group) of possible subjects who would be feasible to follow for a
prolonged period. Eligible subjects had to meet certain criteria (inclusion criteria) to be included in the
study as subjects. The investigators then determine the initial or "baseline" characteristics, behaviors, and
other "exposures" of all subjects at the beginning of the study. Information is collected from all subjects
in the same way using exactly the same questions and data collection methods for all subjects.
Of course, data analysis cannot take place until enough 'events' or 'outcomes' have occurred, so time must
elapse, and the analyses will look at events that have occurred during the period of time from the
beginning of the study until the time of the analysis or the end of the study. It goes without saying that
analysis is always done retrospectively, because a span of time has to have elapsed before incidence can
be compared. The thing that makes prospective cohort studies prospective is that they were designed
prospectively, and subjects were enrolled and had baseline data collected before any of them developed
any of the outcomes of interest. Determining baseline exposure status before disease events occur gives
prospective studies an important advantage in reducing certain types of bias that can occur in
retrospective cohort studies and case-control studies, though at the cost of efficiency.

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The following notes relate cohort to case-control studies:
• Outcome is measured after exposure

• Yields true incidence rates and relative risks
• May uncover unanticipated associations with outcome
• Best for common outcomes
• Expensive
• Requires large numbers
• Takes a long time to complete
• Prone to the bias of change in methods over time
The role of toxicological testing

Toxicology testing, also known as safety assessment, or toxicity testing, is conducted to determine the
degree to which a substance can damage a living or non-living organisms
Toxicity studies are required to assess potential hazards to humans through the acute, sub chronic, and
chronic exposure. The more specific types of toxicity that are determined include carcinogenicity;
developmental (including teratogenicity in offspring) and reproductive toxicity; mutagenicity; and
neurotoxicity. With the exception of the acute toxicity tests, most tests are conducted to determine the
nature of any toxicity that can be produced by repeatedly dosing animals over an extended period. The
results enable toxicologists to estimate the safety of a material of humans.
Following guidelines should be considered before initiating a toxicity test:
1. Use, wherever practical or possible, one or more species that biologically handle the material
qualitatively and/or quantitatively as similarly as possible to man. For this, metabolism,
absorption, excretion, storage and other physiological effects might be considered.
2. Where practical, use several dose levels on the principle that all types of toxicological and
pharmacologic actions in man and animals are dose-related. The only exception to this should be
the use of a single, maximum dosage level if the material is relatively nontoxic; this level should
be a sufficiently large multiple of that which is attainable by the applicable hazard exposure route,
and should not be physiologically impractical.
3. Effects produced at higher dose levels are useful for delineating mechanism of action, but for any
material effect, some dose level exists for man or animal below which this adverse effect will not
appear. This biologically insignificant level can and should be set by use of a proper uncertainty
factor and competent scientific judgment.
4. Statistical tests for significance are valid only on the experimental units (e.g., either litters or
individuals) that have been mathematically randomized among the dosed and concurrent control
groups.
5. Effects obtained by one route of administration to test animals are not a priori applicable to
effects by another route of administration to man. The routes chosen for administration to test
animals should, therefore, be the same as those to which man will be exposed. Thus, for example,
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The number of animals to be tested in each dose group depends on a number of factors, including the
purpose of the experiment, the required sensitivity of the study, the reproductive capacity and the fertility
of the species, economic aspects, and the availability of animals.
Vertebrate animal testing
An animal test is any scientific experiment or test in which a live animal is forced to undergo something
that is likely to cause them pain, suffering, distress or lasting harm. Animals used in laboratories are
deliberately harmed, not for their own good, and are usually killed at the end of the experiment.
Animal experiments include:
• Injecting or force feeding animals with potentially harmful substances

• Exposing animals to radiation
• Surgically removing animals’ organs or tissues to deliberately cause damage
• Forcing animals to inhale toxic gases
• Subjecting animals to frightening situations to create anxiety and depression.
Only vertebrate animals (mammals, birds, fish and amphibians) and some invertebrates such as octopuses
are defined as ‘animals’ by European legislation governing animal experiments. Animals used in
experiments are usually bred for this purpose by the laboratory or in breeding facilities.
Some experiments require the animal to die as part of the test. For example, regulatory tests for Botox,
vaccines and some tests for chemical safety are essentially variations of the cruel Lethal Dose 50 test in
which 50% of the animals die or are killed very close to death.
The European chemicals legislation REACH strives for a balance: increase our understanding of the hazards
of chemicals whilst at the same time, avoid unnecessary animal testing. Learning more about chemicals
by testing them on animals is a last resort – registrants may only carry out new tests when they have
exhausted all other relevant and available data sources.
For some chemicals, information on their impact, for example the potential to cause cancer, is still missing.
Industry must therefore fill information gaps to understand the hazards of the chemicals they produce
and use, to ensure safe use and manage the potential risks, and to possibly replace chemicals of high
concern over time with safer alternatives. For this reason, new studies on chemical substances may have
to be conducted, some of them using animals.
Positives of Animal Testing Negatives of Animal Testing

Helps researchers to find drugs and treatments: Animals are killed or kept in captivity: In animal
The major pro for animal testing is that it aids testing, countless animals are experimented on
researchers in finding drugs and treatments to and then killed after their use. Others are injured
improve health and medicine. Many medical and will still live the remainder of their lives in
treatments have been made possible by animal captivity.
testing, including cancer and HIV drugs, insulin,
antibiotics, vaccines and many more. Some substances tested, may never be used for
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Improves human health: It is for this reason that many of these animals received tests for
animal testing is considered vital for improving substances that will never actually see approval
human health and it is also why the scientific or public consumption and use. It is this aspect
community and many members of the public of animal testing that many view as a major
support its use. In fact, there are also individuals negative against the practice, as it seems that
who are against animal testing for cosmetics but the animal died in vain because no direct benefit
still support animal testing for medicine and the to humans occurred.
development of new drugs for disease.
It is very expensive: Another con on the issue of
Helps ensure safety of drugs: Another animal testing is the price. Animal testing
important aspect to note is that animal testing generally costs an enormous amount of money,
helps to ensure the safety of drugs and many as the animals must be fed, housed, cared for
other substances humans use or are exposed to and treated with drugs or a similar experimental
regularly. Drugs in particular can carry significant substance. On top of that, animal testing may
dangers with their use but animal testing allows occur more than once and over the course of
researchers to initially gauge the safety of drugs months, which means that additional costs are
prior to commencing trials on humans. This incurred. The price of animals themselves must
means that human harm is reduced and human also be factored into the equation.
lives are saved – not simply from avoidance of
the dangers of drugs but because the drugs Animals and humans are never exactly the
themselves save lives as well as improve the same: There is also the argument that the
quality of human life. reaction of a drug in an animal's body is quite
different from the reaction in a human. The main
Alternative methods of testing do not simulate criticism here is that some believe animal testing
humans in the same way: Scientists typically use is unreliable. Following on that criticism is the
animals for testing purposes because they are premise that because animals are in an
considered similar to humans. As such, unnatural environment, they will be under
researchers do recognise the limitations and stress. Therefore, they won't react to the drugs
differences but the testing is done on animals in the same way compared to their potential
because they are thought to be the closest reaction in a natural environment. This
match and best one with regards to applying this argument further weakens the validity of animal
data to humans. experimentation
Two ways that REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) aims to keep
the number of animal tests to an essential minimum are:
• Data sharing: Companies registering chemicals must share information on their hazardous
properties and jointly submit this hazard information to European Chemicals Agency (ECHA).
Companies producing or importing the same substance must work together and share the results
of tests on vertebrate animals, such as fish, rabbits or rats. Reliable and adequate studies must
not be repeated.
• Alternative methods and approaches: REACH offers several alternatives to testing on animals. For
example, companies can use existing animal studies, conducted before REACH. They can also
predict the properties of substances by comparing one substance with another similar one where
test data are already available. This approach is called read-across.

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Ames test
It’s a test for determining if a chemical is a mutagen. The use of the Ames test is based on the assumption
that any substance that is mutagenic for the bacteria used in his test may also turn out to be a carcinogen;
that is, to cause cancer. Although, in fact, some substances that cause cancer in laboratory animals (dioxin,
for example) do not give a positive Ames test (and vice-versa), the ease and low cost of the test make it
invaluable for screening substances in our environment for possible carcinogenicity.
A large number of chemicals used in industry give a positive Ames test. Examples are ethylene
dibromide (EDB), which was added to leaded gasoline (to vaporize lead deposits in the engine and send
them out the exhaust), and ziram, which is used to prevent fungus disease on crops. Some drugs, such
as isoniazid (used to prevent tuberculosis) are mutagenic in this test.
Qualitative/Quantitative Structure Activity Relationship (QSAR)
Structure-activity relationships and quantitative structure-activity relationships, collectively referred to

as (Q)SARs, are simplified mathematical representations of complex chemical-biological interactions that
can be used to predict the physicochemical and biological properties of molecules. They can take various
forms of various complexity and either be qualitative or quantitative.
A structure-activity relationship (SAR) usually represents an association between a chemical substructure

and the potential of a chemical containing the substructure to exhibit a certain biological effect.
A quantitative structure-activity relationship (QSAR) quantitative relates the properties of a chemical

(encoded in its chemical structure) to a physical property or to a biological effect (e.g. a toxicological
endpoint).
QSAR has been widely used to predict the toxicity of substances in bulk form and there are several reasons
to use QSAR Models: very fast, often free, reduce the number of animals used in experiments
Purpose of QSAR include:
• To predict biological activity and physico‐chemical properties by rational means

• To comprehend and rationalize the mechanisms of action within a series of chemicals
• Savings in the cost of product development
• Predictions could reduce the requirement for lengthy and expensive animal tests.
• Reduction of animal tests, thus reducing animal use and obviously pain and discomfort to
animals
• Other areas of promoting green and greener chemistry to increase efficiency and eliminate
waste

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There are a large number of applications of these models within industry, academia and governmental
(regulatory) agencies.
• The estimation of physico‐chemical properties, biological activities and understanding the

physicochemical features behind a biological response in drug design.
• The rational design of numerous other products such as surface‐active agents, perfumes,
dyes, and fine chemicals.
• The prediction of a variety of physico‐chemical properties of molecules.
• The prediction of fate of molecules which are released into the environment.
• The identification of hazardous compounds at early stages of product development, the
prediction of toxicity to humans and environment.
Read across and grouping
In the context of hazard assessment, grouping refers to considering closely related chemicals as a group
rather than as individual chemicals. A group of chemicals whose physicochemical and human health
and/or ecotoxicological properties and/or environmental fate properties are likely to be similar or follow
a regular pattern, can be grouped together usually as a result of structural similarity. Not every chemical
in a group needs to be tested for every endpoint. Instead, data for endpoints that have been tested are
used to predict, or read-across to, the same untested endpoints for other chemicals in the group.
The similarities may be based on the following:
• A common functional group (e.g. aldehyde, epoxide, ester, specific metal ion)
• Common constituents or chemical classes, similar carbon range numbers
• An incremental and constant change across the category (e.g. a chain-length category)
• The likelihood of common precursors and/or breakdown products, via physical or biological
processes, which result in structurally similar chemicals (e.g. the metabolic pathway
approach of examining related chemicals such as acid/ester/salt).
As a result of these similarities, data gap filling in a chemical category can be carried out by applying one
or more of the following procedures: read-across, trend analysis, and (external) (Q)SARs.
Grouping of substances and read-across is one of the most commonly used alternative approaches for
filling data gaps in registrations submitted under REACH. This approach uses relevant information from
analogous (‘source') substances to predict the properties of ‘target' substances. If the grouping and read-
across approach is applied correctly, experimental testing can be reduced as there is no need to test every
target substance.

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The meaning of dose-response relationship, NOAEL, LD50, LC50

LD stands for "Lethal Dose". LD50 is the amount of a material, given all at once, which causes the death
of 50% (one half) of a group of test animals. The LD50 is one way to measure the short-term poisoning
potential (acute toxicity) of a material.
Toxicologists can use many kinds of animals but most often testing is done with rats and mice. It is usually
expressed as the amount of chemical administered (e.g., milligrams) per 100 grams (for smaller animals)
or per kilogram (for bigger test subjects) of the body weight of the test animal. The LD50 can be found for
any route of entry or administration but dermal (applied to the skin) and oral (given by mouth)
administration methods are the most common.
LC stands for "Lethal Concentration". LC values usually refer to the concentration of a chemical in air but
in environmental studies it can also mean the concentration of a chemical in water.
According to the OECD (Organisation for Economic Cooperation and Development) Guidelines for the
Testing of Chemicals, a traditional experiment involves groups of animals exposed to a concentration (or
series of concentrations) for a set period of time (usually 4 hours). The animals are clinically observed for
up to 14 days.
The concentrations of the chemical in air that kills 50% of the test animals during the observation period
is the LC50 value. Other durations of exposure (versus the traditional 4 hours) may apply depending on
specific laws.
In general, if the immediate toxicity is similar in all of the different animals tested, the degree of immediate
toxicity will probably be similar for humans. When the LD50 values are different for various animal
species, one has to make approximations and assumptions when estimating the probable lethal dose for
man. Special calculations are used when translating animal LD50 values to possible lethal dose values for
humans. Safety factors of 10,000 or 1000 are usually included in such calculations to allow for the
variability between individuals and how they react to a chemical, and for the uncertainties of experiment
test results.
Results from research studies establish the highest doses at which no toxic effects were identified and the
lowest doses at which toxic or adverse effects were observed. The terms often used to describe these
outcomes are:
No-observed-adverse-effect level (NOAEL): greatest concentration or amount of a substance, found by

experiment or observation, that causes no detectable adverse alteration of morphology, functional
capacity, growth, development, or lifespan of the target organism under defined conditions of exposure.
No-observed-effect level (NOEL): greatest concentration or amount of a substance, found by experiment

or observation, that causes no alteration of morphology, functional capacity, growth, development, or
lifespan of the target organism distinguishable from those observed in normal (control) organisms of the
same species and strain under the same defined conditions of exposure.

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9.7 Asbestos and lead

Identification of types of asbestos
Asbestos refers to a set of six naturally occurring fibrous minerals:
1) Chrysotile (white asbestos): This has long, curly fibers and is the most commonly used form of
asbestos and can be found today in roofs, ceilings, walls and floors of homes and businesses.
Chrysotile asbestos also was used in automobile brake linings, pipe insulation, gaskets and boiler
seals. This type of asbestos is a confirmed cause of asbestos-related diseases including
mesothelioma in humans.
2) Crocidolite (blue asbestos): It has straight fibres and is the least heat resistance and was
commonly used to insulate steam engines. It was also used in some spray-on coatings, pipe
insulation and cement products. This type of asbestos is considered the most lethal form of the
mineral. This is due to the fact that crocidolite has sharp, needle-like fibers that break off easily
and are difficult for the body to expel once inhaled or swallowed.
3) Amosite (brown asbestos): It was used most frequently in cement sheet and pipe insulation. It
can be found in insulating board (which contained up to 40 percent asbestos), ceiling tiles and in
thermal insulation products.
It has needle-like fibers.
4) Anthophyllite: This type
displays a gray-brown color.
It was not commercially used
and was rather found as a
contaminant. Anthophyllite
was most commonly found
in composite flooring.
5) Tremolite: Tremolite can be
white, green, gray and even
transparent. This is not used
commercially, but it can be
Types of asbestos
found as a contaminant in
chrysotile asbestos and talc
powders. It was occasionally found as a contaminant in certain asbestos-containing insulation
products, paints, sealants and roofing materials.
6) Actinolite: This form of asbestos has a harsh texture and is not as flexible as the others. It is most
often found in metamorphic rock. Actinolite was never used commercially, but it can be found as
a contaminant in some asbestos products.
Although asbestos fibers are microscopic in nature, they are extremely durable and resistant to fire and
most chemical reactions and breakdowns. These properties of asbestos were the reasons that supported
its use for many years in a number of different commercial and industrial capacities.
Typical locations where asbestos can be found

The strength of asbestos, combined with its resistance to heat, allowed it to become the material of choice
in a variety of products, including, but not limited to, roofing shingles, floor tiles, ceiling materials, cement
compounds, textile products, and automotive parts.

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Type of Asbestos Where it can be found

Chrysotile Gaskets, Cement, Insulation, Brake pads, Brake linings, Roofing materials
Amosite Cement sheets, Thermal insulation, Plumbing insulation, Insulation boards,
Tiles, including those for ceilings roofs and floors, Chemical insulation, Electrical
insulation, Roofing products, Fire protection, Gaskets, lagging
Crocidolite Ceiling tiles, Fire protection, Insulation boards, Chemical insulation, Spray-on
insulation, Acid storage battery casings. Water encasement (enclosing),
Cement sheets containing asbestos, Electrical or telecommunication wires,
Thermal insulation (lagging and gaskets), Millboards (commercial ovens and
steam pipes)
Tremolite Paints, Sealants, Insulation, Roofing materials, Plumbing materials
Anthophyllite Anthophyllite is one of the rarest types of asbestos and does not have a long
history of commercial use. While considered to be among the noncommercial
types of asbestos, anthophyllite has been used in products containing minerals
such as vermiculite and talc.
Actinolite Insulation material, Gardening, Concrete materials used in construction,
Structural fire-proofing
The control measures for the specific case of asbestos

A control program is necessary when handling or using asbestos-containing material. The goal is to
prevent or minimize the release of airborne asbestos fibres. The employer must make sure that the
control plan is developed and implemented according to the requirements for their local government
regulations.
Preventative methods: Identify where there might be asbestos-containing materials. Consider

eliminating the need to work with asbestos. Can disturbing asbestos be avoided by doing the job some
other way? Some practical measure to prevent asbestos exposure include:
• Not bringing home work clothes or shoes that may have been contaminated with asbestos
• Not sweeping, dust or vacuum asbestos debris
• Disposing of asbestos materials according to legal requirements.
Design and installation: If any building or maintenance work in premises, or on plant or equipment that
might contain asbestos, you need to identify where asbestos is located its type and condition; assess the
risks, and manage and control these risks. Before working with asbestos-containing material (ACM):
• Identify and mark the boundary of the designated work area by barricades, fences, or similar
means.
• Ensure that the immediate work area is cleared of objects, materials and equipment other
than what is needed to do the work.
• Ensure that windows, doorways and all other openings are adequately sealed or secured to
prevent the release of asbestos fibre into other work areas.
• Post signs at the boundaries of the designated work area indicating asbestos work is in
progress, the hazards, and the precautions required for entering the work area. These signs
must be posted in a conspicuous location at the entrances to and on the periphery of each

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restricted area, as appropriate, and must remain posted until the area is no longer a restricted
area.
• Restrict entry into the designated work area to authorized persons who are adequately
protected against the level of risk within the designated work area.
• Workers should not eat, drink, chew or smoke within any work area containing asbestos.
• Drop sheets and barriers used in the work area should be wet-wiped or vacuumed with a
HEPA-filtered vacuum.
LEV: Local exhaust ventilation and dust collection systems shall be designed, constructed, installed, and
maintained in accordance with good practices and applicable laws and standards. All hand-operated and
power-operated tools which would produce or release fibers of asbestos, such as, but not limited to, saws,
scorers, abrasive wheels, and drills, shall be provided with local exhaust ventilation systems
Personal protection must be used to minimise the risk further even if the controls are in place to prevent
or reduce exposure to asbestos fibres when working with asbestos-containing material (ACM). If asbestos
is or may be present, PPE must include:
• Respiratory protective equipment (RPE) – to avoid inhaling asbestos fibres

• Overalls which are impervious to asbestos dust (either disposable or able to be washed) – to
avoid the risk of carrying asbestos fibres away from the worksite on clothing (Washing must
only be done in laundries specifically set up for handling asbestos- contaminated clothing. It
must not be done at home or a public laundry.)
• Footwear – appropriate for the work being undertaken (footwear should be non-laced as
laced footwear is difficult to clean – alternatively wear disposable boot covers).
Cleaning of premises and plant must be carried out frequently and at regular intervals during the work
and immediately on completion of the work. Dust and waste should be cleaned up and removed using a
vacuum equipped with a HEPA filter, or by damp mopping or wet sweeping, and placed in a container.
The container must be:
• Dust tight and suitable for the type of waste

• Impervious to asbestos
• Labelled as containing asbestos waste with a warning that the dust from the contents should
not be inhaled
• Cleaned with a damp cloth or a vacuum equipped with a HEPA filter immediately before being
removed from the work area
• Removed from the workplace frequently and at regular intervals
Disposal of asbestos waste: Mixing of asbestos waste with other waste to get below legal dispose limit is
not allowed. Following must be adhered to when dealing with asbestos waste.
• The asbestos materials shall be packed while still wet into sealable and impermeable
containers for removal. Waste must be packed in UN approved packaging with a CDG hazard
sign and asbestos code information visible. All plastic sheets, tapes, cleaning materials,

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clothing and filter bags used in the vacuum systems and all other disposable materials used
in the work area shall also be packed
• Double wrap and label asbestos waste. Standard practice is to use a red inner bag with
asbestos warnings, and a clear outer bag with the CDG sign. (Don’t overfill bags. Beware sharp
objects that could puncture plastic.)
• If you carry waste, use a sealed skip, or a vehicle with segregated compartment for asbestos,
easily cleanable and lockable. It must be ensured that the outside of the containers is not
contaminated with asbestos debris.
• Otherwise, arrange for transport by a registered waste carrier
• Safe disposal at a licensed disposal site.
Medical monitoring is required on regular basis for workers exposed to asbestos. This monitoring could
include:
• Medical examinations and clinical tests of a worker which may include a screening chest
radiograph, a lung function test, occupational exposure history, and a health questionnaire.
• Personal records to show the exposure of a worker to asbestos at the workplace, including
the time-weighted average exposure of the worker and of the concentrations of asbestos.
Use of specialist contractors for removal and disposal of asbestos

Any workplace where employees may encounter asbestos materials must have an asbestos management
plan in place. These means that all asbestos materials are identified and will be properly maintained at all
times, and that those individuals who work with the material will be instructed as to proper handling to
avoid any asbestos cancer hazard.
Furthermore, employees should

never be expected to handle the
removal of asbestos or take part in
any demolition that may disturb
asbestos materials. Any asbestos in
the workplace should be handled by
licensed asbestos professionals who
are trained in management,
abatement, and disposal of the toxic
material
Asbestos removal is typically Asbestos containing sheets

required before an older building
is demolished, prior to any maintenance or renovation that could disturb asbestos containing materials
or when asbestos containing materials are damaged. An asbestos removal contractor will determine
whether and HSE (Health and Safety Executive-UK) license is required for the job. This type of license is
usually necessary when there is a high probability that asbestos fibers will be released into the air during

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the scheduled work. The removal contractor will assess what is required for removal, perform the removal
work and dispose of the hazardous material.
There are stringent requirements set by federal, state, and local authorities regarding the methods for
asbestos handling, removal, and disposal. The asbestos removal regulations vary state-by-state so it is
important to ensure that the hired removal professional is fully in compliance with all state laws and
regulations.
Asbestos Licensing is a "permissioning regime". Licensing is an addition to the general framework of

health and safety law. It builds on the fact that the legal duty to manage risk lies with the organisations
that create them.
Additional control measures for working with lead with typical workplace examples
Workers potentially at risk for lead exposure include those involved in iron work; demolition work;
painting; lead-based paint abatement; plumbing; heating and air conditioning maintenance and repair;
electrical work; and carpentry, renovation, and remodeling work. Plumbers, welders, and painters are
among those workers most exposed to lead. Significant lead exposures also can arise from removing paint
from surfaces previously coated with lead-based paint such as bridges, residences being renovated, and
structures being demolished or salvaged.
Workers at the highest risk of lead exposure are those involved in:
• Abrasive blasting
• Welding, cutting, and burning on steel structures
• Lead burning
• Using lead-containing mortar
• Power tool cleaning without dust collection systems
• Rivet busting
• Cleanup activities where dry expendable abrasives are used
• Movement and removal of abrasive blasting enclosures
• Manual dry scraping and sanding
• Manual demolition of structures
• Heat-gun applications
• Power tool cleaning with dust collection systems
• Spray painting with lead-based paint.
The most effective way to protect workers is to minimize their exposure through engineering controls,
good work practices and training, and use of personal protective clothing and equipment, including
respirators, where required.
• Make sure to have all the information and training needed to work safely with lead, including
what to do in an emergency, such as a sudden uncontrolled release of lead dust or fume

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• Engineering Controls measures include local and general exhaust ventilation, process and
equipment modification, material substitution, component replacement, and isolation or
automation.
• Do not use practices that produce dust clouds containing lead (e.g. dry sweeping, using
compressed air to clean areas contaminated with lead, using ordinary vacuum cleaners without
HEPA filters).
• Housekeeping and Personal Hygiene: Lead is a cumulative and persistent toxic substance that
poses a serious health risk. A rigorous housekeeping program and the observance of basic
personal hygiene practices will minimize employee exposure to lead. In addition, these two
elements of the worker protection program help prevent workers from taking lead contaminated
dust out of the worksite and into their homes where it can extend the workers’ exposures and
potentially affect their families’ health.
• Protective Clothing and Equipment must be provided by employers to all workers who are
exposed to lead above the PEL or for whom the possibility of skin or eye irritation exists with
clean, dry protective work clothing and equipment that are appropriate for the hazard. Employers
must provide these items at no cost to employees.
• Introduce and follow a health surveillance programme. Have your blood levels checked by a
registered medical practitioner with experience in health monitoring if you are working with lead-
based paint.
Health surveillance for those workers who regularly undertake work where asbestos or
lead are likely to be present
Health monitoring is used to identify changes in a person's health status because of exposure to certain
substances. Health monitoring can be useful following significant exposure to a substance and where
there is an available valid health monitoring technique to detect adverse health effects from that
exposure.
Inhalation of respirable asbestos fibres may cause diseases such as asbestosis, lung cancer and
mesothelioma. Risk factors include the dose (number of fibres inhaled), lifetime exposure, fibre type,
smoking status and genetics.
Asbestos was a popular building material used until the year 2000, due to its insulating, fire retardant
and waterproof properties. Inhaling asbestos fibers can cause very serious health issues such as lung
cancer, mesothelioma and scarring of the lungs (asbestosis).
For Whom; If asbestos exceeds the following action levels, medical surveillance is necessary:
• 72 fibre-hours per milliliter of air – Employees exposed solely to chrysotile.

• 48 fibre-hours per millilitre of air – Employees exposed to any other form of asbestos.
• There are presently exemptions for workers with sporadic and insignificant exposure, please
refer to the legislation.

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What needs to be done; The medical will include a lung function test and an extensive questionnaire of
the employees medical history.
When; Before employment commences and then at least every two years. For non-licensed work,
testing is required once every three years.
Who can carry out medical surveillance?
• Medical surveillance of workers doing non-licensed asbestos work can be conducted by HSE-
appointed doctors or doctors who are not appointed by HSE provided they are GMC-registered
and hold a licence to practise (e.g. a local GP).
• Doctors conducting medical surveillance of workers doing licensed asbestos work must be either
an HSE-appointed doctor or employment medical adviser.
Medical surveillance for workers carrying out non-licensed work:
• Medical surveillance should consist of initial and periodic medical examinations. The first
medical examination must be conducted no more than three years before beginning exposure
to asbestos. Periodic medical examinations must be conducted at intervals of no more than
three years while exposure continues.
• The purposes of medical surveillance are to:
• provide workers with information about their current state of respiratory health;
• alert workers to any early indications of asbestos-related disease and advise them on whether
they should continue working with asbestos;
• warn workers of the increased risk of lung cancer from combined exposure to smoking and
asbestos;
• alert employers or the worker’s GP (with consent) to any particular problems; and
• emphasize the need for workers to use available control measures and follow good working
practices.
When handling a clean solid lead sheet, the potential risk of exposure to lead is not considered to be
significant. Significant lead exposure could occur if the work involves the stripping off of old existing
sheets from a roof where the underside is corroded. Lead dust could be released and then inhaled.
Suitable respiratory protection should be worn and good occupational hygiene practiced. The melting
down of lead for the caulking of sheet joints should be carried out at low temperatures below 500°C to
prevent lead fumes being formed, which if inhaled may cause significant lead exposure to workers.
Lead-based paints were widely available and used. Therefore, most old houses or buildings will contain
some lead-based paint. In poorly maintained buildings the lead paint flakes and peels off and can then
be inhaled. Uncontrolled or uncontained dust and debris from renovation works or repainting can
expose the workers doing the work and occupants of the building to unsafe levels of lead.
Lead abatement projects are designed to permanently eliminate existing lead-based hazards and
prevent future lead exposure. But this work often involves high risk of worker exposure to lead unless

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the work is well planned and the workers protected with adequate respiratory protective equipment. An
example of this would be the removal of lead-based paint from bridges.
The Objectives of Medical Surveillance Are:
• Make an initial assessment of the suitability of an employee to work with lead.

• Evaluate the effect of lead absorbed by an employee and advise on the state of health.
• Monitor exposure of female employees of reproductive capacity.
• Assess the suitability of an employee to continue in work where there is continuing exposure to
lead.
• Detect early health effects of excessive lead absorption.
• Assist employees in their duty to control the exposure of employees to lead.
Role of health surveillance for workers exposed to lead:
Health surveillance is used to prevent occupationally related disease in workers. It allows adverse
variations in their health, due to working conditions, to be identified as early as possible. It must be
carried out by a doctor experienced in occupational medicine. Those workers starting in a job where
they will be working with lead on a regular basis should have a pre-employment medical examination.
The health surveillance programme allows the worker’s health to be protected by:
• Determining the amount of lead going into the workers body through lead in blood monitoring.
• Allowing for remedial action to control lead absorption.
• Allowing for education of workers on the health effects of lead. The amount of lead in the blood
lead sample can be used to determine:
• When an employee should be suspended from lead exposure at work.
• When an urgent review of work practices and personal hygiene should be made.
• When further testing should take place.
• When a worker is safe to return to work after excessive lead exposure
9.8 Ventilation and PPE

The uses and limitations of dilution ventilation
Dilution ventilation reduces the concentration of the air contaminants by mixing (diluting) the
contaminated air with fresh, clean, uncontaminated air. This ventilation system is also known as General
Industrial ventilation.
Dilution ventilation controls pollutants generated at a worksite by ventilating the entire workplace. The
use of general ventilation distributes pollutants, to some degree, throughout the entire worksite and
could therefore affect persons who are far from the source of contamination.
Dilution ventilation can be made more effective if the exhaust fan is located close to exposed workers and
the makeup air is located behind the worker so that the contaminated air is drawn away from the worker's
breathing zone.
When used to control chemical pollutants, dilution must be limited to only situations where:
• The amounts of pollutants generated are not very high

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• Their toxicity is relatively moderate

• Workers do not carry out their tasks in the immediate vicinity of the source of contamination,
and
• The emission rate of contaminants is relatively uniform
As a method for protecting workers, it is important to know the limitations of dilution ventilation:
• Does not completely remove contaminants

• Cannot be used for highly toxic chemicals
• Is not effective for dusts or metal fumes or large amounts of gases or vapours
• Requires large amounts of makeup air to be heated or cooled
• Is not effective for handling surges of gases or vapours or irregular emissions
Selection criteria for dilution ventilation and local exhaust systems
General exhaust ventilation (dilution Local exhaust ventilating is appropriate when:

ventilation) is appropriate when:
▪ Emission sources contain materials of
▪ Emission sources contain materials of relatively high hazard
relatively low hazard. (The degree of hazard ▪ Emitted materials are primarily larger-
is related to toxicity, dose rate, and diameter particulates (likely to settle)
individual susceptibility) ▪ Emissions vary over time
▪ Emission sources are primarily vapors or ▪ Emission sources consist of point sources
gases, or small, respirable-size aerosols ▪ Employees work in the immediate vicinity
(those not likely to settle) of the emission source
▪ Emissions occur uniformly ▪ The plant is located in a severe climate
▪ Emissions are widely dispersed ▪ Minimizing air turnover is necessary.
▪ Moderate climatic conditions prevail
▪ Heat is to be removed from the space by
flushing it with outside air
▪ Concentrations of vapors are to be reduced
in an enclosure
▪ Portable or mobile emission sources are to
be controlled.
The purpose of the typical components of an LEV and their function

Local Exhaust Ventilation systems are designed to control contaminants at the source before mixing with
breathing air occurs. They are used primarily to control the concentrations at the source of highly toxic
contaminants. A local exhaust ventilation system consists of the following parts:

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Typical components of an LEV system
Hood (enclosing, receiving, capturing): The proper design of hoods is necessary to capture the
contaminant at the source of release. To be effective:
• The hood should be positioned as close as possible to the source, or even enclose the source,
ideally less than one hood diameter away
• Enclose the process as much as possible to avoid draughts that will blow the fumes away from
the hood and further into the workplace
• The hood must be the right design for the process and type of contaminant
• The capture velocity must be sufficient to overcome the movement of the contaminant cloud and
draw it into the hood (The term capture velocity is defined as the minimum velocity of hood-
induced air necessary to capture the contaminant.)
• The worker must not stand between the process and the flow of air to the hood
One of the common reasons LEV systems are ineffective is because the hood doesn’t capture and contain
the contaminated air. There are different designs of LEV hood for different processes.
• Enclosing Hood: An example of an enclosing hood is the laboratory hood. This hood actually
encloses the contaminant source and the air is forced in an opposite direction (upward,
downward, or backward, away from the worker). Enclosures are always more effective than
capturing or receiving hoods. A full enclosure is where the process is completely enclosed, e.g. a
glove box. A room enclosure or enclosing room is where the operator and the process are
enclosed, e.g. abrasive-blasting rooms or paint-spraying cabins.
• Capturing Hood: Capturing hood exhaust systems are used at the point of contaminant
generation. An example of this system is a welding fume exhaust system that can be placed in
very close proximity to the point of contaminant generation. The process, source and

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contaminant cloud are outside the hood. A capturing hood has to generate sufficient airflow at
and around the source to ‘capture’ and draw in the contaminant-laden air.
• Receiving Hood: Receiving hoods are used where hot gases and vapors are encountered and
workers do not work directly over the source of emissions. The process usually takes place outside
the hood. The hood receives the contaminant cloud, which has a speed and direction that is
usually process generated. Hoods can be fixed or moveable. The major drawback in using these
hoods is the potential for the worker to place himself/herself between the contaminant and the
exhaust stream.
Different types of LEV hoods (Source: HSE-UK)
Ducting: Exhaust ducts are used to convey the contaminated air from the hood to the air cleaner and/or
to the stack. It consists of some or all of the following:
• Ducting from the hood

• Dampers to adjust or balance the flow in different branches of the LEV system
• Bends, junctions and changes in the duct diameter
• Markings, including test points and hazard warnings of the duct contents
• A connection to the air cleaner and air mover
• Access panels for cleaning and inspection.
Usually all the above are under negative pressure (i.e. lower than that in the workplace). Ducting on the
discharge side of the air mover will be under positive pressure (i.e. higher than that in the workplace).
Ducts can be either circular or rectangular in cross-section. Circular ducts are generally preferable
because they:
• Have a lighter structure for a given cross-sectional area

• Have a greater ability to withstand pressure differences
• Produce less noise, as there are no flat panels to act as secondary sources of vibration.

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Following points must be into account with regard to ductwork:
• Keep the design as simple as possible

• Provide smooth-bore ductwork and an obstruction-free interior for particle extraction
• Have a sufficiently high air velocity to keep particles suspended in the air stream, while low
enough to keep noise levels acceptable
• Route ductwork to minimise noise nuisance
• Keep duct pressures negative within the building, as far as possible
• Have the minimum number of bends and junctions to minimise the flow resistance
• When changes of direction are necessary, they should be made smoothly. Junctions and changes
of section should also be smooth. Do not use T-junctions
• Incorporate tapered sections when the duct cross-section needs to change
• Provide drainage points at any low points in an LEV system for aerosols, mists, or substances that
may condense or support combustion
• Provide access points as appropriate for cleaning and to clear blockages
• Minimise the length of horizontal run for transport of particles
• Depending on the expected range of temperatures, the ducting should accommodate thermal
expansion and contraction.
Air cleaner/arrestor: Air cleaners devices remove the contaminant from the air stream to protect the
community, protect the fan, recover materials, and enable circulation. This may consist of fabric filters,
cyclones, electrostatic precipitators and scrubbers. Must be regularly cleaned and maintained.
Air mover (engine/fan): The fan draws the contaminated air though the hood and ducting to the exhaust
stack. The fan must generate sufficient airflow to achieve a capture velocity that draws the contaminant
away from the worker’s breathing zone.
Discharge/exhaust: Whether or not it has been cleaned, extracted air must not re-enter the building or
enter other buildings unless the contaminant has reached negligible concentrations. Discharged air must
leave the discharge duct at a high enough speed to make sure it is dispersed. Discharge is normally via a
‘stack’. The discharge point should be located well above the highest point of a building. Never use devices
that direct the discharge downwards.
Typical instrumentation: Users of LEV systems, particularly the operators at LEV hoods, must be able to
tell that the hood airflow is still adequate to control exposure. Good practice requires the periodic
monitoring of performance for all hoods. The designer should therefore specify suitable monitors such as
manometers or other airflow indicators. Other necessary instruments may include an alarm for a blocked
or failed filter, e.g. a pressure gauge for continuous monitoring and an advanced detection system
connected to alarms and a system to divert recirculated air out of the workplace.

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Multi branch LEV system (Source: HSE-UK)
Source strength and capture zones

The capture zone of a capturing hood is the space in front of the hood where the air velocity is sufficient
to capture the contaminant cloud. One way to envisage the capture zone is a ‘bubble’ in front of the hood.
This ‘bubble’ is easy to disrupt – it can shrink and change shape. Draughts can severely affect the size and
shape of capture zones, and powerful draughts virtually destroy them.
The capture zone is almost always smaller than the user expects. That is because the air velocity falls very
rapidly in front of a capturing hood. As a rule of thumb, at one hood diameter out from the face of a
capturing hood, the air velocity has fallen to about one tenth of the face velocity.
The working zone is the space where the activity generates the contaminant cloud. For effective exposure
control, the working zone must lie within the capture zone of a capturing hood.
Capturing hoods are usually only effective when the source is within two hood diameters from the hood
face. Further than this and it is likely that the hood will be ineffective. The shape of the capture zone
depends on the hood’s shape. The effective capture zone is severely limited, particularly for small hoods.
In addition to the capture zone, the source must provide adequate suction for effective intake of the
contaminant. This is called Capture velocity. (The velocity required at a contaminant source to overcome
the movement of the contaminant cloud and draw it into the hood). But this is meaningful only with a
defined distance between the source and the hood. Fast-moving contaminant clouds are very difficult to
control with a capturing hood. They normally require a partial enclosure or receiving hood.

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Thorough examinations of LEV

Need for routine checks: Routine checks (daily, weekly, and monthly) keep the LEV system running
properly. The frequency of routine checks and their description should be set out in the system logbook.
A trained employee is able to make routine checks. Employees should report any defects in LEV to their
supervisor. The employer must ensure that those who check or examine LEV have adequate knowledge,
training and expertise, i.e. they are competent.
Following points may be made part of a daily checklist: (HSE- INDG409)
• Does the indicator show the LEV is working properly?

• Is it taking away all the harmful dust, mist, fumes and gas? Remember, some of these may be
invisible. Are you close enough to it so it can do its job properly?
• Are there any signs it is not working properly, like smells or settled dust?
• Are there any unusual noises or vibration coming from it?
• Has it been thoroughly tested, with a ‘tested’ label that is within date?
• Have supervisor been told about anything that may go wrong?
Requirements for examinations/inspections: A thorough examination and test is a detailed and

systematic examination sufficient to ensure that the LEV can continue to perform as intended by design
and will contribute to the adequate control of exposure. The thorough examination would normally
include such functional testing to provide sufficient evidence to indicate adequate control is being
achieved.
Proper maintenance includes regularly:
• Checking for signs of damage or deterioration to capture hoods, ducting, air cleaners/dust
collectors, fans and connections
• Inspecting for and cleaning up contaminant build up (e.g. dust and overspray) regularly
• Testing the unit’s effectiveness using smoke tubes or an anemometer
• Checking the effectiveness of the LEV through observation (e.g. capture of visible dust)
• Checking the pressure drop across the filter (bags) where appropriate. Where it is practicable, a
direct reading device to measure the pressure drop across the filters should be installed
• Removing waste from any collection units
• Changing filters as required.
Annual maintenance of the LEV should be carried out by a competent person and include:
• Checking the operation of the system

• Airflow testing
• Inspecting the fan and motor for noise or vibration, integrity and security of fixings, cleanliness,
and lubricate or grease
• Inspecting belts, bearings and pulleys for tension, alignment, safety guards, and wear and tear
• Checking duct work for cleanliness, damage or holes and secure connections
• Checking electricals (there may also be an automatic sensor operation and time delay system)
• Checking other plant associated with the LEV system.

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Competence of those carrying out the testing: The thorough examination and test may be carried out by
a person who is competent and is able to make an objective assessment of the LEV. This can be:
o An outside contractor; or
o A competent employee of the LEV owner (the employer)
According to HSG-258, routes to becoming professionally competent include qualifications through BOHS,
CIBSE and ILEVE. UKAS Accreditation for Commissioning of LEV or Thorough Examination and Test (TExT)
of LEV is evidence that UKAS have audited the technical competence of a commissioning or inspection
body. LEV examiner responsible for carrying out the thorough examination and test, must have following
knowledge:
• The parts of an LEV system and their function.

• The legal requirements for the thorough examination and testing of LEV systems
• How to recognise a damaged part from a visual inspection
• The purpose of, and how to use, the measuring and assessment instruments and techniques
• The most suitable instrument to test the performance of each part of the LEV system
• The standard to which each part of the LEV system should perform
• How to recognise when a part of the LEV is performing unsatisfactorily, based on the
measurements taken and assessment methods used
• How to assess whether the LEV is effectively reducing airborne contaminant emission and
operator exposure
• How to collate and record information in a clear, concise and useable way
• How to work safely with the LEV plant and the hazards associated with it.
Frequency of testing: The maximum time between tests of LEV systems is set down in COSHH and for
most systems this is 14 months. In practice, this is normally taken to mean annually. If wear and tear on
the LEV system is liable to mean that the system effectiveness will degrade between tests then thorough
examinations and tests should be more frequent.
Understanding the risks from the system: Before carrying out any testing, the work to be done should be
assessed for risks and appropriate action taken. The employee or contractor needs to know if there are
any material residues within the system that could be hazardous. Are there physical hazards such as
working from heights, electrical hazards, moving machinery, manual handling specific to the LEV testing?
Examining filters and scrubbers may increase the risk of chemical contact and the hazards associated with
entering a confined space.
Make sure relevant COSHH assessment for cleaning and maintenance is carried out. Suitable
arrangements must be made for the disposal of material collected by filters or other air cleaning devices.
In the case of wet scrubbers, for example, where collection media may be contaminated with solvents or
corrosive materials, waste may not be discharged into drains, but should be disposed of via the hazardous
waste disposal route
Co-operation between employer and examiner: The examination and test needs to be done by a
‘competent person’. It isn’t normally something companies can do independently. Employers and
employees will need to co-operate with the examiner. Give them the:

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• LEV commissioning report

• LEV user manual
• Logbook with details of checks and maintenance activities
Sources of information available to the examiner: Before carrying out any measurements, the examiner
should have available to him or her:
• A copy of the commissioning report

• The results of the previous annual performance testing if appropriate
• The log of routine testing.
He/she should be able to confirm that there have been no modifications to the system since the last
testing. If these reports are not available, then this test has to become the base-line test. His/her report
should recommend documented routine testing as outlined above
Equipment required for testing: LEV examiners need the appropriate equipment such as Pitot tubes, a
smoke generator, a dust lamp, an anemometer and, sometimes, equipment for air sampling.
Three stages to carrying out testing: Thorough examination and testing of LEV can be considered to
comprise three stages:
• Stage 1: A thorough visual examination to verify the LEV is in efficient working order, in good
repair and in a clean condition
• Stage 2: Measuring and examining the technical performance to check conformity with
commissioning or other sources of relevant information
• Stage 3: Assessment to check the control of worker exposure is adequate
Further information on each detail is given in HSG-258
Report on LEV testing: The HSE website has an example form for recording this information. The examiner
judges whether the system is contributing effectively to controlling exposure to substances hazardous to
health and produces a prioritised plan for any actions. Where maintenance or repairs are identified as
priorities for action, the employer should plan and schedule such repair, and retest to assure control.
A comprehensive report will include:
• The name and address of the employer responsible for the LEV
• The date of examination and test
• Date of the last thorough examination and test
• The identification and location of the LEV, and the process and hazardous substance concerned
• Conditions at the time of the test and whether this was normal production or special conditions
• A simple diagram of the LEV layout and location, with test points
• Condition of the LEV system including hood serial numbers and, where appropriate, photographs
of relevant parts
• Its intended operating performance for adequately controlling the hazardous substance and
whether it is still achieving the same performance

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• The methods used to make a judgment of performance and what needs to be done to achieve
that performance, e.g. visual, pressure measurements, airflow measurements, dust lamp, air
sampling, tests to check the condition and effectiveness of the filter
• Results of any air sampling relevant to LEV performance
• Comments on the way operators used the LEV
• Comments on system wear and tear and whether components may need repair or replacement
before the next annual test
• The name, job title and employer of the person carrying out the examination and test
• Signature of the person carrying out the examination and test
• The details of any minor adjustments or repairs carried out to make the LEV system effective. The
employer needs to know about critical defects immediately and should not wait for the report.
The employer should keep the examination and test report for at least five years. A copy should be
available at the workplace containing the LEV system.
Interpretation of results and implementing recommendations:
The examiner will attach a ‘tested’ label to all hoods. This will include the name of the examiner and the
date of the next test. If a hood has clearly failed, then a red ‘fail’ label will be attached instead, and urgent
action will be necessary. The examiner will give a report of the examination and test, which should include
a prioritised action plan listing anything that need to be done. If the examination and test show that the
LEV isn’t adequately controlling people’s exposure to airborne contaminants, stop the work and repair
the LEV. If work is to be continued while repairs are being arranged, employees will need further
protection, such as suitable personal protective equipment and respiratory protection. The system should
carry the red ‘fail’ label until it has been repaired. If the thorough examination and test report action plan
contains long lists of repairs and poor performance, this tells that existing checking and maintenance is
not good enough. Use the test report as an audit of the procedures and an opportunity to review all
exposure control measures.
The types of PPE for use with hazardous substances

The use of personal protective equipment should not be regarded as an alternative to engineering or
other suitable control measures but should be provided and maintained where such control measures
cannot ensure protection. Effective action should continue to be taken by the employer to ensure that
control measures are developed and
applied in order to eliminate or
minimise the risk to a level at which
personal protection may not be
required.
• Personal protective
equipment should afford
adequate protection against
the risk from those hazardous
chemicals to which the
wearer is exposed,
Different PPEs

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throughout the period during which such equipment is necessary, having regard to the type of
work
• Items of personal protective equipment provided should comply with national law or be in
accordance with criteria approved or recognised by the competent authority and based on
national or international standards
• The equipment provided should be suitable for its purpose and there should be a sufficient supply
readily available in the workplace for workers who require it
• Workers required to wear protective equipment should be fully instructed in its use
• When workers have been informed accordingly, they should use the equipment provided
throughout the time they are exposed to the risk that requires its use for protection
• Employers should provide supervision to ensure that the equipment is properly used
• All personal protective equipment that is necessary for safety in the use of chemicals should be
provided and maintained by the employer without cost to the worker.
Personal protective equipment includes respiratory protective equipment, protective clothing and
footwear, equipment to protect the face, eyes and hands, and equipment to prevent an accumulation of
static electricity, e.g. anti-static footwear.
Respiratory protective equipment (RPE)

Respiratory Protective Equipment (RPE) is a particular type of Personal Protective Equipment (PPE), used
to protect the individual wearer against inhalation of hazardous substances in the workplace air. RPE
should only be used where adequate control of exposure cannot be achieved by other means, in other
words, as a last resort on the hierarchy of
control measures. Employers are required to
firstly attempt to eliminate the hazard at
source. RPE should only be used after all
other reasonably practicable control
measures have been taken. PPE is considered
a last resort because it only protects
individual workers, is prone to failure or
misuse, such as wearing the wrong RPE for Full face respirator
the job, and employees wearing RPE may get
a false sense of security when using RPE.
RPE at work should:
• Adequately control inhalation exposure to provide the wearer with effective protection
• Be suitable for the intended use
• Be CE-marked or of an approved type/standard
• Be used by properly trained people who are supervised
• Be properly stored, cleaned and checked regularly to ensure it remains effective.

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RPE is the last line of protection. Remember, RPE can protect only the wearer and if it is used incorrectly,
or is poorly maintained, it is unlikely to provide the required protection. Note also that RPE can be
uncomfortable to wear and may interfere with work, which can lead to incorrect use.
Adequate and suitable RPE is required to ensure the wearer is protected. This means:
• Adequate – It is right for the hazard and reduces exposure to the level required to protect the
wearer’s health.
• Suitable – It is right for the wearer, task and environment, such that the wearer can work freely
and without additional risks due to the RPE.
The two main types of RPE are respirators and breathing

apparatus:
• Respirators (filtering devices) use filters to remove

contaminants from the air being breathed in. They can be
either:
o Non-powered respirators – relying on the
wearer’s breathing to draw air through the filter
o Powered respirators – using a motor to pass air
through the filter to give a supply of clean air.
Respirators must not be used in oxygen-deficient
atmospheres. A key component of any respirator
is the filter. Filters are available for solid or liquid
particles, vapours and gases. They can be an
intrinsic part of the device or come separately so
they can be changed on a reusable respirator. It
is vital to choose the correct filter, which will be
SCBA
effective against the hazard.
• Breathing apparatus needs a supply of breathing-quality air from an independent source
There are different types but all:
o Will supply air from an independent source such as a compressed air cylinder or air
compressor
o Can be used against a range of airborne hazards and in different atmospheres.
Both respirators and BA are available in a range of different styles, which can be put into two main groups:

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• Tight-fitting facepieces (often referred to as masks) - rely on having a good seal with the wearer’s face.
These are available as both non-powered and powered respirators and BA. Examples are filtering
facepieces, half and full-face masks.
• Loose-fitting facepieces – rely on enough clean air being provided to the wearer to prevent
contaminant leaking in (only available as powered respirators or BA). Examples are hoods helmets,
visors, blouses and suits.
General classification of the Respiratory Protective Equipment is as follows
Respirators – filter out contamination from the air in the workplace before it is inhaled by the user
Filtering respirators (Unpowered) Powered/assisted respirators
• Filtering face pieces • Powered hoods and helmets with
• Half mask with filter(s) filter(s)
• Full-face mask with filter(s) • Powered-assisted half mask with
filter(s)
• Powered assisted full-face mask with
filter(s)
Breathing apparatuses – provide uncontaminated breathable air from independent source
Compressed airline breathing apparatuses Indented line Self-contained breathing
• Constant flow with any type of face apparatuses
piece • Open-circuit negative demand full-face
• Negative demand half or full-face mask mask
• Positive demand half or full-face mask • Open circuit positive demand full-face
mask
• Closed-circuit full-face mask demand
RPE must be matched to:
• The exposure concentrations (expected or measured)

• The job
• The wearer; and
• Factors related to the working environment.
The correct selection of appropriate RPE for the task undertaken is one of the most important steps in the
RPE lifecycle process. Failing to select, fit-test, use, store and maintain correct RPE will lead to exposure
of hazardous substance(s) at work. Using incorrect RPE can potentially lead to workplace fatalities, in areas
of low oxygen concentration or confined spaces for example. There are four separate areas that need to
be considered when selecting RPE, which may need to be discussed with equipment supplier:

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Equipment factors: Individual factors:

• Must be CE-marked • Medical fitness of the wearer (e.g. asthma,
• Must be adequate for the task in hand bronchitis or heart disease)
• Must be compatible with the environment, the • Facial characteristics of the wearer including
task, the wearer and other personal protective facial hair
equipment used • Physical characteristics of the wearer
• Must be in good working order • Use of spectacles • Use of contact lenses
• Assessment of the fit of tight-fitting face piece
Work environment factors: Task factors:
• Is the atmosphere potentially oxygen • What are the work rates involved?
deficient? • Are there visibility requirements?
• Are any asphyxiants present or is there • Are there any mobility requirements including
potential for sudden release and their likely spatial conditions of the environment?
concentrations? • Are there any communication requirements?
• Is the atmosphere immediately dangerous to • Is there likely to be thermal strain on wearer?
life or health? • Are any other accessories worn in the area in
• Is the atmosphere corrosive or likely to contact with the device?
become so? • What tools are to be used?
• Is the atmosphere explosive or likely to • Are there any other pieces of personal
become so? protective equipment to be worn in addition to
• What are the permeation capabilities of air a respiratory protective device?
contaminants (e.g. via face piece and filters)? • What is the duration of wear?
What is the physical state (e.g. gas, mist, dust, • Will manual handling be involved and how will
and fume) of the contaminant? this affect the type of RPE chosen?
• What is the temperature and humidity of the
atmosphere?
There are various types of respirator and they all rely on filter material to remove the hazard. The filter
material will be different depending on the hazardous substance and its form. There are two basic filter
types available:
• Particle filters
• Gas/vapour filters.
Airborne liquids in the form of fine sprays and mists and solid materials, including dusts, fibres, smoke and
fume, require a particle filter. As air is breathed in, it passes through the filter(s), removing the
contaminants before they reach the lungs. The respirator can either:
• Be made of the filter material

• Have a filter(s) fitted to it; or
• Use a motor to pass air through the filter(s) that may be separate from the facepiece.

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Remember:
• Particle filters do not protect against gas or vapour

• Gas/vapour filters do not protect against particles
• Neither filter type can be used in oxygen-deficient atmospheres.
Some situations may require a combination of filters suitable for the different substances or forms
present.
A fuller explanation on filter types is given in the Appendix 2 of HSG53.
Guidance on use of gas/vapour filters include:
• Change filters as instructed by the manufacturer; for example, AX filters are single use only and
mercury (Hg) filters have a maximum use time of 50 hours
• Change before any expiry date marked on the filter
• Do not use if the expiry date on the filters has passed
• Change when damaged or visibly contaminated
• Change before the contaminant can be smelled or tasted
• Change before the filter life indicated in your risk assessment.
Each RPE type and class is categorized by an Assigned Protection Factor (APF). The APF is a number rating
that indicates how much protection that RPE is capable of providing. For example, RPE with an APF of 10
will reduce the wearer’s exposure by at least a factor of 10 if used properly, or, to put it another way, the
wearer will only breathe in one-tenth or less of the amount of substance present in the air.
There are only a few number ratings used, so RPE APFs will be either: 4; 10; 20; 40; 200 or 2000. When
calculating the protection factor, always choose an APF above the calculated value. More guidance is given
in the guidance documents available at http://www.hse.gov.uk/pubns/guidance/rseries.htm
Some APFs for specific types and classes of device are published in IS EN 529:2005.
Suitable RPE means:
• It provides adequate protection (i.e. reduces the wearer’s exposure to contaminants as low as is
reasonably practicable, and anyway to below the control limits) during the job in hand and in the
specified working environment (e.g. confined spaces)
• It provides clean air and the flow rate during the whole wear period at least conforms to the minimum
recommended by the manufacturer
• The face piece fits the wearer correctly
• It is properly maintained

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• The chosen equipment does not introduce additional hazards that may put the wearer’s health and
safety at risk.
One particular size or type of RPE is unlikely to suit everyone. In addition, the performance of face pieces
(e.g. filtering face pieces, half- and full-face masks) depends on achieving a good contact between the
wearer’s skin and the face seal of the mask. To make sure that the selected face piece can provide
adequate protection for the wearer, the initial selection should include quantitative fit testing. A good fit
would be one which indicates an inward leakage level at or below the value given in the appropriate EN
Standard. This can be done in two ways:
• Using a purpose-built test chamber

• Using an ambient particulate counting device.
Facepiece Fit Testing It is recommended that fit testing is carried out for all tight fitting respirators. The
purpose of fit testing is to ensure a good fit of the mask to the individual and is applicable to tight fitting
filtering face masks. It is also useful for checking that the wearer can put on a respirator face piece
correctly themselves. The correct establishment of a tight seal on the face piece at all times is vital to
prevent exposure.
Skin and eye protection

Skin may include face, hands, arms, body, legs and foot. Each will be discussed below. The main factors to
be considered in selection of skin and eye protection include:
• Substance-related factors e.g. chemical compatibility, level of protection required

• Task-related factors e.g. duration (breakthrough time), choice between dexterity vs durability;
choice of gloves vs gauntlets
• Wearer-related factors e.g. fit/comfort, compatibility, acceptability
• Quality-related factors – conformity with relevant standards
Eye and face protection:
Examples of hazards which could require eye and face protection are:
• Liquid or chemical splash as a result of handling or coming into contact with dangerous liquids or
chemical substances
• Working with power-driven tools, where chippings or debris are likely to fly into the face, or
abrasive materials may be ejected
• Dust, gas or liquid mist from machines, high-pressure cleaning, or using gas or vapour under
pressure

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• Radiant heat, molten metal, hot solids, sparks or hot liquid splash from working in hot conditions,
for example welding, ovens, furnaces etc.
• Intense light or other optical radiation emitted at levels liable to cause risk of injury, for example
welding, lasers etc.
The main types of eye and face protection are:
a) Safety spectacles – May be separate

lenses in a metal or plastic frame
(similar in appearance to
prescription glasses) or have a single
lens/frame moulding (sometimes
called eye-shields). Most designs
have side shields. Spectacles can
incorporate corrective lenses, while
eye-shields may fit over prescription
glasses
b) Goggles – These are made with a Eye and face protection
flexible plastic frame and one or two
lenses with a flexible elastic headband. They give the eyes protection from all angles as the
complete rim is in contact with the face. Some goggles are ventilated and may be unsuitable
for protection against gases and fine dusts
c) Face shields – These have one large lens with a frame and adjustable head harness or are
mounted on a helmet. Most can be worn with prescription glasses. They protect the face but
do not fully enclose the eyes.
The key points to note for eye and face protection are:
• Make sure the eye/face protection fits the user and does not fall off easily. It should be issued on
a personal basis
• Consider misting/fogging. Anti-mist and ventilated eye protection is available
• Store eye protection in a protective case
• Follow the manufacturer’s instructions on cleaning, not forgetting headbands and frames. Use
only anti-mist, cleaning and antistatic fluids and cloths recommended by the manufacturer
• Do not use when visibility is noticeably reduced (e.g. the lenses are deeply scratched or worn) or
the frame, headband or harness is deformed. Throw them away and replace them.

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The storage and maintenance of PPE

Using a defective PPE gives the wearer a false sense of safety, and may do more harm than good. All PPE
should be regularly checked for performance and maintained in good working conditions so that the
equipment can continuously offer the necessary degree of protection for which it is designed. In general,
maintenance includes cleaning, disinfection, replacement, repair, examination and testing. A
maintenance schedule should be established for each piece of equipment and assigned to persons
competent to perform the maintenance work. The schedule should include:
(a) Designation of personnel for maintenance of PPE and their responsibilities

(b) Performance checking, cleaning/disinfection and storage procedures
(c) Information on the expiry date or service lifetime of certain PPE such as safety helmets,
gloves, canisters of respirators
(d) Training on correct maintenance of PPE at the workplace
(e) Time-table for performance check, cleaning/disinfection and other maintenance work
(f) Criteria for replacement.
• PPE should be examined to ensure that it is in good working order before being issued to the
wearer. PPE should also be examined before it is put on and should not be worn if it is found to
be defective, dirty or in unhygienic condition
• It is important that all PPE should be kept cleaned. Cleaning is particularly important for eye and
face protective equipment where dirty or fogged lenses may hinder vision
• All defective equipment should be taken out of service immediately and should be repaired or
disposed of as applicable. A procedure should be established to alert all staff that a certain piece
of equipment is under maintenance or is defective and should not be used. The procedure should
be made known to all staff. Equipment after repair or maintenance should be checked for
performance before it is put into service again
• All PPE should be replaced;
o when it no longer provides the level of protection required to protect the wearer or user
against the particular hazard
o when the service lifetime, as specified by the manufacturer of the equipment, has expired
o when it is damaged and cannot be repaired.
• All PPE should be provided with appropriate accommodation for the storage when it is not in use.
The storage should be adequate to protect the PPE from contamination or damage by harmful
substances, damp or sunlight. PPE should be returned after use to the storage place provided
• Where PPE becomes contaminated during use, it should be cleaned or disinfected, as far as
practicable, before returning to its storage place. If this is not possible, the contaminated PPE
should be separately accommodated to prevent cross-contamination and should be suitably
labelled

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• Where quantities of PPE are stored, PPE waiting for

maintenance or repair should be clearly segregated
from those ready-for-use ones and should be suitably
labelled.
The need for training in the correct use of PPE

After selecting suitable PPE, the employer should inform the
employees what PPE has to be used for a particular risk, why
to use it, when to use it and how to use it. Such messages are
most appropriately conveyed to the employees through a
component of the PPE programme: information, instruction
and training.
Different PPE required on site
It is important that the information, instruction and training provided should be comprehensible to the
employees. The form of presentation should take into consideration the literacy of the employees.
Users should be trained in the proper use of PPE, how to correctly fit and wear it, and what the limitations
are. Managers and supervisors should also be aware of why PPE is being used and how it is used properly.
Employees involved in maintaining, repairing and testing the equipment should also be trained. Training
should include elements of theory as well as practice in using the equipment, and should be carried out
in accordance with the recommendations and instructions supplied by the PPE manufacturer.
Theoretical training should include:

• Explanation of the risks present and why PPE is needed
• The operation, performance and limitations of the equipment
• Instruction on the selection, use and storage of PPE related to the intended use
• Written operating procedures such as permits to work involving PPE should be explained
• Factors which can affect the protection provided by the PPE such as compatibility with other
protective equipment, personal factors, working conditions, inadequate fitting, as well as defect,
damage & wear
• Recognizing defects in PPE and arrangements for repair or replacement.
Practical training should include:

• Practice in putting on, wearing and removing the equipment
• Practice and instruction in inspection and, where appropriate, testing of the PPE before use
• Practice and instruction in the maintenance which can be done by the user, such as cleaning and
the replacement of certain components
• Instruction in the safe storage of equipment.

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9.9 Hazardous substances monitoring

The concept of exposure standards
Regulatory agencies set the limits to which workers can be exposed to particular hazards. These are known
as "Exposure Standards", Workplace Exposure Limits (WEL), Threshold Limit Values (TLVs), Long Term
Exposure Limit (LTEL) and Short Term Exposure Limit (STELs). They are numerical values (e.g. parts per
million and milligrams per metre cubed for chemical fumes; dBA for noise levels, ºC for temperature)
which represent the exposure levels to which workers may be repeatedly exposed and are regarded as an
"acceptable risk".
Exposure standard can be set in occupational health and safety by following process:
• Collecting information on all hazards of the substance, i.e. all physical, chemical, toxicological and
epidemiological data
• Deciding if data are sufficient to derive a health based WEL
• Evaluating all adverse effects
• Establishing which adverse effect occurs at the lowest exposure. That is the critical effect for
setting a WEL
• Selecting relevant human and animal studies of sufficient quality, in which the critical effect has
been shown
• Establishing the mode of action and mechanism, threshold or non-threshold
• Evaluating the dose-response relationship for all relevant adverse effects and establishing the
NOAEL and the LOAEL
• Recommending a numerical value for a LETL expressed as a TWA of 8 hours for a substance below
the NOAEL, while applying appropriate uncertainty factors
• Deciding if a STEL is needed in addition to LTEL expressed as a TWA of 8 hours and recommending
a numerical value for a STEL, if necessary
• Documenting the full process of deriving the WEL for the substance
• Determining the appropriate method for air monitoring in human and animal studies.
The process often involves a decision being reached through consensus amongst representatives of
government, health and safety professionals, unions and employers
Generally, the exposure standard or WELs are determined by a trade-off or balancing of the risks and costs
of removing those risks. The following criteria is considered by those making decisions on what is an
"acceptable" level of risk:
• The level of knowledge about the hazard

• The extent of knowledge of the risk of exposure
• The costs of "living with" the hazard and associated risk:
- extent of injury/disease
- extent of social effects on injury/disease

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- extent of demand on and cost of medical and like services

- costs of compensation premiums and common law claims
• The level of knowledge of ways to control the hazard and reduce exposure levels
• The availability of ways to control the hazard and reduce exposure levels
• The cost to industry of controlling the hazard and reducing exposure levels
• The implications of industry meeting that cost
Therefore the health and safety of workers is not always paramount in the setting of safe standards. A
number of factors point to the limited reliability of the standard-setting process determining absolute
"safe" exposure levels.
• Judgements made in the risk evaluation stage of the process are often subjective, and not
objective
• The "safe" exposure level is determined by a process based on a concept of so-called "acceptable
risk"
• The technical information made available to those evaluating the risk is often controversial (and
sometimes fraudulent)
• The technical information illustrated by dose-response relationships makes predictions for groups
of subjects, showing what is likely to occur "on average" - they cannot predict for individuals
• The dose-response relationships indicate a clear level of risk for equivalent populations - not all
workers' situations are the same, however
• Technical information used to evaluate risk generally results from tests which only assess short
term or acute effects
• Exposure standards are set for individual hazards, and yet workers are generally exposed to more
than one hazard at a given time - the effects of combined exposure are generally unknown
• Exposure standards for chemicals are set for a "normal" working day of 8 hours - allowing the
body 16 hours to "recover". Working arrangements are changing, however, and 12 hour shifts
have become more common
• As more information becomes available and there are advances in control technology, standards
have inevitably been lowered
• For a standard to have some effect in adequately protecting workers' health and safety it must be
strictly enforced (this has implications for the role of Inspectors and prosecution procedures).
Given the limitations of the standard setting process in occupational health and safety, it is union policy
that legal standards should be regarded as the minimum acceptable standard for any workplace hazard.
Workers, through their health and safety representatives and unions, should seek to improve on these
standards through negotiation in the workplace.
The meaning of Exposure Limits for airborne harmful substances
Nearly all industry regulated by the Health and Safety Executive (HSE) is affected in some way by the
COSHH regulations. For example, those using paints in the coating of manufactured products, solvents in
the printing industries, silica and metals used in foundries, wood dust in furniture production and
disinfectant type chemicals used to clean medical instruments in hospitals.

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Under COSHH regulations, it is stated that control of exposure may only be treated as adequate if any
Workplace Exposure Limits (WEL) for that substance is not exceeded. Therefore employers have a duty to
ensure each of their employees is not exposed to any concentration of substance in excess of the
Workplace Exposure Limits for that substance.
The WEL value is expressed as a time weighted average (TWA) and there are two variations, the Long
Term Exposure Limit (LTEL) which is the maximum exposure permitted over an 8-hour period (Also called
Daily Exposure Limit in some countries) and the Short Term Exposure Limit (STEL) which is the maximum
exposure permitted over a 15-minute reference period.
The LTEL is designed to protect the workforce from concentrations of contaminant, which over a large
period of time could cause long term chronic ill health effects. Whereas the STEL exposure limit relates to
peak exposure incidents and is designed to protect against immediate acute ill-health effects.
A ceiling limit is sometimes used which is a concentration of a toxic agent that should not be exceeded at
any time during the workday. A TWA LTEL and a STEL do permit limited excursions above their limits if the
average over their specific time frame (eight hours for a TWA limit or fifteen minutes for a STEL) is below
the exposure limit. In contrast, a ceiling value should never be exceeded at any time.
Another type of exposure limit is called an IDLH value. An IDLH value refers to a condition which is
"immediately dangerous to life or health. IDLH values are airborne concentrations which may cause lethal,
permanent, or escape-impairing effects via inhalation or ocular exposure. The primary purpose of
establishing an IDLH exposure concentration is to ensure that the worker can successfully escape a
situation in the event that failure of the worker's respiratory equipment occurs.
Due to the large amount of chemical compounds used in the workplace there is insufficient information
available on many of these to warrant quantifiable exposure limits to be in place. Consequently not all
chemicals used in the workplace have WEL values. New substances are added and existing ones can be
revised and are published in new additions or supplements to the HSE EH40 booklet.
The significance of short- and long-term exposure limits (STEL, LTEL) and calculation of
timeweighted average (TWA) values
WELs are concentrations of hazardous substances in the air, averaged over a specific period of time,
referred to as a time-weighted average (TWA). TWA values are calculated by taking the sum of exposure
during a workday to a particular toxic contaminant in terms of parts-per-million-hours, and dividing by an
eight-hour period. WELs are defined in terms of 2 exposure limits, the long-term exposure limit (LTEL) and
short-term exposure limit (STEL).
The LTEL is the maximum exposure allowed over an 8-hour period. When calculating the exposure level,
if the exposure period is less than 8 hours, then the exposure limit can be increased providing that
exposure above the LTEL value continues for no longer than an hour.

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The STEL is a limit value above which exposure to a hazardous substance should not occur and usually
relates to a 15-minute reference period. The aim of a STEL is to prevent adverse health effects and other
unwanted effects due to peak exposure that may not be controlled by the application of an 8-hour TWA
limit.
Exposure limits are in place to control the effects of substances, depending on the nature of the substance
and the effects of exposure. Some effects require prolonged exposure, while others may be seen after
brief exposures.
Both LTEL and STEL need to be monitored in order that the correct indication of exposure can be deduced.
It is important to recognise that a substance which does not have a WEL is not guaranteed to be safe, two
examples being NO and NO2. Monitoring and control of exposure within the workplace may still be
necessary.
In some countries, some gases also have an instantaneous level that must not be exceeded under any
circumstances, this is called Immediately Dangerous to Life and Health (IDLH) values.
International examples of exposure limits

The Health & Safety Executive’s publication, EH40, lists the occupational exposure limits as defined by the
Control of Substances Hazardous to Health (COSHH), and it defines and lists gases which have a workplace
exposure limit (WEL). The table below gives some examples of substances listed in Guidance Note EH40.
LTEL STEL
Substances Formula ppm mg/m3 ppm mg/m3
Acrylonitrile CH2=CHCN 2 4 - -
Carbon disulphine CH2 10 30 - -
Isocrynates - 0.02 - 0.07
Trichloroethylene CH2=CHCI 100 535 150 802
Ammonia NH3 25 18 35 27
Sulphur dioxide SO3 2 5 5 13
Chloroform CHC13 10 50 50 225
Disulphur Decafluoride S2F10 0.025 0.025 0.025 0.075
Mercury compounds Hg (except mercury alkyls - 0.05 - 0.15

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For Lead: Source: HSE-UK publication INDG305

Category Action level Suspension level
(a) General employees 50 µg/dl 60 µg/dl
(b) Women of child-bearing 25 µg/dl 30 µg/dl
age
(c) Young people under 18 40 µg/dl 50 µg/dl
For asbestos: There is a single Control Limit in the regulations of 0.1f/cm3 (equivalent to 0.1 f/ml) for all
types of asbestos. There is also a Short Term Exposure Limit (STEL) within the ACOP of 0.6f/cm3 over 10
minutes.
TLVs are workplace exposure standards recommended by a committee of the American Conference of
Governmental Industrial Hygienists (ACGIH).
TLVs are the maximum average airborne concentration of a hazardous material to which healthy adult
workers can be exposed during an 8-hour workday and 40-hour workweek—over a working lifetime—
without experiencing significant adverse health effects.
A TLV has three components:

o Time-weighted Average (TWA) concentration: The concentration of a contaminant averaged
over a workday (usually 8 hours long). It's measured in a workplace by sampling a worker's
breathing zone for the whole workday. ACGIH recommends that the TWA should not be exceeded
for up to an 8-hour workday during a 40-hour workweek.
o Ceiling value: A concentration of a toxic substance in air that ACGIH recommends should not be
exceeded at any time during the workday. This value is often used in conjunction with the TWA.
o Short-term Exposure Limit (STEL) value: A TWA concentration over 15 minutes that ACGIH
recommends not to exceed—even if the 8-hour TWA is within the standards. TWA-STELs are given
for contaminants for which short-term hazards are known.
Substance TLV - TWA TLV - STEL IDLH

Acetone 500 750 2500
Chlorine 0.5 1.0 10
Carbon dioxide 5000 30000 40000
Carbon monoxide 25 - 1200
Ammonia 25 35 300
Sulphur di oxide 2 5 100
Hydrogen sulphide 10 15 100
Surce: ACGIH and NIOSH
Monitoring
Monitoring means measuring to show that control is adequate. It has nothing to do with the state of a
worker's health.
When do you need to monitor?

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Monitoring exposure to substances hazardous to health will sometimes be necessary in the workplace.
This may be to ensure that employees are not unnecessarily exposed to chemicals, may be in response
to complaints from employees, to check the efficiency of engineering controls or to ensure that a
workplace exposure limit (WEL) has not been exceeded.
Monitoring is appropriate:
• when you need to show compliance with a WEL (Workplace Exposure Limit) or BMGV (Biological
Monitoring Guidance Value)
• when you need to show that control equipment or personal protective equipment is working
well enough
What should be monitored?
Employers should monitor and record the exposure of workers to hazardous chemicals to ensure their
safety and health. They should ensure that workers are not exposed to chemicals to an extent which
exceeds exposure limits or other exposure criteria for the evaluation and control of the working
environment. Based on the monitoring data, employers should assess the exposure of workers to
hazardous chemicals.
Airborne concentrations of hazardous chemicals should be measured in all places of work where this is
necessary to ensure the safety and health of workers against inhalation risks.
Measurements of airborne contaminants are necessary if other techniques do not suffice to provide a
valid estimate of the risk of exposure and to assess the existing control measures.
Techniques for this risk assessment may include the following: information on the intrinsic health and
physical hazards, obtained from the chemical safety data sheets; estimation of exposure based on the
method of work and work pattern; advice from the supplier; experience of exposure in the workplace or
of other users; and simple qualitative tests. Simple qualitative tests include, where appropriate, the use
of smoke tubes or pellets to determine ventilation characteristics, and of the dust lamp for illuminating
dust emissions.
The need for a programme for the measurement of airborne contaminants should be based on the local
standards. The extent of the exposure of workers established as a result of the measurements taken,
and the reliance on, and the consequent need to check the effectiveness of, engineering control
measures. Where the need for a programme of measurements is determined for certain hazardous
chemicals, the monitoring strategy should be followed.
Selecting the right people to take part in personal monitoring/sampling

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Only a competent person, this being somebody with the skill, knowledge, practical experience and
training to enable him/her to assess the risks arising from work activities involving substances hazardous
to health should conduct sampling. Sampling should not interfere with the work being undertaken by
altering the workers’ routine and the act of sampling should not alter the air.
The main reasons for sampling are to ensure compliance with legislation, to establish the levels of
exposure and to demonstrate the effectiveness of control measures. As such sampling should be part of
a planned approach, based on risk assessment. It is, however, often the case that air sampling is
reactive, being undertaken due to prosecution or complaints. It is not possible to sample the whole of
an environment and so air sampling is intended to capture a representative portion of that
environment. In terms of occupational health and safety that environment is usually an indoor
workplace but may also include samples taken outside.
An initial appraisal of the hazards and risks and the level of existing control are essential. If it is decided
there is adequate control, routine monitoring may be suitable to ensure this control remains effective. If
the initial appraisal suggests that controls may not be adequate, a more detailed survey should be
undertaken to estimate a worker’s personal exposure. It should be noted that monitoring a hazard is not
a substitute for safe working practices and maintenance.
How can the organisation select a competent occupational hygienist?
An occupational hygiene technician is “a person competent to carry out measurements of the work
environment” but not “to make the interpretations, judgements, and recommendations required from
an occupational hygienist”. The necessary level of competence may be obtained in a comprehensive or
limited field.
International Occupational Hygiene Association (IOHA)
IOHA was formally established, during a meeting in Montreal, on June 2, 1987. At present IOHA has the
participation of 19 national occupational hygiene associations, with over nineteen thousand members
from seventeen countries.
The primary objective of IOHA is to promote and develop occupational hygiene throughout the world, at
a high level of professional competence, through means that include the exchange of information
among organizations and individuals, the further development of human resources and the promotion
of a high standard of ethical practice. IOHA activities include scientific meetings and publication of a
newsletter. Members of affiliated associations are automatically members of IOHA; it is also possible to
join as an individual member, for those in countries where there is not yet a national association.
Certification
In addition to an accepted definition of occupational hygiene and of the role of the occupational
hygienist, there is need for the establishment of certification schemes to ensure acceptable standards of
occupational hygiene competence and practice. Certification refers to a formal scheme based on

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procedures for establishing and maintaining knowledge, skills and competence of professionals (Burdorf
1995).
IOHA has promoted a survey of existing national certification schemes (Burdorf 1995), together with
recommendations for the promotion of international cooperation in assuring the quality of professional
occupational hygienists, which include the following:
• “The harmonization of standards on the competence and practice of professional

occupational hygienists”
• “The establishment of an international body of peers to review the quality of existing
certification schemes”.
Other suggestions in this report include items such as: “reciprocity” and “cross-acceptance of national
designations, ultimately aiming at an umbrella scheme with one internationally accepted designation”
Health and safety professional’s role in specifying the type of monitoring required
As an Occupational Health & Safety Professional or an Industrial Hygienist, you are continuously
auditing, documenting, and taking corrective or preventive actions. It’s the only way to keep your teams
safe and healthy—and to stay in compliance.
A strong safety program depends on good data. Only with correct measurements, can you identify risks,
report on them with confidence, and make informed decisions
As a health and safety professional it’s your responsibility to select accurate and reliable occupational
health and safety instruments to measure what’s important in your safety program.
• Monitor risks such as heat stress, confined space gases, noise, and particulate mass.
• Evaluate workplace exposure, including short-term and long-term exposure to dust, particles, or
gases.
• Build strong respiratory protection programs with quantitative fit testing.
• Optimize comfort and productivity with HVAC and industrial ventilation tools and indoor air
quality assessments
Role of Occupational Hygienist
As an occupational hygienist, you may work in a range of settings, including factories, offices and
building sites. You'll need to understand how chemical, physical and biological agents may affect the
health of the workforce and, in turn, the health of the business.
You'll be concerned with controlling health risks in practical and cost-effective ways by assessing and
resolving practical problems. This will involve looking at the short and long-term health effects, caused
by both acute and chronic exposure to hazards, and helping organisations to respond effectively to
legislative requirements.
Occupational hygienists may also be known as industrial hygienists.

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Role
As an occupational hygienist, you'll need to:
• undertake surveys and evaluate risks to health in the workplace

• accurately measure and sample levels of exposure, often through precise use of specialist
equipment
• record facts or details of procedures in the workplace
• eliminate or significantly reduce risk by making organisational changes and selecting and
designing relevant facilities
• consider all options of control, such as ventilation, containment and personal protective
equipment and find cost-effective solutions
• compile data, write reports and present findings to clients
• liaise with a range of people, including employers and employees, in the process of evaluating
workplaces
• provide clear and accurate information on complex health and safety issues
• train organisation staff on health issues such as asbestos and Control of Substances Hazardous
to Health Regulations (COSHH) awareness
• persuade company management to develop effective hazard controls when required
• provide expert witness services
• liaise with regulatory bodies such as the Health and Safety Executive (HSE)
Biological monitoring can be used to indicate how much of a chemical has entered your body. It involves
measuring the chemical you are exposed to at work (or what it breaks down into) in a sample of your
breath, urine or blood. Which of these three samples is used depends on how the chemical you are
exposed to is processed by your body? Biological monitoring is often used together with air monitoring.
Biological monitoring is especially useful when:
• there is likely significant absorption through the skin; and

• control of your exposure depends on personal protective equipment and your employer needs
to check it is protecting you.
Active sampling
Active sampling is a common method using a pump, typically a flow controlled, rechargeable pump. For
personal sampling the pumps are often attached to a belt with a tube passing to a sampling head on the
worker’s lapel. A known volume of air is drawn through a sampling media. It is often worn for an entire
shift to produce the 8-hour time-weighted average (TWA).
The sampling media may be a filter, a sorbent tube or impinger.
A filter may simply trap the substance of interest, e.g. particles including dust and aerosol, fibres or
semi-volatile organic compounds. The choice of filters is determined by the application e.g. glass fibre or

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cellulose fibre for gravimetric sampling and metal analysis. Gravimetric sampling is the collection of a
substance and the subsequent quantification based on the mass of a solid.
Sorbent tubes are used for gaseous hazards. Sampling tubes are also used in pumped sampling, these
contain a sorbent such as (activated) charcoal, silica gel, Tenax, Chromosorb, molecular sieve.
Impingers (bubble tubes for the collection of airborne substances into a liquid medium) can be used for
both particulates and vapors. Impinger use is limited as they are breakable and can contain harmful
and/or flammable liquids.
Dust particles can be graded by size using devices such as cyclones.
Passive sampling
Passive sampling is a simple alternative to active sampling whereby contaminants in air are adsorbed
onto a sorbent by diffusion. Many sorbents are inert polymers whilst others react to form a derivative,
e.g. formaldehyde onto 2,4-dinitrophenylhydrazine (DNPH) samplers. The surface area may be large as
in the case of badges or cylinders, or small as for tubes. The rate at which the contaminant is absorbed,
the uptake rate, must be derived for each substance on each type of sampler and sorbent. The choice of
sorbent is critical to effective sampling; this could be to ensure the retention of highly volatile
substances or the stabilization of very reactive ones.
Real-time monitoring
There are several types of real-time or direct reading monitors.
Gas detectors, both specific and non-specific, form an important part of safety systems to help protect
users from explosion, fire or ill health (acute and chronic) arising from flammable, toxic or asphyxiant
gases. They provide instant measurements of air exposure. Oxygen monitors allow for safe working in
oxygen deficient atmospheres and/or confined spaces.
Real-time gas detectors monitors are predominantly used to trigger alarms if a specified concentration
of gas is exceeded and measure workers’ exposure to gases. This can provide an early warning of a
problem and help ensure worker’s safety and health. However, a detector does not prevent leaks
occurring or indicate what action should be taken. It is not a substitute for safe working practices and
maintenance.
Real-time dust, aerosol and particle monitors are non-specific monitors used for several purposes
including background sampling, site measurements, assessment of the effectiveness of control systems
and measurement of indoor air quality. They are also used to visualize exposure to identify peaks in
particulate levels due to poor work practice and in the investigation of control techniques [26]. The main
advantage of these monitors is that they give an instantaneous measure of airborne particulate
concentration, thereby reducing considerably the time and effort associated with standard gravimetric
methods.

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A special case is PIMEX (Picture Mix Exposure), which allows the flow of work to be filmed with a video
camera and simultaneously exposure data to be recorded by means of sensors and transducers attached
to the workers. The exposure data are added to the video by means of special software.
Biological sampling
For sampling biological agents such as microbial cells or spores in air, battery powered active samplers
are typical. Common types include filters, impingers and impactors.
The impactor sampler is a device that pumps the air through either a perforated plate (sieve sampler) or
a narrow slit (slit sampler). The air deposits the collected microbial matter onto a solid or adhesive
medium such as agar plates. The agar plate can be removed and incubated to estimate the number of
colony forming units in the sampled air. The most common instruments of this type are Andersen
sampler and the Casella slit sampler.
With impingers the impinger liquid can be cultured to estimate viable microorganisms.
Filter samplers: Here the filter medium is incubated directly by transferring onto the surface of an agar
or gelatine medium. Filtration methods are accurate and reliable but can lead to dehydration stress in
the trapped microorganisms and a potential reduction in viability, especially amongst Gram-negative
bacteria such as E. coli.
Interpreting a hygienist’s report

A typical report is divided into the flowing contents:
• Title
• Executive summary
• Introduction
• Process description
• Methods and measurements
• Results and discussion
• Conclusions and recommendations.
The degree of uncertainty in the estimation of an exposure parameter, for example, the true average
concentration of an airborne contaminant, is determined through statistical treatment of the results from
measurements (e.g., sampling and analysis). The level of confidence on the results will depend on the
coefficient of variation of the “measuring system” and on the number of measurements. Once there is an
acceptable confidence, the next step is to consider the health implications of the exposure: what does it
mean for the health of the exposed workers: now? In the near future? In their working life? Will there be
an impact on future generations?
The evaluation process is only completed when results from measurements are interpreted in view of
data derived from experimental toxicology, epidemiological and clinical studies and, in certain cases,
clinical trials. It should be clarified that the term risk assessment has been used in connection with two

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types of assessments—the assessment of the nature and extent of risk resulting from exposure to
chemicals or other agents, in general, and the assessment of risk for a particular worker or group of
workers, in a specific workplace situation.
In the practice of occupational hygiene, exposure assessment results are often compared with adopted
occupational exposure limits which are intended to provide guidance for hazard evaluation and for setting
target levels for control. Exposure in excess of these limits requires immediate remedial action by the
improvement of existing control measures or implementation of new ones. In fact, preventive
interventions should be made at the “action level”, which varies with the country (e.g., one-half or one-
fifth of the occupational exposure limit). A low action level is the best assurance of avoiding future
problems.
Comparison of exposure assessment results with occupational exposure limits is a simplification, since,
among other limitations, many factors which influence the uptake of chemicals (e.g., individual
susceptibilities, physical activity and body build) are not accounted for by this procedure. Furthermore, in
most workplaces there is simultaneous exposure to many agents; hence a very important issue is that of
combined exposures and agent interactions because the health consequences of exposure to a certain
agent alone may differ considerably from the consequences of exposure to this same agent in
combination with others, particularly if there is synergism or potentiation of effects.
Measurements with the purpose of investigating the presence of agents and the patterns of exposure
parameters in the work environment can be extremely useful for the planning and design of control
measures and work practices. The objectives of such measurements include:
o Source identification and characterization

o Spotting of critical points in closed systems or enclosures (e.g., leaks)
o Determination of propagation paths in the work environment
o Comparison of different control interventions
o Verification that respirable dust has settled together with the coarse visible dust, when using
water sprays
o Checking that contaminated air is not coming from an adjacent area.
Direct-reading instruments are extremely useful for control purposes, particularly those which can be
used for continuous sampling and reflect what is happening in real time, thus disclosing exposure
situations which might not otherwise be detected and which need to be controlled. Examples of such
instruments include photo-ionization detectors, infrared analysers, aerosol meters and detector tubes.
When sampling to obtain a picture of the behaviour of contaminants, from the source throughout the
work environment, accuracy and precision are not as critical as they would be for exposure assessment.

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9.10 Biological agents

The main types of biological agent
Biological agents are found in many sectors of employment. They are rarely visible and so workers are not
always able to appreciate the risks they pose. Biological agents are commonly classified according to their
taxonomy, the most important taxa being bacteria, viruses, fungi (yeasts and moulds) and protozoa
(parasites). Such classification is important because of its implications for detection, identification,
prophylaxis and treatment.
Fungi: Fungi is a general term which is used to describe a group of eukaryotic protists which are
characterized by the absence of chlorophyll and by the presence of a rigid cell wall. Fungi can exist
as single celled yeasts or as larger multicellular moulds and are classified according to the type of
sexual spore they form. Most fungi are decomposers and are commonly found to cause disease in
immune suppressed individuals. Fungi can spread either through direct contact, or it can be
airborne.
Source and examples: Fungi are sometimes
overlooked in biology, especially compared to
bacteria, plants and animals. This is partially because
many fungi are microscopic, and the field of
mycology did not really develop until after the
invention of the microscope. However, there are
many common examples of fungi. Yeasts are one
example.
Fungi are also often associated with food.

Mushrooms are examples of fungi that are edible.
Fungi
Molds are fungi that grow on foods over time, causing
them to spoil. However, some molds are used in the process of cheese-making
Bacteria: These are single celled organisms which are essential to all life and live either
independently or as a parasite. Bacteria have three basic shapes which include bacillus, coccus and
spiral. Bacteria multiply through cell division and in most cases can be killed by antibiotics.
Source and examples: Bacteria are spread in many ways including:
Spread by aerosols (through coughing and sneezing). For example, Streptococcus.
Spread by surface and skin contact. For example, Staphylococcus aureus, including MRSA?.
Spread through body fluids, such as blood and saliva. For example, meningococcal disease
(meningitis).

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Viruses: Viruses are the simplest of microbiological entities and are comprised only of a nucleic acid
core (DNA or RNA), wrapped in a protein coat. Viruses are extremely small and the use of an electron
microscope is needed to view them. Viruses are acellular and need a host cell to enter in order to
reproduce by means of taking over the cells reproductive material. Because viruses live in a host
cell they are immune to the use of anti-biotics and can be spread in many ways including direct
contact or air borne.
Source and examples: Viruses can be spread in many ways including:
From plant to plant by insects that feed on plant sap. For example, Potato virus Y which is spread
by aphids.
From animal to animal by blood-sucking insects. For example, Dengue virus which is spread by
mosquitos.
Spread by aerosols (through coughing and sneezing). For example, influenza virus.
Spread by not washing hands after going to the toilet. For example, norovirus or rotavirus.
Spread by sexual contact. For example, HIV? and Human Papillomavirus (HPV)?.
Spread by exposure to infected blood. For example, Hepatitis B.
Different types of virus

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Protozoa: These are unicellular eukaryotes which live independently or as parasites and can move
by the use of pseudopods, cilia and flagella. Protozoa are mostly found in soil or water and many
can make up the normal flora of larger animals. Protozoa reproduce asexually and have many
shapes. The pathogenic spread of protozoa includes vectors, food borne or direct contact.
Source and examples: Transmission of protozoa that live in a human's intestine to another human
typically occurs through a fecal-oral route (for example, contaminated food or water or person-to-
person contact). Protozoa that live in the blood or tissue of humans are transmitted to other
humans by an arthropod vector (for example, through the bite of a mosquito or sand fly).
Examples: Giardia (ingested), Plasmodium falciparum (causes malaria and is transmitted by
mosquitos), Trichomonas (sexually transmitted)
Protozoa examples
The special properties of biological agents

Rapid mutation
Mutations are physical changes in genes and chromosomes i.e. it refers to any sudden change in DNA—
deoxyribonucleic acid, the genetic blueprint for an organism—that creates a change in an organism's
appearance, behavior, or health. Mutations may be caused by natural events within the environment, by
action or inaction of deoxyribonucleic acid (DNA) repair enzymes, and by human production of chemicals
or high-energy radiation (mutagens). Mutation rates vary from organism to organism, from gene to gene,
from time to time, and from place to place. They can have a significant effect not only on the individual,

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but on the evolution of species. This rapid mutation rate in biological agents make them difficult for our
body to recognise and combat.
Virulence is the relative severity of the disease caused by a microorganism. Different strains of the same
species may cause diseases of different severity. Some strains of Francisella tularensis, for example, are
much more virulent than others.
Incubation period is the time elapsing between exposure to an infective agent and the first appearance
of the signs of disease associated with the infection. This is affected by many variables, including the
agent, the route of entry, the dose and specific characteristics of the host and require few hours to weeks
before the symptoms appear in the affected population. In a typical infectious disease, incubation period
signifies the period taken by the multiplying organism to reach a threshold necessary to produce
symptoms in the host. For example, the incubation period of chickenpox is 14-16 days. The incubation
period of primary pneumonic plague is one to three days and is characterized by development of an
overwhelming pneumonia with high fever, cough, bloody sputum and chills. While that of HIV is 2-3
months or even longer
Infectious characteristic of a biological agent reflects its capability to enter, survive and multiply in a host,
and may be expressed as the proportion of persons in a given population exposed to a given dose who
become infected. The dose that, under given conditions, infects half the population receiving it is termed
the ID50. Doses higher or lower than this will infect a larger or smaller proportion of such a population.
For some pathogens the ID50 may be many thousands or more of infective cells or virus particles while
for others it may be only a few. It cannot be ruled out that even a single infective cell or virus particle can
initiate infection, albeit with correspondingly low probability.
Rapid multiplication
The most important property of biological agents is their ability to multiply in a host. It is this that gives
them their aggressive potential. The disease that may be caused results from the multifactorial interaction
between the biological agent, the host (including the latter’s immunological, nutritional and general
health status) and the environment (e.g. sanitation, temperature, water quality, population density). The
consequences of using biological agents to cause disease will reflect these complex interactions.
Lethality reflects the ability of an agent to cause death in an infected population. The case-fatality rate is
the proportion of patients clinically recognized as having a specified disease who die as a result of that
illness within a specified time (e.g. during outbreaks of acute disease).
The special properties of Zoonotic/Vector-borne diseases

A zoonosis is any disease or infection that is naturally transmissible from vertebrate animals to humans.
Animals thus play an essential role in maintaining zoonotic infections in nature. Zoonoses may be
bacterial, viral, or parasitic, or may involve unconventional agents. As well as being a public health

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problem, many of the major zoonotic diseases prevent the efficient production of food of animal origin
and create obstacles to international trade in animal products.
Animal Influenza: Influenza, commonly known as the flu, is an infection of the nose, throat and
lungs caused by the Influenza A or B (or rarely C) viruses. It is highly infectious
For most people, influenza resolves on its own. But sometimes, influenza and its complications can
be deadly. People at higher risk of developing flu complications include:
• Young children under 5, and especially those under 2 years
• Adults older than 65
• Residents of nursing homes and other long-term care facilities
• Pregnant women and women up to two weeks postpartum
• People with weakened immune systems
• People who have chronic illnesses, such as asthma, heart disease, kidney disease and diabetes
• People who are very obese, with a body mass index (BMI) of 40 or higher
Occurrence: Flu viruses travel through the air in Symptoms: Initially, the flu may seem like a
droplets when someone with the infection common cold with a runny nose, sneezing and
coughs, sneezes or talks. One can inhale the sore throat. But colds usually develop slowly,
droplets directly, or can pick up the germs from whereas the flu tends to come on suddenly. And
an object — such as a telephone or computer although a cold can be a nuisance, you usually
keyboard — and then transfer them to your feel much worse with the flu.
eyes, nose or mouth. Common signs and symptoms of the flu include:
People with the virus are likely contagious from • Fever over 100.4 F (38 C)
the day or so before symptoms first appear until • Aching muscles, especially in your back,
about five days after symptoms begin, though
arms and legs
sometimes people are contagious for as long as
10 days after symptoms appear. Children and • Chills and sweats
people with weakened immune systems may be • Headache
contagious for a slightly longer time. • Dry, persistent cough
Influenza viruses are constantly changing, with • Fatigue and weakness
new strains appearing regularly. If you've had
• Nasal congestion
influenza in the past, your body has already
made antibodies to fight that particular strain of • Sore throat
the virus. If future influenza viruses are similar to
those you've encountered before, either by
having the disease or by vaccination, those
antibodies may prevent infection or lessen its
severity.
But antibodies against flu viruses you've
encountered in the past can't protect you from
new influenza subtypes that can be very
different immunologically from what you had
before
Factors that may increase your risk of developing
influenza or its complications include:

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• Age. Seasonal influenza tends to target

young children and older adults.
• Living conditions. People who live in
facilities along with many other residents,
such as nursing homes or military barracks,
are more likely to develop influenza.
• Weakened immune system. Cancer
treatments, anti-rejection drugs,
corticosteroids and HIV/AIDS can weaken
your immune system. This can make it easier
for you to catch influenza and may also
increase your risk of developing
complications.
• Chronic illnesses. Chronic conditions, such
as asthma, diabetes or heart problems, may
increase your risk of influenza
complications.
• Pregnancy. Pregnant women are more likely
to develop influenza complications,
particularly in the second and third
trimesters. Women who are two weeks
postpartum are also more likely to develop
influenza-related complications.
• Obesity. People with a BMI of 40 or more
have an increased risk of complications from
the flu.
Target Organs: For a young and healthy person, Control: Following measures may help ease the
seasonal influenza usually isn't serious. Although symptoms:
one may feel miserable while suffering from it, • Drink plenty of liquids. Choose water, juice
the flu usually goes away in a week or two with and warm soups to prevent dehydration.
no lasting effects. But high-risk children and • Rest. Get more sleep to help your immune
adults may develop complications such as:
system fight infection.
• Pneumonia
• Consider pain relievers. Use an over-the-
• Bronchitis
counter pain reliever, such as
• Asthma flare-ups
acetaminophen (Tylenol, others) or
• Heart problems
ibuprofen (Advil, Motrin IB, others), to
• Ear infections
combat the achiness associated with
Pneumonia is the most serious complication. For
influenza. Don't give aspirin to children or
older adults and people with a chronic illness,
pneumonia can be deadly. teens because of the risk of Reye's

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syndrome, a rare but potentially fatal

condition.
The influenza vaccine isn't 100 percent effective,
so it's also important to take measures such as
these to reduce the spread of infection:
• Wash your hands. Thorough and frequent
hand-washing is an effective way to prevent
many common infections. Or use alcohol-
based hand sanitizers if soap and water
aren't readily available.
• Contain your coughs and sneezes. Cover
your mouth and nose when you sneeze or
cough. To avoid contaminating your hands,
cough or sneeze into a tissue or into the
inner crook of your elbow.
• Avoid crowds. Flu spreads easily wherever
people congregate — in child care centers,
schools, office buildings, auditoriums and
public transportation. By avoiding crowds
during peak flu season, chances of infection
are reduced. And, if you're sick, stay home
for at least 24 hours after your fever
subsides so that you lessen your chance of
infecting others.
Cryptosporidiosis: Cryptosporidiosis is a diarrheal disease caused by parasites

named Cryptosporidium; the parasites have a life cycle that can be completed in humans and many
types of animals.
The disease cryptosporidiosis is spread from person to person after the parasites are shed into the
environment; they may be found in soil, food, water, or on surfaces that have been contaminated
with feces from infected humans or animals.
People who are at increased risk of developing cryptosporidiosis include:
• Those who are exposed to contaminated water
• Children, particularly those wearing diapers, who attend child care centers
• Parents of infected children
• Child care workers
• Animal handlers
• Those who engage in oral-to-anal sexual activity
• International travelers, especially those traveling to developing countries
• Backpackers, hikers and campers who drink untreated, unfiltered water
• Swimmers who swallow water in pools, lakes and rivers

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• People who drink water from shallow, unprotected wells

Occurrence: One can become infected with Symptoms: The first signs and symptoms of
cryptosporidia by touching anything that has cryptosporidium infection usually appear within
come in contact with contaminated feces. a week after infection and may include:
Methods of infection include: • Watery diarrhea
• Drinking contaminated water that contains • Dehydration
cryptosporidium parasites • Lack of appetite
• Swimming in contaminated water that • Weight loss
contains cryptosporidium parasites and • Stomach cramps or pain
accidentally swallowing some of it • Fever
• Eating uncooked, contaminated food that • Nausea
contains cryptosporidia • Vomiting
• Touching your hand to your mouth if your Symptoms may last for up to two weeks, though
hand has been in contact with a they may come and go sporadically for up to a
contaminated surface or object month, even in people with healthy immune
• Having close contact with other infected systems. Some people with cryptosporidium
people or animals — especially their feces — infection may have no symptoms
which can allow the parasite to be
transmitted from your hands to your mouth
Target Organs: Control: Cryptosporidium infection is

• Inflammation of a bile duct — the passage contagious, so take precautions to avoid
between your liver, gallbladder and small spreading the parasite to other people. There's
intestine no vaccine that can prevent a cryptosporidium
• Inflammation of gallbladder, liver or infection.
pancreas All preventive methods aim to reduce or prevent
Cryptosporidium infection itself isn't life- the transmission of the cryptosporidium germs
threatening. However, if you've had a transplant that are shed in human and animal feces.
or if you have a weakened immune system, Precautions are especially important for people
developing complications can be dangerous. with compromised immune systems. Follow
these suggestions:
• Practice good hygiene. Wash your hands for
at least 20 seconds with soap and water
after using the toilet and changing diapers,
and before and after eating. Alcohol-based
hand sanitizers do not effectively kill the
germs that cause cryptosporidium infection.
• Thoroughly wash with uncontaminated
water all fruits and vegetables that you will
eat raw, and avoid eating any food you
suspect might be contaminated. If you're
traveling in a developing country, avoid
uncooked foods.
• Purify drinking water if you have a
weakened immune system or are traveling
in an area with a high risk of infection.

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Methods include boiling — at least one

minute at a rolling boil — or filtering,
although filtering may not be as effective as
boiling.
• Limit swimming activities in lakes, streams
and public swimming pools, especially if the
water is likely to be contaminated or if you
have a compromised immune system.
• Avoid fecal exposure during sexual activity.
• Handle newborn farm and domestic animals
with care. Be sure to wash your hands after
handling the animals.
Always refrain from swimming anytime you're
experiencing diarrhea. If you know you've had a
cryptosporidium infection, don't go swimming
for at least two weeks after your symptoms
subside because you may still be contagious.
Malaria: Malaria is caused by a parasite (Plasmodium) that is transmitted to humans via the bite of
an infected female Anopheles mosquito. In humans, the parasites grow and multiply first in the liver
and then in the red blood cells. Eventually, the red blood cell is destroyed releasing daughter
parasites which go on to invade other red cells.
People who are living in or travel to tropical areas where malaria is common are at an increased risk
of becoming infected. Occasionally malaria is transmitted by blood transfusion. For this reason,
people who have travelled to countries where malaria occurs may be deferred from giving blood for
a short period. Malaria can also be transmitted from a mother to her fetus.
Occurrence: Malaria is caused by a type of Symptoms: A malaria infection is generally
microscopic parasite that's transmitted most characterized by recurrent attacks with the
commonly by mosquito bites. following signs and symptoms:
Because the parasites that cause malaria affect • Moderate to severe shaking chills
red blood cells, people can also catch malaria • High fever
from exposures to infected blood, including: • Sweating
• From mother to unborn child • Fatigue
• Through blood transfusions Other signs and symptoms may include:
• By sharing needles used to inject drugs • Headache
• Vomiting
• Diarrhea
Malaria signs and symptoms typically begin
within a few weeks after being bitten by an
infected mosquito. However, some types of
malaria parasites can lie dormant in your body
for up to a year.
Target Organs: Malaria can be fatal, particularly Control: If going to be traveling to a location
the variety that's common in tropical parts of where malaria is common, talk to a doctor a

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Africa. In most cases, malaria deaths are related few months ahead of time about drugs that can
to one or more serious complications, including: be taken — before, during and after the trip —
• Cerebral malaria. If parasite-filled blood cells that can help protect from malaria parasites.
block small blood vessels to your brain In general, the drugs taken to prevent malaria
(cerebral malaria), swelling of your brain or are the same drugs used to treat the disease.
brain damage may occur. Cerebral malaria Your doctor needs to know where you'll be
may cause coma. traveling so that he or she can prescribe the drug
• Breathing problems. Accumulated fluid in that will work best on the type of malaria
your lungs (pulmonary edema) can make it parasite most commonly found in that region.
difficult to breathe. Scientists around the world are trying to develop
• Organ failure. Malaria can cause your a safe and effective vaccine for malaria. As of
kidneys or liver to fail, or your spleen to yet, however, there is still no malaria vaccine
rupture. Any of these conditions can be life- approved for human use.
threatening. In countries where malaria is common,
• Anemia. Malaria damages red blood cells, prevention also involves keeping mosquitoes
which can result in anemia. away from humans. Strategies include:
• Low blood sugar. Severe forms of malaria • Spraying your home. Treating your home's
itself can cause low blood sugar, as can walls with insecticide can help kill adult
quinine — one of the most common mosquitoes that come inside.
medications used to combat malaria. Very • Sleeping under a net. Bed nets, particularly
low blood sugar can result in coma or death. those treated with insecticide, are especially
recommended for pregnant women and
young children.
• Covering your skin. During active mosquito
times, usually from dusk to dawn, wear
pants and long-sleeved shirts.
• Spraying clothing and skin. Sprays
containing permethrin are safe to use on
clothing, while sprays containing DEET can
be used on skin
Blood cell infected with malaria
Psittacosis: Psittacosis (sometimes called ornithosis or parrot disease or parrot fever) is an infection
of the lung (pneumonia) caused by the bacterium Chlamydophila (Chlamydia) psittaci. The bacteria
causing the disease are carried by wild and domesticated birds and it is likely that all birds are
susceptible.
Even apparently healthy birds can shed Chlamydophila psittaci. People become infected when they
inhale the bacteria from dried nose and eye secretions, droppings or dust from feathers of infected
birds. Infection is a risk in:
• Pet shop employees
• Pet owners
• Poultry farm workers
• Abattoir workers
• Veterinarians (vets)

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Occurrence: Psittacosis is caused by the Symptoms: Symptoms of psittacosis can take

bacterium Chlamydia psittaci which is carried in from one to four weeks to appear after exposure
bird droppings. People become infected by but usually occur within one to two weeks.
breathing in bacteria from dried droppings, Symptoms can include any of the following:
secretions, and dust from feathers of infected • Fever
birds. Infected birds often appear healthy and • Headache
can have lifelong infections. Pet birds are • Rash
frequently the source of human infection. It isn’t • Muscle aches
known how long people remain contagious. The • Chills
disease is not typically spread from person-to- • Dry cough
person and usually occurs only where there is • Upper or lower respiratory disease
severe coughing from the disease. Human disease is most often mild or moderate
Pet birds, especially psittacine birds, are often but can be severe, especially for untreated
the cause of infection, especially when owners patients.
clean a cage with dried droppings. Occupational
exposure can also occur when workers are
exposed to areas with contaminated dust during
clean up, repair or demolition. Laboratory
infections have occurred as well. Farms or
rendering plants may be a source of exposure for
workers. Many seemingly healthy birds may
shed the agent when stressed by crowding or
transport. Dramatic outbreaks may occur in
poultry packing plant workers. Anyone exposed
to the dust and droppings of infected birds is at
risk for becoming infected.
Target Organs: Lungs is the organ most often Control: The following precautions should be
affected by psittacosis, the disease can observed to prevent the spread of psittacosis:
potentially affect many organ systems in the • Obtain birds only from a licensed pet store
body including the gastrointestinal tract, heart, or aviary.
liver, skin and central nervous system • Pet owners and animal handlers should be
made aware of the dangers of household or
work-related exposure to infected birds and
the risk of inhalation of dried bird droppings,
even from seemingly healthy birds.
• Special care should be taken by bird owners
to clean cages, etc. with the least amount of
disturbance of dried droppings, feathers,
and dust.
• Birds that are bought, traded, or otherwise
acquired should be raised and handled in a
way that prohibits psittacosis spread.

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Additional control measures that may be required for general/incidental exposure to

biological agents
Working with animals:
In principle, employers are required to:
• assess the risks posed by biological agents; and

• reduce the risk to the workers by;
• elimination or substitution;
• exposure prevention and control;
• inform and train workers; and
• provide health surveillance as appropriate.
Strategies for the assessment and management of risks posed by biological agents may be affected by
the nature of the process and activity involved. In general, where the work activity involves the
intentional use of biological agents, such as cultivating a microorganism in a microbiological laboratory
or using it in health care or food production, the biological agent will be known. This allows exposure to
be monitored more easily and prevention measures can be tailored to the risk posed by the organism.
In contrast, when the occurrence of the biological agents is unintentional (that is occurring as a
consequence of the work), such as in agricultural activities, during waste management and handling, the
assessment of risks that workers are exposed to will be more difficult. Nevertheless, for some of the
activities involved, information on specific exposures and protection measures is available, whereas for
others control is subject to the general principles of occupational Hygiene.
Risk assessment for biological agents should be performed in a proactive manner and similar to the one
applied for other agents. However, some situation may be complex and in such cases any risk
assessment needs to be adapted to the particular biological risk concerned. It is important that, once an
activity where workers may be exposed to biological agents is identified, information about the
exposures is collected. If the use of biological agents is deliberate then information about the nature and
effects of the biological agent used should be included in the inventory of hazardous substances. When
risks from biological agents are analyzed it is also important to account not only for the workers directly
involved but also for those who might be indirectly affected such as cleaning personnel.
Any risk assessment should pay particular attention to any vulnerable workers such as young persons,
pregnant workers and those known to be immune-compromised.
Control Measures from Infectious People:
Infection Control Practices
Infection control practices are critical to reduce the transmission of infections from one person to
another, such as from a healthcare worker to a patient or vice versa. See:
Everyday healthy habits that prevent the spread of disease infection control practices for health care
settings and long-term care facilities

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What is Infection Control?
In health care and public health practice settings, infection control includes various measures that
prevent and contain the spread of infectious disease. These measures include:
• Hand Washing
• Infection control standard, contact, droplet and airborne precautions
• Procedures for decontamination of persons and disinfection of equipment and the
environment
• Quarantine of contacts (if necessary)
• Prophylaxis of exposed individuals
• Control of the vectors of infection
Handling waste material contaminated with micro-organisms
• Runoff carrying animal waste from barnyards, manure storage areas, dairy farms, pig
farms, pastures, and the land application of manure is a significant source of microbial
contamination. Ensure animal waste runoff is properly collected, settled, and stored.
Manure storage sheds should be sited away from surface waters and should have
impermeable floors and roofs. Install vegetative buffer strips to slow runoff flow and to
act as a filter for microbial contaminants. Livestock should be kept out of streams and
water bodies
• Rainwater and snowmelt flow over the land picking up pollutants and then depositing
them into water supplies. Runoff can also collect microbial contaminants (such as pet
waste) from suburban environments. Minimize impervious surfaces within your
watershed. Install catch basins and settling basins to slow down flows and filter out
contaminants. Use landscaping techniques such as native plants, low maintenance
grasses, shrubs, and rock gardens that conserve water and limit runoff. Require the
proper removal and disposal of pet waste.
• Some microbial contaminants can be removed by water treatment coagulation and
filtration processes. Disinfection has proven effective against bacteria and viruses, but
protozoa such as Giardia and especially Cryptosporidium are very resistant to
chlorination alone
Control measures for working with Sewer:
• Ensure that employees and line management understand the risks through proper
instruction, training and supervision
• Provide suitable personal protective equipment, that may include waterproof/ abrasion-
resistant gloves, footwear, eye and respiratory protection. Face visors are particularly
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• Provide adequate welfare facilities, including clean water, soap, nailbrushes, disposable
paper towels, and where heavy contamination is foreseeable, showers. For remote
locations portable welfare facilities should be provided
Areas for storage of clean and contaminated equipment should be segregated and separate from eating
facilities:
• Provide adequate first-aid equipment, including clean water or sterile wipes for
cleansing wounds, and a supply of sterile, waterproof, adhesive dressings
• Make effective arrangements for monitoring the health of staff
9.11 Noise
The basic concepts of sound pressure, sound intensity, frequency, the decibel scale
• Nature of sound waves
Sound is a longitudinal, mechanical wave. Sound can travel through any medium, but it cannot travel
through a vacuum. There is no sound in outer space.
Sound is a variation in pressure. A region of increased pressure on a sound wave is called

a compression (or condensation). A region of decreased pressure on a sound wave is called
a rarefaction (or dilation). The sources of sound include:
o Vibrating solids
o Rapid expansion or compression (explosions and implosions)
o Smooth (laminar) air flow around blunt obstacles may result in the formation of vortices that snap
off or shed with a characteristic frequency. This process is called vortex shedding and is another
means by which sound waves are formed. This is how a whistle or flute produces sound. Also the
aeolian harp effect of singing power lines and fluttering venetian blinds
The following are the properties of Sound waves:
o Material medium is mandatory for the propagation of the sound waves.

o Sound waves are mostly longitudinal in common nature.
o Speed of sound in air at N.T.P is 332 m/s.
o Sound is audible only between 20 Hz to 20 KHz.
o Sound waves cannot be polarized.
o Sound waves travel through the air in the form of longitudinal wave.

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Sound wave and basic terms
• Wave properties
o Wavelength: A longitudinal wave consists of a repeating pattern of compressions and
rarefactions. Thus, the wavelength is commonly measured as the distance from one compression
to the next adjacent compression or the distance from one rarefaction to the next adjacent
rarefaction. Since a wave repeats its pattern once every wave cycle, the wavelength is sometimes
referred to as the length of the repeating patterns - the length of one complete wave. The product
of the wavelength and the frequency of a sound wave yields the velocity of that wave.
o Amplitude: The maximum height of the wave is called its amplitude. If the sound is more than the
amplitude is more.
o Frequency/pitch: In general, frequency is defined as the number of vibrations, oscillations, or
cycles in a repeating process occurring per unit time. In the context of sound, it is the number of
compressions passing a fixed point of reference in one second. The resulting unit of frequency is
called Hertz (Hz).The frequency of a sound wave is called it pitch. High frequency sounds are said
to be "high pitched" or just "high"; low frequency sounds are said to be "low pitched" or just
"low". In simple words, the highness or lowness of a sound is called pitch.
Sound wave with different wavelength
• Sound pressure
Since a sound wave consists of a repeating pattern of high-pressure and low-pressure regions moving
through a medium, it is sometimes referred to as a pressure wave. If a detector, whether it is the human
ear or a man-made instrument, were used to detect a sound wave, it would detect fluctuations in pressure
as the sound wave impinges upon the detecting device. At one instant in time, the detector would detect

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a high pressure; this would correspond to the arrival of a compression at the detector site. At the next
instant in time, the detector might detect normal pressure. And then finally a low pressure would be
detected, corresponding to the arrival of a rarefaction at the detector site. The fluctuations in pressure as
detected by the detector occur at periodic and regular time intervals. In fact, a plot of pressure versus
time would appear as a sine curve. The peak points of the sine curve correspond to compressions; the low
points correspond to rarefactions; and the "zero points" correspond to the pressure that the air would
have if there were no disturbance moving through it.
Sound Pressure is measured in Pascals - symbol Pa, units Newton per square metre; 1 Pa = 1 N/m2 = 1
J/m3 = 10-5 bar = 1 kg/(m·s2)
Some typical sound pressures are given in the table below
Sources at 1 m Sound pressure (Pa) Sources at 1 m Sound pressure (Pa)

Rifle 200 Passenger car as heard 0.1
from roadside
Threshold of pain 20 Talking 0.02
Pneumatic hammer 2 Library 0.002
Jack hammer 2 TV Studio 0.0002
Street traffic 0.2 Threshold of hearing 0.00002
• Sound intensity
The time rate at which sound energy flows through a defined area. Since the flow of energy is power, the
dimensions of sound intensity are power/area. Usually, sound intensity is measured in watts/meter^2.
Intensity is perceived as loudness.
• Interference:
Generally, interference is a synonym for superposition which is the way in which sound waves, and waves
more generally, interact. In essence, two waves passing through the same point in space at the same time
combine in a linear fashion to create a single new wave.
Constructive Interference - The amplitude of the combined wave created by superposition is

greater than the amplitude of either component wave.
Destructive Interference - The amplitude of the combined wave created by superposition is less
than the amplitude of either component wave.
• The decibel (dB) scale and its logarithmic nature (with workplace examples at different sound levels)
The decibel unit (symbol dB) is a logarithmic unit expressing the ratio between two values. Zero dBA
corresponds to the threshold of hearing (auditory threshold). 130 dBA is about the threshold of pain.

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Specifically, 1 bel is a ratio of 10, and 1 decibel is 1/10th of a bel. Hence if something is described as 40
decibels higher than something else, it is actually 10000 times as high as that other thing. You divide 40
decibels by 10 to get 4 bels, which means the 40 decibels is another way of saying ratio is 104. (This is why
sometimes things are labeled with negative decibels. For example, if 0 dB is the max level, -10 dB is 1/10th
of max, -20 dB is 1/100th of max, etc.)
When measuring sound, following logarithmic formula is used to determine the sound pressure level (SPL)
in decibels.
Here p is the sound pressure we are measuring, and Pref is our reference, the pressure of the smallest
sound we can hear, 2.0×10-5 Pa
So a pressure change of 0.4 Pa equates to about 86 dB. Below is the table including sound pressure
level:
Sources Sound Pressure (Pa) Sound Pressure Level (dB)

Normal conversation 0.01 54
TV set at home 0.02 60
Passenger car as heard from
roadside 0.1 74
Jack hammer 2.0 100
Jet engine as heard from 100 yards 100 134
Extremely loud rock band 200 140
Jet engine as heard from 1 yard 630 150
• Human auditory frequency sensitivity:

Humans are generally capable of hearing sounds between 20 Hz and 20 kHz. Sounds with frequencies
above the range of human hearing are called ultrasound. Sounds with frequencies below the range of

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human hearing are called infrasound. Typical sounds produced by human speech have frequencies on the
order of 100 to 1,000 Hz. The peak sensitivity of human hearing is around 4000 Hz.
• The significance of A-weighting ‘dB(A)’ and C weighting ‘dB(C)’

The A-weightings and C-weightings refer to different sensitivity scales for noise measurement. For
example, we’ve heard it said that animals have better hearing sensitivity than humans. This increased
sensitivity is true not only for the intensity of a sound (a cat can hear sounds that are much quieter than
humans can hear), but also for the frequency of a sound (a high-pitched dog whistle is easily heard by a
dog, but is beyond the frequency range perceived by humans, even though it is quite loud). So hearing
sensitivity must be measured not only in intensity, but also in terms of frequency.
The human ear responds more to frequencies between 500 Hz and 8 kHz and is less sensitive to very low-
pitch or high-pitch noises. The frequency weightings used in sound level meters are often related to the
response of the human ear, to ensure that the meter is measuring pretty much what you actually hear.
It is extremely important that sound level measurements are made using the correct frequency weighting
o A Weighting: The most common weighting that is used in noise measurement is A-Weighting as
it also predicts quite well the damage risk of the ear. Like the human ear, sound level meters set
to the A-weighting scale will also effectively cut off the lower and higher frequencies that the
average person cannot hear. A-weighted measurements are expressed as dBA or dB(A).
o C Weighting: The response of the human ear varies with the sound level. At higher levels, 100 dB
and above, the ear's response is flatter. Although the A-Weighted response is used for most
applications, C-Weighting is also available on many sound level meters. C Weighting is usually
used for Peak measurements and also in some entertainment noise measurement, where the
transmission of bass noise can be a problem. C-weighted measurements are expressed
as dBC or dB(C).
• Paths of noise from source to receiver
Sound paths from source to receiver are predominantly through the air. Along these paths, sound reduces
with distance due to (1) divergence, (2) absorption/diffusion and (3) shielding.
The Time Weighted Average (TWA) shows a worker's daily exposure to occupational noise (normalized to
an 8 hour day), taking into account the average levels of noise and the time spent in each area. This
parameter is essential in assessing a workers exposure and what action should be taken.
For example, a worker wears a noise dosimeter for a 2-hour sampling period, during which time he works
in fluctuating noise ranging from 83 dB to 98 dB. The resulting noise dose can be converted into an
equivalent 8-hour time-weighted average. Even though the sampling period may be less than 8 hours, a

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time weighted average allows us to apply the sample measurement to an 8-hour work shift. According to
current OSHA standards, the Permissible Exposure Limit is an 8-hour time-weighted average of 90 dBA.
The Time Weighted Average is calculated using these noise levels together with the amount of time that
the worker is exposed to them.
First calculate the Noise Dose as:
Dose = 100 x (C1/T1 + C2/T2 + C3/T3 + ... + Cn/Tn)
where
Cn = time spent at each noise level
Tn = 8 / 2(L-90)/5 (L is the measured sound level)
(Example: A worker is exposed to 86 dB for six hours and 92 dB for a three hours, giving a nine hour
working day. Dose = 100 x (6/13.9 + 3/6.1) = 92.3%)
Once Dose% is calculated, TWA can be calculated using the following equation:
TWA = 16.61 Log10 (D/100) + 90
Where
TWA is the 8-hour Time Weighted Average Sound Level
D is the Dose % as calculated above (or measured with a dosimeter)
Log10 is the Logarithm to base 10
(Example Continued: From our example above TWA = 16.61 x Log10 (92.3 / 100) + 90
TWA = 89.4 dB)

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Leq is the preferred method to describe sound levels that vary over time, resulting in a single decibel value
which takes into account the total sound energy over the period of time of interest. Because occupational
noise is often a complex signal, the noise level needs to be averaged over a minimum sample time. The
sampling time can be as short as a few minutes if the noise signal is steady or repetitive over a short cycle;
some jobs could require a full day’s monitoring. Whatever the actual duration, it should be a
representative sample of the entire exposure. If the activity is not typical of the shift then either more
sampling is required when the condition is fulfilled or corrections to your measurements may be required.
LAeq - It is common practice to measure noise levels using the A-weighting setting built into all sound
level meters. In which case the term is properly known as LAeq and the results should say so - for example
LAeq = 73 dB or Leq = 73 dBA
LEX is the noise exposure level. LEX is useful as a single number measure of the noise exposure in decibel
form. LEX is the sound level, energy-averaged over 8 hours, which would give the same daily noise
exposure dose as the varying noise over a typical full shift. It is closely related to the Leq which is
actually measured.
Daily Personal Noise Exposure : LEP,d is the averaged A-weighted noise exposure level for a nominal 8-
hour working day and is for assessing the noise exposure of a employee during a working day. It is also
known as LEX,8h.
LEP,d is calculated from the measured Sound Exposure, the Exposure Time and a Reference Time of 8 h.
If the Leq is measured over 8 hours then Leq and LEP,d and LEX,8h would all be the same.
The Control of Noise Regulations 2005 specify actions necessary when daily or weekly workplace noise
exposures exceed specific levels. These specific Values are:
• Firstly, the Lower Exposure Action Value – a daily or weekly exposure to workplace noise (an
LEP,d) of 80 dB
• After that, the Upper Exposure Action Values – a daily or weekly exposure to workplace noise (an
LEP,d) of 85 dB
• Finally, the Exposure Limit Value – a daily or weekly exposure of 87 dB which workers must not
exceed
In addition to the daily and weekly exposure action values and exposure limit, there are peak levels that
the noise must not exceed. These measurements are made using C-weighting and are expressed as
LCpeak in dB(C). The LCpeak assesses workplace noises that are present as loud impulse noises or bangs.
The noise regulations specify the actions that employers need to take when peak noise levels exceed the
limits. These limit values are:
• Lower Exposure Action Value for peak sound pressure is an LCpeak 135 dB
• Upper Exposure Action Values for peak sound pressure is an LCpeak of 137 dB

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• Exposure Limit Value is a peak sound pressure is an LCpeak of 140 dB
The physical and psychological effects on the individual

There are several kinds of hearing loss. Some are the result of disease, such as infections of the middle
ear and scar tissue formation on the eardrum; others are the result of trauma, such as perforation of the
eardrum or separation of the ossicles of the middle ear. Conductive losses involve the outer and middle
ear. Sensory losses involve the organ of Corti and sensory nerves. Hearing loss that can occur in the brain
involves difficulties in interpreting sound. There are also psychological hearing impairments that have no
physiological basis.
Decibels Exposure Effects

85-90 Exposure over a length of time may Most hearing loss happens over a period
cause hearing loss of time – weeks months, or years. No
Examples: subway, loud shouting Pain at this level of exposure.
90-100 Exposure over a length of time At this level of exposure, the noise can
causes hearing loss. be uncomfortable.
Examples: power mower, air
hammer
100-130 Exposure over a short period of time Tinnitus (ringing in the ears) may occur
causes hearing loss. after an exposure at this level.
Examples: riveter, compacter, rock Discomfort threshold is 120 dB(A)
concert
140+ A single exposure can cause hearing Pain threshold.
loss.
Examples: jet taking off, shotgun
Hearing damage is especially dangerous because while ringing, buzzing or loss of hearing from short-term
noise exposure can be overcome with rest, if exposure is sustained, it may result in irreversible long-term
damage. Hearing loss in the workplace can present safety risks if workers are unable to hear alarms or
critical communications from other workers.
Acute and chronic physiological effects of exposure to high noise levels
There is a connection between excessive noise and hearing loss. The hearing loss can either be temporary
or permanent. A continuous noise level of 85 dB will result in hearing damage and either cause permanent
or temporary hearing loss. This is the sound level of heavy road traffic. Compressed air hammers have a
sound level of about 100 dB and rock concerts almost always reach 110-120 dB - the same sound intensity
can easily be produced in headsets when you listen to your stereo

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Noise exposure and intense sounds can cause two main types of hearing loss, namely acute and chronic
effects.
Exposure to high levels of noise can cause permanent hearing loss (Chronic effect). Neither surgery nor a
hearing aid can help correct this type of hearing loss. Short term exposure to loud noise can also cause a
temporary change in hearing (Acute effect) or a ringing in your ears (tinnitus). These short-term problems
may go away within a few minutes or hours after leaving the noise. However, repeated exposures to loud
noise can lead to permanent tinnitus and/or hearing loss.
Noise induced hearing loss (NIHL): Exposure to noise can produce hearing loss. Such losses are a function
of duration of exposure and sound intensity. High frequencies are more damaging than low frequencies,
and continual noise is more damaging than intermittent noise. There are also individual differences among
people. An exposure may not produce the same losses in two people.
NIHL develops gradually so that people may lose a significant amount of hearing before becoming aware
of its presence. Some of the warning signs of the presence of, or exposure to, hazardous levels of noise
are as follows:
o Can’t hear someone talking three feet away

o Have a feeling of “fullness” in the ears after leaving a noisy area
o Hear ringing or buzzing (tinnitus) in ears immediately after exposure to noise
o Suddenly have difficulty understanding speech after exposure to noise; can hear people talking
but have difficulty understanding them.
Acoustic Trauma / Instantaneous hearing loss: A single incident which produces an abrupt hearing loss.
Loud noise from explosions or similar sources of pressure waves may rupture the eardrum or damage the
structure of the middle or inner ear. Such conductive damage is called acoustic trauma. Welding sparks
(to the eardrum), blows to the head, and blast noise are examples of events capable of producing acoustic
trauma. In some cases the damage is temporary. The injured tissue may heal, restoring hearing to full or
near-full sensitivity.
Temporary threshold shift (TTS): The hearing threshold increases after exposure to excessive noise
because sound damages the organ of Corti and its receptor hair cells. Relatively short exposures to loud
noise can produce TTS. One example is listening to a highly amplified music group for an hour or two. This
disability is temporary and hearing sensitivity returns to pre-exposure levels after a recovery period. Other
examples include burst, explosion etc.
Any time some of the hearing capacity is lost, even if only temporarily, that's a warning sign. Remember
what caused it, and take it as a useful lesson that that situation can be harmful to hearing.

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Permanent threshold shift: Continued exposures to noise that produces TTS will cause a permanent
decrease in hearing sensitivity or permanent threshold shift. The sensitivity does not return after a
recovery period and the sensory damage to the organ of Corti becomes permanent. There are many
examples of hearing loss such as tractor-driving farmers exposed to engine noise.
Another common cause is age. We all lose our hearing as we age and hearing loss is a natural consequence
of getting older. A permanent threshold shift may also occur as a result of disease, infection or drugs. It
may be inherited or be a result of physical damage to the ears or to the head.
Tinnitus: Tinnitus is the medical term that refers to the perception of sound in one or both ears when no
sound is actually present in the environment. Tinnitus isn't a condition itself — it's a symptom of an
underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.
Ringing-in-the-ears or a fullness-of-the-head sensation are the most common symptoms of tinnitus. While
ringing is the most common experience, the noise can also sound like a buzzing, hissing or whizzing sound.
It can range from a low pitch to a high pitch and may be soft or loud at times. In severe cases, the ringing
in the ears is loud enough to interfere with work or daily activity, whereas those with mild tinnitus can
experience soft ringing that is no more than a minor annoyance.
Noise risk assessment and planning for control

Noise risk assessment and planning for control (with reference to the British HSE’s L108: Controlling
noise at work)
When is a noise risk assessment needed?
You must do a risk assessment if any employee is likely to be exposed to noise at or above the lower
exposure action values. A person’s daily noise exposure depends on both noise level and length of
exposure.
If your workplace is intrinsically noisy, i.e. it is significantly noisier than you would expect from the
sounds of everyday life, it is possible that the noise levels will exceed 80 db. This is comparable to the
noise level of a busy street, a typical vacuum cleaner or a crowded restaurant – you will be able to hold a
conversation, but the noise will be intrusive. Working in an environment of 80 dB for eight hours will
result in exposure at the lower exposure action value.
Controlling noise
This regulation places duties on you:
(a) to take action to eliminate risks from noise exposure completely wherever it is reasonably
practicable to do so (regulation 6(1));
(b) if it is not reasonably practicable to eliminate the risks completely, to reduce them to as low a level
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(c) to introduce a formal programme of measures to reduce noise exposure Regulation 6 Guidance 6
Controlling noise at work Page 20 of 130 Health and Safety Executive whenever an employee’s exposure
to noise is likely to exceed the upper exposure action values (these measures cannot include hearing
protection, which is addressed separately) (regulation 6(2));
(d) not to expose anyone above the exposure limit values (regulation 6(4)).
Eliminate or reduce risk:
This general duty applies whenever there is a risk from noise and irrespective of whether any exposure
action values are exceeded. It is likely, however, that only inexpensive and simple measures will be
reasonably practicable if the lower exposure action values are not exceeded. To comply with this duty,
you need to:
(a) consider whether there are alternative processes, equipment and/or working methods which would
eliminate risks from noise exposure;
(b) follow good practice and industry standard control measures;
(c) take noise into account when selecting tools and machinery;
(d) maintain machinery in accordance with manufacturers’ recommendations;
(e) explore any opportunity to provide your employees with periods of relief from noise exposure.
“Establishing and implementing a programme of organisational and technical measures”
The action plan produced during your noise risk assessment should describe a programme of control
measures and your plans to put it into action with realistic timescales. The programme of control
measures should be devised to reduce noise exposures so far as is reasonably practicable.
The actions you take will depend on the particular work activities and processes and the possibilities for
control, but in general you should:
(a) identify what is possible to control noise exposures, how much reduction could be achieved and so
what is reasonably practicable;
(b) establish priorities for action and a timetable;
(c) assign responsibilities to individuals to deliver the various parts of the programme;
(d) ensure that the work involved in implementing the noise-control measures is carried out;
(e) check that what you have done has been effective in reducing noise exposures.
Some controls may take time to put in place, particularly where equipment must be replaced or new
industrial processes developed. Other controls may be considered to be not reasonably practicable but

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may become so over time as circumstances change. You will need regularly to review the feasibility of
further noise reductions.
“The general principles of prevention”
In identifying and putting in place appropriate noise-control and risk-reduction measures you should
follow the general principles of prevention set out in Schedule 1 to the Management of Health and
Safety at Work Regulations 1999:
(a) avoiding risks; Guidance 6 Guidance 6(1) Guidance 6(2) Guidance 6(3) Controlling noise at work Page
21 of 130 Health and Safety Executive
(b) evaluating the risks which cannot be avoided;
(c) combating the risks at source;
(d) adapting the work to the individual, especially as regards the design of workplaces, the choice of
work equipment and the choice of working and production methods, with a view, in particular, to
alleviating monotonous work and work at a predetermined work-rate and to reducing their effect on
health;
(e) adapting to technical progress;
(f) replacing the dangerous by the non-dangerous or the less dangerous;
(g) developing 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;
(h) giving collective protective measures priority over individual protective measures;
(i) giving appropriate instructions to employees.
Regulation 6(3) lists several possible noise-control and risk-reduction methods, following the general
principles of prevention. There are other ways of reducing noise and no single technique will be
appropriate for every situation. A programme of noise control should adopt a systematic approach to
identifying what can be done, and should not be restricted to considering what is listed in regulation
6(3).
“Choice of appropriate work equipment emitting the least possible noise”
For many types of equipment there will be models designed to be less noisy. Noise-reduction
programmes are only likely to be effective if they include a positive purchasing policy which makes sure
you take noise into account when selecting machinery. When buying, hiring or replacing equipment you
should ask potential suppliers for information on the noise emission of machines under the conditions
you intend to use it, and use that information to compare machines.

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Where you find it is necessary to purchase machinery which causes workers to be exposed over the
action levels, you will find that keeping a record of the reasons for the decision will help guide future
action, e.g. by providing those responsible for future machine specifications with information on
improvements that are needed.
“Appropriate maintenance programmes for work equipment”
Maintenance of machinery, carried out in accordance with the manufacturer’s recommendations, can
prevent noise emissions increasing over time. You should ensure that appropriate maintenance is
performed on equipment so that its performance does not deteriorate to the extent that it puts
employees at risk due to the noise emitted. Operators should be instructed to report any unusually high
noise levels and check that machines are operating properly.
“Limitation of the duration and intensity of exposure”
When all reasonably practicable steps have been taken to reduce noise levels the next step to reduce
exposure is to limit its duration
“Appropriate work schedules with adequate rest periods”
Workers exposed to loud noise should have the opportunity to spend time away from the noisy
environment and, wherever possible, breaks should be taken in quiet zones. Even if this does not
significantly reduce daily exposure it will help by allowing recuperation and, in some circumstances,
preventing the need to wear hearing protection continuously.
Reduction of exposure below the exposure limit values
You must not permit an employee to be exposed above the exposure limit values. You will need to check
whether your programme of control measures, including, in this case, the provision of hearing
protection, is enough to prevent this level of exposure.
If you discover that an exposure limit value is exceeded, you must immediately take action to reduce
exposure. Address the reasons for the overexposure by reviewing your programme of control measures.
You should consider the technical and organisational controls, the adequacy of any hearing protection
supplied and the systems you have in place to ensure that noise-control measures and hearing
protection are fully and properly used and maintained.
You should not consider the exposure limit values to be a target for your noise control programme –
remember that regulations 6(1) and 6(2) require you to reduce risks and exposures to as low a level as is
reasonably practicable. “Any employee or group of employees whose health is likely to be at particular
risk from exposure to noise”. As well as special efforts to restrict exposure for such individuals an
increased level of health surveillance may also be appropriate.

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The use of noise calculators to determine mixed exposure

The noise exposure calculators can help work out the daily and/or weekly noise exposures, and estimate
the performance of hearing protection. Such calculators are given at
http://www.hse.gov.uk/noise/calculator.htm
The hierarchy of noise control

Management is mainly responsible to make sure that potentially controllable noise sources are identified,
and that priorities for controls are set and accomplished. The use of these controls should reduce
hazardous exposure to the point where the risk to hearing is eliminated or at least more manageable.
1- Eliminate/control at source
• Substitution: Replacing excessive noise sources with less noise sources including belt drives as
opposed to noisier gears, or electrical rather than pneumatic tools; replace metal gears with plastic
gears (beware of additional maintenance problems); - replace steel or solid wheels with pneumatic
tyres.
• Damping: – dissipates vibrational energy before it can build up and radiate as sound. Soundproofing
and sound damping are two terms that are sometimes confused as the same thing, when in reality,
sound damping is just one of the ways to reduce noise in an object or room. Put simply, damping is
about reducing or eliminating stored energy created by sound. If you put up a wall between two rooms
and the wall has no damping, sound in one room will simply pass through the wall and enter the next
room as sound. If you want to isolate that sound, you want the best damping you can find.
• Workplace layout: Relocate of all noisy equipment separately and apply collective control measures
so that its cost effective and residual sound level does not significantly increase the noise level of quit
areas. Another option is to direct the sound from a source away from locations where people will be.
For example, one can direct an opening in a machine (vent, duct, material feed opening, etc.) away
from operators or extend a vent or duct through a roof or wall.
• Mufflers and Silencers: Mufflers (also called silencers) can be used on noisy, pressurized air
equipment to reduce noise at the source. A muffler is a device that reduces the noise level from a
moving air or gas stream, such as one found in a pneumatic tools. Like the muffler on an automobile,
it absorbs some noise before it can reach the receiver. In general, mufflers must be cleaned on a
regular basis to be effective at reducing noise; if they are not cleaned, they actually can increase noise
levels.
• Re-design of equipment/task: High-speed and high-pressure gases and liquids passing through pipes
and ducts often create high sound levels. This is particularly true for flow-through valves, bends, and
other transitions where turbulence is high. Reducing pressures and speeds can reduce sound sources.
The higher the force producing oscillations and vibrations, the greater the amplitude of sound
generated. Reducing shaft speed and balancing rotating equipment reduce forces in rotating shafts
that are slightly eccentric. Separating vibrating sources from sheet metal panels and structures
through flexible couplings and flexible connections reduces sound sources. Examples are placing
motors and vibrating equipment on independent footings and connecting air handlers from ductwork
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There are many kinds of isolating pads that prevent transfer of vibrations from machines to the
structures they rest on or are attached to. One should obtain manufacturer’s data and engineering
information to help determine if commercial isolators will be satisfactory for the frequencies and
forces involved with particular applications.
• Maintenance: carrying out preventive maintenance: as parts become worn, noise levels can change.
So periodic lubrication and greasing will be required.
o Listen out for changes in noise levels - it may be time to replace worn or faulty parts.
o Increased attention to maintenance of tools and equipment will reduce noise levels.
Maintaining your plant and equipment in good order not only increases its life, but makes it
safer to use and quieter.
o Machine maintenance can be critical in reducing noise. Machines deteriorate with age and
use, and if not maintained are likely to produce more noise due to factors such as worn parts,
poor lubrication and loose panels vibrating. Maintenance can, if carried out periodically, limit
the increased noise emission due to wear.
• Purchasing policy: When hiring or buying equipment, consider noise alongside other factors (e.g.
general suitability, efficiency). Compare the noise data from different machines as this will help buy
from among the quieter ones. Watch for high-velocity flow of gases and fluids, high-speed equipment,
and high pressure processes, which often are sources of noise. Establish source noise specifications
and analyze processes and systems to reduce noise generation. Often, it is cheaper to design facilities
and buy equipment with noise control than to try to control noise sources later.
Manufacturers of work equipment have legal duties regarding the equipment they supply ( under
Supply of Machinery (Safety) Regulations 2008 (SMR)) and employers have a duty under the Provision
and Use of Work Equipment Regulations 1998 to only provide workers with equipment that meets
relevant supply laws. When using a manufacturer’s noise data ensure that the data is representative
of the way equipment is intended to be used. Be cautious when using manufacturers’ data other than
for comparing equipment; for example, the data is likely only to be a guide to personal noise exposure
as many factors affect the noise levels experienced by employees.
2- Control along transmission path

• The behaviour of sound at interfaces – transmission, reflection, absorption
The ideal enclosure for noise control is a full one that has no openings and fully encloses a sound
source. However, we seldom achieve full enclosures because there are openings for feeding materials
or for other purposes, and there may be cracks around temporary openings or doors. Considerable
amounts of sound can leak through small openings and cracks. Inside the enclosure, there is
reverberant buildup. By lining the inside of an enclosure with sound-absorbing materials, reverberant
buildup is minimized. The sound transmitted through an incomplete enclosure is largely a function of
the unenclosed portion of the full enclosure, whether from cracks or other openings.
One can place sound-absorbing materials on the surfaces of a room or surfaces of objects within it to
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absorbing materials. There is a practical limit to this approach. To a great extent, the effectiveness of
additional treatment depends on the lack of sound-absorbing surfaces before treatment.
Another approach for reducing sound transmission along a path is to insert a barrier, often some type
of panel, along the path. The purpose of a barrier is to deflect sound waves that would otherwise
move between a source and a receiver. A barrier extends from the floor to some height short of a
ceiling.
• Sound reduction indices and absorption coefficients and their use in materials selection
Sound Reduction Index is the measured quantity which characterises the sound insulating properties
of a material or building element in a stated frequency band - laboratory measurement.
R = L1 - L2 + 10 lg S/A (dB)
where:
L1: average Sound Pressure Level in the source room
L2: average sound pressure level in the receiving room
S: area of the test specimen (m2)
A: Equivalent Sound Absorption area of the receiving room
The sound absorption Coefficient is a scalar representation of the amount of sound energy absorbed
upon striking a particular surface. A noise absorption coefficient of 0 indicates perfect reflection; and
of 1 indicates perfect absorption. In particular, it is the average of four sound absorption coefficients
of the particular surface at frequencies of 250 Hz, 500 Hz, 1000 Hz, and 2000 Hz. These frequencies
encompass the fundamental frequencies and first few overtones of typical human speech
These are the most important performance considerations in the acoustic design of a room. As well
as providing the right balance between reflection and absorption, the selection quantity and
positioning of sound absorbing materials are key factors in achieving the correct reverberation time
(s measured in seconds and is defined as the time taken for a generated sound to decay by 60 dB once
the sound source has been stopped)for the rooms intended use.
• Techniques of damping, isolation, diffusion, barriers, acoustic enclosures, distance
Look for noisy locations in a floor plan or plant layout and for ways to enclose potentially noisy
activities, processes, and equipment to prevent noise from travelling to less noisy areas. Group noise
sources to lessen controls costs and try to separate people from noise sources by distance and
barriers. Look for and avoid routes or channels by which sound can travel from one location to
another.
Diffusion in simple terms is the scattering of sound energy. When sound bounces off hard flat surfaces,
the energy remains very much intact yielding discrete echoes. These echoes will produce destructive
effects like comb filtering, standing waves and flutter echoes which degrade speech intelligibility and
music clarity. Installing sound diffusers can deal with this problem. Diffusers interrupt discrete echoes
by scattering or diffusing sound energy over a wide area without removing it from the room. This
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During the design phase, one can specify and select sound-absorbing surface finishes for ceilings,
walls, and floors. This will help reduce sound to acceptable levels. However, there is a limit to the
benefit from absorbing surfaces.
To control noise in a room, one must analyze sound travel. Noise will travel away from a source, and
the energy level in a sound field will decay with the square of the distance from a source. However,
most rooms have reflective surfaces, such as floors, walls, and ceilings, and placement of noise sources
in a corner in conjunction with a highly reflective floor and walls will concentrate noise energy into an
emitted area. Conversely, placement of noise sources away from reflective surfaces gives noise a
chance to dissipate before reaching reflective walls, ceilings, and floors.
Some materials, processes, and equipment have components that transmit sound or have natural
frequencies that can amplify sounds. Metal panels, pipes, and tubes often vibrate and ring. The flow
of high-pressure and high-velocity liquids and gases often produce higher noise levels than those with
low pressures and velocities. One should look for these potential sources of problems and seek to
reduce them during design of processes, buildings, and equipment.
Sound, like water, has a way of seeping through any available crack, gap, or fissure. The only way to
stop sound from moving from one space to another it to prevent the sound from finding a way through
by using some type of barrier.
Acoustic enclosures are closed chambers, made of acoustic materials that ensure sound or noise
isolation and absorption. These are specifically designed and built for the purpose of reduction,
minimisation, or attenuation of the noise generated by particular types of equipment or
machinery. Such as large air conditioning and refrigeration units, power generators, manufacturing
lines, grinders, blowers, compressors, pumps, saw booths, gear boxes, etc.
• Active noise cancellation
Active noise control (ANC), also known as noise cancellation, or active noise reduction (ANR), is a
method for reducing unwanted sound by the addition of a second sound specifically designed to
cancel the first. This find a wide use in headphones and car audio systems.
3- Control exposure at the receiver

• Acoustic havens
In certain circumstances it is not always feasible to treat the noise at source, particularly in
environments where there are multiple noise sources contributing to the overall exposure
experienced by operators. In such cases, noise havens can be installed which are designed to offer
respite for operators in noisy environments.
This applies solely to occupational exposure. Instead of putting the machine in an enclosure, the
operator spends most of his time in an enclosure away from the process and the exposure is reduced.
The design factors are similar to a noise enclosure. To be effective, operators should spend most of
their time inside the haven; therefore, the location of controls and monitors inside the haven is as
important as the construction of the enclosure.
• Hearing protection zones: A more practical control is to provide for quiet areas where employees can
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from noise. If these areas must be near the production line, they should be acoustically treated to
minimize background noise levels.
When hearing protection zones (except rest areas) are provided within the workplace in the form of
operator cabins/booths, ergonomics must be considered along with optimal work efficiency. For
example, work posture (sitting, standing, bending) as well as existing environmental factors (lighting,
heating, and cooling) must be considered. Lighting, heating, and cooling must ensure comfort and be
sufficient to prevent reduction in efficiency and work quality. Enclosures should be of adequate size
and have enough window area to prevent claustrophobia. Windows should be positioned carefully to
enhance proper usage by employees, and the glass may need to be tilted to prevent glare. In situations
where employees will be working on or around equipment fitted with engineering controls, it is
important to explain to everyone involved why the controls should not be modified, removed, or
otherwise defeated.
• PPE: In the absence of feasible engineering or administrative controls, personal hearing protection
devices (often referred to as hearing protectors) remain the only means of preventing hazardous noise
levels from damaging one's hearing. Unless great care is taken in establishing a hearing protector
program, employees will often receive very little benefit from these devices. Each employee can react
differently to the use of such devices, and a successful program should respond to individual needs.
• Limiting exposure time: Examples include operating a noisy machine on the second or third shift when
fewer people are exposed, or shifting an employee to a less noisy job once a hazardous daily noise
dose has been reached. Generally, such administrative controls have limited use in industry because
employee contracts seldom permit shifting from one job to another. Moreover, the practice of
rotating employees between quiet and noisy jobs, although it may reduce the risk of substantial
hearing loss in a few workers, may actually increase the risk of small hearing losses in many workers.
• Training: All employees exposed to noise levels that meet or exceed an 8-hr TWA of 85 dBA shall be
trained and then periodically retrained. The training shall include:
o The effects of noise on hearing.
o Contributing factors that cause hearing loss.
o The purpose of hearing protection.
o Advantages and disadvantages of the different types of hearing protection.
o The attenuation factors of hearing protection.
o How to select hearing protection.
o How to properly use hearing protection.
o The purpose of audiometric testing and what it means.
o Employee responsibilities.
o Employer responsibilities.
• Role of health surveillance: Audiometric evaluation is crucial to the success of the hearing loss
prevention program in that it is the only way to determine whether occupational hearing loss is being
prevented. When the comparison of audiograms shows temporary threshold shift (a temporary
hearing loss after noise exposure), early permanent threshold shift, or progressive occupational

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hearing loss, it is time to take swift action to halt the loss before additional deterioration occurs.
Because occupational hearing loss occurs gradually and is not accompanied by pain, the affected
employee will not notice the change until a large threshold shift has accumulated. However, the
results of audiometric tests can trigger changes in the hearing loss prevention program more
promptly, initiating protective measures and motivating employees to prevent further hearing loss.
For maximum protection of the employees (and for that matter, the company), audiograms should be
performed on the following five occasions:
1. Pre-employment
2. Prior to initial assignment in a hearing hazardous work area
3. Annually as long as the employee is assigned to a noisy job (a time-weighted average exposure
level equal to or greater than 85 dBA)
4. At the time of reassignment out of a hearing hazardous job
5 At the termination of employment
In addition, it is suggested that employees who are not exposed be given periodic audiograms as part
of the company's health care program. The audiograms of these employees can be compared to those
of the exposed employees whenever the overall effectiveness of the hearing loss prevention program
is evaluated. In an optimally effective program, the two employee groups will show essentially the
same amount of audiometric change.
Following are the three categories of hearing protection devices:
Ear plugs are inserted to block the ear canal. They may be premolded (preformed) or moldable (foam
ear plugs). Ear plugs are sold as disposable products or reusable plugs. Custom molded ear plugs are
also available.
Semi-insert ear plugs which consist of two ear plugs held over the ends of the ear canal by a rigid
headband.
Ear muffs consist of sound-attenuating material and soft ear cushions that fit around the ear and hard
outer cups. They are held together by a head band.
Ear Plug Advantages Ear Plug Disadvantages
• Small and easily carried • Requires more time to fit

• Convenient to use with other personal • More difficult to insert and remove
protection equipment (can be worn with ear • Require good hygiene practices
muffs) • May irritate the ear canal
• More comfortable for long-term wear in • Easily misplaced
hot, humid work areas • More difficult to see and monitor usage
• Convenient for use in confined work areas
Ear Muffs Advantages Ear Muffs Disadvantages

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• Less attenuation variability among users • Less portable and heavier

• Designed so that one size fits most head • More inconvenient for use with other
sizes personal protective equipment.
• Easily seen at a distance to assist in the • More uncomfortable in hot, humid work
monitoring of their use area
• Not easily misplaced or lost • More inconvenient for use in confined work
• May be worn with minor ear infections areas
• May interfere with the wearing of safety or
prescription glasses: wearing glasses results
in breaking the seal between the ear muff
and the skin and results in decreased
hearing protection
Selecting the correct hearing protection is essential. There are many factors to be considered - chiefly
the fact that any PPE is only effective if it is worn. The same is true of hearing protection. It has always
been the case that the use of hearing protection should be a last resort after noise control measures
have been taken as far as reasonably practicable. Even so, many employers still provide them and
need to be able to produce evidence that the correct protection has been selected for each
application or task
There are three methods for predicting the overall attenuation that a hearing protector will give, and
each rises slightly in the amount of mathematics required. All the methods of assessing the
effectiveness of hearing protection are based on using data supplied by the manufacturer of the
defenders. The methods for calculating the effectiveness of hearing protection are:
o SNR
o HML
o Octave band
In terms of accuracy in predicting the attenuation, the SNR method is the least accurate and the
octave band is the most accurate, and hence is the preferred method. However, it does require a little
more calculation.
• The use of octave band analysis to aid selection of hearing protection and other control measures
The best method of all is to measure the Octave Band frequency levels and use the table provided by the
manufacturer. The octave band measurement gives a fairly detailed breakdown of the level of noise
protection at various frequencies, so when the manufacturers’ data is applied, a much better picture will
emerge of the effectiveness of the hearing protection device.

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Noise can either be measured as a 'lump of noise' where you measure the number of decibels for the
noise as a whole, or you can break it down into individual frequencies and measure the noise level for
each of those separately
In an octave band measurement we don't measure individual notes as that would be just too many
measurements to make in one go but instead, we group them together into 'bands' and then measure the
noise level for each of those bands individually.
One of the classic and most widespread forms of hearing protector is the Classic - the yellow foam plugs
seen everywhere. These are a good protector and have been around for years to prove it. They come with
an SNR of 28 so at their basic you can assume they knock 28dB off the noise levels the wearer is
experiencing, but are they offering the same level of protection across all frequency bands?
And the answer to this is no, they are not, but this is not a fault and is entirely normal.
The important number is the 'APV' - assumed protection factor which accounts for variation in fit by the
user. At the low end of the frequency range, 63Hz, the plugs are knocking around 16.9dB off the noise
levels, reaching a peak at 4kHz of 38.1dB, then back to 34dB at 8kHz, so there are large changes between
the low frequency bass noises and the top end high frequency stuff.
And this takes us nicely back to the point of the octave band measurement which allows a check to be
made that the hearing protection is performing adequately well at the right frequencies. In the table
above, it may be no good having these protectors for a loud noise source which was predominantly 1kHz
or lower while the plugs are performing at their strongest at the 4kHz level. The Octave band noise
measurement allows calculations to be done to confirm the hearing protection is not just strong enough
overall, but is strong enough at the right frequencies.
The software supplied with most higher-end noise meters will be able to do the involved calculation for
you, usually including a database of hearing protectors and their performance data for comparison.
Otherwise there are several online tools/calculators where you can put the numbers in and the calculation
is done for you. Visit www.hse.gov.uk or www.noisemeters.co.uk

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• Single Number Rating (SNR) and HML (high, medium, low) methods
An SNR is a single number rating system determined according to International Standard ISO 4869. SNRs
are expressed in dB's and are used as a guide for comparing the potential noise reduction capability of
different hearing protection devices. For further details please refer to the Canadian Standard CSA Z94.2
or American Standard ANSI S12.6.
The Single Number Rating (SNR) method is the simplest form of calculation, but does not take into account
the frequency content of the noise in any depth. To do this, simply take the SNR value quoted for the
hearing protector away from the ‘C’ weighted sound pressure level which needs to be measured for the
employee in question.
The Single Number Rating is an estimate of the average, overall protection offered by a particular plug or
muff etc. The problem is that ear defenders work considerably better at stopping high frequency sound
than they do with low frequencies, so if the noise in question is predominantly low frequency, then it is
easy to under estimate the amount of protection and over expose the employee. Great care should be
exercised when using the SNR method.
The HML assessment method uses a measurement of both the ‘A’ and ‘C’ weighted sound levels to give
some indication of the amount of low frequency noise present. Using a simple formula and table, which
is described in the guidance notes, a slightly more accurate prediction can be made. A sound meter must
be able to measure an ‘A’ weighted and ‘C’ weighted level as an Leq, so that the SNR or HML methods can
be used
For the SNR and HML methods of performance calculation, the regulations state that the effectiveness of
the defender should be de-rated by 4dB. For SNR numbers, this means subtracting 4 from the value given
on the data-sheet and for HML numbers, it means decreasing the predicted noise reduction (PNR) level
by 4dB.
• The problems of over-protection
Even in noisy environments, there are sounds we want to hear clearly - warning signals and alarms, voices
of co-workers, even maintenance sounds from machinery. Just as hearing protectors may not provide
enough attenuation, there are many instances where they provide too much attenuation. If the protection
(known as attenuation) provided by personal ear protection is too high, workers are overprotected.
Communication becomes difficult and people are working in isolation. Standard EN 458 states that the
level of attenuation (protection) is good if the noise level is 5 dB under the national action level. This will
mean that communications in the workplace is not disturbed too much. Workers who are overprotected
; feel isolated and cut off from their work environment - and not as safe

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9.12 Vibration
The basic concepts
Any vibration has two measurable quantities. How far (amplitude or intensity), and how fast (frequency)
the object moves helps determine its vibrational characteristics. The terms used to describe this
movement are frequency, amplitude and acceleration.
Displacement and Velocity: A vibration signal plotted as displacement vs. frequency can be converted
into a plot of velocity vs. frequency by a process of differentiation. Differentiation involves a multiplication
by frequency, and this means the vibration velocity at any frequency is proportional to the displacement
times the frequency. For a given displacement, if the frequency is doubled, the velocity will also double,
and if the frequency is increased tenfold, the velocity is also increased by a factor of ten.
Frequency: A vibrating object moves back and forth from its normal stationary position. A complete cycle
of vibration occurs when the object moves from one extreme position to the other extreme, and back
again. The number of cycles that a vibrating object completes in one second is called frequency. The unit
of frequency is hertz (Hz). One hertz equals one cycle per second.
Amplitude: A vibrating object moves to a certain maximum distance on either side of its stationary
position. Amplitude is the distance from the stationary position to the extreme position on either side and
is measured in metres (m). The intensity of vibration depends on amplitude.
Acceleration: (measure of vibration intensity) The speed of a vibrating object varies from zero to a
maximum during each cycle of vibration. It moves fastest as it passes through its natural stationary
position to an extreme position. The vibrating object slows down as it approaches the extreme, where it
stops and then moves in the opposite direction through the stationary position toward the other extreme.
Speed of vibration is expressed in units of metres per second (m/s).
Acceleration is a measure of how quickly speed changes with time. The measure of acceleration is
expressed in units of (metres per second) per second or metres per second squared (m/s2). The
magnitude of acceleration changes from zero to a maximum during each cycle of vibration. It increases as
vibrating object moves further from its normal stationary position.
Resonance: Every object tends to vibrate at one particular frequency called the natural frequency. The
measure of natural frequency depends on the composition of the object, its size, structure, weight and
shape. If we apply a vibrating force on the object with its frequency equal to the natural frequency, it is a
resonance condition. A vibrating machine transfers the maximum amount of energy to an object when
the machine vibrates at the object's resonant frequency.
• Occupational vibration exposure, with examples of machinery and their typical emission levels
Exposure to hand-arm and whole body vibration is measured in units of acceleration. Acceleration is the
rate of change in speed of an object. The units used are “metres of distance per second per second”.

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The International Organization for Standardization (ISO), the American Conference of Governmental
Industrial Hygienists (ACGIH®), and the European Committee for Standardization (CEN) have developed
standards and threshold limit values (TLVs®), which are considered to be health-based recommended
maximum exposure levels. The ISO standard deals with whole body vibration only, while ACGIH® and CEN
provide limits for both hand-arm and whole body vibration. The standards are fairly complex, and the
measurement of exposure and evaluation of exposures against the standards requires specialized
equipment and expertise.
Certain factors such as the way a tool is used, the characteristics of the tool or equipment, the
environment in which the tool or equipment is used, protective practices used, etc. affect a worker’s
susceptibility to vibration.
Examples of occupational vibration exposure types are given in the table below
Industry Type of Vibration Common Source of Vibration

Agriculture Whole body Tractors
Boiler making Hand-arm Pneumatic tools
Construction Whole body Heavy equipment vehicles
Hand-arm Pneumatic tools, Jackhammers
Diamond cutting Hand-arm Vibrating hand tools
Forestry Whole body Tractors
Hand-arm Chain saws
Foundries Hand-arm Vibrating cleavers
Furniture manufacture Hand-arm Pneumatic chisels
Iron and steel Hand-arm Vibrating hand tools
Machine tools Hand-arm Vibrating hand tools
Mining Whole body Vehicle operation
Hand-arm Rock drills
Rubber Hand-arm Pneumatic stripping tools
Sheet Metal Hand-arm Stamping Equipment
Shipyards Hand-arm Pneumatic hand tools
Shoe-making Hand-arm Pounding machine
Textile Hand-arm Sewing machines, Looms
Transportation Whole body Vehicles
• Comfort levels
For the evaluation of vibration in relation to annoyance and comfort, overall weighted rms acceleration
values of the vibration in each orthogonal axis are preferred (BS 6472). The Control of Vibration at Work
Regulations 2005-UK require to take specific action when the daily vibration exposure reaches a certain
action value.

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The greater the exposure level, the greater the risk and the more action employers will need to take to
reduce the risk. For hand-arm vibration the EAV is a daily exposure of 2.5 m/s2 A. There is also a level of
vibration exposure that must not be exceeded. This is called the exposure limit value.
The exposure limit value (ELV) is the maximum amount of vibration an employee may be exposed to on
any single day. For hand-arm vibration the ELV is a daily exposure of 5 m/s2 A. It represents a high risk
above which employees should not be exposed.
• Concept of equivalent vibration dose
The Control of Vibration at Work Regulations 2005 (the Vibration Regulations) aim to protect workers from risks to
health from vibration. The regulations introduce action and limit values for hand-arm and whole-body vibration.
For hand-arm vibration
The daily exposure limit value is 5 m/s2 A(8)
The daily exposure action value is 2.5 m/s2 A(8)
For whole body vibration
The daily exposure limit value is 1.15 m/s2 A(8)
The daily exposure action value is 0.5 m/s2 A(8)
The daily exposure limit value (ELV) is the

Figure 1: Heavy machinery - source of WBV
maximum amount of vibration an employee
may be exposed to on any single day. The daily exposure action value (EAV) is the level of daily exposure
to vibration above which you are required to take certain actions to reduce exposure.
Useful tools to calculate the vibration dose are given at HSE-UK website
www.hse.gov.uk/vibration/wbv/wbv.xls
www.hse.gov.uk/vibration/hav/hav.xls
The groups of workers at risk and effects of Hand-arm vibration (HAV) & Whole-body
vibration (WBV)
HAV WBV
What is it? HAV is vibration transmitted to the WBV is vibration transmitted to the
hand and arm when using hand-held whole body by the surface supporting
power tools, and hand guided it, for example through a seat or the
machinery like powered lawn-mowers floor.

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and while holding materials being

processed by machines.
Who is at risk? Hand-arm vibration exposure can WBV is commonly experienced by
happen in many different jobs such as:
• Building and maintenance of roads drivers, operators and passengers in
and railways vehicles and machines when travelling
over uneven surfaces. WBV is not
• Construction and demolition
restricted to seated work like driving
• Maintenance of parks and
and may be experienced while
groundskeeping
standing, for example standing on
• Forestry
platforms attached to a concrete
• Foundries
crushing plant.
• Heavy engineering
• Manufacturing concrete products
• Mines and quarries
• Motor vehicle and equipment
Manufacture and repair
• Meat cutting
• Oil well drilling and servicing
• Public utilities (e.g. water, gas,
electricity, telecommunications)
Sources • Chainsaws • Mobile Crane
• Jackhammers • Dump truck
• Concrete and masonry saws • Surface haulage truck
• Hammer drills • Mining vehicles
• Hand-held grinders • Lift truck
• Powered sanders • Skid Steer Loader
• Impact wrenches • Zoom boom
• Riveting tools • Bus
• Chipping tools • Helicopter
• Jigsaws • Fast boat
• Needle scalers • Large fuel-fired electrical
• Pedestal grinders generators
• Polishers • Long haul transport
• Power hammers • Backhoe
• Power chisels • Bulldozer
• Ground tampers / compactors • Excavator
• Snow blowers • Compactor
• Hand-guided soil tillers / • Grader / Scraper
cultivators • Farm tractors and similar vehicles
• Needle guns / needle scalers • Railway vehicles
• Concrete vibrators • Large static production machines
• Concrete finishers used for compaction, hammering,
• Floor sanders punching
• Floor polishers
• Hand-guided road sweepers
• Power washers

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Health effects Regular long-term exposure to The effects of vibration are complex.
excessive HAV can disrupt a person’s How vibration passes through the body
circulation in their hand and forearm, depends on posture. Exposure to WBV
and cause damage to nerves, tendons, may:
muscles, bones and hand and arm
joints. These conditions are collectively • Cause discomfort
known as hand-arm vibration • Reduce performance
syndrome (HAVS) and include: • Cause health effects
• Carpal tunnel syndrome – a • Aggravate pre-existing conditions
disorder of the hand and arm The longer a worker is exposed to WBV
which may involve tingling, the greater the risk of health effects
numbness, pain and weakness in and musculoskeletal disorders. The
parts of the hand. most commonly reported disorder is
lower back pain.
• Musculoskeletal disorders –
• Neck and shoulder problems
muscular and vascular disorders
• Herniated discs, and
like weakness, pain and stiffness in
• Early degeneration of the spine
the joints of the hands and arms
and little or no grip strength. Exposure to WBV may contribute to
other health effects including:
• Vibration white finger (Raynaud’s
phenomenon) – a sudden • Cardiovascular, respiratory,
constriction of the blood vessels neurological, endocrine and
which slows blood flow to the metabolic changes
extremities, most often fingers and • Digestive problems
toes. The skin will change in colour, • Reproductive organ damage in
usually accompanied by both men and women
discomfort like pain, tingling and • Impairment of vision, balance or
numbness. Severe cases can result both
in complete loss of touch sensation
Exposure to WBV may cause
and manipulative dexterity which discomfort, fatigue and other problems
when work activities are being carried
can interfere with work and out.
increase the risk of acute injuries
due to incidents.
• Dupuytrens contracture – fingers
becoming permanently curled
towards the palm and reduced grip
strength.
Workers exposed to vibration while

carrying out manual tasks may also
notice pain in their hands and arms and
reduced muscle strength. Workers
exposed for long periods and over a

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number of years may notice whitening

of the fingers which is usually triggered
by cold temperatures. This is from the
temporary closing down of blood
circulation to fingers. Tingling & loss of
sensation in the fingers, loss of light
touch, pain & cold sensations between
periodic white finger attacks, loss of
grip strength and bone cysts in fingers
& wrists is also reported
Factors Tool characteristics: Working posture, size and proportions
influencing the • Higher vibration emission
effects of of the body, muscle tone, physical
exposure • Poor tool maintenance workload and individual factors like
• Little or no handle insulation age, pre-existing disorders and muscle
force can make the health effects of
• Heavy tools
WBV worse. Operating mobile plant
• Larger surface area of hand in can also strain the back, shoulders and
contact with tool neck which can be caused by:
• Hardness of material being • Prolonged sitting in constrained or
contacted (e.g. metal for grinding) poor postures
• Frequent twisting of the spine
Work organisation:
• Long exposure during each work • Adopting twisted head postures
Shift and over a number of years • Frequent lifting and material
• Short and few rest periods handling e.g. delivery drivers
• Cold temperatures • Traumatic injuries
• Harder material being contacted • Unexpected movements
• Bad postures and working • Cold work temperatures
overhead • Stress
Individual worker characteristics: Factors that can impact on WBV

• Clothing exposure include:
• Seat design, suspension and
• Body size
maintenance
• Posture
• Cab layout, design and orientation
• Body tension
• Task design and work organisation
• Body composition Gripping the
• Lighting and visibility
handle more tightly than needed
• Low operator skill e.g. poor
technique
• Lifestyle factors e.g. smoking
• Medical history e.g. disease or
prior injury to fingers, hands or
wrists

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Vibration parameters
• Frequency, amplitude and
direction of vibration
• Area of the contact surface
between the vibration source with
the hand
• Level of acceleration produced by
the tool (vibration energy)
• Aggravating factors
Exposure to cold aggravates the tactile depression

induced by vibration, because low temperature has a
vasoconstrictive effect on digital circulation and
reduces finger skin temperature. In vibration-exposed
workers who often operate in a cold environment,
repeated episodes of acute impairment of tactile
sensitivity can lead to permanent reduction in sensory
perception and loss of manipulative dexterity, which, in
turn, can interfere with work activity, increasing the risk
for acute injuries due to accidents.
Smoking and exposure to cold, which also constrict the
HAV source
small blood vessels, may trigger or aggravate the
symptoms of hand–arm vibration syndrome.
Example: Young males, many of whom smoke cigarettes, working outside in winter, using
jackhammers in road construction have multiple risk factors predisposing them to HAVS. Similarly,
forestry workers using chainsaws outside in cold conditions are very susceptible to HAVS.
• Use of the Stockholm scale to indicate severity
The Stockholm scale is often used to grade severity. Any employee diagnosed as suffering from HAVS
will need to receive advice from the doctor about their medical condition and the likelihood of disease
progression with continued exposure. The advice will vary according to the severity of the disease.
Raynaud’s phenomenon is the most common health effect from hand-arm vibration. The small blood
vessels of the hand narrow, reducing blood flow through the hands and fingers. The fingers become
white, cold and numb. This effect can last for minutes or up to an hour after exposure to vibration.

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Raynaud’s phenomenon can range from mild to very severe. HAVS is classified according to severity
in stages using the Stockholm Workshop scales.
Stockholm Scale for the Classification of Cold-Induced Raynaud’s Phenomenon in Hand-Arm

Vibration Syndrome
Stage Symptom Description

severity
0 None No Symptoms
1 Mild Occasional attacks affecting only the tips of one or more fingers
2 Moderate Occasional attacks affecting distal and middle (rarely also

proximal) bones of one or more fingers
3 Severe Frequent attacks affecting all bones of most fingers
4 Very severe As in stage 3, with skin changes in the fingertips
In very serious cases, permanent damage can affect blood flow to the worker’s fingers. The fingers
may turn a dark and blue-black colour, develop open sores, and even become gangrenous.
Other conditions from hand-arm vibration exposure include blood clotting in the arteries of the arm
and fingers (ulnar artery thrombosis and digital artery thrombosis). In each case, a clot forms in the
artery, blocking blood flow. Symptoms of artery thrombosis depend on the degree of blood flow
obstruction caused by the clot. Where the clot is small and causes insignificant blood flow reduction,
there may be no symptoms at all. As clot size and degree of blood flow obstruction increases,
symptoms become more severe, and can include whiteness of the skin, coldness, numbness, pain,
weakness, and loss of function.
Hand-arm vibration syndrome can also affect the nerves of the hands and arms. Affected workers
sense tingling and numbness in their fingers and hands, their sense of touch and temperature may be
reduced, and their manual dexterity may be affected. Symptoms have been categorized as shown in
Table below:
Stockholm Scale for Classification of Cold-Induced Raynaud’s Phenomenon in Hand-Arm

Vibration Syndrome
Stage Description
0 Exposed to vibration but no symptoms

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1 Intermittent alternating periods of numbness, with or without tingling
2 Intermittent alternating periods of or persistent numbness, lessened touch

sensation
3 Intermittent alternating periods of or persistent numbness, lessened touch

sensation, and/or ability to move the hands and fingers
The use of vibration calculators to determine mixed exposures

• To comply with Control of Vibration at Work Regulations 2005, HSE has produced a calculator to assist
in calculating exposures for hand-arm vibration. This calculator is available at
http://www.hse.gov.uk/vibration/hav/vibrationcalc.htm
Another Vibration Calculator is used to calculate the risk of WBV (Whole Body Vibration) in the
workplace. It calculates the daily vibration exposure that an employee is subjected to allowing the
employee to analyse the risk and an employer to meet health and safety requirements. This can be
taken from http://www.hse.gov.uk/vibration/wbv/calculator.htm
Vibration risk assessment and planning for control

The Vibration Regulations require that you make a ‘suitable and sufficient’ assessment of the risks from
vibration. This risk assessment should identify the measures that need to be taken to meet the
requirements of the regulations. You should keep a record of your risk assessment. The exact content of
a record of a suitable and sufficient assessment will change according to the circumstances but will
contain the date of the assessment, who made the assessment, and will usually include at least:
(a) the employee or job roles assessed: (i) the tasks, operations and processes; (ii) a description of the
power tools, machines, workpieces, method of working etc; (iii) the regularity and frequency of
exposure to vibration and, if the exposure patterns change, how they change over weeks, months and
longer; (iv) any information, e.g. from (anonymised) health surveillance results, associating the task with
HAVS;
(b) the likelihood of the exposure action and limit values being exceeded: (i) the likely vibration
magnitudes (levels) and sources of this information (manufacturers’ information, databases, your own
measurements, consultants’ advice etc); (ii) estimates of daily exposure duration associated with each
vibration magnitude (iii) the people whose daily vibration exposures are likely to reach or exceed the
EAV and/or exceed the ELV; (iv) the duties arising under regulations 6, 7 and 8 (requirements for
reduction of risk and exposure, health surveillance, information and training etc);
(c) the measures you have put in place to control and manage the risk: (i) the steps, if any, to ensure
exposure remains below the ELV; (ii) the factors that prevent further reasonably practicable reductions
in exposure;

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(d) a programme of measures, with timescales, for any future controls you plan to introduce: (i)
identification of the measures likely to reduce exposure to vibration, and the resources that would be
required (see guidance on regulation 6); (ii) any further information necessary to help you comply with
your duties to reduce exposure and control risk; (iii) persons (eg managers, supervisors and operators)
for carrying out the items of work described in the action plan; (iv) timetables for implementation of the
work items in the action plan;
(e) the appropriate information, instruction and training to be provided to employees (see paragraphs
79–84);
(f) the scheme of health surveillance in use or planned: (i) any susceptibility identified in your
employees; (ii) persons (e.g. managers, supervisors) for reviewing (anonymized) health surveillance data
and assessing the implications for the current and planned control measures.
Whole Body Vibration:
Five steps to vibration risk assessment:
You will need to take five basic steps in assessing the risks from WBV in the workplace:
Step 1 Look to see whether there is likely to be a WBV hazard
Step 2 Identify all workers likely to be exposed to the hazard
Step 3 Evaluate the risks arising from the hazard – estimate the vibration exposures to help you decide
what further action is appropriate to comply with regulations
Step 4 Record the findings
Step 5 Review the assessment and revise it if necessary
Practical control measures to prevent or minimise exposure

This regulation means you have to take action to prevent risk from vibration exposure completely
wherever it is reasonably practicable to do so (regulation 6(1)). You will need to consider whether there
are alternative processes, machines and/or working methods which would largely eliminate exposure to
vibration, in particular vibration containing large shocks and jolts. If it is not reasonably practicable to
eliminate the risks completely, you should reduce them to as low a level as is reasonably practicable
(regulation 6(1)). You should:
(a) introduce a formal programme of control measures whenever your employees’ daily exposure to
vibration is likely to exceed the exposure action value (regulation 6(2)). Your programme of controls
should be proportionate to the degree of risk;
(b) not expose your employees above the exposure limit value (regulation 6(4)).
“Establishing and implementing a programme of organisational and technical measures”

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The action plan produced during your vibration risk assessment should describe a programme of control
measures, and your plans to put it into action with realistic timescales. Risk are likely to be low for
exposures at or just above the exposure action value and since your controls should be proportionate to
risk, little (if any) action is likely to be required in these circumstances. Higher exposures, particularly
those closer to the exposure limit value and where the vibration includes large shocks and jolts, will
need proportionately more control action. The programme of control measures should be devised to
reduce the risks from vibration exposure to as low a level as is reasonably practicable. The actions you
take will depend on the particular work activities and processes and the possibilities for control.
Some controls may take time to put in place, particularly where machines must be replaced or new
industrial processes developed. Your programme of controls is likely to include several different actions
and may be planned for implementation over several months or even years. The action plan should also
state clearly which managers, supervisors and employees have responsibility for delivering the various
parts of the plan and by when. It should also include provisions for testing the effectiveness of control
measures.
“The general principles of prevention”
Schedule 1 to the Management of Health and Safety at Work Regulations lists the general principles of
prevention:
(a) avoiding risks;
(b) evaluating the risks which cannot be avoided;
(c) combating the risks at source;
(d) adapting the work to the individual, especially as regards the design of workplaces, the choice of
work equipment and the choice of working and production methods, with a view, in particular, to
alleviating monotonous work and work at a predetermined work-rate and to reducing their effect on
health; (e) adapting to technical progress;
(f) replacing the dangerous by the non-dangerous or the less dangerous;
(g) developing 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;
(h) giving collective protective measures priority over individual protective measures;
(i) giving appropriate instructions to employees
The list of possible control measures in regulation 6(3) is specific to vibration but follows similar
principles.
“Other working methods which eliminate or reduce exposure”

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There are few examples of other methods of work that eliminate or reduce exposure to WBV. It is
possible in some cases to minimize the transport of goods or materials or to replace manned with
unmanned machines such as remotely controlled conveyors.
“Choice of work equipment of appropriate ergonomic design”
The choice of machine can be an important means of reducing exposure to vibration, though the
difference in vibration emissions of directly competing machines can be small. However, equipment
selected must be suitable for the job and the efficiency of the machine should be taken into account
when evaluating the likely effect on exposure.
“The provision of auxiliary equipment”
There are few items of auxiliary equipment that can reduce risks from WBV. They are largely limited to
the choice of seat (including suspension seats) and the choice of tyres.
“Appropriate maintenance programmes”
Suspensions are prone to wear and will need regular servicing. Components such as suspension seats
will usually wear out several times during the life of a machine. Maintenance of unmade roads and
ground conditions throughout sites to suit the machines that use them will greatly reduce shocks and
jolts.
“The design and layout of workplaces”
The choice of machine should take account of ergonomic factors that influence the risk of back pain and
other health complaints. For example: (a) visibility should be such that the machine can be operated
without stretching and twisting to observe the work, especially when simultaneously exposed to WBV;
(b) it should be easy to get in and out of the machine by using handholds and footholds so that the
temptation to climb or jump is minimized; (c) access to manually loaded areas should be unimpeded by
the machinery structure and involve minimal lifting; (d) if the machine cab is the sole workplace of the
machine operator, including break time, it should have sufficient space and facilities for rest periods.
The design and layout of workplace sites can reduce the need to transport materials, and so reduce the
WBV exposure of transport machinery operators
9.13 Radiation
The distinction between ionising and non-ionising radiation
Ionising radiation Non-ionising radiation
Has more energy than non ionising radiation; Found at the long wavelength end of the
enough to cause chemical changes by breaking spectrum and may have enough energy to excite
chemical bonds. This effect can cause damage to molecules and atoms causing then to vibrate
living tissue. faster. This is very obvious in a microwave oven
Shorter wavelength ultraviolet radiation begins where the radiation causes water molecules to
to have enough energy to break chemical vibrate faster creating heat.
bonds. X-ray and gamma ray radiation, which

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are at the upper end of electromagnetic Non ionising radiation ranges from extremely
spectrum, have very high frequencies and very low frequency radiation, shown on the far left
short wavelengths. Radiation in this range has through the radiofrequency, microwave, and
extremely high energy. It has enough energy to visible portions of the spectrum into the
strip electrons from an atom or, in the case of ultraviolet range.
very high-energy radiation, break up the nucleus
of the atom. Extremely low-frequency radiation has very long
wavelengths (in the order of a thousand
The process in which an electron is given enough kilometres or more) and frequencies in the
energy to break away from an atom is range of 100 hertz or less. Radiofrequencies
called ionisation. This process results in the have wavelengths of between 1 and 100 metres
formation of two charged particles or ions: the and frequencies in the range of 1 million to 100
molecule with a net positive charge, and the free million hertz. Microwaves that we use to heat
electron with a negative charge. food have wavelengths that are about 1
hundredth of a metre long and have frequencies
Each ionisation releases energy which is of about 10 billion hertz.
absorbed by material surrounding the ionised
atom. Compared to other types of radiation that
may be absorbed, ionising radiation deposits a
large amount of energy into a small area. In fact,
the energy from one ionisation is more than
enough energy to disrupt the chemical bond
between two carbon atoms. All ionising
radiation is capable, directly or indirectly, of
removing electrons from most molecules.
There are three main kinds of ionising radiation:

• Alpha particles, which include two protons
and two neutrons;
• Beta particles, which are essentially
electrons; and
• Gamma rays and x-rays, which are pure
energy (photons).
Alpha particles and beta particles are not part of
the electromagnetic spectrum; they are
energetic particles as opposed to pure energy
bundles (photons).
The electromagnetic spectrum

Light waves and other types of energy that radiate (travel out) from where they're produced are
called electromagnetic radiation. Together, they make up what's known as the electromagnetic spectrum.
Our eyes can see only a limited part of the electromagnetic spectrum—the colorful rainbow we see on
sunny-rainy days, which is an incredibly tiny part of all the electromagnetic radiation that zaps through
our world. We call the energy we can see visible light and, like radio waves, microwaves, and all the rest,
it's made up of electromagnetic waves. These are up-and-down, wave-shaped patterns of

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electricity and magnetism that race along at right angles to one another, at the speed of light (300,000
km per second or 186,000 miles per second, which is fast enough to go 400 times round the world in a
minute!). The light we can see stretches in a spectrum from red (the lowest frequency and longest
wavelength of light our eyes can register) through orange, yellow, green, blue, and indigo to violet (the
highest frequency and shortest wavelength we can see)
Following types of radiation are in electromagnetic spectrum ranged in order from the longest wavelength
to the shortest. Note that these are not really definite bands with hard edges: they blur into one another
with some overlap between them.

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• Gamma rays: Gamma rays have the

smallest wavelengths and the most
energy of any wave in the
electromagnetic spectrum. They
are produced by the hottest and
most energetic objects in the
universe, such as neutron stars and
pulsars, supernova explosions, and
regions around black holes. On
Earth, gamma waves are generated
by nuclear explosions, lightning,
and the less dramatic activity of
radioactive decay. Gamma rays
ionize atoms (they are ionizing
radiation), and are thus biologically
hazardous.
Unlike optical light and x-rays,

gamma rays cannot be captured
and reflected by mirrors. Gamma-
ray wavelengths are so short that
they can pass through the space
within the atoms of a detector.
• Radio waves: If our eyes could
see radio waves, we could (in
theory) watch TV programs just by
staring at the sky! Well not really,
but it's a nice idea. Typical size:
30cm–500m. Radio waves cover a
huge band of frequencies, and their
wavelengths vary from tens of
centimeters for high-frequency
waves to hundreds of meters for
lower-frequency ones. That's
simply because any
electromagnetic wave longer than a
microwave is called a radio wave.
• Microwaves: Obviously used for
cooking in microwave ovens, but
also for transmitting information
in radar equipment. Microwaves Electromagnetic spectrum
are like short-wavelength radio
waves. Typical size: 15cm (the length of a pencil).
• Infrared: Just beyond the reddest light we can see, with a slightly shorter frequency, there's a kind
of invisible "hot light" called infrared. Although we can't see it, we can feel it warming our skin

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when it hits our face—it's what we think of as radiated heat. If, like rattlesnakes, we could see
infrared radiation, it would be a bit like having night-vision lenses built into our heads. Typical
size: 0.01mm (the length of a cell).
• Visible light: The light we can actually see is just a tiny slice in the middle of the spectrum.
• Ultraviolet: This is a kind of blue-ish light just beyond the highest-frequency violet light our eyes
can detect. The Sun transmits powerful ultraviolet radiation that we can't see that's why you can
get sunburned even when you're swimming in the sea or on cloudy days—and why sunscreen is
so important. Typical size: 500 nanometers (the width of a typical bacteria).
• X rays: A very useful type of high-energy wave widely used in medicine and security. Typical size:
0.1 nanometers (the width of an atom).
Radio waves have the lowest frequencies and longest wavelengths, while gamma waves have the highest
frequencies and shortest wavelengths. All of these waves travel at the same speed in free space, which is
the speed of light or about 300,000,000 m/s (metres per second)
Electromagnetic radiation Uses
Radiowaves broadcasting
communications
satellite transmissions
Microwaves cooking
communications
satellite transmissions
Infrared cooking
thermal imaging
short range communications
optical fibres
television remote controls
security systems
Visible light vision
photography
illumination
Ultraviolet security marking
fluorescent lamps
detecting forged bank notes
disinfecting water
X-rays observing the internal structure of objects
airport security scanners
medical X-rays
Gamma rays sterilising food and medical equipment
detection of cancer and its treatment

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A wave has a trough (lowest point) and a crest (highest point). The vertical distance between the tip of a
crest and the wave’s central axis is known as its amplitude. This is the property associated with the
brightness, or intensity, of the wave. The horizontal distance between two consecutive troughs or crests
is known as the wavelength of the wave. These lengths can be visualized as follows:
Electromagnetic waves are characterized by a set of parameters that include frequency (f), wavelength
(λ), electric field strength, magnetic field strength, electric polarization (P) (the direction of the E field),
velocity of propagation (c) and Poynting vector (S). The frequency is defined as the number of complete
changes of the electric or magnetic field at a given point per second, and is expressed in hertz (Hz). The
wavelength is the distance between two consecutive crests or troughs of the wave (maxima or minima).
The frequency, wavelength and wave velocity (v) are interrelated as follows:
v = fλ
The velocity of an electromagnetic wave in free space is equal to the velocity of light, but the velocity in
materials depends on the electrical properties of the material—that is, on its permittivity (ε) and
permeability (µ). The permittivity concerns the material interactions with the electric field, and the
permeability expresses the interactions with the magnetic field.
Electromagnetic waves can bring energy into a system by virtue of their electric and magnetic fields. These
fields can exert forces and move charges in the system and, thus, do work on them. If the frequency of
the electromagnetic wave is the same as the natural frequencies of the system (such as microwaves at
the resonant frequency of water molecules), the transfer of energy is much more efficient.
But there is energy in an electromagnetic wave, whether it is absorbed or not. Once created, the fields
carry energy away from a source. If absorbed, the field strengths are diminished and anything left travels
on. Clearly, the larger the strength of the electric and magnetic fields, the more work they can do and the
greater the energy the electromagnetic wave carries.
A wave’s energy is proportional to its amplitude squared. This is true for waves on guitar strings, for water
waves, and for sound waves, where amplitude is proportional to pressure. In electromagnetic waves, the
amplitude is the maximum field strength of the electric and magnetic fields.

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Particulate radiation properties

In summary, the most common types of radiation include alpha particles, beta particles, gamma and x-
rays, and neutrons. Alpha particles are heavy and doubly charged which cause them to lose their energy
very quickly in matter. They can be shielded by a sheet of paper or the surface layer of our skin. Alpha
particles are only considered hazardous to a persons health if an alpha emitting material is ingested or
inhaled. Beta and positron particles are much smaller and only have one charge, which cause them to
interact more slowly with material. They are effectively shielded by thin layers of metal or plastic and are
again only considered hazardous if a beta emitter is ingested or inhaled.
Gamma emitters are associated with alpha, beta, and positron decay. X-Rays are produced either when
electrons change orbits within an atom, or electrons from an external source are deflected around the
nucleus of an atom. Both are forms of high energy electromagnetic radiation which interact lightly with
matter. X-rays and gamma rays are best shielded by thick layers of lead or other dense material and are
hazardous to people when they are external to the body.
Neutrons are neutral particles with approximately the same mass as a proton. Because they are neutral
they react only weakly with material. They are an external hazard best shielded by thick layers of concrete.
Neutron radiation will be discussed in more detail in the discussion of nuclear power.
Type of Nature of the Penetrating power Ionising power - the Uses

radiation radiation (and speed), and ability to remove
emitted & what will block electrons from
symbol formation, it (more dense atoms to form
structure, material, more positive ions, the
relative mass, radiation is process is
electric charge absorbed BUT called ionisation
smaller mass or
charge of particle,
more penetrating)
a helium Low penetration, Very high ionising Alpha

nucleus of 2 slowest speed (but power, the biggest particles are
protons and 2 still ~10% speed of mass and charge of most
Alpha neutrons, mass = light!), biggest the three commonly
particle 4, charge = +2, is mass and charge, radiation's, the used in smoke
radiation expelled at high stopped by a few biggest 'punch' in alarms. These
speed from the cm of air or thin ripping off electrons alarms
nucleus sheet of paper from molecules, contain a tiny
other ions are amount of
formed decaying
Americium
between two
sheets of

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metal. The
decaying
Americium
emits alpha
radiation. A
small electric
current is
then passed
through one
of the sheets
and into the
second one.
When the
field of alpha
radiation is
blocked by
smoke, the
alarm goes
off. This alpha
radiation is
not harmful
because it is
very localised
and any
radiation that
might escape
would be
stopped
quickly in the
air and would
be extremely
difficult to get
into your
body.
e– high kinetic Moderate Moderate ionising

beta energy penetration (~90% power, with
minus electrons, mass speed of a smaller mass and
= 1/1850, charge light), 'middle' charge than the

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particle = -1, expelled values of charge alpha particle, but

radiation when a neutron and mass, most still quite good at
changes to a stopped by a few knocking off
proton in the mm of metals like electrons from
nucleus aluminium, will molecules -
travel quite a few moderate ionisation
metre in air
high KE positive Theoretically as Theoretically as Beta radiation

electron called above, BUT, the above, BUT when is mainly used
e+beta a positron, mass positron is electron meets in industrial
plus = 1/1850, charge the antiparticle of positron, actually processes
particle = +1, expelled the electron. it is called annihilation! such as paper
emission when a proton identical to an mills and
changes to a electron but aluminium foil
neutron in the opposite in charge. production. A
nucleus. Destroyed when it beta radiation
meets an electron source is
(see on right) placed above
producing two the sheets
high energy coming out of
gamma ray the machines
photons, so it while a Geiger
doesn't get very counter, or
far. radiation
reader, is
placed
underneath.
The purpose
of this is to
test the
thickness of
the sheets.
Because the
beta radiation
can only
partially
penetrate
aluminium
foil, if the

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readings on
the Geiger
counter are
too low, it
means that
the aluminium
foil is too
thick and that
the presses
are adjusted
to make the
sheets
thinner.
Likewise, if
the Geiger
reading is too
high, the
presses are
adjusted to
make the
sheets thicker.
very high Very highly The lowest ionising Gamma rays

frequency penetrating (100% power of the three, are the most
electromagnetic speed of light !), gamma radiation useful type of
Gamma radiation, mass smallest mass and carries no electric radiation
radiation = 0, charge = 0, charge and charge and has because they
gamma emission greatest speed, virtually no mass, so can kill off
often most stopped by a not much of a living cells
accompanies thick layer of steel 'punch' when easily,
alpha and beta or a very thick colliding with an without
decay layer of concrete, atom to remove an lingering
but even a few cm electron, weak there. They
of dense lead ionisation are therefore
doesn't stop all of often used to
it! gamma rays can fight cancer
pass through many and to
m of air. sterilise food,
and kinds of
medical

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equipment
that would
either melt or
become
compromised
by bleaches
and other
disinfectants.
Gamma rays
are also used
to detect
leaking pipes.
In those
situations, a
gamma ray
source is
placed into
the substance
flowing
through the
pipe. Then,
someone with
a Geiger-
Muller tube
above-ground
will measure
the radiation
given off. The
leak will be
identified
wherever the
count on the
Geiger-Muller
tube spikes,
indicating a
large
presence of
gamma
radiation

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coming out of
the pipes
Neutron neutron, mass = Highly Can't ionise

radiation 1, charge = 0, penetrating (more directly, but they
fundamental than alpha & beta are absorbed by the
particle of the & sometimes nuclei of atoms
nucleus gamma). However, they pass through.
neutrons are most This can make the
readily absorbed atom unstable -
by light nuclei so radioactive, hence
hydrogen-rich other nuclear
materials like radiations may then
water, be produced,
poly(ethene) producing an
plastic and 'indirect ionisation'
concrete are used effect. So neutron
for neutron radiation is as
radiation shielding. dangerous as any of
The nuclei formed the others.
often emit gamma
radiation so an
extra thick
protective layer of
lead is needed
around a neutron
rich environment !
Non-ionising radiation
Sources of non-ionising radiation
Non-Ionizing radiation originates from various sources:
Natural origin: (such as sunlight or lightning discharges etc.) and man-made (seen in wireless
communications, industrial, scientific and medical applications). The NIR spectrum is divided into two
main regions: optical radiations and electromagnetic fields.

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Optical radiations: The optical radiations are centered around visible light; those with higher energies are
termed UV radiation and those with lower energies IR radiation. Sources of UV radiation are the sun, arc
welding, oxy-gas welding, sun lamps, lasers (UV), sterilization (germicidal) lamps, low pressure gas
discharge lamps, high pressure discharge lamps. Sources of IR radiation are from hot processes such as
steelmaking, glassmaking, welding, and also lasers (IR). The application of laser as a coherent light source
is increasing rapidly. Medical applications include UV and neonatal phototherapy, surgical and therapy
lasers, physiotherapy heat lamps
Electromagnetic fields: Microwaves are used in telecommunications, radar/satellite links, mobile phones,
microwave ovens, TV transmitters. RF is used in radio communications, visual display units, television sets.
Extremely low-frequency (ELF) electric and magnetic fields (EMFs) surround electrical machinery, home
appliances, electric wiring, and high-voltage electrical transmission lines and transformers. Medical
applications include: microwave hyperthermia, therapeutic and surgical diathermy, and magnetic
resonance imaging (MRI).
Workers may be exposed to high magnetic fields if they work near electrical systems that use large
amounts of electric power (e.g. large electric motors, general motors, generators, or the power supply or
electric cables of a building). High magnetic fields are also found near power saws, drills, copy machines,
electric pencil sharpeners, and other small electric appliances. The strength of the magnetic field depends
on equipment design and current flow, not on equipment size, complexity or voltage.
Workers exposed to sources of EMR above normal levels include those in the power industry,
telecommunications, offices and the construction and metal industries.
Leisure industry: Curing with UV (e.g. inks, coatings on floor & wall coverings, timber panels, fibre optics,
etc), Lasers, Spotlights
Manufacturing: UV sources in photocopiers and laser printers, Lasers, Welding, Infrared is a component
of radiant heat, therefore a factor in foundries & smelters, Molten glass, Infrared lamps, Dielectric heaters
for plastic sealing, glue curing, particle & panel board production, Induction heaters for hardening,
tempering, forging, etc
Healthcare: UV sources in photocopiers and laser printers, Lasers
Telecommunications: TV, FM radio & radar transmitters, Mobile communications (phones, CB radios,
walkie talkies), Power lines & cables, airport millimeter scanners, motion detectors, long-distance
telecommunications, radar, Wi-Fi

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Ultraviolet (UV) Radiofrequency Fields

• The sun - meaning those who work
outdoors are at risk of exposure Used mainly as a source of heat or in the
• Curing with UV (e.g. inks, coatings on communications industry:
floor & wall coverings, timber panels,
fibre optics, etc.) • TV, FM radio & radar transmitters
• UV sources in photocopiers and laser • Mobile communications (phones, CB
printers radios, walkie talkies)
• Lasers • Dielectric heaters for plastic sealing,
• Black lights glue curing, particle & panel board
• Welding production.
• Germicidal lamps • Induction heaters for hardening,
UV radiation reflects off water, sand, snow, tempering, forging, etc.
concrete or any light-coloured surface. It also • Microwave ovens
increases in intensity with altitude • Plastic welders
Infrared Visible light
• Infrared is a component of radiant heat, • Lasers

therefore a factor in foundries & • Spotlights
smelters. • welding arcs
• Lasers
• Molten glass
• Infrared lamps
• The sun
Routes and effects of exposure
Exposure to EMR can result in a number of adverse health effects. The frequency of the waves, as well as
the strength of the fields may all be important factors in determining the effects on health. Some health
effects have been well researched and are well established, while others are not.
The energy absorbed by body tissue is responsible for damage done. Generally, high energy radiation (UV
and visible light) is absorbed only by the outer layers of the body, while low energy radiation (infrared and
microwaves) is absorbed by deep body tissues.
Ultraviolet (UV) Radiofrequency

Eyes:
• Welder's flash or arc eye: inflammation There are two main health effects: Thermal and
of superficial membranes, cornea and Non-thermal.
eyelids ("sunburn" of the eyes). The
condition is caused by exposure to Thermal:
intense UV radiation, affecting welders,
for example.

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• Snow blindness: burn to eye caused by An increase of more than 6ºC body's
sunlight reflected from white surfaces. temperature can lead to death. Lower increases
• Cataracts: clouding of the eye lens. can cause heat stroke, brain damage, infertility
clouding of the eye lens. in men and birth defects. Other possible thermal
• Photokeratitis and photo conjunctivitis: effects are cataracts and localised burns.
These are acute inflammatory reactions
resulting from exposure to UVB and UVC Non-thermal:
radiation which appear within a few
hours of excessive exposure and The non-thermal effects of RF Fields are not well
normally resolved after one to two days. understood, but headaches, eye strain, fatigue,
• Retinal injury from bright light: Although loss of appetite, sleep disturbance have been
thermal injury to the retina from light reported. More studies are being undertaken as
sources is unlikely, photochemical there is a lack of sufficient evidence (for example
damage can occur from exposure to studies on the effects of mobile phones).
sources rich in blue light. This can result However, given the proliferation of RF Fields,
in temporary or permanent reduction in there is cause for concern. A number of animal
vision. However the normal aversion studies have indicated that RF fields cause
response to bright light should prevent changes in cells.
this occurrence unless a conscious effort
is made to stare at bright light sources. RF fields can also be a safety hazard, as those
The contribution of UVR to retinal injury lower than 100MHz can charge metal and poorly
is generally very small because grounded objects, including people. The
absorption by the lens limits retinal potential effects include shock, activation of
exposure devices, ignition of flammable substances, and
interference with electronic equipment.
• Pterygia: a growth on the surface of the
eye.
Skin:
• Sunburn, with blistering and swelling if
severe
• Sun spots, which can turn into cancers
• Basal cell carcinomas: the most common
type of skin cancer (small, round
flattened bumps)
• Melanomas: the most dangerous skin
cancer which if not detected early can
be fatal.
• Erythema: Erythema, or “sunburn”, is a
reddening of the skin that normally
appears in four to eight hours after
exposure to UVR and gradually fades
after a few days. Severe sunburn can
involve blistering and peeling of the skin.
• Photosensitization: The use of certain
medicines may produce a
photosensitizing effect on exposure to

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UVA, as may the topical application of

certain products, including some
perfumes, body lotions and so on.
Reactions to photosensitizing agents
involve both photoallergy (allergic
reaction of the skin) and phototoxicity
(irritation of the skin) after UVR
exposure from sunlight or industrial UVR
sources. (Photosensitivity reactions
during the use of tanning equipment are
also common.) This photosensitization
of the skin may be caused by creams or
ointments applied to the skin, by
medications taken orally or by injection,
or by the use of prescription inhalers
Visible light Infrared
Visible light is not normally a problem, but • Burns to the eye, including the retina.
where intense (e.g. in lasers) can potentially • Cataracts.
cause damage to the cornea and retina of the • Heating of body tissues.
eye. It can also cause cataracts. Another effect is • Skin burns
that pulsing or stroboscopic light can cause fits
in susceptible people.
Radiation risk assessment to consider

While carrying out the risk assessment, following factors must be considered
• Sources of non-ionising radiation both natural origin (such as sunlight or lightning discharges
etc.) and man-made (seen in wireless communications, industrial, scientific and medical
applications).
• The comparison of measured exposure levels with exposure limits and values
• The potential for misuse or misunderstanding of safety precautions
Control measures to prevent or minimise the exposure

The best way to reduce the risk of exposure to non-ionizing radiation is to eliminate the source of
exposure. If that's not possible, there are other risk controls to use which will be identified in your
exposure control plan. To protect workers from discreet sources, creating distance between them and the
source of the non-iodizing radiation is often effective. As the worker moves away, exposure quickly
decreases. If the source is not from a specific location or increasing the distance from the source is not
possible, shielding might be appropriate.

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Design
Workplaces contain many potential sources of microwave/RF radiation exposure. Some of these sources
(primarily antennas) are designed to emit microwave/RF radiation into the environment. Other types of
sources (co-axial cables, waveguides, transmission generators, heaters, and ovens) are designed to
produce or safely contain the microwave/RF radiation, but may present a hazard should they leak for
some reason. A third type of source (primarily power supplies) may create microwave/RF radiation as a
byproduct of their operation.
The hazards from exposure to microwave/RF radiation are related to the following parameters:
• Frequency of the source

• Power density at the point of exposure
• Accessibility to the radiation field
• Does the exposure occur in the near or far field
• Orientation of the human body to the radiation field
Equipment must be designed and maintained so as to meet safety standards. Enclosures with proper
grounding and safety markings are required for all electronics.
Enclosures
To reduce the control measures required and the potential hazard from a NIR source, a complete
enclosure of the NIR source shall be used when feasible. A closed installation (any location where NIR are
used will be closed to transient personnel during operation) provides the next most desirable hazard
control measure. For example, specific control measures to reduce the possibility of exposure of the eye
and skin to hazardous laser radiation and to other hazards associated with the operation of those devices
are outlined in the "American National Standard for the Safe Use of Lasers" (ANSI Z136.1-2007).
Siting
Magnetic fields drop off dramatically within about a metre of the source, so the design and placement
of work stations can be in such a way as to reduce worker exposure.
Direction control
Can be achieved by for example placing reflective objects between sources of IR radiation and workers.
For lasers and other visible light sources, optical systems (mirrors, lenses) should be aligned so those
primary or reflective beams cannot enter the eye directly.
Reduction of stray fields/beams
Many people are similarly exposed above these levels, though for shorter periods, at work (in certain
industries and offices involving proximity to electric and electronic equipment) or while travelling in trains

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and other electrically driven conveyances. There are uncertainties as to exposure (involving questions
relating to the importance of field frequency, to other modifying or confounding factors, or to knowledge
of the total exposure day and night) and effect (given the consistency in findings as to type of cancer), and
in the epidemiological studies, which make it necessary to evaluate all risk assessments with great caution.
The manually operated older appliances in the workplaces are frequently more problematic than the new
automatic appliances where the operator can control the device remotely. For example, microwave ovens
are nowadays of little concern because as a rule the heating process is well shielded and the units have to
meet product standards.
Engineering controls
Making physical modifications to facilities, equipment, and processes can reduce exposure. Some
questions to consider:
• Can guards or barriers be used to restrict access to high exposure areas?
• Can antennas be raised so they are above the working level of the roof?
• Can shields be erected to eliminate nearby workers from exposure?
This is the main way of reducing exposure to non-ionising radiation exposure. The main types of
engineering controls include the use of filters, screens, enclosures, protective housings, shutters, key and
password access controls for equipment, emergency stop controls, remote viewing, specialist curtains,
safety interlock systems, clamping of work pieces, dedicated room, remote controls and time delays
Increase distance between workers and a radiation source. Decrease the amount of time spent near a
radiation source. The greater the shielding around a radiation source, the smaller the exposure…The
amount of shielding required to protect against different kinds of radiation depends on how much energy
they have.
Alpha: A thin piece of light material, such as paper, or even the dead cells in the outer layer of human skin
provides adequate shielding because alpha particles can’t penetrate it. However, living tissue inside body
offers no protection against inhaled or ingested alpha emitters.
Beta: Additional covering, e.g. heavy clothing, is necessary to protect against beta-emitters. Some beta
particles can penetrate and burn the skin.
Gamma: Thick, dense shielding, such as lead, is necessary to protect against gamma rays. The higher the
energy of the gamma ray, the thicker the lead must be.
Time, distance and screening

Shortening the time of exposure, increasing distance from a radiation source and shielding are the basic
countermeasures (or protective measures) to reduce doses from external exposure.
• Time: The less time that people are exposed to a radiation source, the less the absorbed
dose
• Distance: The farther away that people are from a radiation source, the less the absorbed
dose.
• Screening/Shielding: Use of shade structures and awnings made from material offering
sufficient protection against UVR from the sun and enclosures for Arc welding process.

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To reduce doses from intake of radioactive substances, the following basic countermeasures can be
considered:
• Shortening time of exposure to contaminants
• Preventing surface contamination
• Preventing inhalation of radioactive materials in air
• Preventing ingestion of contaminated foodstuffs and drinking water.
Safe systems of work

Changing work practices and work policies, and using awareness tools, and training, can limit the risk of
non-ionizing radiation exposure. Some questions to consider:
• Can the equipment be turned off to do work around it?
• Is access to communication and data transmitting equipment secured or restricted?
• Can warning signs be posted to indicate high radiation areas?
• Can the amount of time workers spend near the antenna be limited?
• Can a notification system be set up to alert contractors when an antenna is present?
• Is a UV protection program in place?
Instructions and training
The requirement for information, instruction, training and supervision applies to all people who could be
exposed to non-ionising radiation. However, different categories of people (for example, laser workers,
managers, cleaning and maintenance staff etc.) will require different levels of IITS depending on their
activities, the levels of risk involved, their past training and their roles.
IITS should be appropriate to the nature of the work and the needs of the individual and in most cases will
consist of core training, along with departmental training in arrangements and procedures. Employees
must receive training covering at least following topics
• Location of sources and potentially hazardous areas.

• Health effects and safety standards.
• Extent of exposures compared to standards and common sources.
• Required SOP's and controls.
• Emergency procedures.
• How to know when things are "abnormal".
• Optional controls employees may use
Personal protective equipment
This is the least preferred control. It must always be used in addition to at least one other control. Some questions
to consider:
• Do workers have the proper eyewear and protective clothing?

• Has personal protective equipment been verified to ensure it is working properly?
• Is sunscreen provided?

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The benefits of UV radiation:
The sun's rays provide warmth and light that enhance your general feeling of well-being and stimulate
blood circulation. Some UV radiation is essential to the body as it stimulates the production of vitamin D.
Vitamin D has an important function in increasing calcium and phosphorus absorption from food and plays
a crucial role in skeletal development, immune function and blood cell formation. There is no doubt that
a little sunlight is good for you! But 5 to 15 minutes of casual sun exposure of hands, face and arms two
to three times a week during the summer months is sufficient to keep your vitamin D levels high. Closer
to the equator, where UV levels are higher, even shorter periods of exposure suffice.
Hence, for most people, vitamin D deficiency is unlikely. Possible exceptions are those who have very
limited sun exposure such as the housebound elderly, or those with heavily pigmented skin who live in
high-latitude countries where UV levels are relatively low. Recognising the need for vitamin D, many
countries have introduced supplements into common food like flour, cereals and milk. Naturally occurring
vitamin D is very rare in our diet, it is present mainly in fatty fish and cod liver oil.
UV radiation has been used to successfully treat a number of diseases, including rickets, psoriasis, eczema
and jaundice. This therapeutic use cannot eliminate the negative side-effects of UV radiation but
treatment takes place under medical supervision to ensure that the benefits outweigh the risks.
Ionising radiation
Sources of ionising radiation
Manufacturing industry: The use of ionising sources in industry is very heterogeneous. Ionising radiation
is used in level meters for example. It can be found in brewery where on the assembly line production an
ionising radiation source is installed on one side of the line and a detector on the other. Radiation travels
from the source to the detector. If a bottle passing between is full, the radiation is absorbed into the beer
and only a small fraction of emitted radiation reaches the detector. This produces a “pass” indication and
the bottle can proceed to another phase of production. It the bottle is not full, more radiation reaches the
detector, giving a “fail” indication and the bottle is ejected from the production line.
Ionising radiation is often used for non-destructive testing. The method is similar to diagnostic use in
medicine. Ionising radiation penetrates pipes, tubes, casts or other products where on the other side is a
detector, usually to ionising radiation sensitive film. The image on the film shows if there are any defects
in the object such as cracks, homogeneities or foreign material.
A nuclear density gauge is a tool used in civil construction and the petroleum industry as well as for mining
and archaeology purposes. It consists of a radiation source that emits a directed beam of particles and a
sensor that counts the received particles that are either reflected by the test material or pass through it.
By calculating the percentage of particles that return to the sensor, the gauge can be calibrated to
measure the density and inner structure of the test material.
In some industries, accumulation of naturally occurring radioactivity can occur. Everything around us is
radioactive. In some cases, this natural radioactivity can accumulate. It accumulates in the Oil and Gas
industries. We drill into solids to extract oil. Solids may contain naturally occurring radioactive material
that can accumulate in vessels or deposit on internal surfaces. Workers working in the vicinity of such
places are exposed to elevated levels of ionising radiation. In the zircon sand industry, workers might be

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exposed to naturally occurring radiation since elevated levels of uranium and thorium can be found in
zircon.
Healthcare is one of the main workplaces where ionising radiation is deliberately used – others examples
include the nuclear industry, academic research centres and the construction industry (where X-rays are
used for nondestructive testing). Smoke detectors, used in many workplaces and homes, also use low
levels of ionising radiation.
X-rays: X-rays are the most common use of ionising radiation in medicine. X-rays are transmitted through
tissues but different tissues allow varying amounts through, creating a shadow image of the structures of
the body. X-rays don’t make the patient radioactive and expose them to low doses of radiation – typically
a chest X-ray is equivalent to the normal background dose of radiation received every three days.
However, healthcare workers who are routinely involved in X-rays risk multiple exposures to very small
amounts of radiation unless precautions are taken. CT scans provide a 3D view of the body by using
multiple images produced by an X-ray beam. CT examinations give doses of radiation equivalent to that
received from background radiation in three to four years.
Nuclear medicine: This uses radioactive substances attached to drugs to reach certain parts of the body.
The substances used have a short half life – which means the radioactivity declines very quickly – which
minimises the radioactive dose to the patient. These radiopharmaceuticals are used in the diagnosis of
many diseases of the internal organs and also in the treatment of some conditions, such as hyperactive
thyroid glands and prostate cancer.
Radiotherapy: Radiotherapy works by using high doses of radiation targeted to kill cancer cells but to leave
surrounded tissues unharmed. This is either through a beam of radiation or by planting sources of
radiation close enough to the tumour to kill it. The doses received from radiotherapy are hundreds of
thousands of times greater than those from diagnostic procedures
Research: Examples where ionising radiation may be used include:
• Diagnostic Radiographic procedures: (i.e. Plain film radiography, fluoroscopy, interventional

radiography (angiography), CT examinations and DEXA scans)
• Nuclear Medicine procedures: (i.e. The in vivo application of unsealed radioactive sources)
• Therapeutic procedures: (i.e. The use of ionising radiation for radiotherapeutic purposes)
Power generation: Neutrons are used which are the uncharged particles mostly released by nuclear
fission (the splitting of atoms in a nuclear reactor), and hence are seldom encountered outside the core
of a nuclear reactor. Thus they are not normally a problem outside nuclear plants. Fast neutrons can be
very destructive to human tissue. Neutrons are the only type of radiation which can make other, non-
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Naturally occurring-radon: Ionising radiations can also occur naturally, the best example of this being
radon, which is a radioactive gas that occurs mainly at or near granite outcrops where there is a presence
of uranium. It is particularly prevalent in Devon and Cornwall. The gas normally enters buildings from the
substructure through cracks in flooring or around service inlets. Buildings where radon is detected may
need to be fitted with sumps and extraction fans. We are all exposed to a little radiation in the
environment, but at levels which are not considered harmful. This is referred to as background radiation.
When radiation is used in healthcare, staff may be exposed to a small dose during the procedure or while
they are caring for a patient who has received treatment with radioactive substances.
Routes and effects of exposure

People can be exposed to ionizing radiation under different circumstances, at home or in public places
(public exposures), at their workplaces (occupational exposures), or in a medical setting (as are patients,
caregivers, and volunteers).
Exposure to ionizing radiation can be classified into 3 exposure situations.
• The first, planned exposure situations, result from the deliberate introduction and operation of
radiation sources with specific purposes, as is the case with the medical use of radiation for
diagnosis or treatment of patients, or the use of radiation in industry or research.
• The second type of situation, existing exposures, is where exposure to radiation already exists,
and a decision on control must be taken – for example, exposure to radon in homes or workplaces
or exposure to natural background radiation from the environment.
• The last type, emergency exposure situations, result from unexpected events requiring prompt
response such as nuclear accidents or malicious acts
Radiation exposure may be internal or external, and can be acquired through various exposure pathways.
Internal exposure to ionizing radiation occurs when a radionuclide is inhaled, ingested or otherwise enters
into the bloodstream (for example, by injection or through wounds). Internal exposure stops when the
radionuclide is eliminated from the body, either spontaneously (such as through excreta) or as a result of
a treatment.
External exposure may occur when airborne radioactive material (such as dust, liquid, or aerosols) is
deposited on skin or clothes. This type of radioactive material can often be removed from the body by
simply washing.
According to the subjects on which the effects occur, the biological effects of radiation are classified into:
"Somatic effects" and "Genetic effects".
Somatic effects
This is the biological effects that occur on the exposed individuals. There are two broad categories of
health effects: chronic (long-term) and acute (short-term).

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• Chronic exposure is continuous or intermittent exposure to radiation over a long period of time.
With chronic exposure, there is a delay between the exposure and the observed health effect.
These effects can include cancer and other health outcomes such as benign tumors, cataracts,
and potentially harmful genetic changes.
• Acute health effects occur when large parts of the body are exposed to a large amount of
radiation. The large exposure can occur all at once or from multiple exposures in a short period
of time. Instances of acute effects from environmental sources are very rare. Examples include
accidentally handling a strong industrial radiation source or extreme events like nuclear
explosions
Genetic effects
Genetic effects refer to biological changes on the descendants of the exposed individuals due to mutation
of their genetic cells.
When genetic cells are irradiated, the chromosomes or DNA of the cells may be affected which may lead
to genetic mutations, chromosome aberrations or changes in the number of chromosomes in the cells. As
a result, the probability of genetic changes will increase, bringing detrimental effects to the descendants
of the exposed persons.
Effect of different ionising radiations in humans

Alpha particles Alpha particles are the least dangerous in terms of external exposure.
They don't penetrate very deeply into the skin, if at all -- in fact,
clothing can stop alpha particles. Unfortunately, alpha particles can be
inhaled or ingested, usually in the form of radon gas. Once ingested,
alpha particles can be very dangerous. However, even then they don't
typically cause radiation sickness -- instead, they lead to lung cancer
Beta particles Beta particles are electrons that move very quickly -- that is, with a lot
of energy. Beta particles travel several feet when emitted from a
radioactive source, but they're blocked by most solid objects. A beta
particle is about 8,000 times smaller than an alpha particle -- and that's
what makes them more dangerous. Their small size allows them to
penetrate clothing and skin. External exposure can cause burns and
tissue damage, along with other symptoms of radiation sickness. If
radioactive material enters food or water supplies or is dispersed into
the air, people can inhale or ingest beta particle emitters unknowingly.
Internal exposure to beta particles causes much more severe
symptoms than external exposure.
Gamma rays Gamma rays are the most dangerous form of ionizing radiation. These
extremely high energy photons can travel through most forms of matter
because they have no mass. It takes several inches of lead -- or several
feet of concrete -- to effectively block gamma rays. If you're exposed to
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tissues from your skin to the marrow of your bones. This causes
widespread, systemic damage.
X-ray X-ray is the same as a gamma ray, but originates external to the atom
by the movement of electrons between energy shells (from a higher to
lower energy shell). The excess energy associated with this electron
movement is released as an X-ray. X-rays have less energy than gamma
rays, are less penetrating, and require less shielding. In all other aspects,
X-rays behave in the same manner as gamma rays
Neutrons A neutron has no charge, and high energy neutrons are very
penetrating and present an external hazard. Neutrons most commonly
are indirectly ionizing, in that they are absorbed into a stable atom,
thereby making it unstable and more likely to emit off ionizing radiation
of another type. Neutrons are, in fact, the only type of radiation that is
able to turn other materials radioactive.
Radiation risk assessment to consider

A prior radiological evaluation of hazards and risks and prevention and control measures should, in
consultation with workers and/or their representatives, be the first step in establishing a radiation
protection programme. The degree of effort, formalities and details of the evaluation and the scrutiny to
which it is subjected should be in line with the magnitude of normal and potential exposures and the
probability of the latter. The prior radiological evaluation should include for all aspects of operation:
(a) an identification of the sources of normal and reasonably foreseeable potential
exposures;
(b) a realistic estimate of the doses;
(c) an identification of the radiological protection measures needed to meet the
optimization principle.
Ionizing radiation
Prior evaluation should be used to help determine what can be achieved at the design stage of
installation to establish satisfactory working conditions through the use of engineered features, including
the provision of shielding, containment, ventilation and interlocks. These considerations should aim to
minimize the need for relying on administrative controls and personal protective equipment for
protection and safety during normal operation. Where authorization by registration or licensing is
required, the legal person applying for the authorization should make an assessment of the nature,
magnitude and likelihood of the exposure and, if necessary, make a safety assessment. Such a safety
assessment should contribute to the design of the radiation protection programme. The safety
assessment should include, as appropriate, a systematic critical review of:
(a) the nature and magnitude of potential exposures and the likelihood of their

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occurrence;
(b) the limits and technical conditions for operation of the source;
(c) the ways in which structures, systems, components and procedures related to
radiation protection or safety might fail, singly or in combination, or otherwise lead
to potential exposures, and the possible consequences of such failures;
(d) the ways in which changes in the environment could affect protection or safety;
(e) the ways in which operating procedures related to protection or safety might be
erroneous, and the consequences of such errors;
(f) the protection and safety implications of any proposed modifications.
The safety assessment should be documented and reviewed. Additional reviews should be
performed as necessary to ensure that the technical specifications or conditions of use continue to be
met whenever:
(a) significant modifications to a source or its associated plant or its operating or
maintenance procedures are envisaged;
(b) operating experience or other information about accidents, failures, errors or other
events that could lead to potential exposures indicates that the current assessment
might be invalid;
(c) any significant changes in activities, or any relevant changes in guidelines or
standards are envisaged or have been made.
Control measures to prevent or minimise the exposure

To keep radiation doses low, three methods are used: time, distance and shielding. The dose is
proportional to the time of exposure. This means that if someone is exposed for two hours, the dose
would be two times the dose compared to if the exposure was one hour. The radiation reduces with the
distance from the source. If the distance is increased from 1 m to 2 m, the dose will be reduced by a factor
of 4. If the distance is increased from 1 m to 3 m, the dose will be reduced by a factor of 9. We say that
radiation is reduced by the square law by distance. Whenever necessary, we can reduce doses through
the use of shields. Different shielding material is used depending on the nature of the ionising radiation.
The most common material is lead due to its high density and convenient price.
Only in some very rare cases, we can achieve that workers are not exposed. Basic radiation protection
principles are justification, optimization and dose limitation. The principle of dose limits is not applied in
medical exposures. When we use radiation in medicine, we primarily search for a disease or treat diseases

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that can be in some cases be fatal. Still, we are not allowed to expose patients to high doses, but they
must be kept below so called reference levels. Radiation protection has improved over the last 20 years,
and today doses to workers are normally low.
External ionising radiation (shielding, distance, time)
Time: The more time one is exposed to ionising radiation, the larger the dose that will be received and
the more harmful the radiation will be. The relationship is linear: doubling the exposure time doubles the
dose that is received. It is very important that we minimise the exposure time in order to minimise the
dose.
Distance: The second very efficient way of minimising the doses is increasing distance. The nature of
ionising radiation is such that there is an inverse square law relationship between dose and distance. If
we increase the distance from the source from one meter to two metres, the dose will decrease by a
factor of four. If the distance is increased from one meter to three metres, the dose will decrease by a
factor of nine. So whenever possible, we must be as far as possible from the source. Unfortunately, this is
not always possible.
Shielding: There are activities that require workers to be close to the source and in a high radiation field.
In that case, we minimise the doses by using shielding and protective clothing. When working with X-ray
devices in medicine, the most common personal protective clothing is lead aprons. Led aprons made of
0.25 mm thick lead attenuate X-rays more than 100 times. In some cases when eyes are exposed,
spectacles made of lead glass are used as protection. Also, lead gloves can be used, however such gloves
are quite thick and not appropriate for detailed work.
Internal ionising radiation
External exposure may occur when airborne radioactive material (such as dust, liquid, or aerosols) is
deposited on skin or clothes. This type of radioactive material can often be removed from the body by
simply washing.
Internal dose, due to the inhalation or ingestion of radioactive substances, can result in stochastic or
deterministic effects, depending on the amount of radioactive material ingested and
other biokinetic factors.
The risk from a low level internal source is represented by the dose quantity committed dose, which has
the same risk as the same amount of external effective dose.
The intake of radioactive material can occur through four pathways:
• inhalation of airborne contaminants such as radon
• ingestion of radioactive contamination in food or liquids
• absorption of vapours such as tritium oxide through the skin
• injection of medical radioisotopes such as technetium-99m
The occupational hazards from airborne radioactive particles in nuclear and radio-chemical applications
are greatly reduced by the extensive use of gloveboxes to contain such material. To protect against
breathing in radioactive particles in ambient air, respirators with particulate filters are worn. To monitor
the concentration of radioactive particles in ambient air, radioactive particulate monitoring instruments
measure the concentration or presence of airborne materials.

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For ingested radioactive materials in food and

drink, specialist laboratory radiometric assay
methods are used to measure the
concentration of such materials
It is very important that we prevent ingestion
or inhalation of radioactive material. This is
especially important at workplaces were
workers work with radioactive material in
liquid, powder or gaseous form. In such
workplaces, there is a possibility of skin
contamination of workers or even of
inhalation or ingestion of radioactive
material. Suitable Personal protective
clothing in these cases includes latex gloves,
coveralls, gas masks, shoes covers, etc. When Glove box
working in very contaminated areas, workers
must wear even special overpressure suits.
Besides radiation protection of workers, it is important to protect the general public also. This is why the
rooms where ionising radiation is used are usually shielded by thick concrete walls and doors with lead
foil inside, have no windows and in some cases are arranged as a labyrinth. Such shielding of rooms is
called structural shielding.
9.14 Musculoskeletal issues, Manual handling
Human musculoskeletal system
The musculoskeletal system consists of the bones, muscles, nerves, ligaments and tendons. The function
of the musculoskeletal system is to:
• Protect and support the internal structures and organs of the body
• Allow movement of the body
• Produce movements of structures inside the body.
• Give shape to the body
• Produce blood cells
• Store calcium and phosphorus
• Produce heat
• Maintain position of the body against gravity
The muscular system is composed of specialized cells called muscle fibers. Their predominant function is
contractibility. Muscles, attached to bones or internal organs and blood vessels, are responsible for
movement. Nearly all movement in the body is the result of muscle contraction. Exceptions to this are the
action of cilia, the flagellum on sperm cells, and amoeboid movement of some white blood cells.

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The human body is composed of over 500 muscles working together to facilitate movement. It is very
important to understand the muscular system and how it works in conjunction with the skeletal system
to allow us to move and maintain our posture.
Humans are vertebrates, animals having a vertebral column or backbone. They rely on a sturdy internal
frame that is centered on a prominent spine. The human skeletal system consists
of bones, cartilage, ligaments and tendons and accounts for about 20 percent of the body weight.
The Spine:
The spine is made up of a series of bones

called vertebrae. Discs and a series of
muscles, fine ligaments and capsules hold
the 24 moveable vertebrae together. The
discs act as shock absorbers and allow the
spine a great range of movement and
postures, which are controlled and
activated by the muscles. Ligaments and
capsules protect the smaller joints in the
spine. There are four fixed vertebrae in
the lower end of the tailbone known as
the coccyx.
The spine is often considered a ‘weak

link’ in humans because it is frequently
subject to injury. The exact reverse is
true. The spine is the axis of human The structure and segments of spine
movement and must meet two
competing mechanical requirements: rigidity and plasticity. The muscles and ligaments act like the stays
on a ship’s mast to achieve this. The spine sits on the pelvis and extends to the head and neck. The
shoulders are set transversely and act like a mainyard to stabilise the upper spine and this is linked in turn
by muscles and ligaments to the pelvis. . These multiple components superimposed on one another and
interlinked with muscles and ligaments allow for movement and stability. It is therefore a remarkably
adaptable and flexible structure. Flexibility and adaptability come at a price and that is strength. The spine
is not well designed for the heavy loads and the repeated abuses it suffers in modern life. It needs to
remain reasonably flexible and strong to function correctly. Overweight, lack of physical fitness and
overuse lead to injuries and these are common in leisure and work. Most injuries, especially in the early
stages, are simply muscle strains and small tears of the ligaments or other supporting soft tissues.
However, over time more serious injuries can develop and may result in damage to the vertebrae and,
more commonly, the intervertebral discs. Therefore back injuries are nearly always cumulative in nature
and arise after months or years of excessive loads on the structures of the back.

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Human Skeleton
Bones:
Bone is a dry, dense tissue composed of a calcium-phosphorus mineral and organic matter and water.
Bone is covered with a living membrane called the periosteum. The periosteum contains bone-forming
cells, the osteoblasts. The centre of bone contains marrow where blood vessels, fat cells and tissue for
manufacturing blood cells are all found. There are four main shapes of bones:
• Flat e.g. ribs

• Irregular e.g. vertebrae
• Short e.g. hand (carpals)

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• Long e.g. upper arm (humerus)
There are 206 bones in the adult body. The bones perform five main functions for the body:
• Provide support: The skeletal system provides structural support for the entire body.
Individual bones or groups of bones provide a framework for the attachment of soft tissues
and organs.
• Store minerals and lipids: Calcium is the most abundant mineral in the body. (Ninety-nine
percent of the body's calcium is found in the skeleton.) The calcium salts of bone are a
valuable mineral reserve that maintains normal concentrations of calcium and phosphate ions
in body fluids. The bones of the skeleton also store energy reserves as lipids (fats) in areas
filled with yellow marrow.
• Produce blood cells: Red blood cells, white blood cells, and other blood elements are
produced in the red marrow, which fills the internal cavities of many bones.
• Protect body organs: Many soft tissues and organs are surrounded by skeletal elements. For
example, the rib cage protects the heart and lungs, the skull protects the brain, the vertebrae
protect the spinal cord, and the pelvis protects the delicate reproductive organs.
• Provide leverage and movement: Many bones function as levers that can change the
magnitude (strength) and direction of the forces generated by muscles.
Muscles:
Muscle exerts its effects by contraction, which is the development of tension in a muscle. However when
the muscle ‘contracts’ it does not always shorten. Contraction may be static (no movement) or active
(movement). These states are further categorised as:
• Isometric (static) – the muscle builds up tension but the length remains unchanged. Static
muscle work is the most energy efficient but is also the most tiring. Compression of blood
vessels and nerves stops nutrients and wastes from muscle activity from being dispersed e.g.
when attempting to lift an immovable object or when an object is held stationary.
• Concentric (active) – muscle fibres contract to shorten the muscle e.g. the biceps muscle
bends the elbow and overcomes the resistance of the weight of the arm, the source of the
resistance being inertia and the force of gravity.
• Eccentric (active) – allows for controlled lengthening of the muscle(s) against gravity.

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Human muscular system
Static muscle work is common in postural muscles of the neck, shoulders, back and buttocks. These
stabilise the trunk allowing for more accurate and efficient movement of the limbs. The positioning of the
body for optimum movement occurs naturally where the environment allows. Both types of active muscle
work use more energy but are less tiring than static muscle work.
Nerves:
Nerves control the contraction of skeletal muscles, interpret sensory information, and coordinate the
activities of the body's organ systems. The nervous system consists of billions of neurons in constant touch
with each other for the purpose of monitoring and regulating the internal and sensory functions. The
central nervous system, or CNS, includes the brain and spinal cord, and the peripheral nervous system, or
PNS, includes all the nerves outside the central nervous system. The spinal cord behaves like an
information superhighway, speeding signals from the brain to the PNS and vice versa. Like the muscular
system, the PNS, consisting of all the roads that ultimately lead to the superhighway, has a dual function.
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control. These three things are characterized by the nervous system and greatly explain the performance
of the nervous system in a very simplistic way.
Human nervous system
• Irritability. The nerve cells are able to conduct information when they get irritated from a
certain stimulus.
• Conductivity. The nerve cells can conduct information from the central nervous system to the
peripheral parts of the body and vice versa and also between individual nerve cells.
• The ability to secrete. The nerve cells can secrete different agents for example neurosecretory
cells in the hypothalamus in the brain.
Tendons:
Tendons connect muscle to bone. These tough yet flexible bands of fibrous tissue attach the skeletal
muscles to the bones they move. Essentially, tendons enable you to move; think of them as intermediaries

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between muscles and bones. This tendon is vulnerable to tearing and tendonitis, so do take care and
stretch the calf muscle to keep the tendon flexible too.
The tendons of many muscles extend over joints and in this way contribute to joint stability. This is
particularly evident in the knee and shoulder joints, where muscle tendons are a major factor in
stabilizing the joint.
Ligaments:
These attach bone to bone and help to stabilize joints they surround. They are composed mostly of long,
stringy collagen fibers that create bands of tough, fibrous connective tissue. Ligaments are slightly elastic,
so they can be stretched and gradually lengthen, increasing flexibility. But if stretched beyond a certain
point, ligaments can become overstretched and compromise the integrity of the joint they are supposed
to be stabilizing — so stretch with caution.
The types of injury and ill-health conditions resulting from repetitive physical activities,
manual handling and poor posture
Work-related musculoskeletal diseases (MSDs) occur when the physical capabilities of the worker do not
match the physical requirements of the job. Prolonged exposure to ergonomic risk factors can cause
damage a worker’s body and lead to MSDs. Conditions that are likely to cause MSD problems include the
following:
a) Exerting excessive force

b) Excessive repetition of movements that can irritate tendons and increase pressure on nerves
c) Awkward postures, or unsupported positions that stretch physical limits, can compress nerves and
irritate tendons
d) Static postures, or positions that a worker must hold for long periods of time, can restrict blood flow
and damage muscles
e) Motion, such as increased speed or acceleration when bending and twisting, can increase the amount
of force exerted on the body
f) Compression, from grasping sharp edges like tool handles, can concentrate force on small areas of
the body, reduce blood flow and nerve transmission, and damage tendons and tendon sheaths
g) Inadequate recovery time due to overtime, lack of breaks, and failure to vary tasks can leave
insufficient time for tissue repair
h) Excessive vibration, usually from vibrating tools, can decrease blood flow, damage nerves, and
contribute to muscle fatigue
i) Whole-body vibration, from driving trucks or operating subways, can affect skeletal muscles and cause
low-back pain
j) Working in cold temperatures can adversely affect a worker’s coordination and manual dexterity and
cause a worker to use more force than necessary to perform a task.

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These risk factors, either alone or in combination, can

subject workers’ shoulders, arms, hands, wrists,
backs, and legs to thousands of repetitive twisting,
forceful, or flexing motions during a typical workday.
To contribute to MSDs, however, these risk factors
must be present for a sufficient duration, frequency,
or magnitude.
Following conditions can arise from repetitive

physical activities, manual handling and poor posture:
1. Work-Related Upper Limb Disorders

2. Musculoskeletal injury and discomfort
3. Back pain
4. Eye and eyesight effects
5. Fatigue
6. Stress
7. Muscle sprains/strains
8. Fractures and lacerations
Carpel Tunnel Syndrome
1- Work-Related Upper Limb Disorders: Work related upper limb disorders (WRULDs) have also been
referred to as repetitive strain injuries (RSI) or musculoskeletal disorders of the upper limbs cover a range
of some 20 medical conditions, which include tenosynovitis and carpal tunnel syndrome.
The table below outlines occupational risk factors and symptoms of the most common disorders of the
upper body associated with WRULDs.
Identified disorders, occupational risk factors and symptoms
Disorders Occupational risk factors Symptoms
Tendonitis/tenosynovitis Repetitive wrist motions Pain, weakness, swelling, burning

Repetitive shoulder motions sensation or dull ache over affected
Sustained hyper extension of arms area
Prolonged load on shoulders

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Epicondylitis (elbow Repeated or forceful rotation of the Same symptoms as tendonitis

tendonitis) forearm and bending of the wrist at
the same time
Carpal tunnel syndrome Repetitive wrist motions Pain, numbness, tingling, burning
sensations, wasting of muscles at base
of thumb, dry palm
DeQuervain's disease Repetitive hand twisting and forceful Pain at the base of thumb
gripping
Thoracic outlet syndrome Prolonged shoulder flexion Pain, numbness, swelling of the hands
Extending arms above shoulder
height
Carrying loads on the shoulder
Tension neck syndrome Prolonged restricted posture Pain
The conditions are often difficult to treat and are very painful. They can be disabling, often permanently.
They are a growing cause of concern in the workplace and they are not restricted to keyboard work, but
can occur in a wide range of situations, including manufacturing, e.g., poultry processing; electronics.
Although these conditions can be caused or at least made worse by work, they can also be caused by
other activities such as sports or housework, e.g., tennis elbow.
Most people will suffer from aches and pains from time to time and if they do occur, it is easy to ignore
them, but if the pains persist in the muscles used for a job, or if several people in a workplace suffer from
the same aches and pains, these symptoms should be taken as a warning of the increasing risk of WRULDs.
Upper limb disorders include aches and pains in any part of the body from the shoulder to the fingers and
can include problems with soft tissue, muscles, tendons and ligaments as well as the blood circulation or
nerve supply to the upper limb. The symptoms, which can all be exacerbated by the work a person does
include:
• Tenderness
• Sharp pain
• Stiffness or a weakness to the muscle
• Tingling sensation
• Numbness
WRULDs can occur in jobs that require repetitive finger, hand or arm movements. These could be twisting,
pressing, squeezing, pushing, pulling, lifting or any number of similar movements. Although the most well

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known cases have been in display screen equipment operators, they can and do occur in many manual
jobs, particularly if it is repetitive work such as on a production line, assembly, packing or inspection.
Although repetition is the main concern, it is not the only factor which leads to increasing the risks. The
other factors include the amount of force used in the task, posture, work rates and recovery times, and
all need to be considered.
WRULDs Risk Factors

Need For a Lot of Force Awkward or Static Posture
Does the job involve: Does the job involve:
• Strong force at the same time as awkward • Cramped body position, and/or not enough
movements or posture e.g. bent wrists, work space to change posture?
with arms raised or fully extended? • Arms stretched or overhead for long periods?
• Forceful use of hand/forearm muscles? The job involve awkward movement?
• Trying to do something with ill-fitting • Work at awkwardly high or low height
components by forcing them into place? (crouching, stooping or reaching up)?
• Tools not ideal for repetitive or frequent use • Poor posture for any other reason?
particularly if squeezing, twisting or hammering
actions required?
• Use of equipment designed for a larger or
stronger person?
Rapid, Awkward or Frequent Movement Work for Long Periods without Breaks or
Does the job involve: Changes of Activity
• Machine pacing e.g. to keep up with a Does the job involve
conveyor? • No changes to work routine or variation of
• Frequent repetition of the same small number tasks?
of movements? • No breaks or infrequent breaks?
• Pressures on employees to work fast e.g. from • Worker not able to have short pauses when
piecework or bonus payment systems? desired?
Individual variation: Psychosocial factors and work organisation:
• The physical capacities of workers can vary • Affect how workers feel about their job, such
dependent upon their body build, age, and the as the way the work is organised, who does
level of physical development. Previous injuries which job, how jobs are done, how fast and for
may have reduced the capacity of the body and how long
made it more vulnerable to impairment even • Workers who perform monotonous jobs that
after recovery involve only a few, similar tasks or that have
• Workers’ lack of experience or familiarity with incentives or quotas to encourage a faster work
the job can increase their exposure to overload. rate have a higher risk of developing WRULDs
(Although appropriate, job-related training may

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help workers to reduce their exposure by • Excessive work demands, limited control by
enabling workers to use a better technique, or the worker over what they do, limited
by taking short breaks and changing their opportunities for social interaction, or little
posture more often) support from their managers, supervisors and
• Ill-fitting clothing or personal protective other workers can all increase the risk of
equipment can restrict postures and may developing WRULDs.
increase the force applications necessary to do
the work.
Work environment: Interactions
• Poor workspace layout can result in the
adoption of stressful working postures and the All of the above factors may act on their own or
need to apply force when reaching to full stretch in combination to increase the risk of workers
• Physical climate (temperature, air speed, developing WRULDs. The risk is greater if several
humidity). The temperature of the workplace apply; for example, the risk of WRULDs increases
affects the body’s muscles: excessive heat with repeated hand movements if there is need
increases overall fatigue and produces sweat for a high gripping force at the same time.
which makes it hard to hold tools, requiring
more force to be applied; excessive cold can
make the hands feel numb, making it hard to
grip and requiring more force
• Poor lighting can create glare or shadows, and
these may require workers to move into
awkward positions to see what they are doing
clearly
• High levels of noise may cause the body to
tense, resulting in static body postures and the
more rapid onset of fatigue
• Hand-held vibrating equipment may cause
blood circulation changes resulting in numbness,
tingling or loss of sensation, and the need to use
more force when gripping.
These activities increase the risk of developing WRULDs in the neck and shoulders:
• Postures that require the weight of the body parts and objects to be held, such as
o Working with elevated arms and holding heavy objects
o Working with the head either bent or rotated postures (for example, using a
microscope; turning the head to the side)
• Prolonged work in static postures (for example, office work at computer workstations)
• Repeated elevations of the arms or turning the head to the side.

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These activities increase the risk of developing WRULDs in the elbow, wrist and hands:
• Use of high muscular force to handle objects, such as

o High gripping force
o Grasping with a large grip or pinch grip
• Working with the wrists in deviated postures, towards either the little finger or thumb, are
hazardous;
• Repeating the same wrist movements
• Sharp edges pressing on the wrists or hands.
2 - Musculoskeletal injury and discomfort: May cause musculoskeletal pain with varying symptoms and
causes. Some of the more common types of pain include:
• Bone pain: This is usually deep, penetrating, or dull. It most commonly results from injury. It
is important to be sure that the pain is not related to a fracture or tumor.
• Muscle pain: This is often less intense than bone pain, but it can still be debilitating. Muscle
pain can be caused by an injury, an autoimmune reaction, loss of blood flow to the muscle,
infection, or a tumor. The pain can also include muscle spasms and cramps.
• Tendon and ligament pain: Pains in the tendons or ligaments are often caused by injuries,
including sprains. This type of musculoskeletal pain often becomes worse when the affected
area is stretched or moved.
• Joint pain: Joint injuries and diseases usually produce a stiff, aching, "arthritic" pain. The pain
may range from mild to severe and worsens when moving the joint. The joints may also swell.
Joint inflammation (arthritis) is a common cause of pain.
3 - Back pain: For most people the cause of

back pain is unknown. It may arise from any
number of pain-sensitive structures in the
lumbar spinal column, including joints,
ligaments, muscles, and soft
tissues. Persons at high risk of low back
pain include those whose jobs involve
physical labour, especially lifting, pushing,
or pulling heavy objects, or twisting during
lifting. Another risk factor for low back Muscle pain and discomfort
pain is cigarette smoking and poor
physical fitness may also contribute to it.

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4 - Eye and eyesight effects: Any activity that requires intense use of the eyes for a prolonged time or
under difficult conditions can cause eye strain. These include extended periods of:
• Reading
• Writing
• Computer work
• Driving
Exposure to bright light or straining to see in dim light can also cause eye strain.
One of the most common causes of eye strain is staring for long periods at digital devices such as:
• Computer screens
• Smartphones
Eye strain is associated with uncomfortable and annoying symptoms, such as:
• Sore or irritated eyes

• Difficulty focusing
• Dry or watery eyes
• Blurred or double vision
• Increased sensitivity to light
• Headache or brow-ache
It may be accompanied by pain in the neck, shoulders or back due to holding a bad posture for a
prolonged period.
5 – Fatigue: Every day, we go through the process of fatigue and then recovery. Each day we fatigue the
body. Each night we sleep as the body’s natural process to recover from the day. The three primary work
related risk factors that may cause additional fatigue are:
• Awkward postures (bending, twisting)

• Highly repetitive motions (frequent reaching, lifting, carrying)
• Forceful exertions (carrying or lifting heavy loads)
A proactive improvement process ensures that jobs and tasks are within the worker’s physical capabilities.
It’s about identifying the ergonomic risk factors in the work environment and putting control measures in
place to limit exposure. This process is the foundation for preventing back injuries for manual material
handling tasks. An ergonomically designed work environment reduces fatigue and discomfort for workers.
This, in turn, limits the risk of an injury occurring.

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Fatigue will eventually turn into an MSD, it’s important to encourage early reports of fatigue and
discomfort so that proactive control measures be put in place to prevent fatigue from developing into an
injury. The earlier the signs of fatigue and discomfort are discovered, the better.
6 – Stress: This is usually a negative side effect of dealing with long-term injuries that have disabling and
difficult-to-manage symptoms. Physical ailments are more readily recognised than mental health issues
related to poor manual handling, but we must not overlook the fact that long-term injuries can have a
serious knock-on effect: they can lead to poor mental health due to the stress and anxiety triggered by
long-term physical issues.
7 - Muscle sprains and strains: Otherwise known as muscle cramps, they occur when a muscle involuntary
and forcibly contracts and cannot relax. These are very common and can affect any muscle. Typically, they
involve part or all of a muscle, or several muscles in a group. The most common sites for muscle cramps
are the thighs, calves, foot arches, hands, arms, abdomen and sometimes along the ribcage. Following
factors may contribute to developing muscle cramps.
• Insufficient stretching before physical activity

• Muscle fatigue
• Exercising in heated temperatures
• Dehydration
• Electrolyte imbalances in potassium, magnesium and calcium
8 - Fractures and lacerations: Injuries can occur for example: cuts, bruises, tears, small fractures etc.
Usually caused by sudden and small, unexpected accidents, e.g. losing grip and dropping a load, lifting an
excessively heavy load at an awkward angle, or falling while carrying a load.
Types of ill-health conditions resulting from sitting for long periods and how these can be
controlled/managed
Living a sedentary lifestyle can be dangerous to your health. The less sitting or lying down you do during
the day, the better your chances for living a healthy life.
If you stand or move around during the day, you have a lower risk of early death than if you sit at a desk.
If you live a sedentary lifestyle, you have a higher chance of being overweight, developing type 2
diabetes or heart disease, and experiencing depression and anxiety.
Health Issues due to sitting:
Legs and gluteals (bum muscles)
Sitting for long periods can lead to weakening and wasting away of the large leg and gluteal muscles.
These large muscles are important for walking and for stabilizing you. If these muscles are weak you are
more likely to injure yourself from falls, and from strains when you do exercise.

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Weight
Moving your muscles helps your body digest the fats and sugars you eat. If you spend a lot of time
sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body.
Even if you exercise but spend a large amount of time sitting, you are still risking health problems, such
as metabolic syndrome. The latest research suggests you need 60–75 minutes per day of moderate-
intensity activity to combat the dangers of excessive sitting.
Hips and back
Just like your legs and gluteals, your hips and back will not support you as well if you sit for long periods.
Sitting causes your hip flexor muscles to shorten, which can lead to problems with your hip joints. Sitting
for long periods can also cause problems with your back, especially if you consistently sit with poor
posture or don’t use an ergonomically designed chair or workstation. Poor posture may also cause poor
spine health such as compression in the discs in your spine, leading to premature degeneration, which
can be very painful.
Anxiety and depression
We don’t understand the links between sitting and mental health as well as we do the links between
sitting and physical health yet, but we do know that the risk of both anxiety and depression is higher in
people that sit more. This might be because people who spend a lot of time sitting are missing the
positive effects of physical activity and fitness. If so, getting up and moving may help.
Cancer
Emerging studies suggest the dangers of sitting include increasing your chances of developing some
types of cancer, including lung, uterine, and colon cancers. The reason behind this is not yet known.
Heart disease
Sitting for long periods has been linked to heart disease. One study found that men who watch more
than 23 hours of television a week have a 64 per cent higher risk of dying from cardiovascular disease
than men who only watch 11 hours of television a week.
Some experts say that people who are inactive and sit for long periods have a 147 per cent higher risk of
suffering a heart attack or stroke.
Diabetes
Studies have shown that even five days lying in bed can lead to increased insulin resistance in your body
(this will cause your blood sugars to increase above what is healthy). Research suggests that people who
spend more time sitting have a 112 per cent higher risk of diabetes.
Varicose veins

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Sitting for long periods can lead to varicose veins or spider veins (a smaller version of varicose veins).
This is because sitting causes blood to pool in your legs.
Varicose veins aren’t usually dangerous. In rare cases, they can lead to blood clots, which can cause
serious problems (see deep vein thrombosis, below).
Deep vein thrombosis
Sitting for too long can cause deep vein thrombosis (DVT), for example on a long plane or car trip. A
deep vein thrombosis is a blood clot that forms in the veins of your leg.
DVT is a serious problem, because if part of a blood clot in the leg vein breaks off and travels, it can cut
off the blood flow to other parts of the body, including your lungs, which can cause a pulmonary
embolism. This is a medical emergency that can lead to major complications or even death.
Stiff neck and shoulders
If you spend your time hunched over a computer keyboard, this can lead to pain and stiffness in your
neck and shoulders.
Control Measure:
Build more activity into your day
Some ways you can incorporate activity into your day are:
• Walk or cycle, and leave the car at home.

• For longer trips, walk or cycle part of the way.
• Use the stairs instead of the lift or escalator, or at least walk up the escalator.
• Get off the bus one stop early and walk the rest of the way.
• Park further away from wherever you’re going and walk the rest of the way.
• Calculate how long it takes you to walk one kilometer – you may find you can reach your
destination faster by walking than if you wait for public transport.
Here are some simple ideas to keep you moving while you’re at home:
• When you’re tidying up, put items away in small trips rather than taking it all together.
• Set the timer on your television to turn off an hour earlier than usual to remind you to
get up and move.
• Walk around when you’re on the phone.
• Stand up and do some ironing during your favorite television shows.
• Rather than sitting down to read, listen to recorded books while you walk, clean, or
work in the garden.
• Stand on public transport, or get off one stop early and walk to your destination.
• If you work in an office:
• Stand up while you read emails or reports.

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• Move your rubbish bin away from your desk so you have to get up to throw anything
away.
• Use the speaker phone for conference calls and walk around the room during the calls.
The principles of ergonomic design as applied to the control of musculoskeletal risks

In order to consider the ergonomics involved in different workplaces, universal principles of ergonomics
can be applied which include:
Principle 1. Maintain Neutral Posture: Neutral postures are postures where the body is aligned and
balanced while either sitting or standing, placing minimal stress on the body and keeping joints aligned.
Neutral postures minimize the stress applied to muscles, tendons, nerves and bones and allows for
maximum control and force production.
The opposite of a neutral posture is an “awkward posture.” Awkward postures move away from the
neutral posture toward the extremes in range of motion. This puts more stress on the worker’s
musculoskeletal system, is a contributing risk factor for Musculoskeletal Disorders (MSDs), and should be
avoided.
Principle 2. Reduce Excessive Force: The design for heavy products should consider reducing the excessive
force needed or used to pull, push, or carry the product. Alternative solutions should be adapted to reduce
the use of force such as using wheels to these products. Also, adding handholds can reduce the force used
to carry objects.
Principle 3. Keep Everything in Easy Reach: The next principle deals with keeping things within easy
reach. In many ways, this principle is redundant with posture, but it helps to evaluate a task from this
specific perspective. One concept is to think about the "reach envelope." This is the semi-circle that the
arms make as you reach out. Things that are frequently used should ideally be within the reach envelope
of full arm. Things that are used extremely frequently should be within the reach envelope of the
forearms.
Principle 4. Work in the Power / Comfort Zone: This principle is very similar to maintaining a neutral
posture, but is worth expounding upon here.
The power zone for lifting is close to the body, between mi-thigh and mid-chest height. This zone is where
the arms and back can lift the most with the least amount of effort.
This can also be called the “hand shake zone” or “comfort zone.” The principle here is that if you can
“shake hands with your work”, you are minimizing excessive reach and maintaining a neutral posture.
Working from the power / comfort / handshake zone ensures that you are working from proper heights
and reaches, which reduces MSD risk factors and allows for more efficient and pain-free work.
Principle 4. Reduce Excessive Motion: This principle aims to reduce the amount of motion spent while
dealing with the design. The motion refers to any movement applied using the figures, wrist, or other

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parts of the body. One of the examples of applying this principle is the usage of screwdriver. The electric
screwdriver is designed to reduce hand motion during usage.
Principle 5. Reduce Static Load: Static load refers to the position where the person stays in the same
position or holds something for a long time. This load create discomfort fatigue.
A good example of static load that everyone has experienced is writer’s cramp. Do not hold onto a pencil
very hard, just for long periods. Muscles tire after a time and begin to hurt. Having to hold arms overhead
for a few minutes is another classic example of static load, this time affecting the shoulder muscles.
Sometimes the orientation of the work area can be changed to prevent this, or sometimes extenders may
be added to the tools. Having to stand for a long time creates a static load on legs. Simply having a footrest
can permit to reposition the legs and make it easier to stand.
Principle 6. Minimize Pressure Points: Another thing to watch out for is excessive pressure points,
sometimes called "contact stress."
A good example of this is squeezing hard onto a tool, like a pair of pliers. Adding a cushioned grip and
contouring the handles to fit the hand makes this problem better. Leaning the forearms against the hard
edge of a work table creates a pressure point. Rounding out the edge and padding it usually helps. We’ve
all had to sit on chairs that had cushioning and so understand almost everything we need to know about
pressure points. A particularly vulnerable spot is behind the knees, which happens if the chair is too high
or when dangling the legs. Another pressure point that can happen while sitting is between thigh and the
bottom of a table
Principle 7. Provide Clearance: Having enough clearance is a concept that is easy to relate to. Work areas
need to be set up so that sufficient room is available for the head, knees, and feet. You obviously don’t
want to have to bump into things all the time, or have to work in contorted postures, or reach because
there is no space for the knees or feet. Being able to see is another version of this principle. Equipment
should be built and tasks should be set up so that nothing blocks the view.
Principle 8. Move, Exercise, and Stretch: To be healthy the human body needs to be exercised and
stretched.
Depending upon the type of work, different exercises on the job can be helpful. For a physically demanding
job, it may be helpful to stretch and warm up before any strenuous activity.
For a sedentary job, a quick "energy break" may be needed every so often to do a few stretches
It actually would be ideal to alternate between sitting and standing throughout the day. For some tasks,
such as customer service, desks are available that move up and down for this purpose
Principle 9. Maintain a Comfortable Environment: This principle is more or less a catch-all that can mean
different things depending upon the nature of the types of operations. This includes lighting, glare,
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When a manual handling risk assessment is required

Where your general assessment carried out under regulation
3(1) of the Management Regulations indicates a possibility of injury from manual handling operations,
and you conclude under regulation. This regulation breaks these down according to various task factors,
aspects of the load, and the working environment. Where appropriate, it suggests actions to reduce the
risks to help you meet your duties
4(1)(a) of the Manual Handling Operations Regulations that avoidance of the operations is not
reasonably practicable, you should carry out a more specific assessment as required by regulation
4(1)(b)(i). This specific assessment should ask some questions like - Does the task involve twisting the
trunk (torso) or sideways bending? Does the task involve stooping? Does the task involve reaching
upwards? Does the task involve considerable lifting or lowering distances? Does the task involve
considerable carrying distances? Does the task involve considerable pushing or pulling of the load? Does
the task involve positioning the load precisely? Does the task involve a risk of sudden movement of the
load? Does the task involve several risk factors? How detailed this further assessment should be will
depend on the circumstances.
95 Regulation 4(3) and Schedule 1 to the Regulations set out the factors which the assessment should
take into account, including the tasks, the loads, the working environment and individual capability.
First, decide how it should be done, who is going to do it and what relevant information may already be
available to help.
How the simple filters (from L23) can be used to decide if a manual handling risk
assessment is required
There are different filters for four types of manual handling operations.
These are:
• lifting and lowering;

• carrying for up to 10 m;
• pushing and pulling for up to 20 m;
• handling while seated.
If either the start or end positions of the hands are close to a boundary between two boxes you should
use the average of the weights for the two boxes.
The filter for lifting and lowering assumes:
• the load is easy to grasp with both hands;

• the operation takes place in reasonable working conditions;
• the handler is in a stable body position.

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Lifting and lowering risk filter
If the weight lifted exceeds the filter weight or these assumptions are not met, then you can use the
MAC tool to do a more detailed assessment, or carry out a full risk assessment.
Lifting and lowering risk filter:
Each box is a filter value for lifting and lowering in that zone. The filter values are reduced if handling is
done with arms extended, or at high or low levels, as that is where injuries are most likely to happen.
Observe the work activity you are assessing and compare it to the diagram. First decide which zone or
zones the lifter’s hands pass through when moving the load. Then assess the maximum weight being
handled. If it is less than the value given in the matching box, the operation is within the guidelines. If
the lifter’s hands enter more than one zone during the operation, use the smallest weight. If either the
start or end positions of the hands are close to a boundary between two boxes you should use the
average of the weights for the two boxes.
The filter for lifting and lowering assumes:
• the load is easy to grasp with both hands;

• the operation takes place in reasonable working conditions;
• the handler is in a stable body position.
MAC tool to do a more detailed assessment, or carry out a full risk assessment.
Carrying risk filter
The filter weights for lifting and lowering applies to carrying operations where the load:

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• is held against the body;

• is carried no further than about 10 m without resting;
• does not prevent the person from walking normally;
• does not obstruct the view of the person carrying it;
• does not require the hands to be held below knuckle height or much above
• elbow height (owing to static loading on the arm muscles).
MAC tool to do a more detailed assessment.
Where the load can be carried securely on the shoulder without first having to be lifted (as, for example,
when unloading sacks from a lorry) you can apply the filter values to carrying distances up to 20 m
Pushing and pulling risk filter
In pushing and pulling operations the load might be slid, rolled or moved on wheels. Observe the
general posture being used while the pushing or pulling operation is being carried out. The task is likely
to be low risk if:
• the force is applied with the hands; and

• the torso is largely upright and not twisted; and
• the hands are between hip and shoulder level; and
• the distance involved is no more than about 20 m.
Handling while seated risk filter
The filter values for handling operations carried out while seated,
Men Women
5 kg 3 kg
These values only apply when the hands are

within the zone. If handling beyond this box zone
is unavoidable, you should make a full
assessment. Handling while seated
Risk assessment
There are several factors that make manual
handling hazardous, and increase the risk of injury. These are called risk factors. Following ergonomic risk
factors are most likely to cause or contribute to an MSD:
Task: Does the task involve?

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o Exerting considerable physical effort to complete a motion

o Doing the same motion over and over again
o Performing motions constantly without short pauses or breaks in between
o Maintaining same position or posture while performing tasks
o Sitting for a long time
o Using hands or body as a clamp to hold object while performing tasks
o Objects or people are moved significant distances
Load: The risk of injury increases during lifting, carrying, pushing and pulling of loads, if:
o Using hand and power tools

o Gloves bulky, too large or too small
o Objects or people moved are heavy
o Object is slippery or has no handles
o Object is unbalanced, unstable or if the contents can move
o Difficult to reach
Force: Force, although an important factor, is only one of the risk factors that have to be considered.
Handling tasks from a seated position does not allow the operator to use the stronger leg muscles.
Therefore, the risk of injury is increased, particularly if loads are greater than 4 kilograms. The risk
of back injury significantly increases if handling loads greater than 16 – 20 kilograms. This type of
load is common where the manual handling of people is necessary. Apart from lifting, lowering or
carrying, many tasks in the workplace require force to move, hold or restrain objects. When
pushing, pulling or sliding objects, the amount of force required is determined by the weight, the
nature of the load and the surface it has to be moved across. Muscle stress and rapid fatigue
occurs when the same muscles are held in sustained tension, without movement, during a task
e.g. in the neck and shoulders while holding a load, during typing tasks or when painting above
shoulder height. When this type of work is carried out without the opportunity to take rest breaks
or vary the work there is an increased risk of muscular pain and strain.
Working environment: The following characteristics of the work environment may increase the risk of
injury:
o Working surfaces too high or too low

o Vibrating working surfaces, machinery or vehicles
o Workstation edges or objects press hard into muscles or tendons
o Horizontal reach is long
o Vertical reach is below knees or above the shoulders
o Floor surfaces are uneven, slippery or sloped
o A lack of space to carry out the job may lead to inappropriate body postures and
dangerous imbalance in the loads.

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o Insufficient lighting may increase the risk of accidents when handling loads. It may also
make you work in awkward positions to see clearly what you are doing
o Cold temperatures
Equipment: These include:
o Weight and size of tool

o Tool handles and/or grips
o Tool activation (repetitively, one finger)
o Tool kickback, vibration and maintenance
Using hand and power tools; for example, to perform physical work activities does not in
itself mean that employees are exposed to ergonomic risk factors that put them at risk of
injury. Rather, it is a shorthand way of alerting employers that there are aspects of tool
design and use that need to be checked out to see whether ergonomic risk factors may
be present.
Individual capability: There are also some individual factors that can influence the risk of back injury:
o Experience, training and familiarity with the

o Age (the risk of ergonomic disorders increases with the number of years at work)
o Physical dimensions and capacity (length, weight, strength, etc.)
o Personal lifestyle (smoking may, for example, increase the risk of low back disorders)
o History of ergonomic disorders (this is a predictor of future back injuries)
o Willingness to use personal protective equipment (for example, clothing and footwear).
o Pregnancy or disability or health problem?
Exposure to one ergonomic risk factor may be enough to cause or contribute to a covered MSD. However,
most often ergonomic risk factors act in combination to create a hazard. The jobs that have multiple risk
factors have a greater likelihood of causing an MSD, depending on the duration, frequency and/or
magnitude of exposure to each. Thus, it is important that ergonomic risk factors be considered in light of
their combined effect in causing or contributing to an MSD. This can only be achieved if the job hazard
analysis and control process includes identification of all the ergonomic risk factors that may be present
in a job. If they are not identified, employers will not have all the information that is needed to determine
the cause of the covered MSD or understand what risk factors need to be reduced to eliminate or
materially reduce the MSD hazards.
Controlling the contributory factors
Load Possible controls include:

• Split the load into more manageable sized packages. For example a 40kg sack
of flour can be reduced to two 20kg sacks.

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• Aggregate loads – use a large load and mechanical handling, for example bulk
grain and a forklift.
• Reduce the weight or force required to move the load. This may mean you
should consider where it is positioned and how it is moved.
• Improve the stability of the load through repackaging, redesign or by
redistributing its weight.
• Ensure regular maintenance of equipment to allow easy movement and
operation.
• Use slides, rails, roller tracks or castors to reduce friction and therefore
reduce force.
• If the load is greasy or slippery, clean it, use protective equipment while
handling it or use mechanical handling aids.
• Improve or attach appropriate handles – these need to be in the correct
position to allow a good grip and to allow the employee to hold the object
close to the body.
• Label the item with handling instructions, including the weight of the
package.
• Use mechanical means to handle loads that contain hazardous materials or
are extremely hot or cold. Reduce the hazard by enclosing the load to protect
employees, or reduce the hazard some other way (e.g. remove frozen boxes
from freezers well prior to handling so they are not so cold).
• If handling people or animals, specialist advice should be sought from
industry and employer or employee groups.
Environment Possible controls include:
• Reduce the slipperiness of floors or increase cushioning through altering floor
surface or footwear. Ensure that floors don’t get slippery in wet weather or
wet conditions.
• Replace uneven or damaged floor surfaces in areas where handling takes
place.
• Remove clutter and allocate an individual or team to keep the area tidy.
• If there are steps and slopes, and the task cannot be altered to avoid them,
ensure good design and adequate visibility.
• Limit the duration of handling in extreme temperatures or for particular at-
risk tasks. Reduce extreme temperatures where possible. (Where this is not
possible, arrange professional assessment, for example by an occupational
hygienist.)
• Erect windbreaks around outdoor areas where handling occurs regularly.
• Improve air quality through maintenance or improved design, or limit the
employee’s exposure to manual handling when air quality is low (where not
possible arrange professional assessment, for example through an
occupational hygienist).
• Reduce noise that might distract or limit communication.
• Redesign tasks to limit outdoor handling where possible. Reduce exposure to
bad weather by encouraging the delivery of goods closer to indoor areas.
• Ensure lighting provides good visibility, and avoid extremes of glare, high
contrast or dull lighting.

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• Increase the available space for handling by removing unnecessary

equipment, redesigning the layout or altering or changing the location of the
task.
Individual Possible controls include:
• Have sufficient people for the task’s demands.
• Provide appropriate training and education specific to the tasks
• Make sure that there is the best possible “fit” between tasks and the people
doing them – making allowance for strength, size and fitness. In addressing
hazards of this nature the aim should be to bring the task within the reach of
everyone who may need to do it. Controlling the hazards of the task through
redesign or the use of mechanical aids is preferable to using training or
selection. If people are at risk because they are new to a task, then a period
of gradual build-up to full capacity may be appropriate.
• Consider how special needs such as age, fitness, disability, pregnancy and size
might influence the task. For example, plan for reducing manual handling
activities during pregnancy.
• Ensure that appropriate clothing and personal protective equipment are
available and that they are used/worn by the employees. For example: –
divided skirts, culottes, shorts or trousers for nurses – non-slip footwear –
overalls with sufficient room to bend the back and knees easily, stretch and
reach up.
• Plan for less resilient people, for example those returning to work after an
injury.
Task Possible controls include:
• Improve the layout. Allow the handler to get close to the load or force by
reducing horizontal and vertical distances.
• The layout should reduce the need to turn, or to twist the body and reduce
the distances moved, in any direction, between the starting point and end
point of any handling.
• Place objects being handled below shoulder height or above mid-thigh
height. If this cannot be achieved, place regularly handled and heavier objects
close to the employees at the optimum heights. Place rarely handled or
lighter objects in the less suitable working areas.
• Rotate employees between tasks or increase breaks if long handling distances
(e.g. carrying) or durations cannot be avoided.
• Reduce repetition and allow sufficient rest breaks and pauses (these do not
have to be long but should be frequent) and rotate employees between tasks
that have different actions.
• Provide as much space as is required to safely carry out the handling task,
through moving unnecessary equipment and furniture, or redesigning the
layout of the task. This can be established through a trial.
• If teamwork is used, establish whether mechanical equipment might be
better. If teamwork cannot be avoided, ensure that the layout allows
sufficient room and provide training specific to the task.

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• Special clothing or footwear can pose its own hazards, for example by
restricting movement. These should not compromise movement or other
aspects of safety.
• Seating (for example for long distance truck drivers and forestry machine
operators where there is a recognised excess of back injuries) should
incorporate vibration reduction in its design (for example anti-vibration
suspension seating).
• Hand-held tools should be designed to be as light as possible or
counterbalanced. They should have handles designed to reduce awkward
postures and forces, avoid sharp edges, require a reasonable force to operate
and have a reasonable opening span.
• Allow employees control over the pace of work or introduce variation. If the
pace is fixed, allow regular changes in posture and sufficient breaks
• Ensure that mechanical aids are appropriate for the task and that they do not
introduce additional hazards. Train employees in the safe use of any
mechanical handling equipment.
• Ensure any equipment is designed and maintained to reduce vibration, as
well as other factors which may contribute to manual handling hazards.
• Provide employees who are handling in a seated position with appropriate
adjustable seating and ensure regular changes in position. The employee
should be able to reach the load easily and keep the load close to their body.
Forces or weights should be kept to a minimum.
• Redesign the layout to reduce the need for squatting, kneeling or crouching.
If standing for long periods cannot be avoided, rotate employees or ensure
some sort of seating is available. Optimise footwear and flooring.
How to decide if a more detailed assessment should be used

You will need to carry out either a MAC/RAPP (or equivalent) or full risk assessment when any of the
following conditions apply:
• Lifting or lowering with very large forward reaches, lifting below floor level or lifting
above head height.
• The handling is more frequent than one lifts every two minutes
• The handling involves torso twisting
• Team handling occurs
• The activities are complex
• The load is difficult to grasp or handle
• Aspects of the working conditions are not favorable
• Carrying happens with the load not held against the body
The circumstances when the assessment tools should be used

The Manual Handling Operations Regulations 1992 (MHOR) set out a clear hierarchy of measures for
dealing with risk likely to cause harm from manual handling. These are:
• Avoid hazardous manual handling operations so far as reasonably practicable

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• Assess any manual handling operations that cannot be avoided

• Reduce the risk of injury to as low as reasonably practicable.
A detailed assessment of every manual handling operation could be a major undertaking and might
involve wasted effort. Many handling operations, for example the occasional lifting of a small lightweight
object, will involve negligible handling risk. To help identify situations where a more detailed risk
assessment is necessary, filters have been developed to screen out straightforward cases
The Manual handling assessment charts (MAC) and Risk assessment of pushing and pulling (RAPP) tool
are part of HSE’s MSD toolkit, along with the Assessment of repetitive tasks of the upper limbs (the ART
tool) and the Variable MAC tool (V-MAC). The tools were developed to guide users through logical
processes to identify high-risk manual handling operations for which urgent further action is necessary to
reduce risk
• Using the MAC tool will help assess the most common risk factors in lifting (and lowering), carrying
and team handling operations.
• The V-MAC can be used with the MAC tool for lifting operations where load weights or handling
frequencies vary, such as when loading a lorry with a range of items of different weights.
The tools in HSE’s MSD toolkit use a ‘traffic light’ approach to indicate levels of risk. Numerical values are
also provided for each level of risk for each risk factor. The risk levels are based on published data in the
ergonomics literature. It is not required by law to use any of HSE’s tools. There are other available methods
of assessing the risk of work-related MSDs that one may choose to use instead. Risk assessment is required
to be ‘suitable and sufficient’ though.
G = GREEN – Low level of risk Although the risk is low, consider the exposure levels for vulnerable
groups such as pregnant women or young workers, where appropriate.
A = AMBER – Medium level of risk Examine tasks closely.
R = RED – High level of risk Prompt action needed. This may expose a significant proportion of the
working population to risk of injury.
P = PURPLE – Very high level of risk Such operations may represent a serious risk of injury and should
come under close scrutiny, particularly when the entire weight of the load is supported by one
person.
HSE Manual Handling Assessment Tool (MAC): The MAC tool was developed to help the user identify
high-risk workplace manual handling activities. There are three types of assessment that can be carried
out with the MAC:

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o Lifting operations
o Carrying operations
o Team handling operations
It is designed to help you understand, interpret and categorise the level of risk of the various known risk
factors associated with manual handling activities. It incorporates a numerical and a colour-coding score
system to highlight high-risk manual handling tasks.
Using the MAC will help to identify high-risk manual handling activities within the workplace. However,
the MAC is not appropriate for all manual handing operations, and may not comprise a full risk
assessment. Therefore it is unlikely to be acceptable if relied upon alone. To be ‘suitable and sufficient’, a
risk assessment will normally need to take account of additional information such as individual
capabilities, and should conform to the requirements in the MHOR. People with knowledge and
experience of the handling operations, industry specific guidance, and specialist advice may also be
helpful. Remember to consult and involve employees and safety representatives
The MAC leaflet has a single score sheet that covers lifting, carrying and team handling tasks that can be
downloaded from www.hse.gov.uk/ msd/mac/scoresheet.htm
To complete a MAC assessment:
• Spend some time observing the task to make sure what you are seeing is representative of normal
working procedures. Always consider the ‘worst case scenario’. Involve your employees and
safety representatives during the assessment process. Where several people do the same task,
make sure you have some insight into the demands of the job from the perspective of all
employees.
• Select the appropriate type of assessment (i.e. lifting, carrying or team handling, pushing or pulling
loads with or without wheels). If a task involves lifting and carrying, consider both.
• Follow the appropriate assessment guide and flow chart to determine the level of risk for each
risk factor.
• For each factor, enter the colour band and corresponding numerical score on the correct score
sheet. The colour bands help determine which elements of the task require attention.
• Consider individual characteristics such as age, sex, physical fitness, strength and psychosocial
factors when completing the score sheets
• Make sure to complete the task description and consider the indications of a high-risk task
• Use the scores to help identify which risk factors need to be examined and the total level of
exposure to risk.
• If the individual does a number of tasks, assess each one separately and prioritise action to
address the highest scoring task
• You can use the total scores to rank tasks to decide which ones require attention first. You can
also use the scores as a way of evaluating potential improvements. Generally, the most effective
improvements will bring about the highest reduction in the score. The scores can be used for
comparison purposes but the total scores do not relate to specific action levels.

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When you have made changes, repeating the risk assessment will help you check that your actions have
been successful and that no other significant risks remain. More guidance is available in HSE publication
INDG383 Manual handling assessment charts (the MAC tool).
HSE Assessment tool for repetitive tasks of the upper limbs (ART): The Assessment of Repetitive Tasks is
a tool designed to help assess repetitive tasks involving the upper limbs. ART is most suited for tasks that:
o Involve actions of the upper limbs

o Repeat every few minutes, or even more frequently
o Occur for at least 1–2 hours per day or shift
The tasks are typically found in assembly, production, processing, packaging, packing and sorting work, as
well as work involving the regular use of hand tools. ART is not intended for display screen equipment
(DSE) assessments. ART
Before starting the assessment, it is important to consider several things.
• Which task should be assessed first?

• Is the task suitable for assessment with ART?
• Who needs to be involved in the assessment?
• At what time should the assessment be made?
• What equipment is needed during the assessment?
The ART tool is intended for people with responsibility for the design, assessment, management, and
inspection of repetitive work. Repetitive tasks are typically found in assembly, production, processing,
packaging, packing and sorting work, as well as work involving regular use of hand tools. ART is not
intended for Display Screen Equipment (DSE) assessments.
The ART tool is a method that helps to:
• Identify repetitive tasks that have significant risks and where to focus risk reduction
measures
• Prioritise repetitive tasks for improvement
• Consider possible risk reduction measures
• Meet legal requirements to ensure the health and safety of employees who perform
repetitive work
It uses a numerical score and a traffic light approach to indicate the level of risk for twelve factors. These
factors are grouped into four stages:
• A: Frequency and repetition of movements

• B: Force
• C: Awkward postures of the neck, back, arm, wrist and hand
• D: Additional factors, including breaks and duration

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The factors are presented on a flow chart, which gives step-by-step guide to evaluate and grade the degree
of risk. The tool is supported by an assessment guide, providing instruction to help score the repetitive
task being observed. There is also a worksheet to record the assessment.
Detailed guidance is given in Assessment of repetitive tasks of the upper limbs (the ART tool) (HSG 438)
by HSE-UK
HSE Variable Manual Handling Assessment chart (V-MAC): The V-MAC is a tool for assessing manual
handling operations where load weights vary. It should be used in conjunction with the MAC tool.
The MAC tool was designed for assessing handling operations where the same weight is handled over the
workday/shift. However, in practice, load weights are often variable (such as in order picking, parcel
sorting, trailer loading/unloading, and parts delivery in manufacturing). The V-MAC was developed to help
assess these kinds of jobs.
You may not need to use the V-MAC as it is more complex than is needed for assessing many manual
handling operations. It is best suited for order picking and distribution systems which can automatically
generate the data for importing into V-MAC
Significant background knowledge is needed to use the V-MAC successfully; which can be gained from
HSE-UK Research Reports RR838 and RR1003.
The V-MAC can help identify:
o The weights handled

o The number of times each weight is handled
o The distribution of weights handled
o The level of MSD risk for the load weight/frequency risk factor
o How changing the weights of items or how often they are handled affects the overall
demands of the job.
The steps involved and the worksheets are available at http://www.hse.gov.uk/msd/mac/vmac/3-how-

to-use.htm
Appendix 5 (VDU checklist) from HSE guidance (L26): This checklist can be used by employers who need
to comply with the Health and Safety (Display Screen Equipment) Regulations 1992-UK. It lists risk
factors in six areas, with 'yes'/'no' tick boxes:
• Keyboards
• Mouse and trackball
• Display screens
• Software
• Furniture
• Work environment.
Checklist is available at http://www.hse.gov.uk/pubns/ck1.pdf or from Appendix 5 of HSE-UK publication

L26: Work with display screen equipment Health and Safety (Display Screen Equipment) Regulations

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1992 as amended by the Health and Safety (Miscellaneous Amendments) Regulations 2002 Guidance
on Regulations
NIOSH Manual Material Handling (MMH) Checklist: This checklist published is the USA by the National
Institute of Occupational Safety and Health (NIOSH) is not designed to be a comprehensive risk
assessment technique but rather as a tool to quickly identify potential problem jobs. Additional risk factors
may exist that are not accounted for in this checklist. It is common practice to follow up checklist
observations with more precise techniques to confirm problem risk factors.
This checklist is given in Appendix 2 of Ergonomic guideline for manual material handling book Published 2007 by
the California Department of Industrial Relations (https://www.cdc.gov/niosh/docs/2007-131/pdfs/2007-131.pdf)

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Rapid Upper Limb Assessment (RULA): RULA was developed to evaluate the exposure of individual
workers to ergonomic risk factors associated with upper extremity MSD. The RULA ergonomic assessment
tool considers biomechanical and postural load requirements of job tasks/demands on the neck, trunk
and upper extremities. A single page worksheet is used to evaluate required body posture, force, and
repetition. Based on the evaluations, scores are entered for each body region in section A for the arm and
wrist, and section B for the neck and trunk. After the data for each region is collected and scored, tables
on the form are then used to compile the risk factor variables, generating a single score that represents
the level of MSD risk.
Using the RULA worksheet, the evaluator will assign a score for each of the following body regions:
• Upper arm
• Lower arm
• Wrist
• Neck
• Trunk, and
• Legs
After the data for each region is collected and scored, tables on the form are then used to compile the
risk factor variables, generating a single score that represents the level of MSD risk as outlined below:
Score Level of MSD risk

1-2 Negligible risk, no action required
3–4 Low risk, change may be needed
5–6 Medium risk, further investigation, change
soon
6+ Very high risk, implement change now
A RULA assessment gives a quick and systematic assessment of the postural risks to workers. The scoring
generates an action list which indicates the level of intervention required to reduce the risks of injury due
to physical loading on the operator. RULA is intended to be used as part of a broader ergonomic study.
The assessment can be completed online. The first step is to observe the task and select the posture for
assessment. Depending upon the type of study, selection may be made of the longest held posture or
what appears to be the worst posture(s) adopted.
A Step-by-Step Guide Rapid Upper Limb Assessment (RULA) is available at http://ergo-plus.com/wp-

content/uploads/RULA-A-Step-by-Step-Guide1.pdf

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Practical control measures

Elimination/Automation: The obvious method of elimination is simply to not do the job at all. However,
this may not be a practicable solution, although it may be possible to do the job in another way. For
example, it may be possible to:
o Eliminate the need to manually lift, lower, or carry objects by using engineering controls such as
hoists, pallet jacks, carts, and conveyors.
o Eliminate the need to manually push or pull objects by using engineering controls such as
conveyors, hoists, and gravity fed systems.
o Eliminate the need to manually grasp or handle objects by using engineering controls such as
clamps or automated tools.
o Eliminate highly repetitious tasks by using engineering controls such as mechanization (e.g.,
power tools) or automation.
o Eliminate awkward postures by using engineering controls such as adjusting work heights,
minimizing reaching distances, changing orientation of work, changing layout of workstation,
using adjustable or angled tools and equipment, and using turntables, conveyors, tilted surfaces,
or spring loaded surfaces.
Alternative work methods/job design: One alternative is to automate or mechanise the process as
outlined above. Use of some aids such as sack trolleys is not strictly speaking ‘elimination’ since some
manual effort is still needed.
Changes can be made to work routines such that individuals do not spend too long doing a particular task
such as working on a supermarket checkout, which requires some seated handling and twisting and which
affords limited opportunity to move around. In that case, job rotation to other tasks is commonplace.
Allowing workers some control over the pace of the task may also help to reduce the risks.
For large loads, which may not only be heavy but are also bulky, the introduction of team handling will
help to share the load. It may even be possible to break the load down into smaller parts. Following
measures may be particularly helpful depending upon the nature of workplace:
o Require that heavy loads be only lifted by two people to limit force exertion
o Use a device to lift and reposition heavy objects to limit force exertion
o Reduce the weight of a load to limit force exertion
o Reposition a work table to eliminate a long/excessive reach and enable working in neutral
postures
o Use diverging conveyors off a main line so that tasks are less repetitive
o Install diverters on conveyors to direct materials toward the worker to eliminate excessive
leaning or reaching
o Change or modify equipment (e.g., use a long-handled screwdriver to prevent the butt from
digging into the palm).
Some examples of simple mechanical aids that can be used to reduce manual handling effort in lifting
and carrying include levers, lifting devices, such as jacks (which should always be marked with a safe
working load), winches, slings and wheelbarrows etc.

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Ergonomic design of tools/equipment/workstations and workplaces: Altering the layout of the plant,
equipment and furniture in the workplace can greatly improve the workflow and reduce the risk from
manual handling. This should also include attention to housekeeping and maintenance of equipment.
Good design principles should be applied to the design of work-stations. One characteristic of a well-
designed workstation is that the operator can work in an upright posture, with the shoulders resting and
the arms close to the trunk. The working height should be about level with the employee’s elbows,
whether the work is being done from a seated or standing position. If the work involves handling weights,
then the work surface should be about 2-3 cm below the elbow height. The most effective way of ensuring
that all employees are protected from the risk of musculoskeletal injury is to provide adjustable work
stations so that employees are able to adjust working heights to suit their needs.
o Adjust your workstation (e.g., adjust the working height so the elbows are bent approximately 90°
by using adjustable seating, using sturdy, stable step-stools to raise shorter workers, and using
adjustable work benches to improve neck and back posture)
o Maintain a neutral, relaxed posture, and work in a comfortable position, for example by selecting
a tool with the proper angle or grip
o Keep tools and equipment well maintained to reduce effort – for example, sharp knives require
less force; well-maintained lift trucks transmit less vibration to the driver
o Keep frequently used tools, supplies, and equipment within your arm’s natural reach
Job rotation: This can be thought about in order to allow the worker sufficient rest and recovery breaks
o Establish systems so workers are rotated away from tasks to minimize the duration of continual
exertion, repetitive motions, and awkward postures. Design a job rotation system in which
employees rotate between jobs that use different muscle groups
o Staff "floaters" to provide periodic breaks between scheduled breaks
Work routine: Employees sometimes have to work too long, or too rapidly on fast paced production lines
or when trying to meet deadlines. These workers are more likely to tire, become uncoordinated and make
errors. Job rotation may reduce the exposure of employees to these risk factors. This also allows
employees to gain experience in a variety of job tasks e.g. people doing keyboard work could spend time
doing reception tasks at the front desk. Smoothing out peak demands such as tight deadlines will also help
reduce exposure to risk factors. Occasionally when it is not possible to redesign lifting tasks, it may be
appropriate to use team lifting procedures. This must be organised to ensure that adequate personnel are
available and trained for the task.
Eye and eyesight testing: This is commonly applied to those who use display screen equipment as an
integral part of their job. Eye strain can develop over time with heavy use of DSE and so regular testing
helps to give an early warning of deterioration in the worker’s sight so that modifications can then be
made to their workstation or work routine.

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Training and information: Training is essential in supporting the range of control measures that should
be put in place to manage the risk of manual handling injuries. However, training is not a substitute for
removing the risk and should not be used as the primary method for controlling risk (unless it can be
justified that it is not feasible to change the task, provide mechanical assistance or redesign the work
area). Training should cover issues that are specific to the task to enable the worker to develop skill in
performing that task. Risk assessment should have highlighted a range of factors for which training needs
to be provided. Training is an important part of an overall risk management plan, but if most of the control
measures are based on training you may be relying on the workers to practise safe behaviour while
working in a hazardous environment. It is more effective to improve the working environment by reducing
the risk through redesign and providing equipment. Remember that training should be supported by
adequate supervision
Efficient movement principles: Reduce upper body twisting and over reaching by:
o Placing all tools, equipment controls and materials in front of the worker (within 400-mm reach)
o Seating the worker on a chair that swivels
o Providing adequate space to step and move to reach materials and equipment that are used less
frequently
o Enabling the worker to walk around the load or rotate it and
o Providing knee space for seated tasks.
Reduce holding forces by:
o Providing a jig to stabilise the object being assembled or the tool being used
o Supporting and counterbalancing hand tools
o Providing handles on the objects to be handled, e.g. by using a sling, or placing smaller items in
boxes with cut out space for the hands.
Personal considerations: Individual factors include the age, skill, physical characteristics and experience
of the worker e.g. young workers (under the age of 18) have a greater risk of injury than adult workers
as they are still developing physically. Individuals will differ in their physical dimensions, strength and
endurance. Therefore, tasks should be designed to reduce the physical effort required so that the
majority of workers are able to carry out the tasks safely. Reducing the time spent in physically
demanding tasks, training personnel to use equipment safely and providing extra assistance will help to
reduce these risks. This may involve special training such as acquiring a forklift or crane licence.
Wearable technologies (provides continuous data): A range of wearable devices designed to help
reduce the risk of pain and injury to backs, joints and limbs, in other words, musculoskeletal disorders,
has come onto the market recently.
The devices electronically detect movement, angular rotation and free-fall and are designed to be used
within organisations where employees experience occupational back injuries, such as healthcare,
warehousing, manufacturing, logistics, retail and other such sectors. They are also used in clerical

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environments to assist those returning to work following a back or joint related illness, as well as for
those experiencing ongoing back or joint pain.
Worn on a belt for manual handling monitoring purposes, the device vibrates to alert the wearer that
they are stooping during rotation, a movement that should be avoided during handling or lifting.
Whilst in principle the concept of the wearable device for manual handling appears to be a good idea,
with the physical prodding to remind the wearer that he or she is contravening correct procedure, the
approach could potentially be likened to verbal prodding. In other words, is it really any different to
someone saying, ‘bend your knees and keep your back straight’? And do people really understand why
they have to bend their knees and keep their backs straight?
The key point here is, ‘understanding’. Whilst a wearable device will serve to remind an individual that
they are not using correct procedure when moving a load, if that person does not actually understand
WHY they are being reminded, then chances are they will simply continue to keep making the same
mistakes.
If however, they understand the knowledge and principles that form the backbone of good manual
handling technique, and fully appreciate the injuries that can result otherwise, then they will naturally
apply that good technique, and there will be no need for continual corrective prodding of any kind,
whether physical or verbal.
9.15 Workplace temperature, Welfare arrangements

The importance of maintaining heat balance in the body
Ordinarily the body remains at a fairly constant temperature of 98.6°F. It is very important that this body
temperature be maintained and, since there is a continuous heat gain from internal body processes, there
must also be a continuous loss to maintain body heat in balance. Excess heat must be absorbed by the
surrounding air or lost by radiation. As the temperature and humidity of the environment vary, the human
body automatically regulates the amount of heat it gives off. However, the body’s ability to adjust to
varying environmental conditions is limited. Furthermore, although the body may adjust to a certain
(limited) range of atmospheric conditions, it does so with a distinct feeling of discomfort.
The risk of heat-related illness varies from person to person. A person's general health influences how
well the person adapts to heat (and cold).
Those with extra weight often have trouble in hot situations as the body has difficulty maintaining a good
heat balance. Age (particularly for people about 45 years and older), poor general health, and a low level
of fitness will make people more susceptible to feeling the extremes of heat.
Medical conditions can also increase how susceptible the body is. People with heart disease, high blood
pressure, respiratory disease and uncontrolled diabetes may need to take special precautions. In addition,
people with skin diseases and rashes may be more susceptible to heat. Other factors include circulatory
system capacity, sweat production and the ability to regulate electrolyte balance.

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The effects of working in high and low temperatures and humidity
Effects of working in high temperatures Effects of working in Low temperatures

Extended exposures to heat extremes bring Cold-related injuries include chilblains,
about a wide variety of heat-induced disorders. immersion injuries, hypothermia (mild,
Managers and supervisors should insure that all moderate, and severe) and frostbite of varying
workers exposed to potential heat be trained in degrees.
the signs and symptoms of these disorders, and
how to prevent them. The heat related disorders When in a cold environment, most of the body's
include heat rash, heat cramps, heat syncope, energy is used to keep the internal temperature
dehydration, heat exhaustion, and heat stroke. warm. Over time, body will begin to shift blood
flow from extremities (hands, feet, arms, and
The healthy human body maintains its internal legs) and outer skin to the core (chest and
temperature around 37°C. Variations, usually of abdomen). This allows exposed skin and the
less than 1°C, occur with the time of the day, extremities to cool rapidly and increases the risk
level of physical activity or emotional state. A of frostbite. When the body can no longer
change of body temperature of more than 1°C maintain core temperature by constricting blood
occurs only during illness or when vessels, it shivers to increase heat
environmental conditions are more than the production. Maximum severe shivering
body's ability to cope with extreme heat. develops when the body temperature has fallen
As the environment warms-up, the body tends to 95oF. Hypothermia becomes an issue at this
to warm-up as well. The body's internal point.
"thermostat" maintains a constant inner body
temperature by pumping more blood to the skin Hypothermia (mild, moderate, and severe):
and by increasing sweat production. In this way, Hypothermia means "low heat" and is a
the body increases the rate of heat loss to potentially serious health condition. It occurs
balance the heat burden. In a very hot when body heat is lost from being in a cold
environment, the rate of "heat gain" is more environment faster than it can be
than the rate of "heat loss" and the body replaced. Symptoms begin with shivering. As
temperature begins to rise. A rise in the body the body temperature continues to fall, slurred
temperature results in heat illnesses speech, lack of coordination and memory loss
develop and shivering ceases. Once the body
Heat rash are tiny red spots on the skin which temperature falls to around 85° F, the person
cause a prickling sensation during heat may become unconscious, and at 78°, the
exposure. The spots are the result of person could die.
inflammation caused when the ducts of sweat Anyone working in a cold environment may be
glands become plugged. at risk for hypothermia. However, older people
may be at more risk than younger adults, since
Heat cramps are sharp pains in the muscles that older people are not able to generate heat or
may occur alone or be combined with one of the regulate body temperature as quickly.
other heat stress disorders. The cause is salt Certain medications may prevent the body from
imbalance resulting from the failure to replace generating heat normally. These include anti-
salt lost with sweat. Cramps most often occur depressants, sedatives, tranquilizers and some
when people drink large amounts of water heart medications.
without sufficient salt (electrolyte) replacement. Signs and symptoms of the three types of
hypothermia include:

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Heat syncope is heat-induced dizziness and

fainting induced by temporarily insufficient flow Mild hypothermia (98 - 90° F)
of blood to the brain while a person is standing. • shivering
It occurs mostly among unacclimatized people. • lack of coordination, stumbling,
It is caused by the loss of body fluids through fumbling hands
sweating, and by lowered blood pressure due to • slurred speech
pooling of blood in the legs. Recovery is rapid • pale, cold skin
after rest in a cool area. Moderate hypothermia (90 - 86° F)
• shivering stops
Dehydration: Dehydration can be a serious heat- • mental confusion or impairment
related disease, as well as being a dangerous • reduced breathing and/or heartrate
side effect of diarrhea, vomiting, and fever. • unable to walk or stand
When a person is overexposed to the sun and • confused and irrational
not drinking enough water, dehydration occurs. Severe hypothermia (86 - 78° F)
This is caused when the body loses water
• severe muscle stiffness
content and essential body salts, such as
• very sleepy or unconscious
sodium, potassium, calcium bicarbonate, and
• extremely cold skin
phosphate.
• irregular or difficult to find pulse
Symptoms may include:
• Thirst
Chilblains: Chilblains are caused by the repeated
• Less-frequent urination
exposure of skin to temperatures just above
• Dry skin
freezing to as high as 60 degrees F. The cold
• Fatigue exposure causes damage to the capillary beds
• Light-headedness (groups of small blood vessels) in the skin. This
• Dizziness damage is permanent and the redness and
• Confusion itching will return with additional exposure. The
• Dry mouth and mucous membranes redness and itching typically occurs on cheeks,
• Increased heart rate and breathing ears, fingers, and toes.
Symptoms of chilblains include:
Heat exhaustion is one part of the spectrum of • Redness
heat-related illnesses that begin with heat • Itching
cramps, progresses to heat exhaustion, and • Possible blistering
finally to heat stroke. • Inflammation
The body cools itself by sweating and allowing • Possible ulceration in severe cases
that sweat to evaporate. This requires enough
fluid in the body to make sweat, air circulating Immersion injuries (trench foot): Trench foot,
across the skin, and low enough air humidity to also known as immersion foot, is an injury of the
allow that sweat to evaporate. feet resulting from prolonged exposure to wet
Causes of heat exhaustion include activity in a and cold conditions. Trench foot can occur at
hot environment that can overwhelm the body's temperatures as high as 60 degrees F if the feet
ability to cool itself, causing heat-related are constantly wet. Injury occurs because wet
symptoms, and living in a hot environment feet lose heat 25-times faster than dry feet.
without adequate access to water Therefore, to prevent heat loss, the body
for dehydration. constricts blood vessels to shut down circulation
in the feet. Skin tissue begins to die because of
Symptoms of heat exhaustion may start lack of oxygen and nutrients and due to the
suddenly, and include: buildup of toxic products.

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• Nausea or irritability. Symptoms of trench foot include:

• Dizziness. • Reddening of the skin
• Muscle cramps or weakness. • Numbness
• Feeling faint. • Leg cramps
• Headache. • Swelling
• Fatigue. • Tingling pain
• Thirst. • Blisters or ulcers
• Heavy sweating. • Bleeding under the skin
• High body temperature. • Gangrene (the foot may turn dark
purple, blue, or gray)
Heat stroke is the most serious type of heat
illness. Signs of heat stroke include body
temperature often greater than 41°C, and Frostbite: Frostbite occurs when layers of skin
complete or partial loss of consciousness. tissue freeze. In severe cases, amputation of the
Sweating is not a good sign of heat stress as frostbitten area may be required. Frostbite can
there are two types of heat stroke - "classical" be caused by exposure to severe cold or by
where there is little or no sweating (usually contact with extremely cold objects. In fact,
occurs in children, persons who are chronically frostbite occurs more readily from touching cold
ill, and the elderly), and "exertional" where body metal objects because heat is rapidly transferred
temperature rises because of strenuous exercise from skin to metal.
or work and sweating is usually present. Frostbite typically affects the extremities,
Heat stroke requires immediate first aid and particularly the face, ears, fingers and
medical attention. Delayed treatment may toes. Initial symptoms vary, but typically include
result in death. skin that looks waxy and feels numb. Once
Symptoms of heat stroke include: damaged, tissues will always be more
• Hot, dry skin or profuse sweating. susceptible to frostbite in the future.
• Confusion.
• Loss of consciousness. Signs and symptoms include:
• Seizures. • Cold, tingling, stinging or aching feeling
• Very high body temperature in the frostbitten area, followed by
numbness
• Skin color turns red, then purple, then
white or very pale skin, cold to the touch
• Hard or blistering skin in severe cases
The meaning of thermal comfort

Thermal comfort is very difficult to define. This is because you need to take into account a range of
environmental and personal factors when deciding on the temperatures and ventilation that will make
employees feel comfortable. The best that one can realistically hope to achieve is a thermal environment
which satisfies the majority of people in the workplace, or put more simply, ‘reasonable comfort’.
Employers are responsible for assessing risks to the health, safety and welfare of their employees. These
include the effects of heat, cold and humidity. They will need to consider the way in which

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• Environmental factors (e.g. air-conditioning or the weather outside) and

• Factors affecting individual people (e.g. age, sex and state of health)
contribute to how they feel. You will need to ensure that a reasonable balance is achieved between all
these factors.
Essentially, the more extreme the environment, the higher the risk is to workers of being exposed to
serious illnesses and injuries – even death.
Thermal discomfort can seriously impact a worker’s overall morale and work performance. Prolonged
exposure can lead to fatigue, lowered concentration and productivity. In addition, worker complaints and
absenteeism can increase.
Health & Safety Executive advises that a meaningful figure for maximum workplace temperatures cannot
be given (due to the high temperatures found in, for example, glass works or foundries), the Workplace
(Health, Safety and Welfare) Regulations 1992 place a legal obligation on employers to provide a
“reasonable” temperature in the workplace.
A reasonable temperature for a workplace depends on work activity and the environmental conditions of
the workplace. To find out if reasonable workplace temperature exists, a risk assessment must be carried
out. A simple way of estimating the level of thermal comfort in the workplace is to ask employees or their
safety representatives (such as unions or employee associations) if they are satisfied with the thermal
environment i.e. to use the thermal comfort checklist available at
http://www.hse.gov.uk/temperature/assets/docs/thermal-comfort-checklist.pdf
Parameters affecting thermal comfort

Metabolic rate: The more physical work we do, the more heat is produced. The more heat is produced,
the more heat needs to be lost so we don’t overheat. The impact of metabolic rate on thermal comfort is
critical.
A person’s physical characteristics should always be borne in mind when considering their thermal
comfort, as factors such as their size and weight, age, fitness level and sex can all have an impact on how
they feel, even if other factors such as air temperature, humidity and air velocity are all constant.
Clothing: Thermal comfort is very much dependent on the insulating effect of clothing on the wearer.
Wearing too much clothing or PPE may be a primary cause of heat stress even if the environment is not
considered warm or hot. If clothing does not provide enough insulation, the wearer may be at risk from
cold injuries such as frostbite or hypothermia in cold conditions. Clothing is both a potential cause of
thermal discomfort as well as a control for it as we adapt to the climate in which we work. You may add
layers of clothing if you feel cold, or remove layers of clothing if you feel warm. Many companies inhibit
this ability for employees to make reasonable adaptations to their clothing as they require them to wear
a specific uniform or PPE. It is important to identify how the clothing contributes to thermal comfort or
discomfort. By periodically evaluating the level of protection provided by existing PPE and evaluating
newer types of PPE you may be able to improve the level of thermal comfort.
Sweat rate: The sweat that appears on the surface of the skin is evaporated by the cooler temperatures
outside of the body. The evaporation of sweat cools the skin, thereby eliminating heat from the body. The

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problem that encountered in this process is that when environmental temperatures outside of the body
approach normal skin temperature, the cooling process becomes more difficult. However, the heart
continues to pump blood to the surface, the sweat glands pour liquids containing electrolytes onto the
surface of the skin, and the evaporation of the sweat becomes the principal effective means of cooling.
If the sweat is not removed from the skin by evaporation, it will not cool the body. Under conditions of
high humidity, the evaporation of sweat from the skin is decreased and the body’s efforts to maintain
acceptable body temperature may be significantly impaired. With so much blood going to the external
surface of the body, less is going to the active muscles, the brain, and other organs; strength declines; and
fatigue occurs sooner than normal. Alertness and mental capacity also may be affected. Workers who
must perform delicate or detailed work may find their accuracy decrease, and others may find their
compression and retention of information lowered.
Duration of exposure: Greater the duration of exposure greater will be the risk of heat/cold stress.
Employers must introduce work systems to limit exposure to a cold/hot environment for longer periods,
for example by flexible working hours policy and allowing sufficient breaks. Detailed guidance is available
in HSE publication HSG-194
The purpose of the heat stress index WBGT

Workers indoors or outdoors are susceptible to stress in high temperature environments, requiring an
instrument which can monitor temperatures, calculate possible heat stroke conditions, and alert the
workers so they can stop, cool down, drink water, etc. The Heat Stress instrument measures WBGT (Wet
Bulb Globe Temperature) for both indoor and outdoor environments.
The WBGT instruments can measure temperature of wet and dry bulbs and a black globe to estimate
stress in a high temperature working environment, indoors or outdoors. The WBGT index is a single
number derived mathematically from three distinct temperature measurements: wet bulb temperatures,
dry bulb temperatures, and globe temperatures. Heat injuries can be expected at WBGT readings of 75°F
and above unless preventative measures are taken.
The heat stress formula referenced by the U.S. Government Occupational and Environmental Health
Bulletin is:
WBGT (outdoor) = 0.7 x WB + 0.2 x BG + 0.1 x DB
WBGT (indoor) = 0.7 x WB + 0.3 x BG
Where:
WB is the wet-bulb temperature
BG is the 6-inch Vernon Black Globe temperature
DB is the dry-bulb (ambient) temperature
WBGT is the wet-bulb globe temperature index

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The U.S. Government Occupational and Environmental Health Bulletin lists several of the WBGT index
general guidelines, which include the following:
WBGT Index = 78.0 - 81.9°F. Extremely intense physical exertion may precipitate heat exhaustion or heat
stroke; therefore caution should be taken.
WBGT Index = 82.0 - 84.9°F. Discretion should be used in planning heavy exercise for unseasoned
personnel. This is sometimes used as the marginal limit of environmental heat stress.
WBGT Index = 85.0 - 87.9°F. Strenuous exercise such as marching at standard cadence should be
suspended in unseasoned personnel during their first three weeks of training. Training activities may be
continued on a reduced scale after the second week of training. Outdoor classes in the sun should be
avoided above this temperature.
WBGT Index = 85.0°F or greater. Outdoor classes in the sun should be avoided.
WBGT Index = 88.0°F. Strenuous exercise should be curtailed for all recruits and other trainees with less
than 12 weeks training in hot weather.
WBGT Index = 90.0°F or greater. Physical training and strenuous exercise should be suspended for all
personnel (excluding essential operational commitments not for training purposes, where risk of heat
casualties may be warranted).
The practical control measures to minimise the risks when working in extreme thermal
environments
Control heat source
By reducing/increasing the temperature and/or insulating or cladding the source of heat or cold.
Ventilation, air cooling, fans, shielding, and insulation are the major types of engineering controls used to
reduce heat stress in hot work environments. Heat reduction can also be achieved by using power assists
and tools that reduce the physical demands placed on a worker.
However, for this approach to be successful, the metabolic effort required for the worker to use or operate
these devices must be less than the effort required without them
Control other environmental parameters

• Replace hot air with cold, or replace cold air with hot, as required
• Humidify or dehumidify the air as required
• Increase air movement by ventilation or air conditioning
• Reduce draught discomfort by directing the ventilation or air movement so that it doesn't blow
directly onto the employees, e.g. using baffles
Separation
• Insulate around heat or cold generating plant and pipes
• Isolate heat-producing equipment to limit exposure to radiant heat
• Where possible, relocate workstations away from hazard areas, such as direct sunlight or air-
conditioning vents so workers are not exposed to thermal discomfort
• Redesign the job to remove an affected worker from a hazard area

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Workplace design
• Ensure airflow through the building is sufficient
• Where possible, open windows and doors or provide fans
• Enclosing loading and unloading areas will increase comfort in winter conditions, particularly if
combined with increased thermal insulation
Job design including job rotation

• Restrict the length of time that employees are exposed to hot or cold conditions
• Control the amount of work and rate of work employees are expected to do. The more physical
the work is, the more heat is produced by the body. Care must be taken so workers don’t overheat
• Sedentary work in cool or cold environments can make it difficult for workers to generate heat.
• Introduce mechanical aids (e.g. lifting aids or power tools) to assist physically demanding jobs in
warm and hot environments or when employees are wearing a lot of clothing
• Consider alternative shift patterns or working hours i.e. earlier start and finish times
Providing hot/cold drinks

• Make drinks readily available and encourage employees to take an extra break
• Employers are required to provide an adequate supply of cool drinking water close to the work
area for workers exposed to heat. Employees should drink small amounts frequently; for example,
one cup every 30 minutes. Fluids that contain caffeine or alcohol are not appropriate because
they increase dehydration.
• Drink warm, sweet beverages and avoid drinks with caffeine or alcohol to avoid cold stress. Add
soups and other calorie rich foods in your diet.
Clothing/PPE
• If PPE is worn, make sure that employees are not wearing more PPE than is appropriate (ie a
higher protection factor than is needed)
• If uniforms are worn, evaluate alternative designs, new materials etc to improve the thermal
comfort of clothing
• Evaluate dress code and allow employees to adapt their clothing where possible
• Multiple layers of clothing enable employees to make reasonable adjustments to their clothing
based on their individual needs
Health surveillance
• Workers may have physical or medical health conditions that make them more likely to be
affected by heat or cold, e.g.: overweight; underweight; respiratory disease; taking any
medication, drugs or alcohol
• Thermal comfort can be affected by a worker’s age, fitness level and sex. For example:
o A fit body regulates its temperature more efficiently
o Aging can make it harder for people to keep warm or to stay cool due to hormone changes

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o Women tend to feel the cold more than men because they’re less muscular and
commonly wear less layers of clothing
• Tense or stressed workers can feel colder.
• Pay special attention to those at higher risk i.e.. pregnant or older employees
Training
The key to preventing heat/cold stress is educating the employees on the hazards of working in extreme
temperatures and the benefits of implementing proper controls and work practices. The employer should
provide information about:
• Signs/symptoms of heat-related illnesses. Dehydration, exhaustion, fainting, heat cramps, heat

exhaustion, and heat stroke must be recognised by employees as heat disorders
• Factors that affect a person’s sensitivity to heat such as age, weight and types of medication
• Employees’ responsibilities
• Strategies for prevention, including the implementation of engineering controls, acclimatization,
reduction of physical demands, alternating work and rest periods and fluid replacement. First aid
workers should be trained to recognise and treat heat stress disorders.
Facilities for pregnant women and nursing mothers, together with the practical
arrangements
Employers can either modify existing risk assessments or produce a new one as soon as they are notified
in writing by the worker. They should consider how the health and safety of the worker could be affected
by the pregnancy. An example would be the difficulties an individual may have with lifting or other manual
handling activities. The employer also has a legal duty to provide the worker with a place to be able to
raise their feet or express milk. There are different controls for the different risks associated with new and
expectant mothers:
• Short term changes to the workplace to increase comfort and improve health and safety, for
example, lower back support for office chairs.
• Allocating different tasks which will be less detrimental to the expectant mother’s health (at the
same rate of pay).
• Suspending them, with pay, from their duties in order to protect their health and safety.
The facility for pregnant women and nursing mothers should, when possible, be situated near the welfare
facilities (i.e. toilet and washing facilities) and be equipped to allow persons to lie down. Adequate space,
heating and lighting are required.
In a limited number of countries, a special quiet room is to be provided only for pregnant women or
nursing mothers. Even where legislation does not require employers to provide nursing facilities, many
enterprises choose to maintain an on-site nursery or a quiet room, where nursing mothers can express

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their milk during the workday for later use at home. Unless nursing facilities are clearly designated and
appropriately situated, nursing mothers may suffer a lack of privacy and security from unwarranted
intrusion.
ILO Recommendation No. 191 calls for the provision of Breastfeeding facilities or nursing rooms which are
simply places where a worker can feed her baby or express her milk. The requirements are similar to those
for preparing safe food: that they are clean and have clean water available for washing hands and cleaning
utensils. Many women request that the facility offer a certain degree of privacy.
To set up an appropriate place for employees who are breastfeeding requires:
• A private, clean, quiet, warm room or space – such as a screened off area (spaces don’t need to
be sterile, just clean), which needs to be big enough to maneuver a pram
• A low comfortable chair
To ensure privacy, windows or glass walls may need to be screened. If an employee is expressing breast
milk, in addition to the things listed above the following are needed:
• A lockable door
• A washbasin
• A refrigerator or cooler for storing expressed breast milk
• A table
• A clean space to store equipment (e.g. a small locker or cupboard)
• The availability of electricity (if using an electric breast pump).
Toilets are not acceptable places to breastfeed or express breast milk. Toilets are not only unsanitary, but
are also in appropriate for all cultures.

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HEAD OFFICE INDIA

Green World Management Consultants & Training Institute
249/2, P Block MMDA Main Road, Arumbakkam, Chennai – 600 106
Tel: 044 48561333
Email: info.india@greenworldsafety.com
CORPORATE OFFICE UAE

Green World Safety and Security Consultancies LLC
Suite # 102 First Floor, Sapphire Tower, Near Dnata, Deira, Dubai Po Box: 83127
Tel: +971-4-2698807
Email: info@greenwgroup.com
Green World International Training Center

Suite No: # 606, 06th Floor,
#101 Business Tower
King Abdul-Aziz Street, Jubail city,
Kingdom of Saudi Arabia,
Tel: +966 13 3617730.
Email: info.saudi@greenwgroup.com
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International Diploma for Occupational Health

and Safety Management Professionals

Unit ID2 : Do – Controlling Workplace

Unit ID2: Do – Controlling Workplace Health Issues (International)

All rights reserved.

Green World Safety & Security Consultancies LLC

GWG - NEBOSH IDIP Textbook - Version 1 (June 2021)

Specification Date: July 2020

NEBOSH Syllabus Publication Date: April 2021

Unit ID2: Do – Controlling Workplace Health Issues (International)

Acknowledgements and Disclaimer

• Health and Safety Executive HSE-UK

We’d like to express a gratitude of thanks to the authors of this book.

Unit ID2: Do – Controlling Workplace Health Issues (International)

Unit ID2: Do – Controlling Workplace Health Issues (International)

The types of interventions for mental ill-health ................................................................................. 35

Unit ID2: Do – Controlling Workplace Health Issues (International)

When testing for alcohol/drugs should be carried out....................................................................... 74

Unit ID2: Do – Controlling Workplace Health Issues (International)

Unit ID2: Do – Controlling Workplace Health Issues (International)

The use of vibration calculators to determine mixed exposures ..................................................... 203

Unit ID2: Do – Controlling Workplace Health Issues (International)

The importance of maintaining heat balance in the body................................................................ 267

Unit ID2: Do – Controlling Workplace Health Issues (International)

9.1 Occupational health services, Equality in the workplace

Unit ID2: Do – Controlling Workplace Health Issues (International)

Importance of making reasonable adjustments in the workplace:

The role and benefits of ‘pre-placement’ assessment

The benefits of conducting pre-employment medical assessments include:

• A safer working environment

Unit ID2: Do – Controlling Workplace Health Issues (International)

• Reduction in Workcover claims and insurance costs

• Height, weight, body mass index (BMI)

Managing long-term sickness absence and capability

Unit ID2: Do – Controlling Workplace Health Issues (International)

The meaning of vocational rehabilitation

• Comprehensive rehabilitation evaluation to determine abilities, skills, interests, and needs

Employee benefits Employers benefits

Unit ID2: Do – Controlling Workplace Health Issues (International)

Possible barriers to the effective rehabilitation of workers

Unit ID2: Do – Controlling Workplace Health Issues (International)

What needs to be considered in a risk assessment prior to return to work

• Provide new or modify existing equipment and tools

Unit ID2: Do – Controlling Workplace Health Issues (International)

• Modify workstations, furniture, movement patterns

A sample risk assessment form in relation to a Return to Work is given below:

Name of Employee: ____________________________ Name of Reviewer:__________________________

Date: _____________________________ Reviewer’s Signature: _____________________________ Employee’s

Unit ID2: Do – Controlling Workplace Health Issues (International)

Unit ID2: Do – Controlling Workplace Health Issues (International)

The role of agencies that can support employers and workers

Type of service Description

Assessment Services provided and activities performed to determine an individual's

Vocational Discrete therapeutic counselling and guidance services necessary for an

Unit ID2: Do – Controlling Workplace Health Issues (International)

Type of service Description

Rehabilitation The systematic application of technologies, engineering

The roles of typical occupational health specialists

Unit ID2: Do – Controlling Workplace Health Issues (International)

Name of Employee: __ Name of Reviewer:

Date: _ Reviewer’s Signature: _ Employee’s