BACHELOR OF OCCUPATIONAL SAFETY AND HEALTH MANAGEMENT WITH

HONOURS

SEMESTER JANUARY / 2023

XBHM3103

OCCUPATIONAL HEALTH
 TABLE OF CONTENTS
TASK 1: Report and Powerpoint Slides ............................................................................. 2
1.0 Introduction .......................................................................................................... 2
2.0 Hazard Identification ............................................................................................ 3
3.0 Risk Assessment................................................................................................... 6
4.0 Risk Control ......................................................................................................... 6
5.0 Risk Factor ........................................................................................................... 7
6.0 Type of Diseases .................................................................................................. 8
7.0 Control Measure for Workplace ......................................................................... 12
8.0 Health Surveillance ............................................................................................ 15
9.0 Recommendation ................................................................................................ 17
10.0 Presentation Slide ........................................................................................... 19
TASK 2: Online Class Participation ................................................................................. 31
REFERENCES ................................................................................................................. 32

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TASK 1: Report and Powerpoint Slides

1.0 Introduction
In a short summary, the purpose of a cooling tower is to cool down water that gets heated
up by industrial equipment and processes. Water comes in the cooling tower hot (from
industrial process) and goes out of the cooling tower cold (back into the industrial
process). There are a few types Of Cooling Tower Systems:
• Crossflow Cooling Towers
• Counterflow Cooling Towers
• Forced Draft & Induced Draft Cooling Towers Process
• Natural Draft & Fan Assisted Natural Draft Cooling Towers
• Factory Assembled Cooling Towers (FAP) Factory Assembled Product
• Field-Erected-Towers (FEP) Field Erected Product

Before starting a cooling tower task, it is important to identify all potential safety and
health hazards associated with the work and identify how each hazard will be eliminated
or controlled. Planning ahead helps alert workers to potential safety hazards and take
appropriate preventive action.

The current case study was on identification of existing and potential hazards followed by
quantitative risk assessment to prioritize the hazards. Implementation of control measure
for the workplace area to reduce the risks and control the residual impact to increase the
safety during repairing, maintenance, servicing and cleaning of fresh water-cooling tower
of air conditioning systems. As precaution, health surveillance is step for protection and
monitor the health of worker.

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2.0 Hazard Identification
Hazard can be defined as a situation with a potential to harm in terms of human injury or
ill health, damage to property or environment or a combination of these. It is employer’s
responsibility to provide a safe working environment by eliminating and minimizing
hazards. Adequate knowledge through training, instructions and appropriate supervision
shall be provided to employees to ensure safety and health at workplace. Primary focus is
given for employer’s responsibility in Malaysian Occupational Safety & Health Act to
ensure safety and health aspects at workplace.

Hazards can be identified or grouped under various categories, as listed below. The items
listed under each category are provided as examples.
▪ Observations
▪ Workplace inspection by walk through survey
▪ Hazard identification checklist
▪ Job hazard analysis
▪ Feedback from workers
▪ Advice from specialists
▪ Accident records
▪ MSDS/CSDS

Walk through survey is extremely useful for identification and evaluation of hazards. It
also gives a better understanding about the job nature and potential hazards could be
identified. Apart from identifying key hazards, it also helps to obtain an overview of the
activities where the effectiveness of control methods could be seen (Jeyakumar, 2008).

The following are factors that consider cause health and safety hazards:
i.) People actions, whether they display them or not, have a significant impact on
workplace health and safety.
ii.) Equipment can potentially emit harmful chemicals and certain equipment can
produce physical agents such as heat, noise, vibration, or radiation during operation.

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iii.) Material include raw material, products, hazardous chemicals, and other substances
that workers use, process, or handling can cause to the property such as spills,
corrosions, burns, or explosions.
iv.) Process is the hazards that may be prevalent a process between these factors occurs.
v.) Environment refers to all parts of a workplace that can be a potential hazard.

Hazards happen upon safety not practised or maybe caused by careless act by a worker
that result accident or unwanted situation. Figure 1 describe the classification of
workplace hazards.

Figure 1: Classification of Workplace Hazards

From the case study, hazards that identify at Cooling Towers, as follows: -

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▪ Electrocution or electrical shock from not turning off the power supply before
servicing
▪ Electrocution or electrical shock from contacting live electrical components
▪ Electrocution or electrical shock from failing to turn off the power supply before
leaving the site
▪ Trip or fall hazards from cluttered work areas or uneven surfaces
▪ Slips, trips, and falls from working at heights or in wet areas
▪ Inhalation of harmful chemicals or vapors from the cooling tower water or cleaning
agents
▪ Contact with harmful bacteria or other microorganisms present in the cooling tower
water
▪ Strain or injury from heavy lifting or awkward positioning
▪ Burns or cuts from working with sharp or hot components

To achieve and implement Occupational Safety and Health aspects at work place, the
need to look into HIRARC which helps to identify and overcome the hazards. HIRARC
involves three consecutive activities: Hazard Identification, Risk Assessment and Risk
Control.

In Malaysia, the Department of Occupational Safety and Health (2008) had published the
HIRARC guidelines. The guidelines explain a systematic approach to identify hazards
and assess their related risks to provide objective measures to control the hazards.
According to Occupational Safety and Health Act 1994 (Act 514), it is the duty of an
employer to provide a safe workplace for employees.

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3.0 Risk Assessment
Risk assessment is carried out by collecting data on each identified hazard; then using the
collected data to determine the likelihood and severity of each hazard. A qualitative or
quantitative risk table is created using these data.

Risk assessment is done based on likelihood and consequence of the accident/event

sequences. Numerical value is given to likelihood and severity in order to assess the risk
value through quantitative analysis. This is used to gauge the risk magnitude and
prioritize the identified hazards. Previous data is used as modelling outcomes of past
incidents to determine the consequence. The values of consequence, likelihood and their
combination give the risk level. (Other guideline of risk assessment can be refer from
Department of Occupational Safety and Health, 2008).

Risk assessments are based on two key factors (refer figure 2):
• the consequence of any injury/illness resulting from the hazard, and
• the likelihood that the injury/illness will actually occur.

Figure 2: Risk Matrix

4.0 Risk Control

The introduction of measures which will eliminate or reduce the risk of a person being
exposed to a hazard. Urgent action is required for risks assessed as Extreme. The actions
required may include:
• Instructions for the immediate end of the work, process, activity, etc
• Isolation of the hazard until more permanent measures can be implemented.

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5.0 Risk Factor
The following risk factors are identified from case study at cooling tower:

• stagnant water, for example, lack of water circulation is likely to result in solids in
the system settling as sludge encouraging the formation of microbial growth
• nutrient growth, including the presence of algae that can encourage more rapid
bacterial growth
• poor water quality, for example, cleanliness, presence of corrosion products, scale
and fouling
• deficiencies in the cooling tower(s), including issues with physical design (such as
leaks and dead legs – pipes that are full of water and have little or no flow through
them) condition and maintenance of the system
• the location of, and access to, a cooling tower system or cooling tower systems,
including the potential for environmental contamination of the system and the
potential for exposure of people to the aerosols of the system.

For this case study the issue raise, the tower was not cleaning and disinfected regularly.
Various risk factor was conducted on identifying the hazards and evaluate the work-
related illness risk based on the investigation it is due to bacterial infection;
i.) Infection may occur during servicing or cleaning through punctures, cuts, inhalation
or dermal contact.
ii.) Transmission of viral pathogens had happened workers did not take precaution
measure when handling of contaminated water.
iii.) The amount of dust retained in the lung and airway passages.
iv.) Particle size – only inhaled dust very small size that capable of reaching the lungs and
deposited to cause damage in the bronchioles and alveoli walls
v.) Solubility and physiochemical activity

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6.0 Type of Diseases
Poorly maintained air-conditioning systems can cause respiratory tract infections, such as
the common cold, flu, tonsillitis, coughs, and everything in between from dirty filters.
Filters in an air-con system are there to remove bacteria and other contaminants. And
because of that it can be acquired when an individual breathes in water droplets
containing bacteria, facilities that don’t monitor or check could be creating hazardous
conditions for both workers at the facility and those who live in surrounding areas. In this
case one of the larger considerations for employer, to monitor and maintain cooling
towers at industrial facilities is the risk that comes from bacteria that can cause a serious
lung infection as follows: -

i.) Pneumonia
Pneumonia is an infection in one or both lungs. Bacteria and viruses are the most
common causes of pneumonia. Fungi can induce pneumonia, too. The infection causes
inflammation in the air sacs of the lungs. This results in a buildup of fluid that makes it
hard to breathe. When it comes to air, we are constantly breathing in other stuff, like
microbes.

Figure 3: Type of microbes causes pneumonia

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 Even though we have protection
ourself, its avoidable microbes might
succeed in colonizing the lung that
caused pneumonia. Pneumonia
typically affects the lungs, but
complications can lead to problems
in other areas of the body, too. These
can be very serious and even deadly.
These microbes multiply and cross
over from the airways into the lung
tissue. Figure 4 shown the effect of
pneumonia on the body.

Figure 4: The effect of pneumonia on the

body

ii.) Legionnaires' disease

Unmanaged cooling water systems can
provide ideal conditions for the growth and
transmission of Legionella bacteria. People
can become infected by inhaling fine
airborne aerosols generated by cooling
towers. Infection may cause Legionnaires'
disease, a serious and potentially life-
threatening condition.

According to the Occupational Safety and

Health Administration, inhaling water mist
that contains Legionella bacteria is the only
way a person can develop Legionnaires’
disease. The disease is not contagious. It
can’t be transmitted from person to person. Figure 5: Legionnaires' disease

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As the cooling tower moves air through a recirculated water system, it releases a
“considerable amount of water vapor” into the atmosphere. If it contains bacteria, people
can get sick by inhaling that vapor.

Figure 6: Aerosol Inhalation

Legionnaires' disease symptoms are similar to other types of pneumonia and it often
looks the same on a chest x-ray. Legionnaires' disease can also be associated with other
symptoms such as diarrhea, nausea, and confusion refer figure 5. Symptoms usually
begin 2 to 14 days after being exposed to the bacteria, but it can take longer.

iii.) Pontiac Fever

Pontiac fever is an acute, nonfatal respiratory disease caused by various species of Gram-
negative bacteria in the genus Legionella. It causes a mild upper respiratory infection that
resembles acute influenza. Pontiac fever resolves spontaneously and often goes
undiagnosed. Both Pontiac fever and the more severe Legionnaire's disease are caused by
the same bacteria, but Pontiac fever does not include pneumonia. Symptoms are flu-like,
fever, tiredness, myalgia, headache, sore throat nausea and cough is depend. Species of
Legionella known to cause Pontiac fever include Legionella pneumophila, Legionella
longbeachae, Legionella feeleii, Legionella micdadei, and Legionella anisa. Pontiac fever
does not spread from person to person. It is acquired through aersolization of water
droplets and/or potting soil containing Legionella bacteria. Pontiac fever is known to
have a short incubation period of 1 to 3 days. No fatalities have been reported and cases
resolve spontaneously without treatment.

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Figure 7: Comparison of disease caused by Legionella Pneumophila

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7.0 Control Measure for Workplace
Most use control measure is on the hierarchy of risk control comprise of six aspects.
These include:
1) Elimination - Remove the hazard or hazardous work practice from the workplace.
The effectiveness is 100%.
2) Substitution - Substituting or replacing the hazard or hazardous work practice with
less hazardous one
3) Isolation - Isolating the hazard or hazardous work practice from workers or general
work area
4) Engineering control - Modifying the tools and equipment using enclosures,
guarding, mechanical ventilation or automated process
5) Administrative control - Introduce policies or changes in work practices and
procedures that could reduce the risk. This includes reducing the time employees
exposed to the hazard, reducing the number of employees exposed, job rotation, log
out or tag out procedures, and prohibiting eating or drinking at contaminated area.
6) Personal protective equipment - PPE as risk control measure should be considered
only when other control measures are not are not practicable, used together with other
measures to provide greater measure, when specified by legislation as a basic
requirement (Risk Management Training Material, NIOSH, 2004)

Figure 8: Hierarchy of Controls

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Based on the issue highlighted in the study case, regular safety inspections should be
performed to ensure that your cooling tower is clean, safe, and functioning as it should.
However, routine cooling tower disinfection should always be performed regardless of
the outcome of the inspection, as cooling towers are breeding grounds
for Legionella, which can cause Legionnaires’ disease.

The primary precaution recommended before performing maintenance or cleaning on a

cooling tower is the use of personal protective equipment or PPE. PPE for cooling tower
inspection or cleaning will look different than those worn by medical staff, or those in
other industries. Obviously, the workers fail to do so or practices it. PPE for those doing
work on cleaning towers or maintenance should include:
• Hard hat
• Safety glasses (or goggles)
• Work gloves
• High-top leather boots with nonslip soles

If a worker must enter the structure, then:

• A full-body harness
• Two shock-absorbing lanyards that are six feet long or more

Health and Safety Control Measures while Servicing Cooling Towers

1) Electrocution or electrical shock:
• Turn off the power supply before servicing
• Use electrical test equipment to verify that electrical components are de-
energized before servicing
• Use grounded tools and equipment
• Wear rubber gloves and other insulating personal protective equipment
(PPE) as necessary

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2) Trip or fall hazards:
• Keep work areas clean and free of clutter
• Use caution when working on uneven surfaces, such as ladders or
scaffolding
• Wear slip-resistant shoes with good traction
• Use guardrails or safety harnesses when working at heights

3) Inhalation of harmful chemicals or vapors:

• Use appropriate respiratory protection, such as a half-face respirator or full-
face respirator, when working with chemicals or vapors
• Avoid breathing in any mist or spray from the cooling tower water or
cleaning agents
• Ventilate the area as necessary to reduce exposure to harmful substances

4) Contact with harmful bacteria or other microorganisms:

• Use appropriate personal protective equipment (PPE), such as gloves and eye
protection, when handling the cooling tower water
• Wash hands thoroughly after handling the cooling tower water or cleaning
agents
• Disinfect the work area after servicing

5) Burns or cuts:
• Wear gloves and other appropriate PPE, such as eye protection and long
sleeves, to protect against cuts and burns
• Use caution when working with sharp or hot components
• Use proper lifting techniques and equipment to avoid strain or injury

6) Strain or injury from heavy lifting:

• Use proper lifting techniques and equipment to avoid strain or injury
• Get help when lifting heavy components or equipment
• Use a hoist or crane when necessary

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8.0 Health Surveillance
Health surveillance most likely an assessment of the health of individual at the workplace
which align with risk management. Usually, it is use to investigate and assess the changes
in the individual health condition due to exposure of hazardous material. “Health
surveillance is the ongoing systematic collection, analysis interpretation, and
dissemination of health data for improving health and safety” (Thacker, Choi, &
Brachman, 1983).

Employer need to fulfil with the requirements of Regulations 27(1) for Health
Surveillance Programme in a comprehensive and integrated approach in conjunction with
Occupational Safety and Health (Use and Standard of Exposure of Chemicals Hazardous
to Health). Early Detection of Occupational Diseases is important in order to control and
treat it. Occupational diseases are caused by exposure to harmful chemical and biological
agents and physical hazards at the workplace.

Therefore, health surveillance is a process, mainly to monitor the worker and workplace
area for detection of risk, hazards and work-related diseases. Also to make sure employer
compliance with legal requirement and providing proper training and education to their
employees. Figure 9 shows the process of indication for starting.

Figure 9: Health Surveillance Activities

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Medical Surveillance
Medical Surveillance is a clinical approach in identifying and monitoring the changes in
health status and necessary treatment for recovery that only involve history of illness,
physical examination, laboratory analysis or medical imaging and diagnosis excluded
medical treatment but the workers who are diagnosed with injury or diseases during
medical assessment will be referred to relevant clinic or hospital. The components of
Medical Surveillance Programme include:
▪ Pre-employment and pre-placement medical examination.
▪ Biological monitoring and biological effect monitoring.
▪ Health effects monitoring.
▪ Investigation of occupational disease and poisoning including workplace
inspections.
▪ Notification of occupational disease and poisoning.
▪ Assist in disability assessment.
▪ Return to work examination after medical removal protection.
▪ Record keeping and monitoring.

In health surveillance, to control and prevent disease from occurrence and reduce its
consequences known as health prevention. Refer figure 10 describe its summary.

Figure 10: Summary of health prevention

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9.0 Recommendation
Case Finding
• Workplace area was not cleaned and disinfected regularly
• Worker absence due to high fever, chest pain, cough, difficulty to breath and mental
confused
• Additional effects of other irritants such as tobacco smoking
• Chest X-ray suspected pneumonia
• No monitoring and training provide to perform on-site job
• No precaution measure taken
• Investigation result diagnosis of bacterial infection

Remediation
A cooling tower water treatment specialist will diagnose biological contamination within
a cooling tower by collecting water samples. By analyzing the sample, the specialist will
identify the type of contamination in the water and determine the best way to treat the
water appropriately. During the treatment process, the specialist will collect more
samples for analysis to verify that all contaminants were removed from the system.

Biological contamination is often treated by shocking the cooling tower’s water

with chlorine to kill any contaminants before flushing and refilling the tower with fresh
water. However, chlorine is a corrosive chemical that can damage cooling tower interiors
if used frequently. For this reason, cooling tower water treatment specialists may elect to
use different chemicals for treatment and prescribe a consistent treatment plan to help
avoid microbiological contamination.

These activities need to be carried out at predetermined intervals:

• Training on handling chemical
• Regular inspections
• Regular servicing
• Monthly HCC testing to identify bacterial levels in system
• Legionella testing

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The following recommendations are suggested to improve health hazard and risk
management at the workplace: -
i.) Established a comprehensive training manual for repair and maintenance, servicing,
chemical handling, cleaning and management practices.

ii.) All details on hazards and its associated risks must be briefed to all the workers to
avoid any incidents during improper handling.

iii.) A demonstrative program should be conducted for workers to create better

understanding on the risk and importance of good practices to minimize the risk

iv.) A quantitative risk assessment must be established for management. This will help
to evaluate and get better picture on the risk rating for each hazard.

v.) Implementation of HIRARC and must be reviewed when there is an accident

reported, thus it will make changes in the risk rating. This will help to improve the
risk control measures.

vi.) Internal air quality inspection should be done at the water- cooling tower to
evaluate and ensure the air quality is within the safe limit for working condition.

vii.) Regular safety inspections should be performed to ensure that your cooling tower

viii.) Detail comparison analysis must be done on the medical check-up records of
workers. This would aid in early detection of health problems.

ix.) All accidents regardless of severity shall be recorded and investigated accordingly
in order to identify the root cause and take appropriate preventive measures.

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10.0 Presentation Slide

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TASK 2: Online Class Participation

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REFERENCES

The University of Melbourne (February 2019). Cooling Towers: Controlling The Critical

Risks And Operational Programs, https://safety.unimelb.edu.au/

Calvin K. Cook, M.S., Deborah Friedman (April 1996). Health Hazard Evaluation Report

No. 94–0402, Xerox Corporation Webster, New York.

Krish Tangella MD, MBA, FCAP (December 19, 2022).

https://www.dovemed.com/diseases-conditions/pontiac-fever/, Pontiac Fever.

Centers for Disease Control and Prevention (n.d). Hierarchy of Controls,

https://www.cdc.gov/niosh/topics/hierarchy/default.html.

Dr. Yusof Omar (2022). XBHM3103 Occupational Heatlh, Open University Malaysia.

YBhg. Dato’ Ir. Shaffi Mohamad (September, 2018). Hazard Identification at Workplace,

Occupational Safety, Health and Built Environment Department (OSHBE).

Kauselya Muniandy (2015). Dissertation Submitted In Partial Fulfilment Of The

Requirement For The Degree Of Master Of Technology (Environmental

Management), Institute Of Biological Sciences Faculty Of Science University Of

Malaya Kuala Lumpur

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