Professional Documents
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CBH Standards Issue 2 - Read Only
CBH Standards Issue 2 - Read Only
INDUSTRY STANDARDS
FOR WORKPLACE HEALTH
IN UK CONSTRUCTION
Table of Contents
Foreward .............................................................................................................................. 4
Introduction to the Construction Better Health Standards Background ......................... 4
Key Findings From The Pilot................................................................................................ 5
Chief Executives Welcome................................................................................................... 6
Purpose Scope and Applications of the Industry Standards ............................................. 7
Definitions and Glossary...................................................................................................... 8
List of Abbreviations ........................................................................................................... 10
Workplace Health ................................................................................................................ 11
Workplace Health Management ........................................................................................ 12
The General Principles of Prevention ................................................................................. 12
Health Risk Assessment ....................................................................................................... 13
Services that Can Enhance Health at Work........................................................................ 15
General Duties of Employers .............................................................................................. 17
RIDDOR................................................................................................................................. 17
Equality Act 2010 ................................................................................................................ 19
Do You Need a Professional OH Service Provider? ............................................................ 20
Occupational Health Service Providers............................................................................... 21
The Tendering Process ......................................................................................................... 24
Working with OHSPs ........................................................................................................... 24
Obtaining Consent in Occupational Health....................................................................... 25
The Mental Capacity Act 2005 ............................................................................................ 26
Language ............................................................................................................................. 27
Bio-Psychosocial Model ....................................................................................................... 27
Medical Records in Occupational Health ........................................................................... 27
Health Surveillance.............................................................................................................. 29
Health Screening ................................................................................................................. 29
OH Referral for Individuals ................................................................................................. 30
Additional Hazards in the Construction Sector:
• Heat Stress ........................................................................................................................ 31
• Night work ........................................................................................................................ 31
• Biological Hazards ............................................................................................................ 31
• Confined Space Working ................................................................................................. 32
• Lone Working ................................................................................................................... 32
• Musculoskeletal Disorders ............................................................................................... 32
• Working at Height .......................................................................................................... 33
• Contaminated Land ......................................................................................................... 33
Statutory Health Screening:
• Rail Track Side ................................................................................................................... 33
• Divers ................................................................................................................................ 34
• Seafarers and Maritime Workers ..................................................................................... 35
Foreword
The Construction Industry forms the largest employment sector in the UK with over 2
million workers and consists of large and small businesses; managed through sometimes
complex contractual chains involving large numbers of mobile workers. Health issues
are difficult to identify and manage, yet it makes good business sense to protect the
long term health of the highly skilled workforce. The reason that health issues remain
largely unresolved is due to the complex supply chain; the transience and mobility of
the workforce; and that approximately half of the workforce employs 5 or less in a
company.
It is well known that accidents on construction sites can be devastating in nature;
however, at least 100 times as many workers are made ill by work than are injured.
Added to that, construction workers have one of the highest rates of work related
illness of all occupational groups. An estimated 2.8 million working days are lost due to
an illness caused or made worse by a current or most recent job in construction. The
estimated annual cost of work related ill health to the Construction Industry is £760
million; with the overall cost to society being significantly higher.
It is therefore critical that skilled and experienced workers are retained in the industry
through an improvement in the way construction employers manage the health of
workers – called ‘workplace health’.
Constructing Better Health (CBH) has been established by the Construction Industry and
Trade Unions to set standards of what is required to meet the occupational health
requirements of the Construction Industry
Michelle Aldous
Chief Executive
Constructing Better Health
List of Abbreviations
ACOP Approved Code of Practice
AFOM Associateship of the Faculty of Occupational Medicine
BPS Model Bio Psychosocial Model
CBH Constructing Better Health
CHAT Construction Health Action Toolkit
CLAW Control of Lead at Work
CSCS Construction Skills Certification Scheme
DoccMed Diploma in Occupational Medicine
FFOM Fellow of the Faculty of Occupational Medicine
FFT Fitness for Task
GMC General Medical Council
GP General Practitioner (Family Doctor)
HASAWA Health and Safety at Work etc. Act 1974
HAVS Hand Arm Vibration Syndrome
HSE Health and Safety Executive
HSG Health and Safety Guidance
MFOM Member of the Faculty of Occupational Medicine
MSD Musculoskeletal Disorder
NMC Nursing and Midwifery Council
OH Occupational Health
OHA Occupational Health Adviser
OHN Occupational Health Nurse
OHP/OP Occupational Health Physician
OHSP Occupational Health Service Provider
PTS Personal Track Safety
PPE Personal Protective Equipment
SCW Safety Critical Worker
Workplace Health
Work or occupational health (OH) deals with work related health issues; assessing and
advising on the effect work could have on an employee’s health, and what effect an
employees health may have on work. It is a two way process.
The Health and Safety Executive states that good occupational health services are
central to the effective management of workplace health and can:
• Protect and promote the health and well-being of the working population
• Enhance a company’s image and reputation as a good employer
• Provide early advice to help prevent workers being absent for health-related reasons
• Improve opportunities for people to recover from illness while at work
• Provide critical support to the process of effective absence management and increase
the number of staff returning to work earlier
• Fulfil the statutory requirement to have access to ‘competent’ occupational health
advice as part of the organisational arrangements to ensure that the health of staff
and others is not adversely affected by their work
The starting point for deciding on how to monitor health is to assess the health risks in
the workplace; the risk assessment will show where there are significant residual risks to
health even after reasonably practicable control measures have been applied. Health
risks are perceived as being more difficult to assess than safety risks, as poor health
resulting from an exposure to a hazard can happen many years after the event.
Policy Organisation
Audit Plan
and Improvement
Review
Measure
and
Target
Fig 2
• Toxicologist: Professional services that study the nature and effects of poisons and
treatment
• Ergonomist: Professional service that considers the dangers of poor body position,
repetitive work and how work is performed for maximum comfort and efficiency
• Physiotherapy: Hands on treatment of massage, exercise and advice/education
linked to health issues mostly associated with musculoskeletal injuries e.g. bad back
• Holistic services: Acupuncture, chiropractor, osteopaths who are professionally
qualified in hands on treatments for musculoskeletal issues
2. Risk Management: Specialist professionals to undertake unusual or high risk site
activities where competent advice is required
3. Education and Awareness: Companies who specialise in technical
training/education programmes for a particular work activity e.g. manual handling
training
4. Sickness Absence Management: A system of recording and monitoring sickness
absence levels by an organisation looking for:
• Possible links to work undertaken
• Issues of safety which could be linked to illness e.g. safety critical worker with a
heart condition
• Identifying lost revenues
5. Occupational Health Professionals: Those providing occupational health services
and accredited with Constructing Better Health. Can be engaged to advise on
health risk assessments, first aid and wellbeing services and to undertake health and
medical surveillance to comply with legislation e.g. Control of Noise at Work
Regulations
6. Reactive Support Services: Doctors, Nurses, Technicians, First Aid personnel who
provide various emergency on site services for accidents, emergencies and
treatments such as blood pressure monitoring to assist the employee
7. Legal: Qualified solicitors, barristers to advise on case law, mandatory
requirements, legislation relating to employment law and health and safety
application
8. Materials and Equipment Suppliers: Companies who supply tools, implements to
the trades that could cause or alleviate health issues e.g. with regard to vibration,
noise emission, fork lift trucks etc.
9. Employee Assistance Programmes: Support services providing debt, legal,
employment, welfare, counselling/advice to employees, provided by the employer
and accessed when required. Usually supported with web accessed information e.g.
hand-outs, leaflets
10. Counselling: Talking therapies for employee support when distressed or
experiencing stressful life/work events. Practitioners should be accredited to the
British Association of Counselling
11. Wellbeing: Programmes in the workplace that consider health aspects of the
employee not associated with the job role e.g. well man, blood pressure checks,
stop smoking advice etc.
12. Primary Care: The National Health Service – in particular the GP’s who provide free
‘cradle to grave’ personal confidential health advice and treatments to their
patients/employees
13. Rehabilitation: The process of modifying the workplace for the employee
experiencing health issues whether on a temporary or permanent basis, specialist
organisations are Remploy or the Shaw Trust and supported by Access to Work
14. Drug and Alcohol Specialists: UKAS accredited laboratories who organise,
administer and oversee policy, testing and results of testing in the workplace
The professional services listed here all have a part to play in good health risk
management.
For more information contact Constructing Better Health
To Employees
To provide relevant and comprehensible information about:
• Risks to health and safety
• Preventive and protective measures
• Emergency/evacuation procedures
• Health and safety law (via a poster or leaflet)
• Responsibilities to comply with site rules
• How to use work equipment and personal protective equipment
• The provision of information, instruction and training in order to ensure health and
safety
To Other Employees
In all construction sectors, where often workplaces are shared, each employer must take
steps to inform other employers of the risks to employees’ health and safety arising
from work activities as part of the business. (Reg. 11 of the 'Management' Regulations
1999)
To Non-Employees
To provide information, instruction and training, where necessary, for health and safety,
so far as is reasonably practicable.
MUST DO
Health Surveillance
Asbestos Lead
Details required to
Ionising radiation
be kept of who, when
Compressed Air,
where. Health records
Night, to be generated
Computer workers by OHSP.
MUST DO
Start
Health checks to
Risk Noise, Chemicals, moniter health
Here
Assessment dust, fumes, and control
vibration methods for risks
SHOULD DO
Health screening
Fitness for work tasks,
required to ensure
safety critical,
Drugs & Alcohol,
safety of self
Musculo-skeletal , and others
stress, lone worker
SHOULD DO
COULD DO
All Occupational Health services should provide services for those coloured red as a minimum. Not all OHSP are able to offer all services and more than
one provider may be purchased. It is important that providers communicate regularly regarding health issues that could affect health surveillance or
screening requirements. Regular review with service providers is recommended on a 3 monthly basis to ensure quality and suitability of service.
© CBH 2011
Fig 3
20 Helpline: 0845 873 7726 www.cbhscheme.com Standards Issue 2 ©CBH 2012
ttp CBH folder text:ttp CBH folder text 26/1/12 11:26 Page 21
APPROVED DOCTORS
These are doctors approved by the HSE to undertake cetain medical checks e.g. divers
medicals.
APPOINTED DOCTORS
These are doctors registered with the HSE who undertake statutory medicals e.g. Lead.
Expert Opinion
Some aspects of health surveillance also require additional competences to be
demonstrated e.g.
• HAVS: a Faculty of Occupational Medicine approved training course in HAVS or
equivalent level of competency
• Noise induced hearing loss: a British Society for Audiology approved course for
industrial audiometricians or equivalent level of competency
• Respiratory: Association for Respiratory Technology and Physiology (ARTP) diploma or
equivalent level of competency
Occupational health service providers (OHSP) must hold appropriate business and
professional indemnity insurance, comply with applicable legislation, and should not
undertake work without having seen or had access to the employer’s relevant health
and safety policies to determine how health and safety is managed.
The health professional should be able to demonstrate awareness of legislation, policies
or programs that might interfere with or affect the performance of the health
assessment, for example, drug alcohol policy, critical incident management programs,
anti-discrimination legislation, medical ethics and privacy legislation.
Occupational health service providers should have:
• Appropriate quality monitoring processes i.e. a clinical audit programme
• Clinical training programmes
• Business and professional indemnity insurance
• Advise the person about the decision and ensure that the restrictions, if any, are
clearly explained to the person
• Advise the management in writing of the decision, the restrictions that will apply and
the review date
• Examples of restrictions that could be applied are: limited location, limited time
period before health re-examination, limitation of some duties, not to work in
isolation etc.
The occupational health professional undertaking fitness judgments in these
circumstances shall be appropriately qualified and competent to make a decision. If in
doubt then the OH professional shall discuss the case with a more qualified or more
experienced OH professional.
GP Specialist reports
Subsequent to a health check (e.g. pre-placement) or following a health incident, the
OHSP may feel it appropriate, subject to consent from the individual, to request a
GP/specialist report. Such a report can be useful in obtaining:
1. Clinical details e.g. results of MRI scan of lumbar spine
2. Details of treatment plan
3. Information on progress of disease
4. GP/Specialist view of current physical or mental capability
The OHSP should provide the GP/specialist with an outline of the job and the hazards
involved. It can be misleading to ask the GP/specialist opinion on whether the person is
fit for the job because GP’s are not specialist occupational health professionals and may
not understand the hazards and risks involved. Both employees and employers can
become confused about the differing roles of OHSPs and a GP.
Issues arising when obtaining GP or Specialist reports:
1. Reports generally take 4 weeks (sometimes longer) to be returned
2. The GP’s role is that of patient advocate, whereas an OH Specialist has a more
objective role
3. Often the reports provide little in the way of useful information as GP’s do not have
training or insight into the nature of construction job roles so may inadvertently
support an employee working in a dangerous occupation
4. Costs for reports are paid by the employer so permission should be gained before
requesting a report or if the report cost is excessive
5. By requesting copies of recent GP notes, there will be reports from Specialists (to
the GP) contained. This may be a more cost effective and rapid way of obtaining
relevant clinical information
6. Employee’s can withdraw consent
7. Employee’s can ask for changes to reports to be made before being seen by
occupational health
The Act also points out that if an employee is unable to make decisions:
• Employees should have as much help as possible to make a decision
• Other people can assist employees to make a particular decision
• Even if someone makes a decision on an employee’s behalf the employee must still be
involved as much as possible
• Anyone making a decision on another’s behalf should have their best interests at
heart.
Language
When talking to clients, contractors, employers and employees, healthcare professionals
should use everyday, jargon-free language with no acronyms. If technical terms are used
they should be explained.
Where possible OH services/employers should provide interpreters for employees whose
preferred language is not English.
Bio-Psychosocial Model
The bio psychosocial model (BPS) is a term used to describe how the symptoms
experienced by a person are influenced by biological, psychological and social factors.
The size of the impact of each factor depends on its seriousness compared to the other
factors. The BPS model relates to most medical situations and so is an important
consideration when an OH practitioner assesses an employee.
Consideration should be given to issues within this model when assessing individual
health issues. For example, OHSPs should enquire into beliefs and social circumstances
when undertaking health checks.
Results from groups of workers who are exposed to identical risks or work in the same
area should be fed back to the employer in the form of statistical reports, so that health
can be easily monitored on a group basis. It is important to ensure that the ‘group’ is
big enough to protect the identity of the worker. This information can be particularly
useful for health comparisons over years or when a new process or system is started.
Health Records
It is a legal requirement for some health surveillance programmes for individual health
records to be kept. Health records do not contain confidential medical information and
should be kept in an easily accessible format for individuals to check their own record
or for visiting HSE inspectors.
A health record should include:
• Employee surname and forenames
• Gender
• Date of birth
• Permanent address and postcode
• National Insurance number
• Date of commencement in current role/employer
• A historical record of jobs involving exposure to substances or processes, in this
employment, that requires health surveillance.
• Conclusions of any health surveillance check will be expressed in terms of the
employee’s fitness for task and will include the conclusions of the occupational health
professional or responsible person, but NOT ‘confidential clinical data.’
Health records should be maintained for those employees for as long as they are under
health surveillance. Some regulations - COSHH and those for lead, asbestos, ionising
radiations and compressed air - state that records should be retained for much longer
(up to 50 years) as ill health effects might not emerge until some time after exposure.
Employers should check with the OHSP for arrangements in case of company closure or
a new OHSP taking over.
Medical Records
Medical records (occupational health records/case notes) may be created by an OHSP
throughout an individual’s employment in one company. Medical records are entirely
separate from the health record as they contain clinical information about the
individual. They are not the same as GP records which stay at the surgery. Employees
can have access to their own medical record on written request under the Data
Protection Act (1998), but details would only be released to others on receipt of
informed written consent of the employee or by court order.
Health Surveillance
HEALTH SURVEILLANCE is a legal requirement and a systematic check on health or
maintaining records on an individual engaged in certain work activities where;
• There is a valid way to detect a disease or condition
• It is reasonably likely that damage to health will occur under the particular conditions
at work
• Health surveillance is likely to benefit the employee
• Steps can be taken to eliminate or reduce the probability of further damage
In some instances health surveillance is specified by law e.g. workers with lead and
asbestos. In other cases the need is not so clear, as it will depend on how long, how
often, what control measures are in place and the likelihood of a worker being
affected. Therefore, in all cases the risk assessment process is fundamental in deciding
whether health surveillance is appropriate.
It is important that the purpose of health surveillance is set out in the company
occupational health policy arrangements. There should be lists of jobs considered to be
a risk to health, and the type of health surveillance or medical checks to monitor health.
The policy should identify how results will be fed back to employees and managers
whether individually or as a group.
Health surveillance programmes can vary from a full medical examination to merely
keeping a paper record of a workers employment history – the type of surveillance will
depend on the substance, type of work and what is required by law. Surveillance might
involve examination by an occupational health doctor, nurse, adviser, responsible
person or technician. Workers need to understand the possible health risks and what to
do if poor health is found within a health surveillance program; therefore it is
important that employee representatives are included early in the risk assessment
processes.
Health Screening
Where there are no specific legal requirements to undertake health surveillance as
defined in regulations or as part of the risk assessment conclusions, the implementation
of health screening procedures may be implemented as evidence based or best practice.
Health screening is designed to assess or monitor an individual’s health against a set
standard of requirements. The outcome will provide an indicator of risk from that
individual in the workplace for the future. Examples of health screening include
pre-placement and safety critical workers health checks.
Throughout the Industry Standards both health surveillance and health screening will
be referred to as health checks.
Night Work
Night work is a specific hazard identified by legislation as having the potential to harm
health in certain groups of workers. Many night workers thrive on night work and
have done so for years without any ill health effects. Night work is defined as working
at least three hours at night (on a regular basis), between the period of 11pm and 6am.
Employees who do the occasional night (rather than regular night work) would not be
classified as a night worker.
There are health issues which could be negatively affected by night work e.g. taking
medication either before bed or in the morning and disruption of the normal sleep
patterns. Due to this, regulations set out that all night workers should be offered a
health assessment before starting night work, followed by health assessment at regular
intervals after; this is generally repeated annually (although not specified in the
regulations).
The health assessment usually takes the form of a health questionnaire completed by
the employee, followed, if necessary, by a health check. The questionnaire will identify
medical conditions that could pose a potential risk to health and safety. It should be
noted that this medical is offered on voluntary basis, and there is no legal obligation on
the employee to complete a questionnaire or attend for a medical check because of
night work.
Biological Hazards
Contaminated water and/or soil can pose a risk of infection from diseases such as Weil’s
disease (Leptospirosis) and Legionella.
Discarded syringes/hypodermic needles can accidentally pierce the skin causing viral
infections such as hepatitis B and HIV.
Other diseases such as psittacosis (parrot disease) and toxicaria (round worms in dog
excrement) may be transmitted from animals to humans. Risk assessment processes
should be undertaken where there is a perceived risk from contaminated soil, water,
land or working in close proximity to animals.
Mobile workers may not have access to health care so employers should ensure new
employees are aware of any biological risks and have all the necessary vaccinations.
For more information regarding specific health issues contact the Health Protection
Agency: http://www.hpa.org.uk/Topics/
Lone Working
Most job roles have a protective factor in that there are other workers in the vicinity of
an individual working. In cases of emergency or need, the group can be called on to
help resolve a situation. For some workers there may be elements of lone working with
the individual being alone on site due to the time of day or nature of the task to be
undertaken. The task may also be hazardous in nature so it is important that there are
processes in place to ensure the health and safety of the lone worker. Risk assessment
should identify protective or control measures required but the individual must be able
to participate in the measures recommended. A full health check may be required from
an occupational health service provider to ensure fitness for working alone.
however individual health issues and/or physical capabilities will influence lifting
abilities. Occupational health service providers can provide assessments for individuals
who may be at increased risk of injury.
Working at Height
Dangers from working at height are well known and there are many instances of work
at height in the Construction Industry:
• Crane drivers
• Scaffolders
• Roof workers
• Aerial riggers climb high aerials, telephone/radio masts, power pylons
• Deep level workers may be required to climb steep vertical ladders, often within
confined spaces
In order to ensure that the climb to and from the work area is safe, it is important that
the climbers are able to both deal with the strenuous nature of the work and be able to
maintain safety e.g. ability to grip, balance etc.
A full risk assessment should be undertaken for the task, which should include
environmental factors and a full rescue plan in case of medical emergency. Individuals
may be seen for a health check from an occupational health service provider prior to
working at height.
Contaminated Land
The UK has a substantial legacy of chemical contaminants in soil, much of it caused by
industrial and domestic pollution of the past. Land contamination can pose a threat to
the environment and the health of humans, animals and plants.
Most soils have a small presence of contaminants caused by natural geology and diffuse
pollution; levels of risk are usually low. However, some land has the potential to pose
unacceptable levels of risk to human health or the environment, including water
pollution, in particular some ex-industrial sites and ex-landfills sites. Land is only
considered to be ‘contaminated land’ in the legal sense if it poses an unacceptable risk.
More information is available from http://www.defra.gov.uk/environment/quality/land/
which sets out the legislative framework for remediation and how to prevent health
issues arising.
Occupational health service providers will be able to provide specific health information
and health checks for those exposed to such risks.
There must also be an accurate and up to date record of assessment and be available
for inspection. There should be arrangements in place for monitoring the competence
and fitness of individuals with special consideration of fatigue (Reg 25).
Part 4 of the ROGS Regulations, sets out what are the safety critical jobs; there are a
dozen broad areas of work that ROGS define as ‘safety-critical tasks’ which fall into
three groups.
Group A: A higher level of fitness required:
1. Driving and train dispatch
2. Operating signals and level crossings, and related communication
3. Coupling or uncoupling vehicles
4. Controlling the power supply connected to track and vehicles
5. Checking vehicles are working properly and, if loaded, loaded correctly
6. Protecting the safety of people working on or near to the track
Health checks in this category should conform to individual company fitness
requirements eg London Underground, Railtrack etc.
Group B: Still classified as safety-critical work under ROGS and named Rail Trackside
(Personal Track Safety) in the Industry Standards matrix. For this group it is important
that tasks are supervised or the work checked by a competent person before the work
has the opportunity to affect the health and safety of people working or travelling on
the transport system:
1. Installing vehicle parts
2. Maintaining vehicles that are being used (and their parts)
3. Installing or maintaining any part of the infrastructure
4. Installing or maintaining the power supply
5. Installing, maintaining or operating the communications systems used to control
vehicles’ movement or call the emergency services
Group C: The final safety-critical task is training – or supervising training – in any of the
above tasks where the training involves carrying out the actual task. Refer to individual
company policy for health standards required.
The purpose of determining the fitness of an individual is to enable work to be carried
out competently and to reduce the risk to health and safety. The risk of any pre-existing
disability or ill health affecting the safety of the individual, others at work, and the
public should be reduced as far as possible.
For further information: The Railways and Other Guided Transport Systems (Safety)
Regulations 2006 Guidance on Regulations Office of Rail Regulation April 2006:
http://www.rail-eg.gov.uk/upload/pdf/283.pdf
Divers
All divers at work must have a valid certificate of medical fitness to dive issued by a HSE
medical examiner of divers. The certificate of medical fitness to dive is a statement of
the diver’s fitness to perform work underwater, and is valid for as long as the doctor
certifies and up to a maximum of 12 months.
Every diver or person who is likely to be subject to hyperbaric conditions as routine
rather than in an emergency, must have a valid certificate of medical fitness to dive. The
HSE approves doctors to carry out diving medical examinations and assessments. These
medical examiners are selected for approval based on their training in diving physiology
and knowledge of diving. There is a regular review of the approved Doctors who must
attend refresher courses in order to continue practising in this area. Details are
available from HSE.
http://www.hse.gov.uk/diving/index.htm
Fit Notes
Sick notes have been replaced by the fit note – GP’s now have the option to say that an
individual may be fit for work if temporary adjustments are made to the workplace. It
is important that a risk assessment approach is taken to recommendations from fit
notes as GP’s generally have limited understanding in construction site matters and the
risks involved in specific roles. OHSPs will be able to offer competent advice if there is
doubt about safety in relation to a return to work.
Due to issues of medical confidentiality the circumstances of medical decisions taken by
the OHSP may not be fully discussed with the employer.
Coding
The coding within the body of the matrix uses the traffic light system – red, amber,
green and identifies: which health checks are:
RED Legally required i.e. there is a legal requirement to undertake health
surveillance/statutory medicals
AMBER* Evidence based or best practice (strongly recommended) and fitness for task
assessments
GREEN Discretionary – should be chosen as an enhancement to the two categories
above and decided on a cost/benefit analysis basis
* CBH strongly suggest that safety critical roles are upgraded to that of an essential
requirement and designated with a ‘C’ on the health matrix
General Health/Lifestyle
Vibration Health Check
Biological Monitoring
Pre-Placement Health
Workplace Stress /
Skin Health Check
(Company Policy)
Musculoskeletal
Blood Pressure
Ionising Radiation
Colour Vision
Visual Acuity
Compressed Air
Urinalysis
Asbestos
Lead
SECTION 1: JOB ROLE/TASK
ADMINISTRATOR (site)
ASBESTOS LICENSED WORKER C
BRICKLAYER
CARPENTER/JOINER/SHOP FITTER
CONCRETE SPRAYER
CONSTRUCTION SITE OPERATIVE - GENERAL
CONSTRUCTION SITE OPERATIVE - SPECIALIST (risk assessment)
DIVER (refer to standards) C
DEMOLITION OPERATIVE
ELECTRICIAN - FITTER/ENGINEER
FORM WORKER
GEOTECHNICAL C
GLAZIER/GLASS FITTER/WINDOW INSTALLER
INDUSTRIAL CLEANER
LGV/HGV DRIVER C
MARITIME OPERATIVE GENERAL (refer to standards)
MARITIME OPERATIVE SPECIALIST (refer to standards) C
PAINTER/DECORATOR
PILING OPERATIVE
PIPE FITTER
PLANT OPERATOR - GENERAL C
PLANT OPERATOR - CRANE DRIVER C
PLANT OPERATOR - MOBILE MACHINE DRIVER C
PLASTERER/DRY LINER
PLUMBER/GAS/HEATING/VENTILATION ENGINEER
PROFESSIONAL
ROAD CONSTRUCTION - ASPHALTER/PAVER
ROOFER - SLATER/THATCHER/TILER
SCAFFOLDER/RIGGER C
SITE FOREMAN/SUPERVISOR
SITE MANAGER
SLINGER/SIGNALLER/BANKSMAN/TRAFFIC MARSHALL C
STEEL ERECTOR STRUCTURAL/FABRICATOR C
STEEPLEJACK C
STONEMASON
TUNNEL BORING GANG C
WALL TILER/FLOOR TILER
WELDER
SECTION 2: HAZARDS TABLE
ASBESTOS (short duration)
BIOLOGICAL
CEMENT/CONCRETE
CHEMICAL - RESPIRATORY (sensitisers)
CHEMICAL - SKIN (sensitisers)
COMPRESSED AIR
CONFINED SPACE C
IONISING RADIATION
LEAD
LONE WORKING
MANUAL HANDLING
NOISE
NIGHT WORK (and annual assessment)
RAIL TRACKSIDE (refer to standards, PTS or equivalent)
ROADSIDE (high speed) C
SILICA
TUNNELLING (Hyperbaric and/or confined space only) C
VIBRATION
WORKING AT HEIGHT (control measures not practicable) C
SECTION 3: SAFETY CRITICAL WORKERS - All workers must be assessed for safety critical worker status
Matrix2/1152/1111/©CBH
C SAFETY CRITICAL - CBH classes this as an ESSENTIAL health check requirement in construction
AMBER + C – Safety critical workers - CBH classes this as essential health check
requirements in construction
Section 2 - Hazards
Hazards associated with any jobs are listed here. The hazards section can be used
where there is an added task that is not normally part of a role but has been identified
as applicable by the risk assessment process, e.g. plumber who works as a lone worker.
Each health assessment in the matrix has an allocated Fitness Standard code (A-R) which
the occupational health service providers will use as a guide for each element of the
health checks undertaken.
Once the type of health checks have been identified and chosen from the matrix by the
employer, the OHSP should be invited to provide the most appropriate occupational
health service that fits in with the health risks and the requirements of the hiring
company. The OHSP will work to the CBH fitness for task standards
In situations where there are many risks or complex projects, the OHSPs should be
invited to visit sites and undertake a needs assessment prior to being selected as the
chosen provider.
The following fitness standards set out the health requirements of each health check
and provide evidence based or best practice guidance to follow. It should be noted that
health issues are not always straight forward and although the employer has access to
the standards, in case of doubt the fitness standards should be applied by a competent
OHSP.
Results of health checks will be categorised as in Fig 5
Drug and alcohol testing Pre placement and for cause testing post
accident. (See CBH recommended policy for
testing)
Safety critical workers (SCW) Pre-placement and then 3 yearly. Also after
absence or health incidents likely to affect
the health status of an individual. Age
factors or health deterioration may
necessitate more frequent assessments.
Industry Standards A - R
A B - Pre-Placement Health/Baseline Assessment
The purpose of pre-placement/baseline health check is:
1. To ensure that the prospective employee is medically fit to fulfill the duties and
responsibilities of the post, with a view to making such adjustments as may be
necessary
2. To assess whether the proposed post may adversely affect the prospective
employee’s health and make recommendations to reduce the risk if necessary
3. To record health information as a starting point for monitoring exposure to health
hazards e.g. a hearing test on an employee working in a noise hazard area. This
type of test is called a baseline test as it is establishing health levels before exposure
4. For some specific work activities there is a legal duty to carry out pre-placement
assessments of an individual’s fitness for work, for example, those working with
lead or compressed air. Although not legally designated as such, for the purposes of
the CBH standards it is recommended that workers classified as ‘safety critical
workers’ require pre-placement screening also
The Equality Act makes it clear that employers have to be very careful about asking
health related questions either prior to or in interview. This is due to the fact that there
remains some prejudice and ignorance about health conditions and the effect on work
especially in relation to mental health. The pre-placement health screening process can
now only be undertaken AFTER a job offer has been made. Failure to comply with this
could result in charges of discrimination if the candidate is subsequently not offered a
post.
After the job offer employers can use 3 methods of assessing pre-placement health:
1. A basic ‘open’ questionnaire which asks 4 general questions and acts as a
pre-screening device and serves to ‘fast track’ those who have no health issues likely
impact on work or the employee (category 1 and 2 above, not appropriate for
category 3 and 4). Any health issues identified with a ‘yes’ on the questionnaire
should trigger a confidential pre-placement questionnaire to be completed and
sent directly to Occupational Health by the employee. Pre-screening questionnaires
may be checked by non qualified medical staff if suitably trained and the applicant
is aware of the process
2. A confidential pre-placement questionnaire for screening by an occupational health
service provider for those in any category but specifically for categories 3 and 4.
The completed questionnaire should be sent directly to the OHSP for screening as
appropriate. The OHSP, on receipt of a completed questionnaire, will conduct
enquiries into health issues that may affect work or prove difficult for the
prospective employee due to health issues. The first step is usually a telephone
discussion where information received will clarify the situation and enable the
OHSP to provide management information back to the employer. Occasionally a
report may be required from the prospective employees’ GP, in which case written
consent must be given by the prospective employee
3. A full health check which would incorporate completing risk specific questionnaires,
discussion, examination by OHSPs to gather baseline information and to undertake
medical tests e.g. drug and alcohol testing
OHSP Process
In order to make a fully informed assessment, OHSPs will consider:
• The job requirements (it may be necessary to see a copy of the job description and
obtain further clarification about details of the post from the manager or HR)
• A relevant medical history which may include information from:
• The health questionnaire
• Consultation with the prospective employee (usually over the telephone,
occasionally in person)
• Further information (with informed written consent) from the prospective
employee's GP, hospital specialist or previous employer
Advice to Employee
If any health condition is highlighted which causes concern for work purposes, the
employee should be advised of the process of informing the employer of the outcome.
Should anything that requires specific recommendation be identified, the individual
should be advised by the OHSP i.e. regarding use of personal protective equipment.
Individuals may also require information sheets or tool box talks which are available
from CBH.
Advice to Employer
Subject to the arrangement between the OHSP and the employer, a fitness for work
certificate should be supplied; this will not include any clinical information unless
specific consent has been obtained from the employee, but generally the fitness of the
individual for the proposed work and whether any restrictions or adjustments are
recommended.
Baseline health checks e.g. for hearing will provide the opportunity for starting the
health record and this should accompany the fitness for work notification.
Pre-placement health checks by the OHSP will be based on objective, informed
assessment of all the available relevant information. It will be carried out in line with
the requirements of the Equality Act 2010 and good occupational health practice.
FITNESS STANDARD A:
PRE-PLACEMENT HEALTH QUESTIONNAIRE
Frequency: Pre-placement
CATEGORY INTERPRETATION
FITNESS STANDARD B:
PRE-PLACEMENT HEALTH ASSESSMENT/MEDICAL
Frequency: Pre-placement
CATEGORY INTERPRETATION
Sleep Disorders
Excessive daytime sleepiness (EDS) may be described as a tendency to fall asleep at
inappropriate times while intending to stay awake. Non-medical causes of EDS include
irregular sleep schedules (e.g. shift work), disturbed sleep, insufficient sleep or sleep
deprivation. Fatigue management strategies often include measures to control the risks
related to EDS due to non-medical causes.
EDS may also be a feature of a number of medical conditions, especially sleep disorders,
of which there are many. The most relevant to SCW is obstructive sleep apnoea (OSA),
present in about 4% of males. The prevalence of sleep apnoea in lorry drivers is
approximately 28%, much higher than that of the general male population.
Obstructive sleep apnoea is characterised by repeated episodes of complete or partial
upper airways obstruction occurring during sleep, causing a sleep-wake cycle which may
occur hundreds of times a night. The symptoms that are suggestive of OSA are EDS,
loud habitual snoring and sudden gasping for air usually reported by spouses or others.
Formal diagnosis and treatment requires referral to a specialist sleep clinic.
FITNESS STANDARD C:
SAFETY CRITICAL WORKERS
Frequency:
Assessment of fitness for SCW is every set at 3 yearly, unless otherwise advised by
relevant legislation. Review can be more frequently for any substantial change in
health circumstances. Such an assessment need only address the specific change in
health circumstances with full re-assessment when next scheduled
Health Questionnaire No evidence of ill health reported that would affect safety
of self or others. Refer to specific medical conditions below
Visual acuity 6/9 in better or 6/12 in the other eye. Also uncorrected
acuity must be at least 3/60
D – Statutory medicals
For serious health risks there is a system of mandatory health surveillance; overseen by a
doctor recommended by the HSE and designated as an Appointed Doctor.
Appointed Doctors (AP) are specialist doctors who advise on specific serious health
issues which could arise when working with substances or in certain situations e.g. lead
or compressed air. AP’s have to attend training and keep up to date with the
regulations relating to the health risk e.g. Control of Lead at Work Regulations (CLAW).
Doctors in this category have duties to the employee, employer and to the HSE and
must have full understanding of work processes to be able to apply their knowledge.
In the Construction Industry these are as follows:
D1 - Asbestos
Past exposure to asbestos is the largest single cause of work-related fatal disease and ill
health in the UK. Almost all asbestos related deaths and ill health are from exposures
several decades ago, but asbestos is still around in many forms, so the risk remains.
Asbestosis is a serious, long-term lung disease caused by inhaling asbestos dust and is
one of a number of conditions that can be caused by asbestos, but there are other
associated diseases such as cancer.
A licence is not required to work with asbestos under the following conditions:
• Short duration work (within any 7-day period a single job lasts less than one hour per
worker or two hours in total)
• Undertaking air monitoring
• Collecting bulk samples to identify asbestos
• Undertaking clearance inspections
Although a licence may not be needed to carry out a particular job; any work will need
to comply with the general rules detailed under the Control of Asbestos Regulations
2006 to prevent exposure to asbestos. This may include a health check.
It should be noted for most jobs, it is an offence to work with asbestos insulation,
asbestos coating or asbestos insulating board without a licence.
The health checks required for licensed asbestos workers are set out in The Control of
Asbestos Regulations 2006 and require that a Doctor (recommended by the HSE) must
be appointed to undertake the health check every two years – to assist with efficiency it
is suggested that the safety critical health check be undertaken at the same time.
For further information visit: http://www.hse.gov.uk/asbestos/index.htm
D2 - Lead
Any work which produces lead dust, fume or vapour can affect construction workers
health most notably in the following;
• Blast removal and burning of old lead paint
• Stripping of old lead paint from doors, windows etc
• Hot cutting in demolition and dismantling operations
• Painting of buildings
• Working with metallic lead and alloys containing lead, e.g. soldering
• Using pigments, colours and ceramic glazes.
Lead enters the body when items containing lead are processed, worked, or recovered
from scrap or waste. The dust created can be absorbed when:
• Breathing in lead dust, fume or vapour
• Swallowing any lead, e.g. during eating, drinking or smoking, biting nails without
washing hands and face
Any lead absorbed will circulate in the blood; some will be expelled naturally, but some
will stay in the body, stored mainly in bones and, remaining there for many years
without any adverse effects.
If the level of lead gets too high, it can cause:
• Headaches
• Tiredness
• Irritability
• Constipation
• Nausea
• Stomach pains
• Anaemia
• Loss of weight
Continued uncontrolled exposure could cause more serious symptoms such as:
• Kidney damage
• Nerve and brain damage
• Infertility
NB: These symptoms can also have causes other than lead exposure.
An unborn child is at particular risk from exposure to lead, especially in the early weeks
before a pregnancy becomes known. Women of child bearing age must follow good
work practices and have a high standard of personal hygiene.
Doctors appointed by the HSE should monitor those considered to be at risk from lead
and will undertake biological monitoring (taking blood and urine samples) to check
lead levels.
D3 - Radiation
There are two main kinds of radiation relevant to the Construction Industry; ionising
(that which requires statutory health surveillance) and non-ionising, both of which may
cause negative health effects.
IONISING RADIATION:
NON-IONISING RADIATION:
• Lasers can cause burns and damage the eye
Ultra-Violet (UV) radiation (e.g. from the sun) can damage the skin and lead to skin
cancer, particularly relevant in summer when hot work warrants the removal of
clothing. Too much sunlight is harmful to the skin. A tan is a sign that the skin has been
damaged by UV rays in sunlight. Some medicines can also make skin more sensitive to
sunlight.
Longer term problems from sun exposure can increase the chance of developing skin
cancer. Skin cancer is the most common kind of cancer in the UK with over 40,000 new
cases diagnosed each year. Workers should be encouraged to check their skin regularly
for unusual spots or moles that change size, shape or colour and to seek medical advice
if there are concerns.
Construction workers should be encouraged to wear a hat, use a sunscreen with a sun
protection factor of 15 or more and to keep shirts on in sunny weather.
Further advice available from: www.sunsmart.org.uk
D4 - Compressed Air
There are various types of health problems which can be caused by working in
compressed air. The most common are:
• Decompression sickness
• Barotrauma principally affecting the the ears and sinuses
• Dysbaric osteonecrosis, which is a long-term, chronic condition damaging the long
bone (hip or shoulder) joints
The Work in Compressed Air regulations 1996 provides a framework for the
management of health and safety risks by those undertaking tunnelling and other
construction work in compressed air. As well as the standard safety provision there is a
duty on employers to provide health surveillance via an Appointed Doctor to provide
occupational health advice on all aspects of the work in compressed air.
FITNESS STANDARD D:
STATUTORY MEDICALS
TYPE
E - Musculoskeletal
Musculoskeletal disorders (MSD’s) are health issues affecting the muscles, tendons,
ligaments, nerves or other soft tissues and joints. MSD’s are the most common
occupational illness in the UK. The areas most affected are the back, joints and
repetitive strain injuries of various sorts. Injury can happen while doing any activity that
involves movement of the body ranging from heavy lifting to typing.
There are certain tasks and factors in the Construction Industry that increase the risk
such as:
• Repetitive and heavy lifting
• Bending and twisting
• Repeating an action too frequently
• Uncomfortable working position
• Exerting too much force
• Working too long without breaks
• Adverse working environment (e.g. hot, cold)
• Stress pressures e.g. high job demands and time pressure
• Whole body vibration
There are no specific health checks to predict that MSD’s are developing, however,
symptoms can be regularly monitored in order to detect symptoms early and ensure the
worker gets appropriate advice and treatment and importantly, modifying the work
where practicable. Schemes for making physiotherapy available have been shown to be
successful.
For further information visit: http://www.hse.gov.uk/msd/index.htm
FITNESS STANDARD E:
MUSCULOSKELETAL HEALTH (MSD), MOBILITY AND CO-ORDINATION
Frequency:
• 3 yearly for SCW or sooner if required i.e. symptoms reported
• Pre-placement for new employees whose work will include a significant amount of
handling or repetitive movement, a pre-placement “fitness for work” assessment
should be conducted to determine any MSD’s already present which may preclude
the intended employment
• Employees should be encouraged to report symptoms of any MSD’s to a nominated
person at any time. Employees attending for other health surveillance should
discuss any symptoms of MSD’s which have not previously been reported. When a
problem is detected a full assessment of all possible causes should be undertaken
3/4 Musculoskeletal: Does not have full movement of the trunk, neck,
upper and lower limbs. Chronic pain or restriction of joint
movement interferes with mobility. Employees with limb
prosthesis may still be able to operate machinery but this should
be based on an individual functional assessment with an OH
professional, manager and operator
Nervous system: Vertigo, giddiness and balance disorders are a bar
to SCW, lack of muscle coordination, double vision, significant
tremor, paralysis, generalized or localized muscular weakness, and
disorders or diseases of the nervous system are all a bar to
machinery/SCW
Employees who have had a stroke or fainting fits should be
restricted until assessed by an OH Physician
Identifiable long term/current medical problem which restrict
capability and ability to stand, walk sit for periods, and may affect
safety of self or others
Operational risk assessment indicated. Equality legislation may
apply
F – Skin Health
Occupational skin disease can be caused by exposure to a physical, chemical, or
biological agent or a repetitive mechanical force. Skin disease is often labelled as work
related dermatitis or eczema and forms 80% of all occupational skin diseases.
There are different types of substances which can harm the skin – some irritate the skin
and others can cause permanent damage. For the Construction Industry the main skin
hazard is from the exposure to cement dust; often mixed with sand or other aggregates
to make mortar or concrete. Treatment by creams and avoidance of the hazardous
substance will resolve the irritation but if exposure continues the condition may go on
to cause a more serious skin condition - allergic dermatitis. This can result in large areas
of skin becoming severely inflamed from tiny exposures and work in the area becomes
untenable for health reasons.
A risk assessment needs to establish known substances that can cause skin allergy and
identify measures to be put in place to protect the worker. Reference to hazard data
sheets can highlight substances which are known to cause skin problems. Health checks
may also be required as a means of monitoring skin in the workplace. CBH accredited
OHSPs are able to assist the employer on what level of health surveillance may be
required.
It is recommended that all employees exposed to certain substances (see CBH matrix)
undergo an initial skin assessment. This provides an opportunity to inform the
employee of the hazards of exposure to certain substances as well as establish baseline
data.
For further information visit: http://www.hse.gov.uk/skin/index.htm and the CBH
website www.cbhscheme.com
FITNESS STANDARD F:
SKIN HEALTH ASSESSMENTS
Frequency:
• Prior to placement if potential employee at risk of contracting allergic contact
dermatitis (e.g. those with a history of atopic eczema or a past history of
work-related skin disorders)
• Within two weeks of employment if employee working in an environment where
there is exposure to possible occupational skin irritants/allergens
• A ‘responsible person’ to carry out regular (monthly) skin checks and annually to
use a brief skin questionnaire
• Employees should be educated to examine their own skin on a regular basis
in-between these intervals
• When an employee informs their manager and/or occupational health of any skin
symptom which may be occupational
• Employees at risk of developing occupational dermatitis and/or skin disorders seen
annually by an OHNA
CATEGORY INTERPRETATION
Occupational Asthma
Occupational Asthma (OA) is asthma that has been caused due to work by a substance
which has be designated as a respiratory sensitiser; as with ordinary asthma it can have
serious implications for both affected individuals and employers. For the affected
individual, continued exposure to the harmful dust or fume usually leads to
deteriorating asthma and the risk of severe, or on rare occasion’s fatal asthma attacks.
Even if exposure ceases, the more severely affected may still be left with persistent
asthma and chronic disability.
FITNESS STANDARD G:
RESPIRATORY HEALTH CHECK
Frequency:
• At pre-placement on occupations known to involve exposure to respiratory hazards
at work and/or who wear respiratory protection
• Health surveillance should include assessments by questionnaire and spirometry,
then 6 weeks and three months after starting work with hazardous substance if
considered a high risk of exposure to respiratory sensitisers
• Surveillance for chronic obstructive pulmonary disease should be annually
• Yearly review thereafter provided there are no problems identified
• Symptoms of allergy to work substances can be the first signs that occupational
asthma may be developing
• On any employee who notifies occupational health of respiratory or allergy
symptoms which may or may not be occupationally related
• Respiratory health surveillance will cease when the employee is not longer exposed
to hazards requiring surveillance or when employment is terminated. Close
proximity to respiratory sensitisers may still require continued surveillance and
should be decided by risk assessment
• Employees who fail to produce results within the normal range and/or have
respiratory symptoms should be referred to an OH Physician in order for a full
investigation to take place. Referral to their GP may also be necessary in order that
treatment can be considered
• Procedures should be in place to enable employees to report any symptoms that
occur between tests
FITNESS STANDARD H:
HEARING HEALTH CHECK
3/4 Where employee has not met criteria 1 and/or 2, for example
• evidence from previous audiometric testing of rapid/reduced
hearing loss in higher and/or lower frequencies
• unilateral hearing loss
• presence of a medical condition - likely to cause unpredictable
fluctuation in hearing levels or permanent reduced levels of
hearing
It is the employer who makes the decision whether an employee
should continue working in a noise hazard area. The role of the
OH practitioner is to provide the employer with a competent
assessment of an employee’s hearing in relation to the job and
work environment. A competent assessment of an individual with
significant hearing loss would include advice from a hearing
specialist. The Equality Act may apply
FITNESS STANDARD I:
VIBRATION HEALTH CHECK
CATEGORY INTERPRETATION
2 Stage 1 symptoms
• Advise the employer to review the risk assessment, and to
reduce further exposure to a level that is as low as reasonably
practicable. Advise a change work practices to eliminate
exposure to vibration and where there is a residual risk despite
control measures, consider job rotation to reduce an exposure
• If there is a suggestion that the disease is progressing rapidly,
then a review at 6 months rather than 1 year may be indicated
• Stage 2 symptoms: exposure must be reassessed, close
monitoring for symptom progression and worsening functional
impairment
• The OH Physician needs to consider whether the individual is fit
to continue to be exposed to hand transmitted vibration (HTV)
Normally the individual will only become unfit if reached late
stage 2. Tier 5 testing may confirm the severity of symptoms. It is
important to recognise that the tests are not necessarily precise,
and therefore the decision as to whether a case is late stage 2
will always be based on clinical judgement
• Management of current cases at Stages 2-3 might be different,
as the disease progression may be clearer. If the employee is
approaching retirement age, continued fitness to work may be
acceptable, particularly if further exposure can be limited, and
there is regular health surveillance. The situation and risks need
to be explained fully to the employee
FITNESS STANDARD J:
BLOOD PRESSURE
CATEGORY INTERPRETATION
FITNESS STANDARD K:
URINALYSIS
CATEGORY INTERPRETATION
1 Fit: Normally the urine test should be negative for glucose. If the
urine is also tested for blood and protein the result should also be
negative.
FITNESS STANDARD L:
VISUAL ACUITY
CATEGORY INTERPRETATION
1 Fit:
Safety Critical Workers standard :
Corrected visual acuity at least 6/9 one eye and 6/12 in the other
Uncorrected visual acuity - at least 3/60 in each eye
Near vision = N8
Visual field: No pathological defect
Corrected visual acuity
Non-safety critical standard
6/18= is considered sufficient to undertake normal duties
If dependent on contact lenses to meet vision requirements,
spectacles of an equivalent prescription shall be carried when in
critical safety roles. (This is so that, if, for any reason, the contact
lenses have to be removed, the person is still able to achieve the
necessary visual performance to continue working safely.) The
order of testing vision should be – unaided – with spectacles – with
contact lenses. No pathological condition of the eyes likely to
cause visual impairment should be present. The use of tinted or
photo chromic prescription spectacles is prohibited. To prevent
adverse effects on colour discrimination and on general vision in
areas of strong contrast between light and shade, only sunglasses
which conform to BS EN 1836, shade 2.5 are permitted
FITNESS STANDARD M:
MID RANGE ACUITY (DISPLAY SCREEN EQUIPMENT) USERS
Frequency:
Visual acuity testing should be undertaken for DSE users:
• As soon as possible after employment commences
• At two yearly intervals or when requested by the employee i.e. reports eyestrain,
focusing difficulties, headaches or similar conditions
CATEGORY INTERPRETATION
N – Colour Vision
FITNESS STANDARD N:
COLOUR VISION
Frequency:
3 yearly or sooner if required i.e. symptoms reported
1 Fit: Has passed Ishihara (24) plates/City test standard for colour
perception, no colour deficiency noted. Employee identified as
potentially safe with milder degrees of anomalous trichromatism
O - Biological Monitoring
Biological monitoring may be required if exposure to chemical hazards is identified
during the risk assessment process.
It is difficult to detail every situation where monitoring is necessary. The decision should
be taken on an individual basis
FITNESS STANDARD O:
BIOLOGICAL MONITORING
The following list, which is not definitive, gives a general idea of where biological
monitoring is required and the type of sample, however further guidance can be
obtained from CBH/OHSP
Workplace Stress
Pressure is part of everyday life, but excessive pressure can lead to stress, which
undermines performance, is costly to employers and can make people ill.
HSE defines work-related stress as:
‘The adverse reaction people have to excessive pressure or other types of demand
placed on them.’
Stress at work can be tackled in the same way as any other risk to health. A recent
survey identified the top five most stressful issues in the Construction Industry as:
• Having too much work to do in the time available
• Travelling or commuting
• Being responsible for the safety of others at work
• Working long hours
• Having a dangerous job
• With management, road maintenance staff, designers and administration staff
reporting more stress than other job roles of labourers and operatives.
Employers have duties to undertake risk assessment for stress the same as other health
hazards.
For further information go to:: http://www.hse.gov.uk/stress/index.htm
FITNESS STANDARD P:
WORKPLACE STRESS/MENTAL HEALTH FITNESS
Frequency:
As identified through risk assessment process or symptoms reported
Definition:
Drug and alcohol misuse is defined as:
• Alcohol dependence, excessive alcohol consumption and/or inebriation in the
workplace
• Taking or possessing illegal drugs
• Misuse of legal substances such as prescribed medicines
• Solvent misuse e.g. inhalation of gases or glues
• Under the Road Traffic Act and the Transport and Works Act, drivers of road vehicles
must not exceed certain statutory limits so as to be under the influence of drugs or
alcohol while driving, attempting to drive or when they are in charge of a vehicle. For
certain rail, tram and other guided-transport system workers must not be unfit
through drugs or alcohol while working on the system
• The Misuse of Drugs Act states that:
• It is unlawful to be in possession of a controlled drug
• The occupier of a premises is committing an offence if it is known that producing,
supplying (or attempting to supply), or the preparation and smoking of controlled
drugs is taking place on those premises
• Companies must take action if illegal drug activity is discovered
• The Human Rights Act aims to ensure that the rights of the individual as well as that
of the community are protected. This means that one individual’s rights may have to
be balanced against another’s. Article 8 covers the individual’s right to private life
and family. A drug and alcohol policy is justified where public safety is concerned.
The Act also makes allowances for interferences where the aim is for the protection
of the health of others as determined by other relevant legislation
• The Data Protection Act sets out principles of confidentiality and legal ways of
processing information. Companies should ensure the principles are applied across
the whole area of testing, training and results. Special care must be taken to inform
employee’s of the terms of a drug and alcohol policy and the consequences if testing
is found to be positive
FITNESS STANDARD Q:
DRUG & ALCOHOL SCREENING
(DEPENDANT ON EMPLOYERS POLICY)
Frequency:
Pre placement, 3 yearly and for cause testing post accident in SCW. Screening for
illicit drugs may be required for pre-placement or change of risk category health
assessments depending on local legislative requirements and organisational practices.
Screening may also be required by management at a triggered health assessment
CATEGORY INTERPRETATION
FITNESS STANDARD R:
GENERAL HEALTH ASSESSMENT/LIFESTYLE
General health assessments can include blood pressure, urinalysis, cholesterol, height,
weight, body mass index (BMI), and health promotion/education. The following are
guidelines which can be followed to determine the type of advice/health promotion
Frequency: 3 yearly for SCW ‘Fitness for Work’ assessment
Cholesterol The National Institute for Health and Clinical Excellence (NICE) and
Department of Health cholesterol guidelines are:
• Total cholesterol: less than 5.0mmol/l
• LDL cholesterol: less than 3.0mmol/l
Height/Weight Body mass index (BMI) is calculated by dividing weight (kgs) by the
BMI square of height in metres (kg/m2) and can be used as a measure
of overweight in adults but needs to be interpreted with caution
because it is not a direct measure of adiposity
Classification BMI
Healthy weight 18.5 – 24.9
Overweight 25 – 29.9
Obesity I 30 – 34.9
Obesity II 35 – 39.9
Obesity III 40 or more
Waist Waist measurement can be used in addition to BMI for those who
Measurement have a BMI less than 35kg/m2. The assessment of health risks
associated with overweight should be based on the following
table:
BMI Classification Waist Circumference
Low High Very High
Overweight No increased Increased Very High
Risk Risk Risk
Obesity I Increased High Very High
Risk Risk Risk
For men, waist circumference of less than 94 cm is low, 94 –
102 cms is high and more than 102 cm is very high
For women, waist circumference of less than 80 cm is low, 80 –
88 cms is high, and more than 88 cm is very high
History taking The past medical and family history can indicate the likelihood of
recurrence or the likely risk of developing a medical condition
INFECTIONS
CANCERS/
TUMOURS
ENDOCRINE
AND
METABOLIC
BLOOD
DISORDERS
MENTAL
DISORDERS
DISEASES
OF THE
NERVOUS
SYSTEM
Organic Limitations on May have side 3 whilst under 2/3 Case by case
nervous muscular power, effects from investigation assessment
disease e.g. balance, treatments and until stable. informed by
Parkinson’s co-ordination and Case by case specialist advice
disease, mobility assessment and based
multiple informed by on job
sclerosis specialist advice requirements
and based
on job
requirements
CARDIO-
VASCULAR
SYSTEM
Ischaemic Risk of sudden loss Risk factor 3 for 1 year 2 (no working at
cerebro- of capability, screening, after TIA or heights) for at
vascular mobility limitation. lifestyle advice, stroke, least 1 month,
disease Risk of other smoking provided fully until stabilized,
circulatory disease cessation advice recovered and then 1
causing loss of no significant
capability risk factors
4 if not fully
recovered/
remaining risk
factors
RESPIRATORY
SYSTEM
DIGESTIVE
SYSTEM
GENITO-
URINARY
CONDITIONS
SKIN
MUSCULO-
SKELETAL
SENSORY
GENERAL
References
• Access to Medical Reports Act 1988
• Agriculture (Tractor cab) Regulations 1974
• Asthmagen? Critical assessments of the evidence for agents implicated in
occupational asthma ISBN 0 7176 1465 4, HSE Books
• At a glance guide to the current medical standards of fitness to drive, issued by the
DVLA
• Blueprint for UK Construction Skills 2007-2011 (Construction Skills Network Model,
2006; Experian)
• Clinical Testing and Management of Individuals exposed to Hand Transmitted
Vibration: An Evidence Review. FOM April 2004
• Control of Lead at Work Regulations 2002 (ISBN 0-7176-2565-6)
• Control of Noise at Work Regulations (2005)
• Control of Vibration at Work Regulations 2005 Management of Health & Safety at
Work Regulations 199
• Cook R (1996) Urinalysis: ensuring accurate urine testing. Nursing Standard. 10, 46,
49-54
• Equalities Act 2010
• Fitness for Work, The Medical Aspects, 4th Edition edited RAF Cox
• Employment Law and Occupational Health, Joan Lewis and Greta Thornbury
• Guidance notes for ADs CLAW 2002
• Hand Arm Vibration at Work. HSE www.hse.gov.uk/vibration/hav/index.htm
• HAVS nomogram http://www.hse.gov.uk/foi/internalops/fod/inspect/havs.pdf
• HAVS Screening Limited www.Whitefinger.co.uk
• Health & Safety (Display Screen Equipment) Regulations 1992
• Health and Safety at Work Act 1974
• HSE guidance note MS26
• HSE Guidance Series L108
• Management of Health and Safety at Work Regulations 1999
• Manual of Clinical Practices. Core Elements of Care: Diagnostic Interventions.
Edinburgh, RIE
• Mechanical vibration. Measurement and assessment of human exposure to
hand-transmitted vibration. BS EN ISO 5349-2:2002
• Medical and occupational evidence for recruitment and retention in the Fire and
Rescue Service, Office of the Deputy Prime Minister
• Medical aspects of occupational asthma MS25, HSE
• NICE Guidelines on Obesity (2006)
• Nice Guidelines on Management of Long Term Sickness Absence and Incapacity for
Work (2009)
Acknowledgements
We would like to thank Dr Ray Quinlan and Dr Martin Philips of RPS Business
Healthcare, Dr Geoff Davies, Wendy Stimson and Jane Coombs; also the HSE for their
contribution to the Industry Standards for Workplace Health in the UK Construction
Industry.