International Diploma Id2

NEBOSH
International Diploma
ID2: Do – Controlling
Workplace Health Issues
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element 9
Do - Controlling Workplace Health Issues
On completion of this Element, candidates should be able to:
9.1 Understand how to treat disability and sickness fairly in the workplace and the role of an occupational
health service.
9.2 Explain how organisations can manage mental ill-health within the workforce, the impacts of well-being
strategies on mental health, how to recognise when there may be risks to the workforce from
violence/the problems associated with lone working.
9.3 Understand the requirements for health surveillance.
9.4 Understand how hazardous substances can affect the human body.
Cont’d.
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On completion of this Element, candidates should be able to (cont’d.):
9.5 Carry out and evaluate an assessment of health risks from hazardous substances, and
evaluate the current, and any additional control measures, that may be required.
ID2 – Do - Controlling Workplace Health Issues
9.6 Understand the role of epidemiology and toxicological testing.

9.7 Summarise how organisations should manage exposure to asbestos and lead in the
workplace.
9.8 Describe different types, use and maintenance of ventilation systems and Personal
Protective Equipment (PPE).
9.9 Recognise when workplace monitoring for hazardous substances is needed.
9.10 Outline where biological agents are likely to be encountered in the workplace and how
these can be controlled.
9.11 Recognise, assess and control noise risks in the workplace.
9.12 Recognise, assess and control vibration risks in the workplace.
9.13 Recognise different radiation risks in the workplace and how they are controlled.
9.14 Explain the different types of musculoskeletal issues and what an organisation must do to
assess and control risks from repetitive physical activities, manual handling, and poor
posture.
9.15 Outline why and how suitable working temperatures for all types of work should be
maintained and what welfare arrangements organisations need to provide for all workers.
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Contents Page No
9.1 Principles and Benefits of Vocational Rehabilitation 8
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Vocational Rehabilitation 12
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Role of Agencies to Support Rehabilitation 16
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Occupational Health Services 18
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The Role of Occupational Health Services 18
Typical Activities Offered by an Occupational Health Service 21
9.2 Mental Ill-Health 25
Anxiety and Depression 26
Occupational
Mental Ill-Health and Work-Related Stress 28
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Factors Likely to Increase the Risk of Work-Related Violence 41
9.3 Health Surveillance 48
Health and Safety Executive’s (HSE) Cycle of Health Surveillance 49
Health Issues
Biological Monitoring 54
Fatigue 57
9.4 Hazardous Substances 60
Target Organs, Target Systems, Local and Systemic Effects 69
9.5 Health Risks from Hazardous Substances 75
REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) 75
GHS – Classification of Substances and Mixtures 76
Health Hazard Classes 76
The Prevention and Control of Exposure to Hazardous Substance 93
9.6 Epidemiology and Toxicology 98
The Role of Epidemiology and Toxicological Testing 98
Types of Epidemiological Study 100
Alternatives to Animal Testing 107
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9.7 Asbestos and Lead 108
9.8 Ventilation and PPE 113
Ventilation 113 NEBOSH

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Local Exhaust Ventilation (LEV) Systems 114

Personal Protective Equipment 135
Respiratory Protective Equipment 136
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9.9 Hazardous Substance Monitoring 152

Occupational Exposure Limits (OEL) for Airborne Harmful Substances 152
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Concept of Exposure Limits 152

Principles of Good Practice 154
Strategies, Methods and Equipment for the Sampling and Measurement of Airborne Harmful Substances 160
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The Role of Other Health Related Professionals 161

Undertaking Air Monitoring 164
Determining a Monitoring Strategy 164
Personal and Static Sampling 167
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9.10 Biological Agents 178
Special Properties of Biological Agents 180
Biological Sensitisation 182
Diseases Caused by Biological Agents 188
Additional Control measures for Exposure to Biological Agents 195

General Hierarchy of Control for Biological Agents 195
9.11 Noise 205
Effects of Exposure to High Noise Level 208
Measurement and Assessment of Noise Exposure 210
The Hierarchy of Noise Control 214
Active Noise Cancellation (ANC) 217
9.12 Vibration 227
9.13 Radiation 241
Types of Ionising and Non-Ionising Radiation 241
Non-Ionising Radiation 245
Ionising Radiation 257
Methods of Measuring 262
Principles of Prevention and Control 264
9.14 Musculoskeletal Issues and Manual Handling 271
Types of Injury and Ill Health Conditions 274
Work Related Upper Limb Disorders (WRULD) 277
Preventive Measures 271
Display Screen Equipment 279
Analysis of Workstations to Assess and Reduce the Risks 284
Manual Handling and Poor Posture 285
Manual Handling Operations 285
The UK Guidelines for Lifting and Lowering 288
9.15 Workplace Temperature and Welfare Arrangements 301
Heat Gain and Loss 301
Health Effects of Working in Extreme Thermal Environment 303

Practical Control Measures to Minimise the Risks when Working in Extreme Thermal Environment 308 NEBOSH International Diploma
The Impact of Lighting Levels on Safety Issues 311
References 322
List of Figures
Figure 1: Health Surveillance Cycle 50
Figure 2: Smoke tube used to test a ventilation system 132
Figure 3: Acoustic haven 222
Figure 4: Numerical Scoring of Vascular Symptoms of HAVS 231
Figure 5: HSE vibration Exposure Calculator 234
Figure 6: The Calculator in Use 235
Figure 7: Whole Body Vibration Calculator 235
Figure 8: Warning sign – laser 251
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List of Tables
Table 1: Examples of BMGVs 55
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Table 2: Summary of Common terms used in Occupational Health are: 71
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Table 3: Types of Epidemiological Study 100
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Table 4: Relative Toxicity Ratings 104
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Table 5: Fixed Dose Method 104
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Table 6: Capture Velocities (Examples) 118
Table 7: Recommended Minimum Duct Velocities (Examples) 119
Table 8: Filter Types – UK source 139
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Table 9: Classes of RPE and APF’s – UK source 141
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Table 10: Factors to be Considered When Using RPE 142
Table 11: A Guide to Choosing Glove Materials 145
Table 12: Permeation Performance Levels 146
Table 13: Breakthrough Times for Common Materials with Specified Chemicals 146
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Table 14: Examples of Chemical Hazards to the Eye, with Occupational Sources: 148
Table 15: Features of Eye Protection 149
Table 16: Examples of Workplace Exposure Limits 153
Table 17: Contrasting standards 158
Table 18: Extract from EH40/2005 159
Table 19: Containment Measures for Health and Veterinary Care Facilities, Laboratories and Animal Rooms 196
Table 20: Containment Measures for Industrial Processes 197
Table 21: The Decibel Scale 206
Table 22: Acute and Chronic Effects of Noise Exposure 209
Table 23: Noise Dosages 222
Table 24: Exposure Action Values and Exposure Limit Values (UK) 228
Table 25: Examples of the Commercial Use of Non-Ionising Radiation 247
Table 26: Common Work-Related Upper Limb Disorders 277
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Table 27: Workstation Requirements 293
Table 28: Examples of Typical Clothing Insulation Values 302
Table 29: WBGTs (°C) and Recommended Work / Rest Regimes 307
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Table 30: Illuminance Standards (HSG 38 ‘Lighting at Work’) 314
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Table 31: UK Minimum Requirements for Toilets and Washing Facilities 316
Table 32: Suggested Numbers of First-Aid Personnel to be Available at all times 319
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List of Flowcharts
Flowchart 1: Design for a Cohort Study 101
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Flowchart 2: Design of a Case – Control Study 101

Flowchart 3: Environments and Adequate Respiratory Protection 136
Flowchart 4: Types of Respiratory Protective Equipment 137
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Flowchart 5: Approach for Assessing Hazards to Health by Inhalation 164

Flowchart 6: Manual Handling chaart 298
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List of Charts
Chart 1: Spinal Pressure 275
Chart 2: Lifting and Lowering simple risk filter 288
Chart 3: Assessing Twist 289
Chart 4: Measuring Pulling Force 290

Chart 5: Handling While Seated 290
List of Illustrations
Illustration 1: Respiratory System 60
Illustration 2: Alveoli Structure 61
Illustration 3: Digestive System 62
Illustration 4: Liver 63
Illustration 5: The Kidneys 64
Illustration 6: Circulatory System 64
Illustration 7: Nervous System 66
Illustration 8: The Skin 67
Illustration 9: The Eye 67
Illustration 10: The Ear 68
Illustration 11: Target Organs 70
Illustration 12: Fume Cupboard 94
Illustration 13: Welding Fume LEV 95
Illustration 14: Dose/Concentration Response Curve 103
Illustration 15: General Ventilation 113
Illustration 16: Typical LEV System 114
Illustration 17: Hoods 115
Illustration 18: Effect of Enclosing Design on the Airflow Required for Control 117
Illustration 19: Bad and Good Ducting Design 118
Illustration 20: In Line Air Filter 119
Illustration 21: Cyclone Dust Separator 120
Illustration 22: Venturi Scrubber 121

Illustration 23: Self-Induced Spray Collector 122
Illustration 24: Bag Filter Unit 123
Illustration 25: Electrostatic Precipitator 124
Illustration 26: Cone Discharge Termination 125
Illustration 27: Vane Anemometer 130
Illustration 28: Face Velocity Measurement Using a Vane Anemometer 130
Illustration 29: Pitot Static Tube Inserted into Ducting 131
Illustration 30: Use of Dust Lamp 133
Illustration 31: Full Face Mask 137
Illustration 32: Power Assisted Respirator with Full Face Mask 138
Illustration 33: Open Circuit Self Contained Breathing Apparatus 139
Illustration 34: Operator Wearing Gravimetric Personal Dust 167
Illustration 35: Stain Detector Tube Pump 168
Illustration 36: Stain Detector Tubes 169
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Illustration 37: IOM Inhalable Sampler 172

Illustration 38: Multi-Orifice Total Inhalable Sampler 172
Illustration 39: Conical Inhalable Sampler 173
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Illustration 40: Respirable Dust Cyclone Sampler 173
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Illustration 41: Cowl Sampler 174
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Illustration 42: Passive (Diffusive) Samplers 175
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Illustration 43: Activated Charcoal Sampling Tube 175
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Illustration 44: Midget Impinger 176
Illustration 45: Class II Biological Safety Cabinet 198
Illustration 46: Class I Biological Safety Cabinet 199
Illustration 47: Biohazard Sign 200
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Illustration 48: A Compressor Unit with Isolation under the Machine and on the Outlet Pipework 216
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Illustration 49: A Porous Silencer for Use on Compressed Air Exhausts 218
Illustration 50: Noise Paths 219
Illustration 51: Noise Control 219
Illustration 52: The Electromagnetic Spectrum 242
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Illustration 53: Features of Waves 242
Illustration 54: Examples of Ionising Radiation 243
Illustration 55: Distribution of natural and man-made ionising sources 258
Illustration 56: Alpha Decay 259
Illustration 57: Beta Decay 260
Illustration 58: Gamma Emission 260
Illustration 59: Time, Distance, Shielding 265
Illustration 60: Examples of Shielding 265
Illustration 61: Five Groups of Vertebrae 271
Illustration 62: The Inter-Vertebral Disc 273
Illustration 63: Discs 275
Illustration 64: Illustration 64: Carpal Tunnel Syndrome 281
Illustration 65: Minimum Requirements for Workstations 292
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Illustration 66: Seating and Posture for Typical Office Tasks 293
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List of Graphs
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Graph 1: Time Varying Concentrations 153

Graph 2: Weighting Scale Graph 207
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Graph 3: Audiogram for Normal Hearing 223

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Graph 4: Audiogram Showing Noise Induced Hearing Loss (NIHL) 224

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Graph 5: Comparison Between Attenuation of Typical Earplugs / Muffs 225

Graph 6: Graphs Representing Displacement, Velocity and Acceleration 227
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9.1 Principles and Benefits of Vocational

Rehabilitation
The Basic Principles of the Bio-Psychosocial Model and

How it Relates to the Health of Individuals
In 1977, American psychiatrist George Engel introduced a major theory in medicine, the BPS model. The
model accounted for biological, psychological, and sociological interconnected spectrums, each as systems
of the body. The model prompted a shift in focus from disease to health.
Bio-psychosocial model is an individual-centred model that considers the person, their health problem and
their social context:
Biological refers to physical or mental health condition.
Psychological refers to the individual’s personal beliefs, coping abilities, behaviour and emotions.
Social refers to the individual’s environment (home and workplace), his/her social interactions and
relationships.

The bio-psychosocial model forms the basis of the World Health Organization International Classification of
Functioning, Disability and Health (ICF) which is the framework for disability and rehabilitation. Day to day
functioning and disability depends on the dynamic interaction between the individual’s health condition and
factors that include psychological and social factors.
Understanding and preventing incapacity requires a bio-psychosocial model that addresses all
the physical, psychological and social factors involved in human illness and disability.
Rehabilitation management should be considered to overcome bio-psychosocial obstacles to
recovery and return to work.
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Why Is It Important to Make ‘Reasonable Adjustments’ for

Workers with Physical and Mental Ill-Health?
Employers have a moral responsibility to provide safe working environment to all employees, including those
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who have some form of disability. In many countries, there are laws that require employers to consider the
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welfare and wellbeing of workers with disability. The employers are obligated to make reasonable adjustments
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to the job/workplace to accommodate an individual’s disability.
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What workplace adjustment is considered as reasonable? Generally, an adjustment is considered reasonable
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if it does not cause “unjustifiable hardship” to the employer. Examples of unjustifiable hardship include:
excessive financial cost, restrictions by local council that would not permit adjustments to be made to the
building/premises, extensive disruption caused to the business operations, or the adjustment would
disadvantage other employees.
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Examples of reasonable adjustments in the workplace that create an inclusive environment to make those
with disability feel valued and supported include:
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x Allowing flexible working hours for those with disability, such as working part-time or starting and
finishing later.
x Redistributing duties that a person with disability finds difficult to do.
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x Provide helpful equipment such as speech recognition software for those who are visually impaired.
x Provide training, mentoring, supervision and support.
x Provide height-adjustable work stations
Workplace adjustments allow people with disability to:
x Perform their job safely with higher level of productivity
x Have equal opportunity in their career development
x Enjoy equitable terms and conditions of employment
Pre-placement Health Assessments
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A pre-placement health assessment is undertaken by an occupational health service at the request of an
employer as part of the risk assessment process and only after a job offer has been made. The pre-placement
assessment can consist of any or all of the following: NEBOSH

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• The completion of a health questionnaire asking individuals about health issues relevant to the
risks presented by a particular job
• Discussion regarding any health matters
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• Consideration of any health checks required as part of an on-going health monitoring programme
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required for the job such as a breathing health check if exposed to respiratory hazards
• Assessment of fitness and medical suitability for the role made by an occupational health service
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The pre-placement health assessment is there to:
1. Ensure that all new employees are medically fit to fulfil the duties and responsibilities of the job,
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and consider adjustments that could be made to assist the person in the role; assess whether the
job may adversely affect the new employee’s health, and whether any extra precautions are
needed
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2. Provide a record of health information as a starting point for comparison before work begins such
as. A hearing test on an employee before beginning work in a noise hazard area to assess their
baseline level of hearing
The pre-placement assessment also offers the opportunity for new staff to:
• Understand their role more fully and be made aware of necessary precautions
• Receive explanations regarding when personal protective equipment is needed, and how it is to be
worn
• Be introduced to the overall philosophy of health and safety in the organisation
Occupational health service providers who undertake pre-placement health assessments are objective,
medically-qualified professionals who understand both health issues and workplace health risks. What is
disclosed in the pre-placement health assessment with an individual is ‘medical in confidence’ so any
discussion can be open and honest without fear of prejudice or discrimination, giving a sound basis on which
to base the assessment.
Managing Long-term or Recurring Short or Long-term Sickness

Absence
There is no commonly agreed definition of long- or short-term sickness absence. For this guidance, short-term
sickness absence is defined as lasting up to 4 weeks. Recurring short-term sickness absence is a number of
episodes of absence from work, each lasting less than 4 weeks. Long-term sickness absence (including
recurring long-term sickness absence) is defined as absences from work lasting 4 or more weeks.
Employers should establish and implement sickness absence policies and appropriate health and safety
practices. As part of these policies and practices, employers should liaise with employees who have been on
long-term sickness absence or taken recurring short- or long-term sickness absence to help them return to
work. This will be of mutual benefit to them and their employee. Employers may ask line managers, human
resource professionals or occupational health specialists to take on this responsibility.
Trades union and employee representatives can play an important role in helping employers to develop
guidance and policies on the recommended interventions. They may also have a role as advocates for – and
supporters of – staff wanting to return to work.
National Institute for Health and Care Excellence (NICE) – NG 146 Guidance
The UK Department of Health (DH) asked the National Institute for Health and Clinical Excellence (NICE) to
produce public health guidance for primary care services and employers on the management of long-term
sickness absence and capability for work.
This guideline covers how to help people return to work after long-term sickness absence, reduce recurring NEBOSH International Diploma
sickness absence, and help prevent people moving from short-term to long-term sickness absence.
This guidance is for:
x Employers' representatives including managers, human resource professionals and occupational

health professionals
x GPs and secondary care specialists
x Employees and their workplace representatives
x Commissioners of advice and support services for people who are not in work and are receiving
benefits because of their health or a disability, and users of these services.
Recommendations
There are 8 recommendation (1.1-1.8). The first seven are intended for employers, senior leadership,
managers, human resources personnel and those assessing and certifying fitness for work.
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The last recommendation is intended for those responsible for commissioning and delivering advice and
support services for people not in work and who are receiving benefits relating to a health condition or disability.
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Recommendations are as follows:
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1.1 Workplace culture and policies
Make health and wellbeing a core priority for the top level of management of the organisation. Foster a
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caring and supportive culture that encourages a consistent, proactive approach to all employees' health
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and wellbeing.
1.2 Assessing and certifying fitness for work. The statement of fitness for work ('fit note') should be completed
by the medical practitioner with the most relevant recent knowledge of the person's health, reason for
absence and prognosis for return to work. This may be a GP or secondary care specialist.
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1.3 Statement of fitness for work
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When a statement of fitness for work ('fit note') is received indicating that someone is not fit for work, start
and maintain a confidential record. This record should include:
x The reason for absence, the anticipated length of absence and any recurrence of absence for the
same reason and
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x Any comments from the medical practitioner about how the person's condition or treatment affects
their capacity for work.
1.4 Making workplace adjustments
Discuss with the returning person whether colleagues need to be informed about the adjustments to help
them understand the need for the adjustments. Record any workplace adjustments agreed with the
employee, including a timeframe for their implementation and how long they are expected to last, in a written
return-to-work plan for the employee and their line manager. Monitor any workplace adjustments that have
been put in place to see if they are meeting the needs of both the employee and employer.
1.5 Keeping in touch with people on sickness absence
Ensure that the employer regularly keeps in touch with people who are 'not fit for work' during periods of
sickness absence. The employer should make contact with the employee as early as possible, and within 4
weeks of him/her being sick.
1.6 Early intervention
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In organisations that offer access to early interventions (such as rehabilitation, counselling or an employee
assistance programme) ensure that all employees are aware of their availability, remit and confidentiality.
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For people who have been absent for 4 or more weeks because of a musculoskeletal condition, consider
interventions to help them return to work. For example, a programme of graded activity delivered by someone
with appropriate training.
For people who resume work after an absence of 4 or more weeks for a common mental health condition,
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consider a 3-month structured support intervention to reduce the likelihood of a recurrence of absence
1.8 People with a health condition or disability who are not currently employed
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Commission an integrated programme to help people receiving benefits who have a health condition or
disability to enter or return to work
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Vocational Rehabilitation
Generally, the meaning of vocational rehabilitation is the process that enables a person with health conditions
such as injury, ill health or disability to overcome barriers to return to employment.
Typical vocational rehabilitation service and methods include vocational assessment and evaluation,
vocational training, general skills upgrading, re-training, career counseling, job search, and consultation with
employers for job accommodation and modification, etc. The amount of assistance varies depending on the
needs of the individual.
Chan et al., (1997) defined vocational rehabilitation as:

"a dynamic process consisting of a series actions and activities that follow a logical, sequential progression of
services related to the total needs of a person with a disability. The process begins with the initial case finding
or referral and ends with the successful placement of the individual in employment. Many activities and
developments occur concurrently and in overlapping time frames during this process".
The Rehabilitation Process

The individual will be referred to diagnostic services such as general and specialty medical examinations,
psychological evaluation, and vocational evaluation. The purpose of these diagnostic examinations is to
determine functional limitations related to disability; to identify psychosocial, educational, and economic
factors that might interact with disabilities to impede ability to work and live independently; to identify the
strengths of the individual; to develop appropriate vocational goals; and to identify services needed to achieve
the individual's immediate objectives and long-term vocational rehabilitation goals. Following the
assessment, a suitable vocational rehabilitation plan will be designed for the individual.
Benefits of Vocational Rehabilitation within the Context of the Worker

and the Employer
Vocational Rehabilitation plays an important role in any organisation, as it can help create a positive working
environment with following benefits to both the worker and the employer:
• Reduction in the length of time the employee is away from the work site, therefore reducing the
costs of training replacement workers
• Improving the organisational climate (including morale and employment relationships)
• Enhancing employees' desire to return to work, which directly raises human performance, which
leads to higher profits
• Retention of skilled workers which enables the organisation to benefit from their knowledge,
experience and abilities

• Worker feels valued which will help improve their morale

• Worker more likely to approach employer for help before health condition worsens
Possible Rehabilitation Barriers

Employers are highly interested in the return-to-work process. Recovery and return to work outcomes often
depend on how employers respond to and support injured workers in the workplace.
Some of the barriers that are likely to impact on a worker’s recovery and return to work include:
• The worker’s fears and beliefs about their injury and the impact to their health on their return to work
i.e., work will make their health worse
• Stressful work and low job satisfaction
• The level of support from managers and co-workers e.g., flexible accommodation and the provision
of work within the capabilities of the injured employee (suitable duties) so as to increase the
opportunity for the injured employee to remain at work or enable the employee to safely return to
work sooner
• The worker’s inability to adapt to injury-related impairments and accept changes in occupational
activities or new job skills
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Occupational health function should monitor and intervene to overcome any return-to-work barriers by
addressing effective rehabilitation planning and strategies to be implemented. Practical examples include:
• Provide modified jobs in the workplace to accommodate workers
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• Contact by the medical practitioner with the workplace and /or workplace rehabilitation provider
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• High support by supervisors and co-workers
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• Worker has control over work and rest periods
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Return to Work Assessment
Employers must have a detailed look when the process of returning to work is required, whether this be to
the employees’ original occupation, or an alternative. This return could be, in ideal circumstances, a return
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to normal work without any adjustments. However, where the employee has an impairment rendering him/her
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unable to return to normal work it is a requirement that the company either makes available appropriate
rehabilitation or to find alternative work or to make reasonable adjustments to the work available. This
suggests interplay between the employee, (with his/her impairment), and the employer (with available work
options).
At this phase of the “return to work” sequence, the role of the physiotherapist, occupational therapist and
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biokinetician is essential for an optimal outcome. A detailed treatise on rehabilitation options is not appropriate
in this document – suffice to say it is a remediation tool, which begins early and continues until such time as
the residual function is optimised.
Rehabilitation generally begins whilst the affected person is under medical treatment (even as early as whilst
the employee is still in hospital). It is all about the restoration of optimal function, given the circumstances of
the impairment. Programmes follow different courses, including complex psychomotor skills training, and
restoration of fine motor control, gross motor strength, and mechanical range of motion. An important element
of rehabilitation, particularly regarding employees involved in major accidents, is aimed at minimising the
psychological effects of the injury. Work readiness is generally a function of physical capability and emotional
readiness. Sometimes intervention measures may be psychological, such as for employees with post-
traumatic stress disorder. This is sometimes identified by an unexplained delay in return to physical readiness.
In working circumstances in which the working conditions are particularly hostile, such as in the underground
mining environment, the return-to-work process should not be too hasty. Some mining complexes have the
advantage of simulated underground environments, where rehabilitating employees can be re-integrated to
the underground environment in a safe and controlled manner. Structured incremental task requirements are
given to the participants of the programme and their progress is monitored and scored. As their performance
improves so does their confidence in their ability to return to work, protracted recovery times are identified
readily, and the appropriate intervention measures can be implemented without delay.
Who should carry out the assessment? NEBOSH

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The assessor should normally be the employee’s line manager, as they have a good understanding of the
nature of the work. The employee should be involved in the assessment, as they will know how the condition
or impairment might affect their work.
By focusing the assessment on the needs of the individual, it’s more likely that the employee will support the
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rehabilitation process. It will also reduce the risk of discrimination. Specialists such as occupational health or
OSH practitioners should give advice when needed.
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Why is an assessment needed?

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An assessment is needed because the line manager may have to:
• Make changes so that certain aspects of the work are accessible to the employee
• Make adjustments to the work or workplace to help the employee work safely and not put others at
risk.
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The assessment process will help the assessor make an informed decision about what adjustments are
needed and whether they would be reasonable. The assessor should back up their decisions with formally
documented evidence. This will minimise the risk of not meeting employment, health and safety, age and
disability discrimination requirements.
What information will the assessor need?

When the assessor carries out the assessment, he/she will need:
• The job description and/or person specification

• Where necessary, a medical report describing any restrictions or adjustments
• A ‘work adjustment assessment form’ – for complex work, the assessor may have to divide the work
into several manageable chunks
• Records of risk assessments that have already been carried out, as well as codes of practice and
other
• Safe working procedures relating to the work
x Risk assessment forms or checklists for specific areas, such as for manual handling or work with
computers.
Carrying out the assessment:
1. Record the work being assessed and where the employee will be based
2. Record the name of the employee
3. Record the name of the person carrying out the assessment
4. Record any barriers to working
5. Identify any health and safety Concerns
6. Identify the measures needed to improve access and minimise risk
7. List any barriers or concerns that haven’t been resolved through reasonable adjustments
8. Decide whether the work is, or can be made, compatible with the employee’s condition or
impairment
9. Agree action
10. Signatures
11. Record the date for the Interview
12. Continue to support the employee
Liaison with other Disciplines in the Assessment and

Management of Fitness for Work NEBOSH International Diploma
“Fitness for work” is considered in two main areas: recruitment of new staff and return to work of those who
have been off sick.
Existing Health Problems

Jobs that require a certain level of fitness often also demand mental strength and stamina as well.
Jobs may be classed as low risk or high risk. Generally low risk jobs do not require any specific fitness
standards. However, it may be necessary for the worker to complete a health questionnaire regarding their
physical and mental health. The declaration may be evaluated by an occupational health nurse or physician.
High risk jobs that involve hazardous activities or material require fitness standards to ensure that workers
with known health problems are not put at risk, or they do not put others at risk.
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In situation where a worker has an existing health condition that affects his ability and fitness for work, it
may be necessary to refer the worker to an occupational health physician to establish the significance and
the degree to which the ill health may affect the worker’s ability to perform his/her work. The identification
of an existing health problem may mean that specific risk controls must be established to minimise any
effect should the person remain in the job. Most people with health problems are treated by their General
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Practitioner and most are able and capable of continuing to work productively.
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However, there may be instances when it may be necessary to prohibit a worker with health problems from
remaining in the job due to the high level of risk exposure to the worker and others. For example, a worker
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with significant heart condition should be prohibited from driving or working at height.
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When workers are absent from work due to ill health, it may be necessary to obtain an independent specialist
medical advice. At times, there may be differing opinions between medical specialists. In this instance, it
may be necessary to arrange for an independent consultant in occupational medicine to examine the
employee, communicate with the employee’s general practitioner and to produce a comprehensive medical
report concerning the employee’s ability to work and any special arrangements that are necessary to be
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implemented at work.
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A medical report can provide the following information:
• The relationship between an underlying condition and work
• The likelihood of further absence and the outlook for a return to work
• The impact of the individual’s condition on the health and safety of others
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• Any restrictions on duties and hours of work
• Recommendation for resettlement into a different job.
Discrimination
An employer's non-discrimination policy typically covers marital or parental status, race, age, impairment,
religion, political belief or activity, trade union/industrial activity, direct or indirect discrimination against
someone who is associated with any of the above. The policy is generally available in employee handbooks
and included in a business' "Code of Conduct" but should also be incorporated as part of job announcements.
In the UK, it is unlawful for an employer to treat a disabled person less favorably than someone else because
of their disability unless there is a justifiable reason. This includes recruitment, training, promotion and
dismissal, for temporary, contract, and permanent staff. Employers have a duty to make reasonable
adjustments in the workplace to overcome the effects of the disability.
An employer may wish to liaise with external independent specialist for advice and support on the assessment
of disabled people, their suitability for particular work and any adjustments that need to be made to the
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workplace to accommodate them.
Substance Misuse
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Two areas of concern in work and society in general today are drugs and alcohol.
The effects of drugs and alcohol can be severe. Medication can induce drowsiness and poor concentration.
Machinery and computer operation and driving can all be affected.
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Alcohol: Many people drink alcohol in moderation, and this may not cause a problem. However consuming
large amounts can cause acute and chronic effects.
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Drugs: There is a growing problem with drugs around the world. We could consider drugs under the heading
of prescribed and others. Prescribed drugs are those that are provided by medical practitioners during medical
treatment. However, there are other drugs that may be illegal in many countries.
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Effects of Drugs and Alcohol: When under the influence of drugs or alcohol, the effects can be lack of
judgment, slower reactions, and aggressive behavior.
Pre-employment Screening: Many organisations now screen all new applicants for jobs to check whether they
have problems with alcohol or drugs. This is not always accurate as the person may stop using illegal drugs
for a period prior to the drug test being then revert after getting the job. However, it is a good starting point.
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Random Sampling: This is an effective way of controlling the problems by making employees aware that they
could be tested at any time. Tests can be done after specific incidents such as an accident.
Screening is a sensitive issue and must be handled carefully. The use of a breathalyser device (blow in a bag)
is quite straightforward but checking for drugs can mean taking blood samples which people may object to.
Due to the sensitivity of the issue, it is essential that an accurate and effective system is chosen. All employees
should be made clearly aware of the company policy and the results of failure of the test.
More and more organisations are encouraging their employees to declare if they have taken substances or
alcohol before commencement of a work shift. This will enable the employer to decide to either send them
home or assign them to other duties. The arrangement would normally be linked to the requirement for the
worker to attend counseling sessions to control or remove their dependence on the substance.
Drugs and Alcohol Policy
The employer should have a drugs and alcohol policy which should cover such things as:
• All new applicants will be screened.

• Random testing will be applied automatically.
• Test will apply to all staff.
• Testing will be carried out after specific incidents.
• Training for supervision to recognise the problem.
• The appropriate assistance to be provided to the employee
• Confidential treatment of employees’ drug/alcohol problems
• The disciplinary actions the employer will take.
It is important that the policy is properly communicated and explained to all employees so that there are no
misunderstandings.
Role of Agencies to Support Rehabilitation

Managing rehabilitation successfully relies on good occupational health advice. Employers who use
occupational health advisers are much more likely to meet their legal obligations under employment and
disability discrimination law.
An occupational health specialist can:

x Advise on whether return to work is appropriate and what's practicable.

x Examine the employee, advise on whether rehabilitation is an option and, if so, the adjustments to
the workplace that may be needed.
x Monitor employees on a rehabilitation programme.
x Give employees advice and recommend specialist advice or treatment.
x Assess whether it would be useful for the employer to pay for certain treatments.
x Provide a second opinion on a GP's report and discuss any differences of opinion
x Assess an employee's eligibility for retirement or disability benefits.
x Support the prevention of work-related illness and injury by advising on a health-related risk
assessment, carrying out health surveillance, giving advice at the early stages of an occupational
disease, and promoting health.
Legally, if an employer is considering the dismissal of an employee on the grounds of ill health, the employer
must demonstrate that they have taken reasonable steps to discover all the relevant facts. This means
getting advice from an occupational health specialist, rather than relying solely on information provided by
the employee's GP.
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If organisations do not have access to full time occupational health support, other options include:
Employee's GP or specialist
While employee’s GP or specialist may not have occupational health expertise, they will understand the
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medical aspects of their patient's condition.
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Employment Medical Advisory Service
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This service, part of the HSE, offers information on the availability of local occupational health services. You
can find your local EMAS office in the phonebook, under 'Health and Safety Executive'.
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Insurance companies
Some insurance companies offer rehabilitation support, particularly where absence is work-related or
prolonged.
Occupational
Workplace Health
IOSH
IOSH's free Occupational Health Toolkit gives occupational safety and health practitioners a wide range of
resources to help tackle key occupational health issues. The site is an occupational health 'hub' for non-
medical practitioners and has lots of tools to help deal with occupational health issues. Currently, it covers
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MSDs, stress, inhalation hazards and skin disorders. To find out more, visit www.ohtoolkit.co.uk.
NHS Plus
In England, some NHS trusts sell occupational health support services to small businesses. For more
information, visit www.nhsplus.nhs.uk. Similar arrangements are available in Wales (www.wales.nhs.uk),
Scotland (www.healthinfoplus.co.uk), and Northern Ireland (www.n-i.nhs.uk).
Occupational health service providers
The Commercial Occupational Health Providers Association (COHPA) is a not-for-profit trade association that
can help you find a commercial occupational health provider. Find out more at www.cohpa.co.uk.
Rehabilitation or case management specialist companies
Case management is a collaborative process that assesses, plans, implements, co-ordinates, monitors and
evaluates the options and services needed to meet an individual's health, care, educational and employment
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needs. For more information, contact the Case Management Society UK on 0870 850 5821 or visit
www.cmsuk.org. Scottish Centre for Healthy Working Lives. This provides free, confidential advice and
information in Scotland on a wide range of workplace health issues, including health promotion, occupational
safety and health, employability and vocational rehabilitation (t +44 (0)800 019 2211, as well as workplace NEBOSH
visits. For more information, see www.healthyworkinglives.com.
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Workboost Wales
This government funded service offers confidential, practical and free advice to small businesses and their
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workers in Wales on workplace health and safety, managing sickness absence and return to-work issues. Visit
www.workboostwales.net or call 0845 609 6006.
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Occupational Health Services

The Role of Occupational Health Services
There is now a clear recognition of the need to maintain the health and efficiency of a skilled workforce.
This is best achieved with a multi-faceted team of professional who are closely attuned to the needs of the
organisation and the individuals within it.
Traditionally, organisations would have included occupational health departments whose staff would be
direct employees of the organisation. Increasingly however, as with many non-core activities, occupational
health departments are contracted out to organisations who can provide an occupational health service.
The role of the occupational health service is to provide support to organisations in order that health at work
is managed efficiently and effectively.
Typical services provided by occupational health service include:
• Stress management intervention

• Health & Safety training
• Sickness Absence Management & Return to Work Services
• Injury treatment and care
• Health Surveillance
• Support to Management (Human Resources, Health & Safety, Line Managers)
• Health Promotion
• Other Services (Training, DSE assessments, D&A screening, Pre-employment screening, etc.
The benefits of occupational health services are:
• Promote good health and well being

• Improved staff productivity
• Enable early detection of adverse health effects
• Improved loyalty of employees
• Reduced medical risk leading to reduced cost of medical treatments
• Reduced liability risk
• Help employers to comply with legal requirements
• Enable the establishment of workplace health standards
• Reduced cost of insurance premiums
Occupational Health Physician NEBOSH International Diploma
Occupational Health Physicians are medical consultants who specialise in evaluating and managing the
interrelationships between work and health. Examples of their service include providing advice to
organisations on health risks association with the workplace, performing medicals on behalf of the employer,
establish systems of employee examination, making recommendations on employee selection via
screening,
Identifying candidates who may not be suitable in their workplaces (e.g., workers who suffer hay fever may
not be suitable to work in places with known respiratory sensitisers such as flour), and monitoring the work
of Occupational Health Nurse
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Occupational Health Nurse

Occupational health nurses may work independently or as part of an occupational health service team. They
will have undertaken formal study in occupational health with recognized qualifications most often at
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university degree level. They provide advice on a wide range of health issues that address health related
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problems that might influence the employees’ attendance or performance at work.
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The occupational health nurse role includes:
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• Absence management • Wellbeing & Health promotion
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• Health Surveillance • Request medical reports from GP
& Consultants
• Return to Work programmes
• Advice on reasonable adjustments
• Occupational Health Audits
Occupational
for rehabilitation
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• Workstation Assessments
Occupational Health Technician

Occupational health technician is a developing role and is a relatively new discipline. Many occupational health
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technicians are trained on the job, but it is also common for people to enter this occupation after earning a
diploma which includes passing theory and practical examinations.
The technician’s role includes testing and monitoring potential hazards (e.g., hand-arm vibration) in the
workplace with the aim of preventing harm to workers, property, and the environment; testing and collecting
samples that may be used to determine the safety of a particular work environment. For example, collecting
dust samples to test the levels of potentially harmful elements that workers can be exposed to.
The technicians are not qualified to provide sickness management policies or develop occupational health
strategies. They must work under the supervision of a registered nurse or physician.
Determining Competence within Occupational Health

Occupational health professionals are experts who must acquire and maintain the competence necessary to
carry out their duties according to good practice and professional ethics.
Occupational health doctors are expected to have skills and expertise that include:
• Understanding of the health hazards that can arise at work
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• Ability to assess risks relating to the health of individuals and groups
• Knowledge of the law relating to workplace issues
• Awareness and understanding of the way business operate. NEBOSH

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For a nurse-led occupational health service, the lead nurse should also be registered with the Nursing
Midwifery Council (NMC) as a specialist community public health nurse in occupational health. Alternatively,
they should be qualified to register as such and have access to specialist occupational physician advice as
needed.
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The HSE UK has recommended that in addition to meeting legal requirements, the following minimum level
of competence should apply to all clinical staff:
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• Doctors should hold the (DOccMed) qualification as a minimum

• Nurses should be registered or qualified to be registered as a specialist nurse practitioner in public
health in occupational health
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• Occupational health technicians should be trained in the specific elements of the service that they
deliver, and must be clinically supervised
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Some aspects of health surveillance require additional qualifications, for example:
HAVS: A Faculty of Occupational Medicine (FOM) approved training course in hand-arm vibration syndrome,
or equivalent level of competency.
Noise-induced hearing loss: a British Society for Audiology approved course for industrial audiometricians, or
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equivalent level of competency.
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Respiratory: Association for Respiratory Technology and Physiology (ARTP) diploma, or equivalent level of
competency.
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Typical Activities Offered by an Occupational Health Service
Occupational
Health Assessment
Workplace Health
As industry becomes increasingly more sophisticated, it is more important that individuals are physically
and mentally suited to the work that they undertake. This is to ensure that the individual has the necessary
attributes for a particular role which includes level of ability, body mass index, visual and aural acuity, etc.
Increasingly, pre-employment health screening has been extended to all prospective employees. Such
screening is usually undertaken by occupational physicians and nurses, although smaller companies will
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often use the retained services of a General Medical Practitioner. Such assessments are sometimes
referred to as fitness for work. Pre-employment screening is helpful in identifying any pre-existing health
conditions which may affect the individual and to provide a baseline for future health surveillance. For
example, a prospective employee may already suffer a degree of hearing loss. An initial hearing test will
establish this and help to defend any future claims for hearing damage due to the period of employment.
Health Surveillance
Health surveillance is the ongoing assessment and/or medical examination of certain employees at regular
intervals.
The benefits of health surveillance include:
• Ensuring the early identification and treatment of an occupational disease.

• Provision of statistics relating to the health of the workforce.
• A feedback mechanism for risk assessments, to establish whether control measures are effective.
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• Provision of relevant information for defending legal action.
Examples of Health Surveillance include:

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• Health questionnaires.
• Lung function tests.
• Hearing tests, known as audiometry.
• Skin inspections.
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• Blood/urine analysis.
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Managing Sickness Absence

Many employers now recognise the cost of their business of sickness absence, much of which may be
occupational related. Occupational Health departments can assist with managing sickness absence by:
• Interviewing staff on return to work or during absence.

• Training managers on how to recognise signs and symptoms of stress.
• Advising on action to be taken, specialist’s referrals if necessary.
• Assisting on action to be taken, specialists’ referrals if necessary.
• Assisting with the development of sickness absence monitoring regimes.
• Collating ill-health and sickness absence statistics; and
• Targeting certain treatment programmes, i.e., inoculation against infections, e.g., flu jabs.
Providing a Treatment Service

This is increasingly a lesser role for an occupational health service, other than in perhaps specific services
such as physiotherapy and dentistry where rapid promotion of recovery can produce clear business benefits.
In fact, many occupational health departments will refuse to undertake first-aid type work, rather
concentrating on their other more proactive functions. However, for some organisations there may be a
role for such services, e.g., for acute poisonings or where there is no nearby accident and emergency
provision (e.g., offshore).
However, Occupational Health professional will regularly make appointments to see employees who have
valid work-related health concerns.
Assistance with Risk Assessment

Although this is often regarded as the domain of the Safety Advisor, the Occupational Health Department has
a valuable input in several areas and may take overall responsibilities for certain areas of assessments such
as Manual Handling or Display Screen Equipment.
Counselling
The confidential nature of many aspects of Occupational Health is often a cause of frustration to line
management who may seek information regarding a particular individual. However, one of the positive
benefits of this is that an effective Occupational Health Department can provide a confidential listening service
and may be able to address certain work-related concerns. The department may also be able to refer staff on
to a specialist counselling service.
Managing stress is one of the most challenging areas facing the health and safety profession currently and NEBOSH International Diploma
Occupational Health professionals often have more experience of dealing with individuals suffering with
stress. There may be specific issues with post-traumatic stress, which occupational health departments can
assist with either directly or by passing on to other specialists. Many organisations have ‘Employee Assistance
Programmes’ in which an external organisation provides a confidential helpline for employees. Occupational
Health Departments have a role in setting up and monitoring such regimes.
Drugs and Alcohol at Work

Workplace safety may be affected by drug and alcohol misuse. Tackling such issues needs to be done
carefully with clear unambiguous policies and procedures. Occupational Health Departments have an
important role to play in this area in the following ways:
x Developing realistic and effective policies, standards and procedures.

x Ensuring correct information is available to staff.
x Implementing effective testing regimes where appropriate.
x Providing support and assistance to staff who declare that they have a problem
Health Education and Health Promotion
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This is an important preventative role which can lead to greater awareness of occupational health hazards for
workers. Publicity campaigns can be used to promote healthy lifestyles. Incentives such as cholesterol tests
and free pedometers can be used to engage staff interest.
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Occupational health staff can work closely with managers to facilitate return to work following illness or injury.
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Recent studies have demonstrated overwhelmingly that it is preferable to bring staff back to work part-time or
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on light duties than to wait until they are fully recovered.
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Occupational
A difficult issue for companies to manage and Occupational Health Departments can assist with providing
independent advice regarding fitness for work.
Workplace Health
Assistance with Overseas Workers
Where staff may travel overseas for work, the Occupational Health Department can assist with vaccinations
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and general health advice.
Advice to the Management

The occupational health providers can offer advice to management on:
x Policy and management system formulation.

x The impact of new legislation and the steps necessary for compliance.
x Defending legal cases and liaise with enforcement officers
Calling on Specialist Help Outside of the Unit When Issues Fall

Outside of the Teams’ Competence
There may be occasions where the employer needs the help of the occupational health service to arrange
for specialist consultants to provide the organisation with the best advice.
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Given below are some examples of specialist help:
Specialist Expertise
• Field of vision, sight lines

• Manual handling/repetitive tasks

• Workspace layout
• Body size
Ergonomists • Aspects of guarding and containment
• Demands of tasks/equipment on people
• The equipment used and whether it is appropriate for the task
• Effects of the physical environment, including lighting,
• Temperature and humidity on people
• Issues of fatigue and opportunities/defenses for human failure
• Assessment of biological hazards
Microbiologists • Advice on risks and control measures to prevent or control

health risks
• Sampling for micro-organisms
• Measure levels
Noise and vibration • Advice on causes, elimination, and practical solutions to
specialists reduce exposure
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9.2 Mental Ill-Health
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Mental disorders are health conditions that are characterised by alterations in thinking, mood, or behaviour
(or a combination of all three) associated with distress and/or impaired functioning. The main issues are
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associated with lack of concentration, feelings of isolation and in some situations inability to interact with
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others.
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The majority of those suffering from mental ill-health conditions have what are classed as common mental
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health disorders, such as anxiety and depression, which tend to range in intensity from ‘mild to moderate’.
Occupational Circumstances Leading to Workplace Mental Ill-

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Occupational
Workplace Health
Common mental health problems and stress can exist independently. For example, people can have work
related stress and physical changes such as high blood pressure, without experiencing anxiety and
depression. They can also have anxiety and depression without experiencing stress. The key difference
between the two is their cause and the way they are treated. Stress at work is a reaction to events or
experiences at work.
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In practice, it can be hard to distinguish when ‘stress’ turns into a ‘mental health problem’ and when existing
mental health problems become exaggerated by stress at work. Many of the symptoms are like those that
people experience when they are under considerable pressure; the key differences are in the severity and
duration of the symptoms and the impact they have on someone’s everyday life. Usually, a general practitioner
(GP) will make the diagnosis and offer treatment e.g. medication, talking therapies or a combination of both.
The majority of people with mental health problems are treated by their GP, and most are capable of continuing
to work productively. Evidence shows that employment can be of great benefit, both to the employer and to
the employee.
Work related Mental Ill Health

The following are some typical circumstances that cause work related mental ill health (stress, anxiety and
depression).
• Lone working - The feeling of loneliness due to long periods of isolation (lack of contact with co-
workers, limited inclusion in team activities, lack of support from manager, etc) can result in stress
and depression
• Agile working (hot desking, home working) – Workers are stressed due to not having their own
personalised space, disruption to their work flow for having search for available desks, health and
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safety can be an issue for employees who have particular needs, etc. Home working can be
challenging as workers with young families may face regular interruptions from young children.
They may also have difficulties in balancing home and work life often ending up working excessive
hours.
• Shift working (especially night shifts) - A person working night shift, which causes disruption to the
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circadian rhythm, is at greater risk of physical, mental health and safety consequences, including
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increased risk of cardiovascular disease, higher risk of mood changes, higher risk of motor vehicle
accidents and work-related accidents, etc.
• Violence, aggression, bullying and harassment – Violence, aggression and bullying are very closely
related and are serious occupational safety and health issues. Bullying incidents may include
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aggression and escalate into violence. Repeated violence and aggression are often associated with
bullying. The Health and Safety Executive (HSE) defines work-related violence as: Any incident in
which a person is abused, threatened or assaulted in circumstances relating to their work. This can
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include verbal abuse or threats as well as physical attacks. Bullying is an unreasonable behaviour
that includes victimising, humiliating, intimidating or threatening. Bullying is a form of abuse that
can impact on the mental health of an individual, causing him/her to suffer depression, anxiety, or
panic.
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• Organisation change – Surveys have shown that employees who have been affected by
organisational change are more likely to suffer from stress, dissatisfaction and loss of trust in their
employer. Typical organisational changes that negatively impact employees are salary cuts, loss of
benefits, downgrading in job position, job loss or relocation to another city or country.
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Working more than one job – impact on mental health
In most cases, taking on more than one job is driven by a need to make ends meet. There are many possible
reasons why people might want to work more than one job. It could be because they have personal debt
issues, unexpected illness in the family that resulted in large medical bills, etc.
To work more than one job, the person will likely have to work long hours, perhaps working a day shift and a
night shift, as well as all weekends.
Research has shown that people working excessive long hours are 2.5 times more likely to develop depression
than those who work regular hours. In addition to stress and depression, they might also suffer other negative
health and well-being effects, including the disruption of circadian rhythm, sleep deprivation, accidents, and
even a possible risk of having a heart attack.
Chronic Pain and Impact on Mental Health

Pain that lasts more than three months is considered to be chronic. The pain could be caused by an injury or
disease such as arthritis, multiple sclerosis, shingles, migraine, etc.
Some work activities also contribute to chronic pain ie. Lower back pain from poor manual handling technique,
carpel tunnel syndrome from repetitive movements, trigger finger from using poorly designed equipment, etc.
Living with chronic pain is physically and emotionally stressful. Chronic pain is known to change the levels of
stress hormones and neurochemicals found within the brain and nervous system. This change can affect a
person’s mood, thinking and behavior. The disruption in the body’s balance of hormones and neurochemicals
can bring on depression in some people.
Chronic pain sufferers may find it difficult to participate in social activities which could lead to isolation and
low self-esteem. They will also experience sleep disturbances, fatigue, trouble concentrating, decreased
appetite, and mood changes. These negative aspects can increase pain and dampen overall mood resulting
in depression and anxiety.
Anxiety and Depression

Anxiety and panic disorders are common but can cause extreme distress to individuals if left untreated.
Symptoms that manifest themselves at work may include loss of interest, poor concentration, low mood and
irritability.
People with anxiety disorders frequently have intense, excessive and persistent worry and fear about
everyday situations that could reach a peak within minutes into panic attacks.
Common anxiety signs and symptoms include:

- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating
- Trembling
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Having trouble sleeping
- Experiencing gastrointestinal problems
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Anxiety disorder can also cause other mental and physical conditions:
- Depression
- Substance misuse
- Trouble sleeping (insomnia)
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- Digestive or bowel problems
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- Headaches and chronic pain
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- Social isolation
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- Problems functioning at work
- Poor quality of life
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- Suicide
Depression - People with mental health problems are more likely to develop physical health problems and
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vice versa.
Workplace Health
Depression is a broad and varied diagnosis and can be mild, moderate, or severe. The main features are
depressed mood and/or loss of pleasure in most activities, a feeling of helplessness. Certain physical
illnesses can trigger depression in people of any age, but conversely people with depression may have
symptoms that they think are caused by a physical illness but are in fact caused by depression.
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Other depression symptoms may include:
- Feelings of sadness
- Angry outbursts, irritability or frustration
- Sleep disturbances, including insomnia
- Tiredness and lack of energy, so even small tasks take extra effort
- Reduced appetite and weight loss or mindless eating and weight gain
- Anxiety, agitation or restlessness
- Trouble thinking, concentrating, making decisions and remembering things
- Suicidal thoughts, suicide attempts or suicide
- Unexplained physical problems, such as back pain or headaches
Fatigue and its Effect on Mental Health

Fatigue can affect a person’s mood, memory, concentration, decision making and emotional state. It is
most commonly described as extreme tiredness resulting from mental or physical exertion or illness. The
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sufferer does not feel refreshed after sleeping or resting.
Some of the causes of fatigue include:
• Insufficient and poor-quality sleep. NEBOSH

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•
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Long commutes and long working days
• Excessive physical activity
• Jet lag from frequent travelling across multiple time zones
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The Meaning of Work-Related Stress and Its Relationship to Mental

Health Conditions
Stress is the adverse reaction people have to excessive pressures or other types of demand placed on them.
There is a clear distinction between pressure, which can create a ‘buzz’ and be motivating, and stress, which
occurs when this pressure becomes excessive.
Mental Ill-Health and Work-Related Stress

Work-related stress and mental health problems often go together, and the symptoms can be very similar.
Work-related stress can aggravate an existing mental health problem, making it more difficult to control. If
work-related stress reaches a point where it has triggered an existing mental health problem, it becomes
hard to separate one from the other.
Common mental health problems and stress can exist independently – people can experience work-related
stress and physical changes such as high blood pressure, without having anxiety, depression, or other mental
health problems. They can also have anxiety and depression without experiencing stress.
Stress is a reaction to events or experiences in someone's home life, work life or a combination of both.
Common mental health problems can have a single cause outside work, for example bereavement, divorce,
post-natal depression, a medical condition, or a family history of the problem. But people can have these sorts
of problems with no obvious causes.
In practice, it can be hard to distinguish when ‘stress’ turns into a ‘mental health problem’ and when existing
mental health problems become exaggerated by stress at work. Many of the symptoms are like those that
people experience when they are under considerable pressure. The key differences are in the severity and
duration of the symptoms and the impact these have on someone’s everyday life. Usually, a general
practitioner (GP) will make the diagnosis and offer treatment e.g., medication, talking therapies or a
combination of both. Most people with mental health problems are treated by their GP, and most can continue
to work productively. Evidence shows that employment can be of great benefit, both to the employer and to
the employee.
Effects of Stress
Psychological Effects:
Physical Effects

• Heart disease.
• Raised heart rate, increased blood pressure.
• Ulcers.
• Increased anxiety.
• Thyroid disorders.
• Reduced concentration.
• Increased sweating.
• Irritability and sudden mood changes.
• Panic attacks.
• Inability to cope.
• Headaches.
• Reduced work output / performance.
• Aching neck / shoulders.
• Increased drug use, e.g., alcohol, tobacco.
• Dizziness.
• Poor sleeping pattern.
• Stomach complaints.
• Suppressed immune system.
• Blurred vision.
• Skin rashes, e.g., eczema and psoriasis.
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High levels of stress can also lead to other behaviours that are not helpful to the sufferer’s health, such as
skipping meals, drinking excessive amount of caffeine, or indeed partaking in recreational drugs.
Work-related stress can have consequences for organisations as well as the individuals working within them.
It may lead to an increase in sickness absence, which can have a domino-effect - one person goes off sick
which leads to his/her workload being shared among the remaining staff. The staff sharing the workload, in
turn, may then be unable to cope, which could affect their health and lead to greater sickness absence,
reduced staff morale, reduced staff performance, and staff seeking alternative employment. Organisations
then have the expense of recruiting, inducting, and training new members of staff as well as dealing with
issues such as conflict, poor relationships and disciplinary problems.
Everyone is vulnerable to stress depending on the pressure they are under at any given time. Even people
who are workaholic could succumb to stress.
Causes of Work-Related Mental Ill Health

The following broad categories are identified as the main risk factors for work-related stress:
Factor 1: Culture - of the organisation and how it approaches work-related stress:
• Whether stress is taken seriously.

• Poor communication.
• Lack of staff consultation.
• No adequate resources are available
• Not supporting staff both emotionally and practically.
• Excessive working hours and taking work home.
Factor 2: Job content - such as workload and exposure to physical hazards:

x Overload – where personnel have too much work to do or insufficient resources, including the
physical or mental ability.
x Underload – routine, boring and unchallenging work.
x Time pressure
Factor 3: Organisation of Work:

x Unrealistic working hours,
x long hours
x shift work
x
unpredictable hours
x changes in working hours
Factor 4: Relationships between employees:
• Physical violence – threatened or actual.

• Verbal abuse – repeated shouting and swearing, malicious gossip.
• Victimisation – excessive supervision, unjustified picking of faults, prevention of career
development.
• Sexual harassment.
• Discrimination due to gender, race, or disability.
Factor 5: Role - whether the individual understands their role in the organisation and whether the
organisation ensures that the person does not have conflicting roles:
x Conflict – different job demands – either working for more than one manager or task perceived to
not be part of role.
x Ambiguity – unclear picture of role, responsibilities, and expectations.
x Lack of control over the job
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Factor 6: Workplace environment

x Exposure to noise, vibration, high and low temperatures, space, lighting, cleanliness etc.
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Factor 7: Home-work interfaces
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x Bereavement of a relative or friend
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x Relationship/marital problems
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x Medical conditions
x Commuting
x Childcare issues
x Caring for elderly relatives
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x Relocation
Workplace Health
Mental Health Controls
Stress is a complex issue and simply thinking of it in terms of health and safety would be a mistake. Indeed,
Health Issues
stress is a large subject that has elements that are:
x Clear health and safety subjects, e.g., training, risk assessment
x Clear human resource subjects, e.g., retirement on medical grounds, attendance management
Occupational Health and Safety Staff

x Provide specialist advice and awareness training on stress
x Train and support managers in implementing stress risk assessments
x Support individuals who have been off sick with stress and advise them and their management on a
planned return to work
x Refer to workplace counsellors or specialist agencies as required
x Monitor and review the effectiveness of measures to reduce stress
x Inform the employer and the health and safety committee of any changes and developments in the field
of stress at work
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Human Resources (HR)
x Give guidance to managers on the stress policy
x Assist in monitoring the effectiveness of measures to address stress by collating sickness absence NEBOSH
statistics
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x Advise managers and individuals on training requirements

x Provide continuing support to managers and individuals in a changing environment and encourage
referral to occupational workplace counsellors where appropriate
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Most people with mental health problems are treated by their GP and most are capable of continuing to work
productively.
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Employers have a 'duty of care'. This means they must do all they reasonably can to support their employees’
health, safety and well-being. This includes:
x Making sure the working environment is safe

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x Protecting staff from discrimination

x Carrying out risk assessments
x Treating mental and physical health as equally important
x Making sure managers make time to talk to employees who are having problems
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x Promoting positive mental health, for example arranging mental health awareness training, workshops
or appointing mental health ‘champions’ who staff could talk to
x Create an environment where employees are encouraged to talk, both formally and informally, to
their manager or another person in their management chain
x Introduce mentoring and other forms of co-worker support
x Provide employee assistance (counselling) services
x Ensuring that supervisors and managers, in positions of confidence and responsibility have the skills
and ability (competence) to recognise and deal with stress at an early stage
The Identification and Assessment of Work-Related Mental

Ill-Health at Individual and Organisational Level
The factors to be considered when conducting a risk assessment (following the 5 steps approach) of stress
in an organisation include:
Step 1: Identifying If There is a Problem

Remember that people are often sensitive about a perceived stigma attached to work related stress.
• Informally by ‘walk and talk’ by observation of the task and how it is handled coupled with ‘chats’
to personnel and supervisors.
• Performance appraisal with an opportunity for open discussion of problems.
• Focus groups facilitator led discussion on work problems.
• Monitoring of attendance records and conducting ‘return to work’ interviews.
• Sickness / ill-health data spotting trend.
• Data indicating reduced productivity may be indicative of work-related stress.
• High staff turnover.
Step 2: Identify Who is at Risk

An open honest and trusting approach is needed. Vulnerable groups will include those who deal with grief,
e.g., counsellors and Accident and Emergency staff and those that deal with the public in stressful situations,
e.g., home visitors or call centre operators. Additional signs of stress in individuals should be considered,
especially when returning to work following a major stressor, e.g., bereavement, divorce, house move, etc.
Step 3: Evaluate the Risk


The seven key factors to address have been highlighted previously. The outcome is to control the risk to
an adequate degree based on level of risk controls already in place and what needs to be done to control
the risk. Many of the factors can overlap and a holistic approach to work related stress is recommended.
Step 4: Record Significant Findings

Ensure that the records are suitable and sufficient, and the findings of risk assessment are communicated
with staff.
Step 5: Review the Assessment

The assessment should be reviewed on a regular basis and prior to any major change or other significant
event, e.g., change in personnel or organisational arrangements.
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The Types of Interventions for Mental Ill-Health

According to the WHO’s World Health Report 2001, approximately 450 million people suffer from mental
disorders, and one in every four people will develop one or more mental or behavioural disorders during
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their lifetime. The report advocates three preventive interventions to focus on reducing risk factors and
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enhancing protective factors associated with mental ill-health – Prevention, Treatment and
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Rehabilitation.
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Prevention (Primary): Primary prevention is to have measures in place that prevent the onset of mental
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illness before the illness process begins. For example, noise reduction control prevents noise induced
hearing loss which in itself is a risk factor for many other conditions including frustration, physical and
psychological stress, reduce productivity, interfere with communication and concentration, and contribute to
workplace accidents and injuries by making it difficult to hear warning signals
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Treatment (Secondary): Secondary prevention is concerned with lowering the rate of established cases of
disorder or illness through early detection and treatment. For example, introducing health screening to detect
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early changes in mental ill-health conditions when symptoms are first noticed. This approach enables
management to introduce appropriate treatment and interventions to prevent deterioration that could lead to
other ill health conditions.
Rehabilitation (Tertiary): Tertiary prevention includes interventions that reduce disability, minimise
suffering, enhance rehabilitation and prevent relapses and recurrences of the illness.
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For example, as part of the rehabilitation program for return to work, an employee identified as suffering from
depression and anxiety disorder will be supported by treatment to help him/her to return to work in a safe and
timely manner. Rehabilitation helps to restore the person to their previous good health and capability.
How Workers with Mental Ill-Health Conditions Can Be Managed in the

Workplace
Employers should consider making reasonable workplace adjustments to manage and support
workers suffering from mental ill-health conditions. It is important that any decisions regarding
workplace adjustments should be made in consultation with the employees.
Examples of workplace adjustments include:
x Speaking to workers as soon as it is recognised that there may be an issue – If a worker is having
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difficulty coping in the workplace, and is displaying symptoms of mental related illness, the employer
should act by speaking to the worker and ask if there is any assistance or workplace adjustment that
could assist the worker in performing his/her job, and to offer the choice of getting confidential support
from an Employee Assistance Program or external professional help. NEBOSH

x Ensure confidentiality – Where mental ill-health cases amongst workers have been identified, the
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employer should ensure that confidentiality is maintained of those workers suffering from mental ill-
health. All personal details must be kept strictly confidential unless the worker agrees for the
employer to disclose the information. If help is needed to manage the cases, the employer should
obtain advice and assistance from external support services (without disclosing the employees’
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personal information). If there is a need to keep interested parties informed, do so without

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compromising the privacy of the employee with mental ill-health to avoid the risk of gossip.
x Use routine management tools to identify and tackle issues - There are various tools which employers
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may use to address mental ill-health issues at an early stage. These include the use of appraisals,
meetings, one-on- one informal conversations on mental health. When asking questions, be positive
do so in a non-judgemental manner. Explore ways in which to help the employee with mental ill-
health issues. For example, assigning a mentor with similar skills, knowledge and experiences to
support the employee in managing work without getting stressed.
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x Support for workers who become emotionally distressed at work – For example provide access to
professional help.
x Support for employees with on-going mental health conditions. For example, flexibility in work
patterns to suit the employee’s needs
x Encourage employees to develop coping strategies to help manage their condition. – Employees
with low levels of coping skills are at higher risk for mental health issues that could inhibit their ability
to solve problems and to make effective decisions. Employers should encourage employees to self-
assess and to recognise work/tasks/situations which they can and cannot cope. With the support of
the employer, employees can develop appropriate coping strategies to alleviate potential conditions
that could contribute or aggravate their mental-ill health conditions.
x Be positive – focus on what employees can do, rather than what they can’t, and providing praise,
positive feedback and encouragement as often as appropriate.
x Work together and involve employees in finding solutions. For example, establishing goals,
reminders and checklists to assist the employee with time-management and to stay on top of the
workload
x Use of ‘advance statements’ – This is a document that contains a statement of the employee’s
treatment preferences in the event he/she becomes unwell and require compulsory mental health
treatment. An Advance Statement must be in writing, be signed and dated and be witnessed, and be
made when the employee is of sound mind and has sound decision making capacity.
x Ensure that the employee knows where to get help and support for their mental ill-health condition
outside of the workplace – For example Human Resources to provide affected employees with
information employer assisted program, such as where to get help along with the contact details
of the company appointed healthcare specialists and counselling service provider.
x Promote positive work relationships. For example, encourage integration and interaction with co-
workers, include him/her in meetings and work social events.
x Workplace adjustments - identifying and modifying tasks that the employees find stressful or
overwhelming, for example, the management of fear in dealing with customer complaints.
x Flexible hours or change to start/finish time - offering flexible working hours, to enable the employee
to take time off for appointments with the treating health practitioner.
The Benefits of Good Nutrition, Exercise and Sleep on Mental Ill-

Health Conditions
Nutrition, exercise and sleep has a vital role in managing and preventing mental ill-health. Individuals who
are undernourished, under-exercised and under-rested often feel stressed, fatigued, and mentally
depressed. The combination of nutrition, exercise and sleep can provide an individual with optimal physical
and mental wellbeing.

Nutrition – A Healthy Diet
Nutrition plays an important role in maintaining mental health. A poor or unhealthy diet can contribute to risk
of poor mental health. For example, compromised immune system and brain function, aggression,
hyperactivity, depression, anxiety, mood fluctuation, obesity, cardiovascular disease, etc.
It is widely accepted that a healthy well-balanced diet is of relevance to mental as well as physical health.
Intervention in the form of dietary improvement can help prevent physical illnesses such as heart disease,
diabetes and obesity, as well as preventing mental disorders.
A good healthy diet should include: plant foods such as vegetables, salads, fruits, legumes (eg. chickpeas,
lentils), wholegrains and raw nuts; fish and lean red meats; and healthy fats such as olive oil. Processed
foods should be avoided.
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Body Exercises
Research has shown that exercise can improve a person’s self esteem and general mental health by
reducing stress, anxiety, improving sleep, increasing energy and lifting the person’s mood.
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To get the most benefit from exercise, it is recommended that a person should exercise regularly for at least
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20 to 30 mins a day.
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Sleep
Sleep and mental health are closely linked. Mental health condition can affect sleep, and poor sleep can
affect mental health.
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Most people tend to need about 6-9 hours of sleep per day to enjoy optimal physical and mental health.
When a person is sleep deprived, he/she may display psychological symptoms that include: mood swings,
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irritability, impatience, anxiety, depression, fatigue, decreased alertness and concentration, impaired
memory, and impaired judgment
There are techniques that can help improve the chances of getting a good night sleep. These include:
voiding caffeine about four hours before bedtime, avoiding a heavy meal just before bedtime, turn off lights,
turn down volume, etc.
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Management Standards for Work Related Stress
The UK HSE Management Standards define the characteristics, or culture, of an organisation where the
risks from work-related stress are effectively managed and controlled.
The Management Standards cover six key areas of work design that, if not properly managed, are
associated with poor health and well-being, lower productivity, and increased sickness absence.
In other words, the six Management Standards cover the primary sources of stress at work. These are
• Demands
• Control
• Support
• Relationships
• Role
• Change
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Now a little more detail on each of the above.
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Management Standards - Demands
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• The organisation provides employees with adequate and achievable demands in relation to the
agreed hours of work
• People's skills and abilities are matched to the job demands
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• Jobs are designed to be within the capabilities of employees

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• Employees' concerns about their work environment are addressed

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Management Standards - Control

• Where possible, employees have control over their pace of work
• Employees are encouraged to use their skills and initiative to do their work
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• Where possible, employees are encouraged to develop new skills to help them undertake new and
challenging pieces of work
• The organisation encourages employees to develop their skills
• Employees have a say over when breaks can be taken
• Employees are consulted over their work patterns
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Management Standards - Support

• The organisation has policies and procedures to adequately support employees
• Systems are in place to enable and encourage managers to support their staff
• Systems are in place to enable and encourage employees to support their colleagues
• Employees know what support is available and how and when to access it
• Employees know how to access the required resources to do their job
• Employees receive regular and constructive feedback
Management Standards - Relationships

• The organisation promotes positive behaviours at work to avoid conflict and ensure fairness
• Employees share information relevant to their work
• The organisation has agreed on policies and procedures prevent or resolve unacceptable behaviour
• Systems are in place to enable and encourage managers to deal with unacceptable behaviour
• Systems are in place to enable and encourage employees to report unacceptable behaviour
Management Standards – Role

• The organisation ensures that, as far as possible, the different requirements it places upon
employees are compatible
• The organisation provides information to enable employees to understand their role and
responsibilities
• The organisation ensures that, as far as possible, the requirements it places upon employees are
clear
• Systems are in place to enable employees to raise concerns about any uncertainties or conflicts they
have in their role and responsibilities
Management Standards - Change

• The organisation provides employees with timely information to enable them to understand the
reasons for proposed changes
• The organisation ensures adequate employee consultation on changes and provides opportunities
for employees to influence proposals
• Employees are aware of the probable impact of any changes to their jobs. If necessary, employees
are given the training to support any changes in their jobs
• Employees are aware of timetables for changes
• Employees have access to relevant support during changes
The Management Standards represent a set of conditions that, if present, reflect a high level of health well-

being and organisational performance.
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Well-Being
The World Health Organization’s (WHO) definition of health is: “A state of complete physical, mental and
social well-being, and not merely the absence of disease.” Therefore, health in the context of the workplace,
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does not focus on illness and absence management alone, but also on wellbeing.
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Although employees have a duty to take care of their own safety, health and well-being, the employer
should nevertheless, proactively ensure staff health and welling by having policies, procedures and
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management systems in place to protect and support employee wellbeing.
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Well-Being and Mental Health
Source: Compendium of factsheets, wellbeing across the lifecourse
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The World Health Organisation (WHO) states that “wellbeing exists in two dimensions, subjective and
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objective. It comprises an individual’s experience of their life as well as a comparison of life circumstances
with social norms and values”. Examples of life circumstance include health, education, work, social
relationships, built and natural environments, security, civic engagement and governance, housing and work-
life balance. Subjective experiences include a person’s overall sense of wellbeing, psychological functioning
and affective states.
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Mental illness and wellbeing are independent dimensions; mental health is not simply the opposite of mental
illness. It is possible for someone to have a mental disorder and high levels of wellbeing. It is also possible
for someone to have low levels of wellbeing without having a mental disorder.
Wellbeing and mental health are correlated with depression and anxiety, which are associated with low levels
of wellbeing. If people experience low mental wellbeing over a long period of time, they are more likely to
develop a mental health problem.
Mental health is a positive concept related to the social and emotional wellbeing of individuals. Having good
mental health, or being mentally healthy, is more than just the absence of illness, rather it’s a state of overall
wellbeing.
Health and Well-Being Workplace Strategy
An organization’s health and prosperity are directly influenced by the health and well-being of its employees.
In this context, it would be beneficial to the employer to put in place a strategy to manage and maintain
optimum health and wellbeing in the workplace. Some of the areas which the strategy could focus on include
engaging and consulting with employees, effective communication, educating managers and staff on mental
and wellbeing, supporting employees with career development, introducing health and wellbeing campaigns,
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etc.
Benefits to the organisation of well-being strategies

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Well-being strategies can help organisations increase productivity as healthier employees tend to be more
productive.
Organisations with a healthy workforce are less likely to have many absenteeism or sickness leave and will
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have a greater percentage of employees at work at any given time. Other benefits of having well-being
strategies include:
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x Identifying issues early so employees can get the support they need
x Reduction in staff health care costs.
x Improvement in staff morale
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x Employee retention
x Enhancement of reputation within the company’s supply chain
x Reduction in stress levels
x Improvement in awareness of health and well-being throughout the organisation
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The cost savings generated from well-being strategies can be measured against worker absenteeism,
reduction in overtime to cover absent employees, and reduction in costs to train replacement employees.
Support from Top Management – Top management can make a difference in employees’ well-being by
connecting with them - listening, asking, coaching, providing support and encouragement and offering
learning opportunities. These actions can help employees feel appreciated, heard and valued.
Types of well-being initiatives – Investing in well-being initiatives can help the employer build a healthy
and happy workforce such as improved mental health, morale, productivity, loyalty, retention, etc.
Examples of well-being initiatives include: provision of subsidised gym membership to encourage
employees to exercise and stay healthy; provision of nutritious snacks such as fruit, vegetables, nuts, and
yoghurts; make lunch break mandatory thus ensuring that employees are taking their breaks; organising
mindfulness/meditation sessions to that will help employees to manage and increase self-awareness and
reducing negative emotions; provision of free access to medical support such as treatment for mental ill-
health conditions; provision of physiotherapy to assist recovery from injuries that could escalate to mental
ill-health; organising medical screening to assess workers mental health – this can provide an opportunity
for early intervention, if needed; financial education which helps workers to understand about budgeting,
and managing their finance.
The role of education and support programmes in promoting well-being in the workforce Education
and support programmes are designed to educate the employees on the dangers of remaining unhealthy
and the benefits of incorporating new healthy habits and choices into their lives. For example: If the goal is
to lose excess weight, the person must first be able to understand that being overweight places him/her at
risk for weight-related illnesses. By attending support programme such as weight loss programme, the
person will be able to comprehend the risks of being overweight and the benefits of maintaining a healthy
weight.
Why well-being initiatives need to be relevant to the majority of employees

Implementing well-being initiatives that are not relevant to majority of employees are a waste of company
resources and are bound to fail.
In order to ensure well-being initiatives are relevant to the majority of employees, the employer will first
need to understand the employees’ concerns such as: needs, problems, fears, motivations, etc. One way
of gathering such information is by the use of a survey that is designed specifically to help get insights into
employees’ state of health and well-being. The information will allow the employer to make better decision
on what well-being program best suits the majority of employees. All employees should be encouraged to
participate in the well-being initiatives as well as to make suggestions for improvements.
Working with partners to improve health and well-being. For example, Occupational health
services (internal and external to the organisation).

Working with partners has the benefit of pooling together experience and specialised knowledge to create
effective programs to improve the health and well-being of the workforce.
Occupational health is a field of health care that consists of several disciplines dedicated to the health and
well-being of employees in the workplace.
Occupational health services (OHS) can be source externally where an organisation enters into a contract
with the OHS for health care services, or the OHS can be provided internally where the organisation
employs full time OHS practitioners to be responsible for the overall general health and well-being of the
workers.
Involving and empowering all workers e.g. Appointing workforce well-being champions to get
involved in well-being initiatives, use of health assessments to empower workers to manage their
own well-being.
Well-being champions are employees who volunteers to act as the company’s ambassador to help promote
well-being strategy with a focus on encouraging positive change that will improve the well-being of the
employees.
Health assessments are useful in identifying issues that have an impact on the employees health and well-
being. This will allow the employer to implement the necessary interventions, one of which is the
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empowerment of workers to manage their own well-being by providing them with the necessary support
and resources.
How monitoring, reviewing and communicating the health and wellbeing strategy can positively
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influence the workforce
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Health and well-being strategies (primary, secondary and tertiary interventions) if left unattended after
implementation may gradually become ineffective and forgotten. It is therefore essential for employers to
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regularly monitor and review the performance of the implemented well-being strategy. This may include
actions such as looking into workplace practices, such as the pace of work, the shift work patterns,
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conditions that support lone working, etc.
Regular communication on the interventions will help to build momentum and employees’ buy-in for the
mental health and well-being strategies.
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Workplace Health
The Link Between Well-Being and Culture
Workplace culture and job satisfaction have a big impact on wellbeing and absence. The choices that people
make and the behaviours they exhibit are often influenced by the context in which they find themselves.
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Those behaviours may or may not enhance wellbeing. The context will overtly or covertly place rules and
guidance on attitudes and behaviours. Within the workplace this is often referred to as the organisational
culture.
An individual’s ability to work productively and fruitfully will be dependent on the organisational culture. As a
result, the culture will either positively or negatively affect mental health and wellbeing. Wellbeing policies
have a positive impact on absence levels, productivity and morale.
A report by the World Economic Forum and consultancy Right Management in 2010 also found that wellbeing
is as much shaped by employee engagement as by physical and psychological health. This same research
found that organisations engaged in promoting wellbeing are more likely to have significant improvements in
employee engagement, productivity, creativity and lower talent drain, which indicates a positive H&S culture.
Source: Personnel Today
Why line managers must be trained on well-being strategies and

initiatives?
If line managers are to be effective in promoting positive mental health in the workplace, it is vital they
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understand how to manage fluctuations in workers’ mental health, what the causes of ill-health can be, how
to recognise when employees may be unwell, and how to advise on where to access further support. Armed
with this knowledge, they can shape the work environment to be conducive to positive mental health and
wellbeing. These are all things that can be achieved through proper training. NEBOSH
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Considering that businesses have both a legal and moral duty to ensure the health, safety and welfare of
their employees, training senior staff to deal with mental health issues should be a top priority. Employers
are already required by law to provide proportionate advice or training on health and safety. Line managers
can be a key asset in creating healthier, happier and more productive workforces and helping their
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employers comply with the law, providing they are equipped with the relevant skills.
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Source: IOSH Workplace Wellbeing - The role of line managers in promoting positive mental health
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Work-Related Violence
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Violence at Work
Violence at work is the subject of increasing interest. High profile cases have been reported in the media
and publicity surrounding initiatives to reduce risks of violence in the workplace has helped to raise
awareness of the issue among the general public, the media, employers, and governments.
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Workers in the protective services where law enforcement is part of their function, e.g., police officers, are
generally the most at risk of violence at work. Health and social welfare professionals, including nurses,
medical and dental practitioners also experienced relatively high levels of risk. The ILO Code of Practice
‘Workplace Violence in Service Sectors and Measures to Combat this Phenomenon’, provides invaluable
guidance for organisations in the service sector.
Violence at work involves two key aspects:

x Internal violence such as harassment or bullying from members of the organisation where repeated
harassment or bullying is unreasonable behaviour, often associated with misuse of power, directed
towards an employee or group that creates a risk to health and safety.
x External violence or uncivil behaviour such as physical or verbal aggression and assault by people
outside the organisation.
Work-related violence is commonly defined as:
“Any incident in which a person is abused, threatened or assaulted in circumstances relating to their work”.
This can include verbal abuse or threats as well as physical attacks.
Physical attacks are obviously dangerous, but serious or persistent verbal abuse can be a significant
problem too, as it can cause damage to employees’ health through anxiety and stress.
For employers, this can represent a real financial cost, through low staff morale and high staff turnover. This
in turn can affect the confidence of a business and its profitability. Further costs may arise from expensive
insurance premiums and compensation payments.
All work-related violence, both verbal and physical, has serious consequences for employees and for the
business they work for. For employees, violence can cause pain, distress and even disability or death.
Harassment
Harassment occurs when someone is repeatedly and

deliberately abused, threatened and/or humiliated in
circumstances relating to work.
Harassment may be carried out by one or more

manager, worker, service user or member of the public
with the purpose or effect of violating a manager’s or
worker’s dignity, affecting his/her health and/or
creating a hostile work environment.
The European agreement recognises that harassment

and violence can:

- Be physical, psychological, and/or sexual
- Be one off incidents or more systematic
patterns of behaviour
- Be amongst colleagues, between superiors
and subordinates or by third parties such as
clients, customers, patients, pupils, etc.
- Range from minor cases of disrespect to
more serious acts, including criminal
offences, which require the intervention of
public authorities
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Physical & Psychological Effects of Violence/Aggression

To the Individual
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x Stress These issues can be
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x Depression addressed through the
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x Self-blame following:
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x Sleep disturbance x High staff awareness of what
constitutes bullying
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x Symptoms of post-traumatic stress
disorder x Investigation of the extent and
nature of the problem
x Social isolation
x Setting a policy and ensure that all
x Physical injuries staff are aware of the standards to
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be maintained
To the Organisation
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x Not tolerating or condoning bullying
x High staff turnover x Management training in conflict
x High absenteeism resolution
x Reduced effectiveness and productivity x Good communication system
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Factors Likely to Increase the Risk of Work-Related
Violence
Affected groups are largely concentrated in the service sector, particularly health, catering, transport, retail,
finance and education, where direct contact with clients increases the risk.
Risk factors include:
• Handling of cash, goods and valuables

• Lone working
• Physical appearance, age or experience
• Regulatory inspection, control and authority functions
• Contact with ‘difficult’ clients, e.g., clients or complainants with a history of violence, people under
the influence of drink or drugs or otherwise mentally impaired
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• Poor management leading to inadequate resources, invoicing or administrative errors
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Occupations at Risk from Violence

Activities which principally involve:
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• Giving a service
• Caring
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• Education
• Cash transactions
• Delivery/collection
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• Controlling
• Representing authority
These are generally considered to be high risk activities, although they are, of course, not exclusive.
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Occupations which involve these activities include:
• Retail trade
• Banking
• Public transport
•
Teachers
• Traffic wardens and ticket inspectors
• Police, prison officers and security personnel
• Mental health workers
• Accident and emergency staff
• Home visitors
• Taxi drivers
In many circumstances, it is a combination of factors that give rise to violence. Factors which can be
influenced include:
• The level of training and information provided
• The environment
• The design of the job
Effective Management of Violence

Employers have a duty of care to ensure employees are not exposed to risks to their health and safety,
including from violence and aggression. Workplace violence and aggression can have both short and
long-term impacts on an employee’s physical and psychological health.
One way to minimise risk of exposure is to follow a risk management process in consultation with the
employees and the health and safety representatives. The risk management involves a four-stage
process as published by the UK HSE Violence at Work, a guide for employers INDG69 (rev):
Stage 1 Finding out if you have a problem
Stage 2 Deciding what action to take

Stage 3 Take action

Stage 4 Check what you have done
The first step in risk assessment is to identify the hazard.

To identify the potential for violence or aggression, gather information about the hazards at the workplace
and assess the associated risk.
To identify hazards at the workplace, it may be useful to:
x Observe work practices to identify risks of exposure. For example, working alone, contact with
the public, or working after hours
x Walk-through and inspect the workplace. For example, low visibility in service areas, entries and
exits for workers after hours, long customer queues and wait times
x Observe customer behaviour and how they interact with workers
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x Identify whether issues already identified between co-workers, customers, patients or others
could escalate to violence
x Observe the culture of the workplace to see whether violence or aggression is accepted as
normal behaviour. For example: name-calling, swearing, sexual or gendered jokes
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x Identify the physical, psychological and emotional demands involved in the work
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x Observe how managers, supervisors, workers and others interact with each another. For
example: poor relationships, cultural or community issues leading to workplace tension, or
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workers avoiding being around certain people
Controlling
x Ask the employees informally through managers supervisors and safety representatives or use a
short questionnaire to find out whether they ever feel threatened.
x Conduct confidential employee surveys about incidents or behaviours that have caused
discomfort and situations that had the potential to become more violent
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x Identify factors external to the workplace which may lead to violence or aggressive behaviour
Workplace Health
that could impact the employees. For example: protest gatherings or people affected by drugs
or alcohol
x Monitor information such as hazard and incident reports and workers’ compensation claims.
Maintain detailed records of all incidents such as:
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x An account of what happened
x Details of the victim(s), the assailant(s) and any witnesses
x The outcome, including working time lost to both the individual(s) affected and to the organisation
as a whole
x The details of the location of the incident
Stage 2 Deciding what action to take

Having established that there is potential for the employees to be exposed to violence, the next step is to
decide what needs to be done.
Decide who might be harmed, and how
Workplace violence and aggression can happen in any industry but is most common in industries where
people work with the public or external clients. Examples of workers in the following professions who are
most at risk:
- Health care and social assistance – this includes nurses, doctors, paramedics, allied health
workers, child protection workers, residential and home carers
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- Public administration and safety – such as police officers, protective service officers, security
officers, prison guards and welfare support workers
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- Retail and hospitality, particularly for new and young workers, including workers at grocery
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outlets, pharmacies, petrol stations, restaurants, bars and takeaway food service, and
- Education and training – including teachers and teachers’ aides.

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New and young workers may also experience higher rates of workplace violence or aggression in the form
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of initiation or hazing. These are activities involving harassment or abuse to recognise or accept a person
as part of the group. Hazing commonly involves negative, humiliating or distressing experiences for new
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and young workers which can result in physical and psychological harm. Hazing and initiation practices
have been known to occur in workplaces with young apprentices such as construction and trades
industries.
Evaluate the risk

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After identifying the hazards and who might be harmed, assess the risks in consultation with the workers.
To do this, think about the following:
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- Do particular tasks increase or decrease the likelihood of violence and aggression? How often
are particular tasks done? Do particular tasks increase or decrease the severity of potential
harm?
- Has violence happened before, either in this workplace or somewhere else? If it has happened,
how often does it happen?
- What are the potential impacts? Will it cause harm to the health of the worker?
- Are existing precautions adequate? Should more be done?
Record your findings

Keep a record of the significant findings of your assessment. The record should provide a working document
for both managers and employees.
Review and revise your assessment

Review the risk assessment regularly or when there are changes to the job or environment, to ensure the
risk of violence continues to be eliminated or minimised as far as reasonably practicable.
Stage 3 Take action

Check that the policy for dealing with violence is incorporated into the organisation’s health and safety policy
statement and that all employees are aware of its existence. The policy will help reinforce co-operation
from employees to follow procedures and to report violence and aggression related incidents.
Stage 4 Check what you have done

Regularly review the control measures to know how well the controls are working - consider whether they
can be improved by implementing new control measures, making changes to the physical work environment,
work policies or procedures, or providing additional training. Ensure any control measures implemented do
not introduce new hazards or risks to health and safety.
Keeping records on reports of violence and aggression and actions taken can be useful in analysing trends,
identifying systemic risk factors, and can be an important source of information for boards and governing
bodies. Records with identifying information must be kept confidential.
Lone Working
Who are lone workers and what jobs do they do?

According to the document (Protecting Lone Workers, INDG73) published by UK HSE, lone workers are

those who work by themselves without close or direct supervision. They can be found in a wide range of
situations, both at fixed base and off fixed base.
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Work Alone at Fixed base

x Only one person works on the premises, e.g. in
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small workshops, petrol stations, kiosks, shops and
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home workers.
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x People work separately from others, e.g., in
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factories, warehouses, training establishments,
leisure centres etc.
Controlling
x People work outside normal hours, e.g., cleaners,
security, special production, maintenance or repair
staff, etc.
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Workplace Health
Work Away from fixed base
x On construction, plant installation, maintenance and
cleaning work, electrical repairs, lift repairs, vehicle
recovery, etc.
x Agricultural and forestry workers.
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x Service workers, e.g. rent collectors, postal staff, social workers, home helps, drivers, estate
agents, sales representatives and similar professionals who visit customer and client premises.
How general risk assessments can be used to avoid and control

risks to lone workers?
Although it is not a legal requirement to conduct a specific risk assessment for lone workers, employers
have a duty of care to ensure that this category of vulnerable workers are protected and that risks to their
safety, health and wellbeing are well looked after. When conducting a general workplace risk assessment,
it is recommended that risks to lone workers are also considered. As such the standard Five Steps approach
could be used.
The following specific issues will need to be addressed in the risk assessment:
x Does the workplace present a special risk to the lone worker?
x Are the potential consequences of injury increased due to working alone? (Consider emergency
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arrangements, first-aid cover, etc.).
x Is there safe access and egress?
x Can any temporary access equipment, e.g. ladders, be safely handled by one person?
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x Can all the plant, substances and goods involved in the work be safely handled by one person?
x Does the work involve lifting objects too large for one person?
x Is there a risk of violence?
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x Are women especially at risk if they work alone?

x Are young workers especially at risk if they work alone?
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In addition to the above issues, the risk assessment should also include:
x Consultation and involvement of the lone workers when considering potential risks and control
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measures.
x The steps to be taken to ensure risks are adequately controlled or eliminated, for example selecting
ladders that can be safely handled by one person.
x The provision of instruction, information training and supervision
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x Periodic review and update of the risk assessments after an incident, changes in staff, equipment
or work process, or the passage of time.
x The identification of potential risks and necessary controls when the lone worker is working away
from fixed base at another organisation’s premises.
There are some high-risk activities where at least one other person may need to be present. The level of
supervision required is a management decision which should be based on the findings of risk assessment.
The higher the risk, the greater the level of supervision required. It should not be left to individuals to decide
whether they require assistance. Example of activities where another person needs to be present include
confined space working where a supervisor may need to be present, as well as someone dedicated to the
rescue role, electrical work at or near exposed live conductors where at least two people are sometimes
required, underwater diving operations where some needs to be present to monitor and supervise the
operation, vehicles carrying explosives or fumigation, etc.
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The Impact on Risk to Lone Workers
Worker issues, vulnerability, experience and training
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Some of the issues which employers should pay special attention when planning safe working arrangements
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for lone workers are as follows:
x
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Special considerations for lone workers who are more vulnerable such as pregnant women,
workers with disability, young workers, trainees, etc.
Controlling
x Training requirements where there is limited supervision to control, guide and help in situations of
uncertainty, and to avoid panic reactions.
x The need for lone workers to be sufficiently experienced and to understand the risks and
precautions fully.
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x Contingency for emergencies such as fire, equipment failure, illness and accidents
Workplace Health
x Check that lone workers have no medical conditions which make them unsuitable for working
alone.
Employers should set the limits to what can and cannot be done while working alone. They should ensure
Health Issues
employees are competent to deal with circumstances which are new, unusual or beyond the scope of
training, e.g., when to stop work and seek advice and how to handle aggression.
Work related violence

The employer should identify those lone workers who are at risk of violence. Those who have face-to-
face contact with the public are normally the most vulnerable. Where appropriate, potentially violent
people should be identified in advance so that the risks from meeting them can be evaluated and
addressed.
Examples of violence risks in the workplace to lone workers include: working in locations where there is
high risk of violence; working unsociable hours where the presence of other workers / people are few or
none; carrying or handling cash or valuables; contact with alcohol and drug users.
Mental Health Issues
Stress, mental health and wellbeing
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Studies have shown that lone workers are at a higher risk of being afflicted by stress, mental ill-health and
wellbeing as a result of vulnerability and loneliness from being isolated from everything and everyone.
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There are practical arrangements which the employer could implement to reduce stress and to protect the
mental health and wellbeing of the lone workers.
Keep in contact: Implement procedure that allow direct communication between lone workers and their
managers. For example, to schedule regular contacts to check on the safety of the lone worker, and listen
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to their concerns, so that he/she will feel like part of the team.
Face to face interaction: Schedule time for the lone worker to visit the office for interaction with co-workers,
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attending meetings, include lone workers in social events, etc.
Consultation on changes: ensure lone workers are included in any consultation on changes
Training: include lone workers in relevant training programs, where required by the organisation or by law.
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Can someone work alone if they have a medical condition?

It may be necessary to check that lone workers have no medical conditions, which make them unsuitable for
working alone. Occupational health advice may be required for lone workers who have a medical condition
which may place them at greater risk while lone working.
Consider both routine work and foreseeable emergencies that may impose additional physical and mental
burdens on an individual. Ensure lone workers have access to first aid facilities for treating minor injuries.
Workplaces. Is it isolated? Is it at other people’s premises, etc
Working in isolated places makes it challenging for lone workers as they would not be able to get immediate
medical help or attention, or emergency services due to the location, or time of work. For example, a cleaner
working by himself/herself at night in an office building.
The main hazards of isolated work are: exposure to violence, mental health and difficulty in getting
emergency assistance.
High-risk work activities ie; confined space working that requires

supervision
There are some high-risk activities where at least one other person must be present, for example working in
confined spaces where supervision is needed. A risk assessment can help the employer decide on the
appropriate level of supervision required for working in confined space. Effective supervision can help ensure
all precautions and preventions are implemented to prevent employee injury, illness or death resulting from
hazards associated with working in confined space.
Communication where English is not a worker’s first language
Lone working non-native English speakers will need special considerations to ensure that they understand
information, instruction and training they need to stay safe. Employers make arrange to provide backup
translation services, website with translation capabilities specially for emergencies.
Emergency situations
Risk assessment on lone working will identify the hazards and risks to lone workers. Based on the findings
and recommendations of the risk assessment, the employer may be required to implement control measures
to protect the safety of the lone workers, and this may include the development of emergency procedures
for lone working, and employees trained on them. The risk assessment may also recommend the provision

of first aid equipment and first aid training.
Working from home
Employers have a duty of care for their workers who are working from home. They must provide the
same level of support, and health & safety controls to protect the homeworkers, including supervision,
education and training on safe working. There should also be arrangements for support to be provided
when things go wrong, assistance for the setting up of suitable workstation, monitoring and intervening if
there is an indication of development of mental health condition due to being isolated. It is also important
for employers to recognise that working from home may not be suitable for everyone.
Employers should also have arrangements for accident and injury liability insurance in the event of an
incident to the worker while working from home.
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Particular Problems Facing Lone Workers

Medical Conditions
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It may be necessary to check that lone workers have no medical conditions, which make them unsuitable
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for working alone. Occupational health advice may be required for lone workers who have a medical
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condition which may place them at greater risk while lone working.
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Consider both routine work and foreseeable emergencies that may impose additional physical and mental
Controlling
burdens on an individual. Ensure lone workers have access to first aid facilities for treating minor injuries.
Training
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The information, training and instruction provided by the employer must address specific items relating to
working alone, including the use of emergency communication devices and following the procedures set up
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such as what can and cannot be done while working alone and dealing with issues that are unusual and new.
Such training would be in addition to general training in safe work procedures for work activities to be
completed whilst the person is working alone. In some cases, there may be the need for additional training,
such as survival techniques where workers are in remote locations.
Procedures for emergencies, such as fire, first aid or spills of hazardous substances must be appropriate
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for workers who work alone.
Supervision
Consideration should be given to the supervision of workers working alone. An employer is expected to
ensure that workers are following safe work procedures and working in a manner consistent with the
instruction and training provided. Adequate supervision should ensure workers take reasonable care of their
own safety and health.
It is up to an employer to determine the most effective way of supervising workers who work alone. Because
of the nature of the work, direct supervision would not be possible. This means a method of indirect
supervision should be in place. It is not sufficient to introduce safe procedures without monitoring
implementation to ensure that they are adopted and are effective. Regular contact between the lone worker
and supervisor, using either: mobile phones, telephones, radios or e-mail, bearing in mind the worker’s
language barrier.
In situations where there is a new worker who is not well known to the employer or, for any other reason, the
employer is not sure of the person’s ability to work alone, that worker should not be assigned to work alone.
As far as practical, the employer should be satisfied that the worker will work in a safe manner and be able
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to follow all emergency procedures when left alone.
Failure to address unsafe behaviour, and provide adequate information, instruction, training and supervision
would be considered a breach of the employer’s duty of care. NEBOSH

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Emergency Arrangements
Lone workers need to be trained and aware of procedures in event of an emergency such as fire, accident
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etc. Means of communication should also be provided to lone workers.

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Other methods should be established for safe working:

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x Procedures in place to ensure that action will be initiated if the lone worker does not make contact
at agreed intervals
x Implement communications arrangements: Telephones, mobile telephones, two-way radios or
walkie-talkies can be a lifeline in some cases
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x Install electronic, visual monitors and security systems such as CCTV and warning devices to
monitor the safety of the lone worker
x Provision of personal alarm
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Lifting objects that are too heavy for one person

Some tasks may not be suitable for lone working as these may involve lifting of equipment or objects that are
too heavy for one person.
Employers should identify the hazards of the work, assess the risks involved, and implement changes to the
workplace and safe working arrangements to ensure the risks are either eliminated or adequately controlled.
When it is not possible to devise arrangements for the work to be done safely by one person, alternative
arrangements providing help or back-up have to be devised.
More than one person needed to operate essential controls or

transport
Lone workers could be put at increased risk through using moving machinery or operating essential controls
without help.
Similar to above situation, an employer should identify the hazards of the work, assess the risks involved,
and implement changes to the workplace and safe working arrangements to ensure the risks are either
eliminated or adequately controlled. When it is not possible to devise arrangements for the work to be done
safely by one person, alternative arrangements providing help or back-up have to be devised
Where the risks are very high then lone working should be avoided, and a second worker provided.
However, control measures and safe systems of work to reduce risks to lone workers may include:
• Avoid lone-working – Confined Spaces, working at height, Working with live energised equipment,
Handling valuables, etc.
• Information and training about risks that may arise
• A first-aid kit
• Supervisors periodically visiting and observing people working alone
• Regular contact between the lone worker and supervisor using either a telephone or radio
• Automatic warning devices that operate if specific signals are not received periodically from the lone
worker
• Other devices designed to raise the alarm in the event of an emergency which are operated
manually or automatically by the absence of activity
• Checks that a lone worker has returned to their base or home on completion of a task
• Personal protective equipment to protect against the hazards identified
•
Ensure vehicles provided are roadworthy and kept in good repair

• Review the building security arrangements where there is a lone worker
• Actions to deal with a lone worker who becomes ill, has an accident, or other emergency NEBOSH International Diploma
• Set up a safe working procedure to facilitate a lone worker to withdraw from a visit or situation if
they feel at risk
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9.3 Health Surveillance
Difference Between Health Surveillance and Health

Assessment
Health assessments are tests done on workers where there may not be known adverse effects, where there
may not be the possibility of detecting a specific health effect at an early stage (i.e., health effects may be
detected once the disease appears for example skin dermatitis) and where there may not be proven valid
tests that can be done.
For example, a health assessment is carried out on lift truck workers to determine their continued fitness (for
example their eyesight, joint flexibility etc) for operating the lift truck.
There is no ‘known adverse health effect’ that can arise out of operating a lift truck.
Similarly, health assessments are offered to define ‘night workers’ to determine if they have any current health
problems that are being or could be made worse by working at night.
There is no ‘known adverse health effect’ specifically related to night work that can be identified at an early
stage in this type of assessment.
Many different types of health effects may be identified, but it is more determined by the individual rather than
the night work itself.
Therefore, health surveillance is looking for some specific health effect in relation to some specific work
exposure and there is a valid means to detect the specific problem at an early stage.
Health assessments are much less specific and assess the general health of the individual or the continued
fitness of the person for their work
Health surveillance is appropriate where:

x There is a reasonable likelihood of an identifiable disease or adverse health effect from that exposure;
or
x Employee exposure is such that:
- An identifiable disease or adverse health effect may be related to the exposure.
- There is a reasonable likelihood that the disease or effect may occur; and
- There are valid techniques for detection of the disease of effect.
When working with prescribed substances medical examination by a relevant doctor (an appointed doctor or
an employment medical adviser) should be carried out at least every 12 months.

Furthermore, where a relevant doctor has certified, by entry in an employee’s health record that an employee
should not be exposed to, or only under certain circumstance be exposed to, prescribed substances then the
employer should ensure exposure is prevented or controlled as certified.
A relevant doctor may also certify that the medical surveillance continues until after exposure has ceased.
Any such certified requirements remain in force unless cancelled by a relevant doctor.
On given reasonable notice by the employee an employer must allow him / her to access their personal
monitoring record. The employer must also provide enforcement bodies with copies of such monitoring when
requested.
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Health and Safety Executive’s (HSE) Cycle of Health

Surveillance
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Health surveillance is a system of ongoing health checks. These health checks may be required by law for
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employees who are exposed to noise or vibration, ionising radiation, solvents, fumes, dusts, biological agents,
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and other substances hazardous to health, or work in compressed air.
– -Managing
Health surveillance is important for:
Controlling
• Detecting ill-health effects at an early stage, so employers can introduce better controls to prevent
them getting worse
• Providing data to help employers evaluate health risks
•
Occupational
Enabling employees to raise concerns about how work affects their health
• Highlighting lapses in workplace control measures, therefore providing invaluable feedback to the
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risk assessment
• Providing an opportunity to reinforce training and education of employees (e.g., on the impact of
health effects and the use of protective equipment)
Your risk assessment should be used to identify any need for health surveillance. You should not use health
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surveillance as a substitute for undertaking a risk assessment or using effective controls.
Health surveillance can sometimes be used to help identify where more needs to be done to control risks
and where early signs of work-related ill health are detected, employers should take action to prevent further
harm and protect employees.
First: Risk Assessment and Controls

• Where some risk remains and there is likely to be harm caused to your employees, you will need
to take further steps. Consider Noise or vibration
• Solvents, dusts, fumes, biological agents and other substances hazardous to health
• Asbestos, lead or work in compressed air
• Ionising radiation
Second: Do I need health surveillance?

If there is still a risk to health after the implementation of all reasonable precautions, you may need to put a
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health surveillance programme in place, see: Health surveillance Decision-making map. Health surveillance
is required if all the following criteria are met:
• There is an identifiable disease/adverse health effect and evidence of a link with workplace NEBOSH
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exposure
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• It is likely the disease/health effect may occur

• There are valid techniques for detecting early signs of the disease/health effect
• These techniques do not pose a risk to employees
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Third: What sort of health surveillance do I need?

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Where risk assessment shows that you need to implement health surveillance, you will need to put into place
a programme that adequately addresses the risks and potential ill-health effects your employees may be
exposed to.
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In its simplest form, health surveillance could involve employees checking themselves for signs or symptoms
of ill health following a training session on what to look for and who to report symptoms to. For examples
employees noticing soreness, redness and itching on their hands and arms, where they work with substances
that can irritate or damage the skin.
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Fourth: Set up and design health surveillance according to need
When setting up health surveillance arrangements, it is important to involve your employees and their
representatives at an early stage as it is only effective with their co-operation. Your employees should also
understand their own duties, (in terms of attending appointments etc) and the purpose of the health
surveillance and their involvement will ensure a 'reality check' from the shop floor is included in the process.
Fifth: Identify who will do the health surveillance

To put an effective programme in place you will need to:
• Involve your employees
• Appoint a responsible person within your business
• Appoint a competent medical professional (where appropriate)
After designing your programme, you may need to appoint an occupational health provider to deliver it and
help you meet your legal obligations. However, by understanding a little more about what they do, you can
be an 'intelligent customer' and purchase the right health surveillance services.
Sixth: Implement health surveillance for those who need it

The next step is to implement your health surveillance programme for those employees who need it. Keep
health surveillance programme under review, to make sure that it remains appropriate and to maintain quality.
Seventh: Manage performance and act on results

Once your health surveillance arrangements are up and running, and you start receiving feedback from your
service provider or responsible person, you need to act on the results. It is often useful to appoint someone
to be in charge of making sure that any findings are promptly fed back to management, who can use this
information to review the risk assessment and controls.
Figure 1: Health Surveillance Cycle

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The Requirements for Keeping Health Records and Medical Records
It is important that all medical contacts, evaluations, assessments and surveys be properly documented, and
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the records safely stored so that, if necessary for legal or research purposes, they may be retrieved years
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and even decades later. For example, in the UK, the Ionising Radiation Regulations (IRR) 1999 specifies the
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need and the content of a health record in Schedule 7 to the regulations.
– -Managing
The ILO Occupational Health Services Recommendation No.171 provides that occupational health services
should record data on workers' health in personal confidential health files.
Controlling
These files should also contain information on jobs held by the workers, on exposure to occupational hazards
involved in their work, and on the results of any assessment of workers' exposure to these hazards.
Personal data relating to health assessments may be communicated to others only with the informed consent
of the worker concerned.
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Workplace Health
The conditions under which and time during which records containing workers' health data should be kept,
communicated or transferred and the measures necessary to keep them confidential, especially when these
data are computerized, are usually prescribed by national laws or regulations or by the competent authority
and governed by recognized ethical guidelines.
Medical record - Medical records are a confidential record. Clinical information used to make decisions on
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fitness to work must not be held on the health record. Health and medical records kept meeting a specific
legal requirement should typically be kept for a minimum of 40 years because of the long latency period of
some illnesses and they also provide useful occupational hygiene data.
Confidentiality and access - In the UK, an employee must be allowed access to their health records that
are kept as a specific requirement of Regulations like the Control of Lead at Work Regulations (CLAW) 2002,
providing they give reasonable notice of their intention to the employer.
Generally, medical records may only be shared with others by a worker giving written consent for their details
to be released, unless the statutory provision requires that they be made available to a third party, usually
the HSE or their EMAS staff.
The Data Protection Act (DPA) 1998 provides a right of access to personal information, including health and
medical records, held by public and private organisations, regardless of the form in which it is held - electronic
or paper (structured files relating to the individual). Individuals have the right to know whether the
organisation, or someone else on its behalf, is processing personal information about them, what information
is being processed, why it is being processed and who it may be disclosed to.
Noise Health Surveillance
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The following has been extracted from Section 9.4 of ILO Code of Practice - ‘Ambient Factors in the
Workplace’.
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Appropriate health surveillance should be conducted for all workers whose noise exposures reach a certain
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level prescribed by national laws and regulations or by national or internationally recognized standards above
which health surveillance should be carried out.
Workers’ health surveillance may include:

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x A pre-employment or pre-assignment medical examination to:

- Determine any contraindication to exposure to noise
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- Detect any sensitivity to noise

- Establish a baseline record useful for later medical surveillance
x Periodical medical examinations at intervals prescribed as a function of the magnitude of the
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exposure hazards too:

- Detect the first symptoms of occupational disease
- Detect the appearance of any unusual sensitivity to noise and signs of stress due to noisy
working conditions
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x Medical examinations prior to resumption of work after a period of extended sickness or in case of
conditions as may be specified in national legislation or internationally recognized standards
x Medical examinations performed on cessation of employment to provide a general picture of the
eventual effects of exposure to noise
x Supplementary and special medical examinations when an abnormality is found, and it requires
further investigation
The results of the medical examinations and of supplementary examinations and tests, such as audiometric
testing, of each individual, should be recorded in a confidential medical file. The worker should be informed
of these results and their significance accordingly.
Audiometry
Audiometry is a technique for evaluating the degree of hearing loss or impairment over the range of
frequencies most necessary for normal conversation (4-6 kHz).
For occupational purposes, audiometry can be used for the early detection and the assessment of the degree
of noise induced hearing loss.
Employers should consult their workers or their health and safety representatives before introducing
audiometric health surveillance
Method
• The subject is placed in a soundproof booth in order to mask ambient noise
• Headphones are fitted and tones, which are generated by an audiometer, are played in sequence to
each ear in turn
• The audiometer generates pure tones at 0.5, 1, 2, 3, 4, 6 and 8 kHz at intensities which are increased
in 5 dB steps until the subject responds by pushing a button
• The reaction is recorded and a graph generated
• Hearing levels from -10 dB to over 90 dB can be recorded
Interpretation
• The ‘normal’ subject will show an almost horizontal line high up on the chart with a slight dip at high
frequencies depending on the subject’s age (due to presbycusis)
• A flat audiogram curve lower down on the chart indicates a similar hearing loss at all frequencies
(indicative of conductive loss)
• The classic pattern of occupational noise induced hearing loss is the ‘4k-dip’
Use of Results NEBOSH International Diploma

• Audiometric health surveillance can be part of pre-employment health screening
• It is used to establish a reference level of hearing ability and identify those people who have a hearing
loss that will require particular arrangements to be made to protect their remaining hearing
• Subsequent to pre-employment screening, audiometric health surveillance is used to identify early
signs of NIHL
• To establish interventions to protect hearing and to confirm the degree to which noise controls are
effective
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Advantages and Disadvantages of Audiometry Programmes
Advantages
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• Will ensure a reference level hearing ability is determined
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• Reduced claims for NIHL
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• Reduced insurance premiums
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• Identifies high risk susceptibility of new workers
•
Controlling
Improves worker morale
• Enables the effectiveness of controls to limit noise exposure to be evaluated
• Ensures best equipment is sourced and provided
Disadvantages
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Workplace Health
• Increased costs to the business for health screening and medical referral
• Increased costs to remedy current controls and systems of work
• It is not uncommon for some that already suspect that their hearing is deteriorating to fear being
transferred into a lower paid job or dismissal when the results confirm their concerns
• As a form of health surveillance, it is reactive, in that it confirms hearing loss rather than preventing
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hearing loss
• Can be inaccurate if the subject being tested is uncooperative
In conclusion the mammalian/human ear is a highly developed sensory organ that has developed in
conjunction with other sensory systems as well as the central nervous system. The binaural capabilities give
the ears an extra dimension to hearing sounds by being able to localise and distinguish between various
noise signals. In conjunction with its sensitivity, i.e., ability to hear sounds of between 20 and 20,000 Hz, the
hearing system is also extremely fragile and prolonged exposure to loud sounds will cause irreparable
damage.
Vibration Health Surveillance
According to the ILO CoP, Ambient Factors in the Workplace, section 10.4, the following should be
considered:
10.4.1 A pre-employment medical examination should examine candidates for jobs affected by hand-arm
vibration for Raynaud’s phenomenon of non-occupational origin and for hand-arm vibration syndrome
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(HAVS) from previous employment. Where these symptoms are diagnosed, such employment should not be
offered unless vibration has been satisfactorily controlled.
10.4.2. If a worker is exposed to hand-transmitted vibration, the occupational health professional responsible NEBOSH
for health surveillance should:
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(a) examine the worker periodically, as prescribed by national laws and regulations, for HAVS and ask
the worker about symptoms.
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(b) examine the worker for symptoms of possible neurological effects of vibration, such as numbness and
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elevated sensory thresholds for temperature, pain, and other factors.

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10.4.3. If it appears that these symptoms exist and may be related to vibration exposure, the employers
should be advised that control may be insufficient. The employer should review the assessment in
accordance with section 3.2 of ILO CoP, Ambient Factors in the Workplace, and in particular control of the
causative vibration.
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10.4.4. Because of possible association of back disorders with whole-body vibration, workers exposed should
be counselled during health surveillance about the importance of posture in seated jobs, and about correct
lifting technique.
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Biological Monitoring
Biological monitoring – the measurement and assessment of workplace agents or metabolites (substances
formed when the body converts chemicals) within the bloodstream, in urine or other target organs in exposed
workers.
Under complex contamination conditions where the substance having the most serious effect (e.g.,
carcinogenic) has not been identified, workers cannot be protected by applying the exposure limits, so that it
is necessary to adopt processes and technical measures ensuring minimum contamination and exposure
and to apply biological monitoring, rather than to concentrate all efforts on monitoring the working
environment.
Whenever valid biological monitoring methods are available, they should be used to complement monitoring
of the working environment in order to increase protection of workers’ health. Under certain circumstances,
such as work in the open, biological monitoring may be the most practical method in view of the difficulty of
monitoring the working environment.
Biological monitoring complements monitoring of the working environment by assessing the absorption of
harmful substances both in the individual and in the group, and by evaluating individual susceptibility.
Biological monitoring requires the full co-operation of workers. Workers should be fully informed by the
appropriate authorities regarding the scope of biological monitoring and the significance of the results.
The frequency of biological monitoring should depend on the magnitude and type of hazard, the biological
half-life of the substance, the uptake curve and other variables in the environment and in the individual worker.
Trained personnel are required for both sampling and analysis. Adequate provision should be made for such
training. 4.3.8. Adequate laboratory facilities should be provided. Depending on the type and the number of
analyses required, they may be performed either on the work premises or in specialised laboratories. The
validity of the results of biological monitoring should be ensured by calibration of equipment, standardisation
of techniques and time of sampling, and replication of analyses
Role of Biological Limit Values (BLVs)

In the United States, Biological Exposure Indices (BEIs) are an example of BLVs for assessing biological
monitoring results. Similar standards exist in the UK in the form of Biological Monitoring Guidance Values
(BMGV), published by the HSE in their guidance document EH40.
BEIs represent the levels of determinants that are most likely to be observed in specimens collected from
healthy workers who have been exposed to chemicals to the same extent as workers with inhalation exposure
at the Threshold Limit Value (TLV). The exceptions are the BEIs for chemicals for which the TLVs are based
on protection against non-systemic effects (e.g., irritation or respiratory impairment) where biological
monitoring is desirable because of the potential for significant absorption via an additional route of entry
(usually the skin).
Biological monitoring indirectly reflects the dose to a worker from exposure to the chemical of interest. The NEBOSH International Diploma
BEI generally indicates a concentration below which nearly all workers should not experience adverse health
effects. The BEI determinant can be the chemical itself; one or more metabolites; or a characteristic, reversible
biochemical change induced by the chemical. The BEIs are not intended for use as a measure of adverse
effects or for diagnosis of occupational illness.
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There are two types of biological monitoring guidance values:
x Health Guidance Value (HGV)

Health guidance values are set at a value at which there is no indication from the scientific evidence
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that the substance being monitored is likely to be injurious to health.
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It is assumed that occasionally slightly exceeding the relevant HGV is unlikely to cause either short-
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or long- term effects. However, regularly exceeding the HGV indicates that control measures may
not be adequate. Current work practices should, therefore, be assessed as to how they can be
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improved to reduce exposure.
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x Benchmark Guidance Value (BGV)
Benchmark guidance values are not health based, and they are set at a level of 90% of biological
monitoring results from a representative sample of workplaces which had adopted good hygiene
practices.
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If a result exceeds the BGV, adverse health effects may not occur. Such a result indicates that control
measures may not be adequate.
Table 1: Examples of BMGVs
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Biological monitoring guidance values
Substance
Health Benchmark
Sampling
guidance guidance Sampling time
time
values values
30 ppm in end -
Carbon monoxide. Post shift.
tidal breath.
20 µmol/mol
Mercury. creatinine in Random.
urine.
At the end of period

15 µmol/mol
Glycerol trinitrate of exposure. This
creatinine in
(nitroglycerine). may be mid shift or
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urine.
at the end of a shift.
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650 mmol
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methyl hippuric
Xylene, o-, m-, p- or
acid/mol Post shift.
mixed isomers.
creatinine in
urine.
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Biological monitoring can assist the occupational health professional detect and determine absorption via
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the skin or gastrointestinal system, in addition to that by inhalation; assess body burden; reconstruct past
exposure in the absence of other exposure measurements; detect non-occupational exposure among
workers; test the efficacy of personal protective equipment and engineering controls; and monitor work
practices.
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Biological monitoring serves as a complement to exposure assessment by air sampling. The existence of a
BEI does not indicate a need to conduct biological monitoring. Conducting, designing, and interpreting
biological monitoring protocols and the application of the BEI requires professional experience in
occupational health and reference to the current edition of the Documentation of the Threshold Limit Values
and Biological Exposure Indices (ACGIH).
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As indicated previously, as well as air monitoring, biological monitoring is a valid technique for estimating
the exposure of a worker to a hazardous substance.
Types of monitoring can include:

x Blood tests, e.g., for lead levels or chromium vi exposure
x Urine tests, e.g., mercury or polycyclic aromatic hydrocarbons

x Skin patch tests (to determine allergic reactions), also referred to as challenge testing
x Exhaled breath monitoring, e.g., carbon monoxide and dichloromethane
x Lung X-ray – fibrosis, silicosis
If a result exceeds the biological limit value (BLV), it does not necessarily mean that ill-health will result,
however it does indicate control measures may not be adequate and more could be achieved.
The advantage of BLVs is that they provide an accurate estimation of the actual exposure and therefore a
definitive indication of whether control measures are effective.
BLVs are either based on a relationship between biological concentrations and health effects, between
biological concentrations and exposure at the level of the EL are based on data collected from a
representative sample of workplaces correctly applying the principles of good occupational hygiene practice.
BLVs are set where they are likely to be of practical value, suitable monitoring methods exist and there are
sufficient data available.
The advantages of this approach are:
x It can be a very useful complementary technique to air monitoring when air sampling techniques
alone may not give a reliable indication of exposure;
x It provides an accurate estimation of the actual exposure and therefore a definitive indication of
whether control measures are effective;
x The overall exposure results are from all routes, i.e., inhalation, ingestion, absorption and injection;
x The exposure does not need to have been observed, thus can be used where air monitoring is not
practicable. It is also effective for monitoring intake of illegal substances.
The disadvantages of biological monitoring, however, are:
x It can be expensive – requiring occupational health and laboratory resources

x A number of external factors may affect the results:
- Individual differences in metabolism
- Health Status of the individual
- When the sample is taken

x It is by nature a reactive form of monitoring i.e., if an excessive concentration of material is found

within the worker’s body, it is too late – the harmful exposure has already occurred
x It can be invasive, and staff may be uncomfortable with giving samples
x Only a certain number of substances can be monitored in this way
BLVs are not an alternative or replacement for airborne exposure limits. BLVs are generally non-statutory
and any biological monitoring undertaken in association with a guidance value needs to be conducted on a
voluntary basis (i.e., with the fully informed consent of all concerned).
Monitoring may need to be carried out at a specific time, e.g., immediately post-shift. This is because some
substances will be quickly metabolised. Alcohol for example, is metabolised at approximately one unit per
hour; thus, the testing needs to be undertaken as soon as possible.
Sometimes the substance itself is monitored, or sometimes a metabolite is measured. For example, to monitor
for styrene, mandelic acid is measured in urine. This is because styrene undergoes a chemical change in the
body or metabolises to produce mandelic acid.
Some BLVs are cited as an amount of material per amount of creatinine in urine. For example, in the UK,
MbOCA used in the manufacture of dense plastics, e.g., shopping trolley wheels, has a BMGV of 15 µmol
total MbOCA per mol of creatinine in urine. Creatinine is a protein which is excreted at a steady rate by the
body, thus is a means of normalising for fluctuations of dilution rates of urine, i.e., when a person has drunk
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a lot of water, materials dissolved in the urine will be more dilute and thus the concentration of material being
analysed will be lower.
Managing Shift/Night Work
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Under the UK Working Time Regulations 1998 (WTR) WTR, night workers have a right to
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receive free health assessments. The assessments could be in the form of a medical check-up, or via a
questionnaire. Health assessment can identify at an early-stage health issues that may require the employer
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to put in additional safety controls to ensure the health of the shift/night workers remains well. It is good
practice for employers to conduct health assessment to check on their suitability and fitness prior to hiring
workers for shift/night work.
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How Shift/night work can be managed
Workplace Health
The main issues associated with shift/night working are disruption of the body’s circadian rhythms, fatigue,
sleeping difficulties, disturbed appetite and digestion, reliance on sedatives and/or stimulants, social and
domestic problems.
Practical measures that employers could adopt to reduce the impact of shift/night work includes:
- Conduct risk assessments for shift/night work to identify the hazards and risks, the adequacy of
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existing controls and whether more needs to be done to control the risks.
- Make shifts shorter when the work is particularly hazardous or exhausting.
- Provide shift workers sufficient breaks during their shifts and scheduled days off so they have
adequate time to rest and recover.
- Have a handover policy in place to ensure effective handover for the next worker.
- Provide information and training on how to identify and manage risks associated with shift/night
work
Fatigue
Fatigue is sometimes described as a condition of declined ability and efficiency of mental and/or physical
activities caused by excessive mental and/or physical activities, or illness.
Fatigue in the workplace if not managed can result in serious consequences. Employers should learn to
recognize signs and symptoms of fatigue and to intervene at early recognition before it becomes a problem
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causing the work environment to become unsafe. Some high-profile accidents have been attributed to
workers being fatigued. The fatigued workers were slow to process information and act quickly, could not
concentrate, made basic mistakes, underestimating risks, etc.
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Some of the causes of fatigue include: lack of sleep, excessive working hours, working nightshifts, prolonged
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exertion, repetitive tasks, stress at work/home, etc.
Practical measures that employers could adopt to prevent fatigue in the workplace:
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- Encourage affected workers to seek medical advice and help if they are concerned about a health
condition that causes fatigue.
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- Introduce short breaks or shift naps (night shift), and health initiatives such stretching or physical
exercise.
- Examine work practices, systems of work and workers’ sign in-out sheets to check that shift workers
are not exposed to excessive work hours or physical activities.
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- Implement maximum work hours, and allow time for recovery.

- Incorporate environmental designs such as adequate and suitable lighting, temperature for cooling
and heating, ventilation, etc. that will improve mental alertness.
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Forms of Health Surveillance
Health surveillance is the monitoring by specific tests to detect early signs of work-related ill health of workers
where there is a known adverse effect. The surveillance may be a statutory requirement or an organisation’s
own internal risk management program. The findings from health surveillance enables employers to implement
intervention in managing harm from an early stage, and supporting recovery.
Workers with known mental ill-health conditions (especially work-related stress)

Health surveillance for employees known to be suffering from work-related stress resulting in mental ill-
health could be conducted by using surveys. The survey questions would be tailored to the organisation
and designed to identify occupational stress in employees. The result of the survey will enable the employer
to either continue monitoring - if the mental health is under control, or to intervene if the employees’ mental
health continues to be impacted.
Workers who will be working at height
Working at heights is a high-risk activity and a leading cause of death and serious injury in the workplace.
Employers need to ensure that workers not only need to have the competence to work at height, they should
also be physically and mentally fit. Workers with health problems such as heart disease, high blood
pressure, psychosis, diabetes and epileptic should be considered unfit for working at height. As part of
overall risk management, employers should implement health surveillance for all workers who will be
working at height to monitor their health condition and fitness to work at height. Health surveillance could
be in the form of paper based or on-line questionnaire.
Driving occupations e.g., fork-lift truck drivers

Workers who spend long periods in a seated position on the job such as forklift truck drivers are at risk for a
variety of adverse health effects that can have an impact on their work performance. The consequences of
prolonged sitting include: cardiovascular disease, diabetes, obesity, poor mental health, musculoskeletal
disorders and discomfort. Employers should carry out health surveillance (via questionnaire), to monitor the
health of the drivers to ensure that they remain fit for the job of driving and to consider any health issues that
could increase risk to the drivers and how these can be managed.
Alcohol/substance abuse at work

Employees unfit for work due to alcohol or other drug consumption put themselves and their co-workers at
risk of harm. Some occupations in critical industries such as road and rail transport, maritime, aviation,
mining and oil and gas have a legal blood alcohol level prescribed by law. Monitoring for signs of
alcohol/drug abuse at work and implementing appropriate interventions such as arranging employee
assistance programmes can help prevent unwanted incidents at work
Random Sampling: This is an effective way of controlling the problems by making employees aware that they
could be tested at any time. Tests can be done after specific incidents such as an accident.
Screening is a sensitive issue and has to be handled carefully. The use of a breathalyser device (blow in a NEBOSH International Diploma
bag) is quite straightforward but checking for drugs can mean taking blood samples which people may object
to. Due to the sensitivity of the issue it is essential that an accurate and effective system is chosen. All
employees should be made clearly aware of the company policy and the results of failure of the test.
Alcohol/Substance Abuse at Work

Two areas of concern in work and society in general today are drugs and alcohol.
The effects of drugs and alcohol can be severe. Medication can induce drowsiness and poor concentration.
Machinery and computer operation and driving can all be affected.
Alcohol: Many people drink alcohol in moderation and this may not cause a problem. However consuming
large amounts can produce acute and chronic effects.
Drugs: There is a growing problem with drugs around the world. We could consider drugs under the heading
of prescribed and others. Prescribed drugs are those that are provided by medical practitioners in the course
of medical treatment. Others may be drugs which may be illegal in many countries.
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Effects of Drugs and Alcohol: When under the influence of drugs or alcohol the effects can be lack of judgment,
slower reactions, and aggressive behavior.
Drugs and Alcohol policy
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A formal drugs and alcohol policy makes it clear to all workers what behaviour is acceptable.
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The drugs and alcohol policy should cover such things as:
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- All new applicants will be screened
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- Random testing will be applied automatically.
- Test will apply to all staff
- Testing will be carried out after specific incidents
- Training for supervision to recognise the problem
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- What help the employer will make available to the employee?
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- If an employee brings to the attention of the employer they have a problem it will be treated with confidence.
- The disciplinary actions the employer will take
It is important that the policy is properly communicated and explained to all employees so that there are no
misunderstandings.
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Benefits of Pre-employment Screening
Many organisations now screen all new applicants for jobs to see whether they have problems with alcohol or
drugs. This is not always accurate as the person may stop using the drugs for a period prior to the test being taken
and revert to them after getting the job. However, it is a good starting point.
Testing for Drugs and Alcohol

x Pre-employment Screening: Many organisations now screen all new applicants for jobs to see
whether they have problems with alcohol or drugs. This is not always accurate as the person may
stop using the drugs for a period prior to the test being taken and revert to them after getting the
job. However, it is a good starting point.
x Post-incident testing: When there’s a reasonable suspicion that drug or alcohol use is a factor.
x Random testing: Random testing is effective in curbing drugs and alcohol use as employees will
not know beforehand if they will be tested.
x Return to duty testing: Employee who was removed from duty due to positive drugs and alcohol
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test will be required to take a return to duty test along with a predefined minimum number of follow-
up tests with negative results before he or she can return to work.
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Disadvantages of Drugs and Alcohol Testing
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x Testing not in real time: Testing only provides an indication that an employee has used drugs /
alcohol sometime in the past.
x Test results may not be accurate: Some types of foods and medications can show up as illicit
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substances, resulting a false positive reading.

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x Law suit against employer for wrongful dismissal: Employees sacked after testing positive for drugs
and alcohol may file a law suit for wrongful dismissal.
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x Creates resentment and opposition from employees: Employees may feel that their rights to privacy
is being violated. The resentment can result in an increase in grievance rates, deteriorating labour-
management relations, decreased morale and reduction in productivity.
x Workplace drugs and alcohol testing is an additional expense: the employer has to allocate
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sufficient budget for drugs and alcohol testing program.
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9.4 Hazardous Substances

Human Anatomical Systems & Sensory Organs
Introduction
A basic understanding of how the body works and therefore how it can be damaged by workplace hazards is
required.
Anatomy is the study of the structure of the body. Physiology is concerned with its function. It must be
remembered that the body is not just composed of discreet organs, rather they are inter-related, and damage
to one part can often have an adverse effect on other parts.
Cells are the building blocks of the tissues and organs. Cells are microscopic entities whose shape and
function depends on the tissue they are part of and thus the role which they are required to perform. Each cell
is controlled to serve the body as a whole and grow and replicate where required. Each cell can be regarded
as a miniature chemical factory, which takes in food and converts it to energy in order to perform work. The
chemical process which converts food into energy is referred to as metabolism.
There are a number of key organs (‘systems’) within the body which are significant with respect to occupational
health hazards. These are discussed as follows.
The Respiratory System

Is of major significance in terms of occupational disease since this provides a major route of entry for
hazardous agents into the body and is itself a key target organ of occupational significance, since it represents
the first ‘port of call’ for inhaled materials.
The respiratory system provides the means by which oxygen enters the body and carbon dioxide leaves the
body. Oxygen is vital to the body in order that the cells of the body can convert food into energy. As a by-
product of this process unwanted carbon dioxide is produced.
The respiratory system also provides a means for excreting this material. Constant large amounts of oxygen
are required in order to supply the needs of all the cells, thus respiratory failure rapidly results in failure of the
body as a whole leading quickly to death if not corrected.
The respiratory tract contains the apparatus which draws air into the lungs and is made up of the mouth, nose,
throat and voice-box and trachea (windpipe) from which it divides into two bronchi (singular: bronchus) leading
to each of the two lungs.
Illustration 1: Respiratory System
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Air enters the nose and is cleansed of its larger impurities by the coarse hairs of the nostrils and warmed and
moistened by the mucous membrane lining as it passes through the nasal cavity. The nose consists of two
nasal cavities (nostrils) leading to a vestibule lined with epithelium containing glands and hairs.
The lining of the inside of the nose contains special cells which are capable of detecting chemicals in the air.
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Nerve fibres pass from these cells into the skull and connect with the brain.
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The nose performs a protective function for the respiratory system. The defence mechanism relies on the
sensitivity of certain nerves, which detect the presence of foreign matter by a reflex action causing sneezing.
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There is also an increase in the secretion by the mucous membranes that dilutes the foreign matter to expel
it (runny nose).
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The entrance to the larynx is protected by a muscular flap, the epiglottis, which closes during swallowing.
Loss of control of the epiglottis can lead to ‘aspiration’ whereby materials, which were intended to be ingested
(eaten), enter the lungs, causing great discomfort.
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Each bronchus branches into bronchioles, which then repeatedly branches out leading to terminal
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bronchioles, to which the alveoli (air sacs) are attached. The bronchial structure, in effect, resembles an
upturned tree.
The respiratory tract is lined with mucous, which is secreted by cells within the lining. Other cells are fringed
with small hairs or cilia, which continuously waft mucous towards the mouth. This system referred to as the
‘muco-ciliary escalator’, whose purpose is to constantly cleanse the respiratory tract of unwanted particles
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that become trapped and transported up and away from the lungs. It is estimated that an average adult
produces approximately one pint of phlegm per day, although most of this passes unnoticed into the stomach
due to unconscious swallowing. Inhaled particles above 10 microns are trapped in this way, together with
varying amounts of smaller particles depending on various other aerodynamic factors.
Illustration 2: Alveoli Structure
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The alveoli (or air sacs) form the delicate lining of the lungs (one cell thick) across which gas exchange
between the blood and air takes place. They may be regarded as resembling a bunch of grapes from which
the flesh has been removed. The alveoli are lined as with small blood vessels whereby oxygen is passed into
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the body with carbon dioxide passing in the opposite direction. Clearly there is an opportunity for any other
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substances to enter the body rapidly via this means. If laid out flat, the alveoli would form an area the size
of two tennis courts, a large area for exchange of the high volume of gas entering and leaving the lungs.
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Damage to these delicate structures can lead to a reduction in the lung capacity. When disease of the lung
structure occurs, scar tissue (fibrosis) usually forms. The lung loses its normal characteristics and also its
ability to function fully as a gas / blood exchange organ.
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The Digestive System

The gastrointestinal tract, or alimentary canal, extends through the body from the mouth to the anus. Its
function is the control of ingested foodstuffs. When food enters the body much of it is in a form which cannot
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be directly used by the tissues since its chemical structure is too complicated. It therefore has to be broken
down into simpler molecules which can then be absorbed into the body and used as appropriate for energy,
growth and repair.
Illustration 3: Digestive System

Ingestion
Food is mechanically broken down by teeth in a mouth and salivary enzymes before being swallowed and
passing into the esophagus. This is the muscular tube about 25cm long reaching from the pharynx to the
stomach. During their passage through the esophagus, slightly alkaline aqueous secretions are passed into
foodstuffs, as part of the digestive process.
Digestion
This process takes place within the stomach which is in effect an enlarged section of the gastrointestinal tract
where foods passed from the esophagus is deposited. It is a muscular structure which enables foodstuffs to
be continually mixed while the main digestive process takes place. The stomach provides an acid medium
(hydrochloric acid) for digestion. A number of digestive enzymes are also added at this stage.
Absorption
Once the food has been broken down by the digestive process, it is ready to be absorbed, mainly within the
small intestine. This is a muscular tube about 6 m long, with an internal diameter approximately 3.5 cm, which
extends from the stomach to the large intestine. The first part of the small intestine is the duodenum, a
horseshoe-shaped section, attached to the digestive organs of the gall bladder and pancreas. These organs
supply digestive secretions and further enzymes to aid digestion in the small intestine.
The large intestine forms the final section of the gastrointestinal tract, leading directly from the small intestine
to the anus. It is about 1.5 m long and about 6.3 cm in diameter, with a muscular structure similar to that of
the small intestine. The large intestine takes no part in digestion or absorption of nutrients. Its main function
is to reabsorb water from the final mixture passed from the small intestine, until the consistency is satisfactory
for normal excretion. Ionic salts, e.g., those of iron, are absorbed with the water.
The Liver
An important part of the digestion process takes place in the liver. Products of digestion pass through the walls
of the digestive tract into blood vessels before entering the liver, which is a large organ made up of units of
cells arranged around blood vessels in a circular fashion. The liver has many functions including the
breakdown of sugars and proteins and the removal of old blood cells from the circulatory system. The liver
also deals with many toxins, rendering them less toxic prior to excretion. During the process the liver can itself
be damaged, by some industrial chemicals or excessive alcohol for example.
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Illustration 4: Liver
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Excretion
Any left over, unwanted products from the digestive process are removed from the body by a process known
as excretion. Water and urea are disposed of via the kidneys, although some water is lost via the skin. Solid
waste leaves via the bowel after water has been extracted by the large intestine. Sometimes the passage of
a poison through the body may leave a trail of destruction and result in permanent liver or kidney damage.
The vomiting mechanism, whereby the body quickly rids itself of unwanted ingested material can also result
in damage to the upper alimentary canal and can lead to the risk of vomit (which is acidic) being aspirated
into the lungs.
Having said all this, ingestion is not generally a significant route of entry for hazardous materials into the
body and is only really likely following poor hygiene.
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The Kidneys
Waste builds up in the blood from the normal breakdown of tissues and from the breakdown of food. The
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body uses the food to provide energy and to carry out self-repairs. After the body has taken what it needs
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from the food, waste is sent via the blood to the kidneys where these wastes are removed.
The kidneys filter the blood in structures inside the kidneys called nephrons. Every kidney has about a million
nephrons. In the nephron, blood capillaries intertwine with a tiny urine collecting tube. A complicated
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chemical exchange takes place, as waste materials and water leave the blood and enter the urinary system.
The urine is collected in the bladder and excreted via the urethra.
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The kidneys remove chemicals like sodium, phosphorus, and potassium and release them back to the blood
to return to the body. In this way, the kidneys regulate the body’s level of these substances. The correct
balance is necessary for life, but excess levels can be harmful.
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Illustration 5: The Kidneys
The Circulatory System

The circulation of blood and lymph provide the means by which each cell is supplied with nutrients and waste
products removed as appropriate. The circulatory system consists of the heart, the arteries, the veins and
smaller blood vessels (capillaries) which permeate all tissues.
Illustration 6: Circulatory System

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Blood Supply
Blood is a viscous fluid which circulates throughout most of the body structure in a network of flexible tubes
known as blood vessels. There are about six litres of blood in the average adult body. It consists of a clear
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yellow fluid (plasma) in which are suspended red blood cells, white blood cells and platelets, which aid
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clotting.
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Haemoglobin is a complex chemical compound which gives the blood its red colour. The HAEM provides the
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active part of the molecule. It is a red pigment, formed by a complex molecule of iron. The GLOBIN is formed
from protein molecules. The two molecular systems are joined in such a way that they make a composite
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functional biochemical structure. Oxygen molecules (O2) from the air are inhaled into the lungs and pass
through the very thin alveoli epithelium (lining) and capillary blood vessels into the blood where they combine
with haemoglobin to form oxy-haemoglobin, which is bright red in colour and is pumped by the heart via
arteries to various parts of the body.
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Having supplied the tissues with oxygen, the waste carbon dioxide forms carboxy-haemoglobin and it is
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returned back through the veins to the lungs.
As with any fluid distribution system there are three essential parts:
• A pump – the heart
• Pipes for carrying the fluid – the blood vessels
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• Valves for regulating the fluid flow – valves within the heart and blood vessels
The Heart
Positioned between the lungs and divided by a septum into right and left sides, the heart is, in effect, two
pumps. Each side has two chambers, an atrium or intake chamber and a ventricle or delivery chamber
separated by non-return valves, which ensure one-way circulation of the blood from the atrium to the
ventricle.
Blood vessels leaving the heart are called arteries. They branch into named arteries to the organs, e.g., the
right and left pulmonary arteries from the main pulmonary artery. Arteries branch into arterioles; and arterioles
branch into blood capillaries, which supply substances to and collect other material from the cells. Blood
from capillaries flows into venules and then into veins.
It is easy to see why foreign matter getting into the bloodstream can have a catastrophic effect. As all parts
of the body are fed by the circulatory system, any toxins will also be distributed throughout the body. This
can result in systemic effects on other organs.
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The Lymphatic System
In addition to blood vessels, the body has a set of small thin-walled vessels called lymphatics. These are NEBOSH
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present in the form of lymphatic capillaries within virtually all tissue spaces. These capillaries then coalesce
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into progressively larger and larger lymphatic vessels, which lead to the neck of the person (infections in this
area are sometimes referred to as swollen glands). The lymph vessels then empty into the blood circulation
at various junctures.
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The primary purpose of the lymphatic system is to return proteins to the circulatory system when they have
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leaked out of blood capillaries. It is in effect a drainage system.

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The lymph vessels drain at intervals through lymph nodes which can be regarded as filters which drain
particulate matter. Cells present within the lymph may also be trapped in lymph nodes. If such cells result
from a tumour, they may divide and multiply within the nodes causing them to enlarge.
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The Nervous System

The nervous system is divided into two main parts: the central and the peripheral. The central nervous system
comprises the brain and the spinal cord. The peripheral part consists of the motor (controlling movement)
and sensory (controlling sensation) nerves. The basic component of the nervous system is the neuron. Nerve
impulses generated at one end of the neuron travel along the nerve fibre to release neurotransmitters at the
other end.
The central nervous system can be affected by organic solvents or heavy metals to produce disordered brain
function ranging from mild disorder to profound coma.
The peripheral nervous system is affected by neurotoxins, such as organophosphate pesticides, mercury
compounds or lead and its compounds, causing sensory disturbances, motor dysfunction or both.
Illustration 7: Nervous System
The Skin
The skin is an organ of the body, in the sense that it performs a function as well as being connective tissue. The
skin forms the outer covering of the body and is continuous with the membrane lining which covers the cavities
within the body structure, and which covers the cavities within the body structure, and which have their openings
at the body’s outer surface. It is the largest organ of the body whose main function is to protect the other organs.
Other functions include assisting with temperature regulation by sweating and enabling sensation via touching.
The skin has a number of layers; the epidermis forms the outermost layer of skin and is composed of:
• The horny zone, which forms the outermost layers of the epidermis, and

• The germinal (or living) zone, which forms the deeper level in the epidermis and consists of living cells
which can reproduce and move to the horny zone.
The dermis, or the true living skin, forms the inner part of the skin structure and consists of mainly fibrous and
elastic connective tissue. The surface of the dermis (under the germinal zone of the epidermis) has groups of
capillary blood vessels set out at various intervals. The flow of blood through these areas is important in the
control of heat transfer mechanisms. Many sensory nerve endings are in the dermis.
The skin is a partially permeable membrane covering the external surface of the body. If water or fat-soluble
materials contaminate it, they may pass through the intact skin and into the underlying subcutaneous tissues,
where they are absorbed into the blood capillary vessels and thence into the circulatory system.
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Illustration 8: The Skin
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The Eye
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The eyeball is spherical in shape and contains transparent media (aqueous and vitreous humour) through
which light is focused by a lens on to a sensitive layer (the retina). The front of the eyeball (the cornea) is
also transparent.
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Light rays entering the eye pass through the cornea and the aqueous humour to be focused by the lens. The
light then continues through the vitreous humour and strikes the retina, where electrical impulses are
generated and transmitted via the optic nerve to the brain.
If the path of the light ray is interrupted by opacity (cataract) of the lens, vision may be distorted or diminished.
Electro-magnetic waves in the form of infra-red or laser radiation can cause damage to the lens or the retina.
The eye is a very sensitive organ that can be irritated or damaged by many common workplace agents, e.g.,
ammonia, chlorine, formaldehyde, etc.
Illustration 9: The Eye
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The Ear
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This organ can be divided into three structures: the outer, middle and inner ear. Sound waves are collected
by the outer ear and pass through the auditory canal to the eardrum. Changes in sound pressure cause the
eardrum to vibrate in proportion to the sound intensity and frequency. The vibrations are transmitted through
the middle ear by three linked bones and eventually reach the cochlea, a snail-shaped organ in the inner ear.
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The cochlea is a spiral tube, which contains hairs that vibrate in response to the stimulus received from the
middle ear. Here, electrical impulses are produced which travel along the auditory nerve to the brain, where
they are perceived as sound. In addition, there are semi-circular canals which regulate balance.
Noise-induced hearing loss occurs when the hairs are damaged and no longer respond to stimuli. The hair
cells do not regenerate, so hearing loss is irreversible. Sudden loud noises may also cause the eardrum to
rupture.
Illustration 10: The Ear
Hormones
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These are chemicals which act as messengers provoking action in some distant part of the body. They are
produced by endocrine glands. For example, the thyroid gland is a gland situated in the front of the neck and
produces the chemical thyroxine.
The suprarenal glands are two small glands situated above the kidneys. They produce a number of hormones
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including adrenaline and cortisone. When the body experiences fear, or anger it makes the muscles in the
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artery walls contract and adrenaline is released. This increases the blood pressure, and consequently the
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supply of oxygen to the muscles, so that an animal is ready to meet a confrontation by either fight or flight.
This is not always an appropriate reaction for human beings in present day stressful situations where they
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cannot fight or run away.
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A number of physical conditions have been linked to stress, e.g., heart disease, asthma and duodenal ulcers.
Another significant hormone is Insulin which is produced within the pancreas. It assists with the digestion of
carbohydrates and produces insulin, which enables the body to use available carbohydrates as a source of
energy. A person who is unable to make enough insulin is classed as a diabetic and must regulate their blood
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sugar and insulin levels, often with regular injections. This may be important from an occupational point of
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view, e.g., for lone working.
Target Organs, Target Systems, Local and Systemic Effects
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Acute and Chronic Effects
As mentioned earlier, acute effects take place following short-term exposure to a hazardous material. The
effects have a quick onset and are generally reversible, unless they are fatal, e.g., being overcome by solvent
fumes.
Chronic effects follow exposure over a long period or short-term repeated exposure. Such effects have a
slow onset and are often irreversible. It can be harder to spot early signs of disease (i.e., what other people
see) and there may not be any obvious symptoms (i.e., what the person affected complains about). It is also
often difficult to link the harmful effect with exposure to the material. This is particularly true with diseases
such as cancer where there may be a number of other possible explanations or interlinked causes for the
disease and a long latent period between exposure and harmful effects.
Some substances have both acute and chronic effects. For example, high exposure to benzene over a short
period cause narcosis, a disturbance of the central nervous system whereas long exposure to lower levels
can cause liver damage, aplastic anaemia or leukaemia (malignant effects on the blood).
Local and Systemic Effects
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Local effects occur when the site of damage is at the point of contact with the substance, e.g., an acid burn
on the hand, irritation of the respiratory tract on inhalation of ammonia, etc. Absorption into the body does
not necessarily occur. Local effects can be chronic or acute. NEBOSH

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Systemic effects occur when the site of damage is at a point other than the point of contact, and so
presupposes that absorption has taken place and the material has entered the body. Routes of entry for
substances are therefore important and are discussed in a subsequent section. Systemic effects can be
chronic or acute, and commonly occur at sites of accumulation (liver, kidney, etc.).
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The most common organs affected include the lungs, liver, kidneys, nervous system, skin and bone marrow,
e.g., a chlorinated solvent may be inhaled, or skin absorbed, then once in the bloodstream may cause
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narcosis, an anaesthetic effect on the nervous system or may cause longer term liver damage.
Substances can cause both local and systemic effects. For example, high, brief exposures to cadmium oxide
fume (e.g., flame cutting cadmium plated bolts in a confined space) causes a local effect in the form of a
chemical pneumonitis (inflammation of the lung tissue). Lower levels of exposure over a period of years can
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cause emphysema (a local effect) and chronic damage to kidney tubules (a systemic effect).
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Systemic Poisons
Systemic poisons are carried by the bloodstream to the organs where the effects occur. The category of
effect is very wide indeed and consequently a concept of target organs has resulted. The following are
examples of specific systemic actions:
x Hepatotoxic Agents (liver damage): The main toxic action of these substances is damage to the
liver. Carbon tetrachloride, tetrachloroethane, and nitrosamines are examples; and
x Nephrotoxic Agents (kidney damage): The main target for these materials is the kidneys, e.g.,
halogenated hydrocarbons.
Illustration 11: Target Organs
Kidneys – Mercury,
cadmium and their
compounds.
Nerves – Solvents,
organophosphates,
mercury,
manganese and
Skin – Detergents, lead.
chlorinated hydrocarbons,
mineral oils and acids, alkalis
and many solvents.
Bone Marrow – Benzene/Lead
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Table 2: Summary of Common terms used in Occupational Health are:
The study the adverse effects of chemicals on living organisms (Klassen and
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Watkins, 1999)
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The ability of a chemical substance to produce injury when it reaches a susceptible
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site in or on the body. The effects may be acute or chronic, local or systemic.
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The level of environmental contamination multiplied by the duration of exposure to
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the contaminant.
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Local effects occur when the site of damage is at the point of contact with the
substance, e.g., an acid burn on the hand, irritation of the respiratory tract on
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Local Effect
inhalation of ammonia, etc. Absorption into the body does not necessarily occur.
Local effects can be chronic or acute.
Systemic effects occur when the site of damage is at a point other than the point of
contact. The body’s circulatory system provides a means for the substance to
Systemic Effect
distribute around the body to a target organ/system. Systemic effects can be
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chronic or acute, and commonly occur at sites of accumulation (liver, kidney, etc.).
An organ within the body to which a specific toxic material exerts its effects, for
Target Organs
example lungs, liver, brain, skin, bladder and eyes.
Central nervous system, circulatory system, and reproductive system.

Substances that have a systemic effect and their target organs/systems are:
Target Systems
Alcohol: central nervous system and liver
Lead: bone marrow and brain damage
Mercury: central nervous system.
The Body’s Defensive Responses (innate and adaptive), with

Particular Reference to the Respiratory System
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The innate immune system is our first line of defence against invading organisms while the adaptive
immune system acts as a second line of defence and also extend protection against re-exposure to the
same pathogen.
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The various systems of the body – respiratory, circulatory, alimentary and excretory, etc. have as their
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main function the maintenance of the internal conditions of the body within a constant narrow range of
limits of temperature, oxygen supply, acidity, nutrients, etc. These systems are constantly regulating
conditions inside the body to take account of the activities of the person and the environmental conditions
outside the body.
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The response of these body systems to various environmental conditions, sometimes called environmental
stresses, will range from the harmless, such as sweating or coughing to a variety of diseases.
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These bodily responses do in effect provide natural defences against attack from hazardous materials.
These are discussed further below.
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Inhalation Defences
The first defence mechanism of the respiratory system is the hair and wetness of the nose, which takes air
in an upwards direction and then turns it down the pharynx. This change of direction results in dust above
10 microns being deposited in the nasal cavity.
Sneezing and coughing are basic body defences to remove inhaled harmful substances.
The respiratory tract (trachea and bronchi) is so shaped that air travelling through it is given a turbulent motion,
which tends to throw dust (5 to 10 microns) outwards to stick on the surface of the tract. The mucociliary
escalator is a continuous clearing mechanism that serves the upper part of the respiratory system, as outlined
previously. The mucociliary escalator can be damaged by a number of agents. These include:
x Viruses
x Metal fumes, e.g., cadmium (Cd), nickel (Ni), and magnesium (Mg) (these also produce other
hazards)
x High concentrations of Oxygen (O2) (rare in occupations)
x Irritant gases chlorine (CI2), ammonia (NH3), oxides of nitrogen (NOx) and sulphur dioxide (SO2)
The bronchus of each lung divides and divides again into thinner and thinner bronchioles, which terminate in
the air sacs (alveoli) where the gas exchange takes place. Dust particles reaching the alveoli are of the range
0.5 to 7 microns or fibres (asbestos, MMMF of less than 5 microns in diameter). Note that asbestos fibres of
this diameter of lengths up to 200 microns have been inhaled according to reports.
Dust particles from 0.2 to 0.5 microns are so small that they tend to remain suspended in air and are exhaled.
Below 0.2 microns particles can be deposited in the lung, being so small they are often considered as being
of little importance, however, there may be large quantities of them in the air therefore their effect must not be
ignored although they are not normally included in monitoring strategies.
These particles which get through the defences above and are deposited in the lung will be attacked by various
antibodies, proteins, phagocytic cells, etc. This will try to deal with the offending material by surrounding it,
removing it to a position where it can be expelled from the body, dissolving it or changing it chemically, these
processes themselves although defensive, may cause disease. Macrophages are highly specialised cells that
reside in lung tissue. Being mobile, they engulf and digest bacteria. They are destroyed in the process. The
debris is cleared by mucociliary escalator or drains to the lymphatic system. The act of destruction of
macrophages results in the release of a powerful proteolytic enzyme which damages the lining of the air sac
and ends in scar formation. The macrophage itself can be engulfed and destroyed by a toxic dust. Dust will
then remain static in the lung.
Substances that enter the blood stream via the respiratory system will eventually reach the liver. Although the
liver can deal with many toxic substances, damage to other parts of the system may be caused before reaching
the liver.

Ingestion Defences
The digestive tract, which is made up of the mouth, oesophagus, stomach, small and large intestine is a long
tube open at both ends through which material passes. To gain access to the body harmful substances have
to survive the acids in the stomach and the various enzymes, starting in the mouth and continuing in the large
intestine, which attack and try to break down materials. Almost all absorption into the body takes place in the
small intestine.
Some harmful substances or micro-organisms will cause an immediate reaction in the body leading to the
defence mechanisms of vomiting and diarrhoea. These are the mechanisms by which unwanted substances
are expelled from the body. Both are often a symptom of food poisoning and can lead to serious dehydration.
The liver and kidneys as discussed earlier are the main defence system for dealing with ingested substances.
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Skin Defences
The skin provides an excellent defence against most substances. The epidermis provides a protective outer
layer while the dermis contains a number of defence mechanisms.
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The sebum secreted by the sebaceous glands of the dermis will provide protection against water and against
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water and against acids and alkalis in weak concentrations. Sebum also prevents the skin drying out when
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subject to heat and friction. This protection can be broken down by high concentrations of corrosive
substances or excessive abrasive action, burns, etc. It can also be removed by the use of solvents
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unintentionally or deliberately.
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The sensory nerve cells are also an important defence mechanism, altering the brain to heat, cold, etc. and
prompting involuntary defence action by the muscles.
Protection against ultra-violet light is provided by the melanin pigment cells, which tan on exposure to sunlight.
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Blisters, rashes, inflammation, etc. are all examples of the body defence system reaction to damage or
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attack and result from increased flow of blood, antibodies, phagocytes, etc. to the affected area.
The Immune System

The body can deal with a number of foreign agents using various cells such as white blood cells and
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antibodies which are specific to particular bacteria or viruses, an agent which causes the body’s defence
mechanism to produce antibodies is known as an antigen. This can be influenced by vaccination, whereby
the introduction of the antigen to the system causes antibody production, which then recognises future
exposures and protect the individual. Certain hazardous agents, e.g., the human immunodeficiency virus
(HIV) can damage the immune system and sensitisation reactions can occur in which the body’s immune
system reacts in an inappropriate manner to the presence of an antigen.
Other Defences
The body has a range of defences against harm including simple ones, such as blinking the eye to protect
against excessive light, lachrymation (watering eye) to complicated and little understood mechanisms which
involve the automatic release of certain hormones, e.g., adrenalin.
Pain is a defence mechanism, which tells us that we are stressing our body beyond its normal capacity.
Manual work, repetitive movements, etc. will result in pain and to continue to carry out the same operation
despite the pain can lead to permanent damage.
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Dusts
In terms of inhalable materials, these are generally referred to as aerosols, which in scientific terms, means
any dispersed system of solid or liquid materials suspended in a gas. This is a broader definition that the
perhaps commonly held view of the output from a spray can.
NB the term micron is used in this element; it is also known as a micrometre and is expressed as µm. The
measurement is one millionth of a metre or 1/1000th of a millimetre.
The size of dust particles is significant in terms its ability to cause harm, since the smaller the particles the
more likely they are to be deposited in the lung tissue after being inhaled.
Dust can be regarded as solid particles ranging up to 150 microns in diameter. Anything over 75 microns is
classed as grit and is unlikely to remain airborne. Dusts can be produced mechanically by grinding or similar
actions.
Dust is divided into the following categories depending on size:
x Total inhalable dust that is dust that will enter the nose and mouth during breathing and is up to
around 100 microns in size.
x Thoracic fraction which is dust of around 7 – 10 microns in size.
x Respirable dust is that part of total inhalable dust that will reach down into the lower levels of the
lung around 0.5 to 7.0 microns in size.
Particles below around 0.5 microns in size will tend to remain airborne and be expelled from the respiratory
system.
If the dust is of a particularly toxic nature, e.g., lead or copper, then the potential for harm is greater particularly
if the material is of the respirable fraction.
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9.5 Health Risks from Hazardous Substances
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REACH (Registration, Evaluation, Authorisation and
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Restriction of Chemicals)
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REACH is a regulation of the European Union, adopted to improve the protection of human health
and the environment from the risks that can be posed by chemicals, while enhancing the competitiveness
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of the EU chemicals industry. It also promotes alternative methods for the hazard assessment of substances
in order to reduce the number of tests on animals.
Aims of REACH
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The aims of REACH include:
x To provide a high level of protection of human health and the environment from the use of
chemicals.
x To make the people who place chemicals on the market (manufacturers and importers)
responsible for understanding and managing the risks associated with their use.
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x To promote the use of alternative methods for the assessment of the hazardous properties of
substances e.g., quantitative structure-activity relationships (QSAR) and read across.
How does REACH work?

REACH establishes procedures for collecting and assessing information on the properties and hazards of
substances. Companies need to register their substances and to do this they need to work together with
other companies who are registering the same substance.
ECHA receives and evaluates individual registrations for their compliance, and the EU Member States
evaluate selected substances to clarify initial concerns for human health or for the environment. Authorities
and ECHA's scientific committees assess whether the risks of substances can be managed.
Authorities can ban hazardous substances if their risks are unmanageable. They can also decide to restrict
a use or make it subject to a prior authorisation.
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REACH's effect on companies
REACH impacts on a wide range of companies across many sectors, even those who may not think of
themselves as being involved with chemicals.

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In general, under REACH you may have one of these roles:

x Manufacturer: If you make chemicals, either to use yourself or to supply to other people (even if
it is for export), then you will probably have some important responsibilities under REACH.
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x
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Importer: If you buy anything from outside the EU/EEA, you are likely to have some responsibilities
under REACH. It may be individual chemicals, mixtures for onwards sale or finished products, like
clothes, furniture or plastic goods.
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x Downstream users: Most companies use chemicals, sometimes even without realising it. You
need to check your obligations if you handle any chemicals in your professional or industrial
activity. You might have some responsibilities under REACH.
x Companies established outside the EU: If you are a company established outside the EU, you
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are not bound by the obligations of REACH, even if you export their products into the customs
territory of the European Union. The responsibility for fulfilling the requirements of REACH, such
as pre- registration or registration lies with the importers established in the European Union, or
with the only representative of a non- EU manufacturer established in the European Union.
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Globally Harmonised System of Classification and

Labelling of Chemicals (GHS) and the EC Regulation No
1272/2008
GHS – Classification of Substances and Mixtures

One of the objectives of the work on the Globally Harmonised System (GHS) has been the development of a
harmonised hazard communication system, including labelling, safety data sheets and easily understandable
symbols, based on the classification criteria developed for the GHS.
GHS includes a harmonized criteria for classifying substances and mixtures according to their health, physical
and environmental hazards. It also includes harmonized communication elements, including requirements for
labelling and safety data sheets.
Hazards associated with a chemical substance is communicated using a hazard statement which is assigned
to a hazard class and category that describes the nature of the hazards of a hazardous product, including
where appropriate the degree of the hazard.
Precautionary statements are used to communicate the recommended measures that should be taken to
prevent or minimize adverse effects resulting from exposure to a hazardous agent.
Criteria for classifying chemicals have been developed for the following hazard classes:
x Acute oral toxicity x Germ cell mutagenicity

x Skin corrosion/irritation x Carcinogenicity
x Serious eye damage /eye x Specific target organ systemic
irritation toxicity - single exposure
x Respiratory or skin x Specific target organ systemic
sensitisation toxicity - repeated exposure
x Reproductive toxicity x Aspiration hazard
Health Hazard Classes
Acute Oral Toxicity

Acute toxicity refers to adverse effects occurring following oral or dermal administration of a single dose of a
substance or a mixture, or multiple doses given within 24 hours, or an inhalation exposure of 4 hours.
The classification of categories and labelling for acute skin and inhalation toxicity are the same as oral NEBOSH International Diploma
exposure, except for slightly different hazard statements. Example of a substance with acute oral toxicity is
arsenic, which is a systemic poison.
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Oral – ATE (based 0n LC50/LD50)
Cat 1- 5mg Cat2 – 5-50mg Cat 3 50-300mg Cat 4 300-2000mg Cat5 2000-5000mg
Dermal ATE
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Cat1 – 50 mg Cat 2 50-200mg Cat 3 200-1000mg Cat 4 1000-2000mg Cat5 2000-5000mg
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Skin Corrosion/Irritation
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Skin Corrosion is the production of irreversible damage to the skin; namely, visible necrosis through the
epidermis and into the dermis, following the application of a test substance for up to 4 hours. Corrosive
reactions are typified by ulcers, bleeding, bloody scabs, and, by the end of observation at 14 days, by
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discolouration due to blanching of the skin, complete areas of alopecia, and scars.
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Skin Irritation is the production of reversible damage to the skin following the application of a test substance
for up to 4 hours.
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Serious Eye Damage/Eye Irritation

Serious eye damage is the production of tissue damage in the eye, or serious physical decay of vision,
following application of a test substance to the anterior surface of the eye, which is not fully reversible within
21 days of application.
Eye irritation is the production of changes in the eye following the application of test substance to the anterior
surface of the eye, which are fully reversible within 21 days of application.
This generally relates to effects on the cornea, iris or conjunctiva.
Category 1: substances have the potential to seriously damage the eyes and the effects are
irreversible.
Category 2A: substances cause severe irritation, and the effects are reversible.
Category 2B: substances cause mild irritation and is fully reversible within 7 days.
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Respiratory or Skin Sensitisation

Respiratory sensitizer is a substance that will lead to hypersensitivity of the airways following inhalation of
the substance.
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Skin sensitizer is a substance that will lead to an allergic response following skin contact.
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Sensitisation involves two phases: the first phase is the recognition stage where the substance following
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contact with the airways or skin, is recognised by the body as a pathogen. The second phase is the
production of antibody and allergic response by exposure of a sensitized individual to an allergen.
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x Respiratory Sensitisation Category 1: substances may cause specific hypersensitivity such as
asthma and rhinitis/conjunctivitis following inhalation.
Examples of respiratory sensitizers include isocyanates and flour dust.
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Skin Sensitisation Category 1: substances that have strong documented evidence of causing allergic
contact dermatitis.
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Annex 1 GHS
Reproductive Toxicity
Reproductive toxicity includes adverse effects on sexual function and fertility in adult males and females, as
well as developmental toxicity in the offspring.
The genetically based heritable effect in the offspring falls under the classification of Germ Cell Mutagenicity
under two main headings:
x Adverse effects on sexual function and fertility which includes alternations to the reproductive system,
effects on the onset of puberty or the reproduction cycle, sexual behaviour, fertility and pregnancy
outcomes.

x Adverse effects on development of the offspring which includes interference with the development of
the foetus or child, before or after birth caused by exposure of either parent prior to conception or
during development of the offspring.
Category 1: Known or presumed human reproductive toxicant. Substances in this category are known to
have produced an adverse effect on sexual function and fertility with the capacity to interfere with reproduction
in human.
Category 2: Suspected human reproductive toxicant. Substances in this category are ones where there is
concern that they may be a human reproductive toxicant.
An example of a substance classified as reproductive toxic is lead.
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Annex 1 GHS
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Germ Cell Mutagenicity

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A mutation means a permanent change in the amount or structure of the genetic material in a cell. This
hazard class is primarily concerned with substances that may cause mutations in the germ cells of humans
that can be transmitted to the progeny.
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Category 1: substances are known to induce heritable mutations in the germ cells of humans
Category 2: substances are ones which cause concern for humans due to the possibility that they may
induce heritable mutations.
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Annex 1 GHS
Carcinogenicity
Carcinogen is defined as a substance or a mixture of substances which induce cancer or increase its
incidence. Substances which have induced benign and malignant tumours in well performed experimental
studies on animals are considered also to be presumed or suspected human carcinogens unless there is
strong evidence that the mechanism of tumour formation is not relevant for humans.
Category 1: substances are known to induce cancer due to related evidence.

Category 2: substances are ones which cause concern for humans due to the possibility that they may induce
cancer.
An example of a carcinogenic substance is benzene which can cause leukaemia.
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Annex 1 GHS
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Specific Target Organ Systemic Toxicity - Single Exposure

Specific target organ systemic toxicity classification (single exposure) is for substances that produce
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specific, non-lethal target organ toxicity arising from a single exposure. The effects can impair function, both
reversible and irreversible, immediate and/or delayed but are not addressed in other classifications.
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Specific target organ toxicity can occur by oral, dermal and inhalation routes.
x Category 1 substances are known to have produced significant toxicity in humans.

x Category 2 substances are presumed to have the potential to be harmful to human health following
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single exposure.
x Category 3 substances cause transient target organ effects which adversely alter human function
for a short duration after exposure and from which humans may recover in a reasonable period
without leaving significant alteration of structure or function. This category only considers narcotic
effects and respiratory tract irritation.
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Annex 1 GHS
Specific Target Organ Systemic Toxicity – Single and Repeated

Exposure
Classification depends on the availability of reliable evidence that a single exposure to the substance or
mixture has produced an identifiable and consistent toxic effect in humans, or, in experimental animals,
toxicologically significant changes which have affected the function or morphology of a tissue/organ or has
produced serious changes to the biochemistry or haematology of the organism and these changes are relevant
to human health.
Repeated Exposure: Specific target organ systemic toxicity classification (repeated exposure) is for
substances that produce specific, non-lethal target organ toxicity arising from a repeated exposure. The
effects may be reversible irreversible, immediate and/or delayed but are not addressed in other classifications.
Specific target organ toxicity can occur by any route that is relevant for humans, i.e., principally oral, dermal,
or inhalation.
x Category 1 substances are known to have produced significant toxicity in humans.

x Category 2 substances are presumed to have the potential to be harmful to human health following
repeated exposure.
All significant health effects that can impair function, both irreversible and reversible, immediate and/or delayed
are included. Classification identifies the substance or mixture as being a specific target organ toxicant and,

as such, it may present a potential for adverse health effects in people who are exposed to it.
It is recognized that human data will be the primary source of evidence for this hazard class. Assessment
should take into consideration not only significant changes in a single organ or biological system, but also
generalized changes of a less severe nature involving several organs.
Aspiration Hazard
Aspiration means the entry of a liquid or solid substance or mixture directly through the oral or nasal cavity, or
indirectly from vomiting, into the trachea and lower respiratory system. Aspiration toxicity includes severe
acute effects such as chemical pneumonia, varying degrees of pulmonary injury or death following aspiration.
Category 1 substances are known to have caused aspiration toxicity in humans.

Category 2 substances are those that cause concern of aspiration toxicity in humans.
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Information on Substances or Preparations/Mixtures Which
Have the Potential to Cause Harm
Health Issues
Concise International Chemical Assessment Documents
Concise International Chemical Assessment Documents (CICADs) are similar to Environmental Health
Criteria (EHC) documents in providing internationally accepted reviews on the effects on human health and
the environment of chemicals or combinations of chemicals. They aim to characterize the hazard and dose-
response of exposure to chemicals and to provide examples of exposure estimation and risk
characterizations for application at the local or national level. They summarise the information considered
critical for risk characterisation in sufficient detail to allow independent assessment but are concise not
repeating all the information available on a particular chemical. For more detail readers of individual CICADs
are to the original source document for the CICAD (either a national or regional chemical evaluation
document or an existing EHC (chemicals series).
The International Programme on Chemical Safety (IPCS), INCHEM Health and Safety
Guides (Series)
Information on dangerous substances can be IPCS INCHEM includes chemical related health,
obtained from medical databases, Chemical safety and environment reports from inter-
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Abstract Service (CAS), Employment Medical governmental organisations and is particularly
Advisory Service (EMAS) and the Health and useful when undertaking assessments of
Safety Executive (HSE), within the UK, e.g., hazardous substance exposure. The information
Environmental Hygiene (EH), Medial Series (MS) can be accessed at www.inchem.org. NEBOSH
and Chemical Safety (CS) Guidance notes.
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From an international perspective, an information This information has been released free of
source worthy of note is the IPCS INCHEM, charge to enable access to people from
produced through cooperation with the World developing countries and compiles chemical-
Health Organisation (WHO). related health, safety and environment
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documents and databases from several

International
This program consolidates information essential international organisations. On average,

for the sound management of chemicals that 170,000 visitors per month visit this site. The
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affect the environment and human health in the widespread global use clearly indicates the need
form of chemical safety cards which have been for such a program.
peer-reviewed.
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Labelling
In respect to labelling, GHS requires the following information:
a) Allocation of label elements

b) Reproduction of the symbol
c) Reproduction of the hazard pictogram

d) Signal words
e) Hazard statements
f) Precautionary statements and pictograms
g) Product and supplier information
h) Multiple hazards and precedence of information
i) Arrangements for presenting the GHS label elements
j) Special labelling arrangements
The Safety Data Sheet is also an important aspect of GHS.
These classifications are used to provide the customer with information detailing the hazard and explaining
how to use the chemical safely.
The information is provided by labels and Safety Data Sheets (SDS), as recommended by the ILO in their
1993 Code of Practice: Safety in the Use of Chemicals at Work.
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Safety Data Sheets

The Role of the Safety Data Sheet (SDS) in the Harmonised
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The SDS should provide comprehensive information about a chemical substance or mixture for use in
workplace chemical control regulatory frameworks. Both employers and workers use it as a source of
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information about hazards, including environmental hazards, and to obtain advice on safety precautions. The
information acts as a reference source for the management of hazardous chemicals in the workplace. The
SDS is product related and, usually, is not able to provide specific information that is relevant for any given
workplace where the product may finally be used.
Occupational
An SDS should be produced for all substances and mixtures which meet the harmonized criteria for physical,
Workplace Health
health or environmental hazards under the GHS and for all mixtures which contain substances that meet the
criteria for carcinogenic, toxic to reproduction or specific target organ systemic toxicity in concentrations
exceeding the cut-off limits for SDS specified by the criteria for mixtures.
The Safety Data Sheet must provide sufficient information to show the user how to protect people at work and
the environment. The information should be provided under the following 16 headings:
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1) Identification of substance / preparation and company
2) Composition / information on ingredients
3) Hazards identification
4) First-aid measures
5) Fire-fighting measures
6) Accidental release measures
7) Handling and storage
8) Exposure controls / personal protection
9) Physical and chemical properties
10) Stability and reactivity
11) Toxicological information
12) Ecological information
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13) Disposal
14) Transport information
15) Regulatory information NEBOSH

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16) Other information
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The Factors to be Considered in the Assessment of Risks to

Health from Hazardous Substances:
The ILO, Safety in the use of chemicals at work, Code x General health, nutritional state and the
of Practice Section 6.2 procedures for assessing risks condition of the immune system where the
states that risk assessments need to be conducted by existence of an existing medical condition
employers and the individual who carries out the may cause immunosuppression, i.e.,
assessment must be competent. reduction in the defensive capabilities of
the body.
Hazard is only one aspect of the risk. The likelihood
of the hazard being realised and the consequence for x Some individuals may be atopic. This
individuals exposed is dependent upon a number of means that they have a particular
factors which could be taken into account during the tendency to allergic reactions and a
assessment: history of asthma and/or eczema. Such
individuals are more likely to be affected
x Numbers exposed by high molecular weight protein antigens
x Aerosol / particle size such as flour, grain, rodent urine, mite
faeces, etc.
x Concentration
x Pre-existing medical conditions, which
x Type and duration of exposure
could be made worse by exposure to
chemicals.
Numbers Exposed x Another example is the case of a pregnant
woman. Before pregnancy, the body may
The more people that are exposed to the hazardous not be harmed at all by exposure to low
substance then the greater the risk there is of levels of a chemical agent. Once
someone being harmed and consequently the greater pregnant. However, the foetus may be
the imperative to ensure collective measures are harmed by the same level of exposure
given priority over individual measures. that would not harm the adult woman or
any others in the group.
Within the group who are at risk of exposure or who
use the substances in their normal work routines there
needs to be consideration of the factors that may
cause the individual to be susceptible to exposure of Who Else Could be Exposed?
the substance in question.
It is important to consider whether those not directly
involved in the operation could be affected, e.g.,
Individual Susceptibilities nearby operators, or members of the public
(depending on location), contractors of cleaning
Individual factors may have a significant impact on the staff who may be in the area after hours.
variability of response to exposure to substances and
includes factors such as:

Aerosol/Particle Size
x Age, the significance of young people in the
workplace and the associated risk control
measures that are required to protect them in
In what form is the substance
the workplace. present?
x Gender, where there are specific risks to the
reproduction systems or the potential for A finely divided solid is more likely to become
effects on new and expectant working airborne and therefore present a greater risk of
mothers then any additional risks will need to inhalation than coarse grit or pellets. An acid in its
be addressed to both the mother and the liquid form is potentially much less harmful than the
child. same material which is being sprayed, since the
aerosol can be breathed in and covers a much
x Genetic make-up, including ethnicity and larger surface area, therefore making the
inherited characteristics, which may make consequence of exposure worse and increase the
individuals more susceptible to effects of likelihood of systemic effects.
exposure to substances or other agents such
as UV light.
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In general, a dust, gas, mist of fume is a significant This toxicity data can be established from the
respiratory hazard, the smaller the particle size then Material Safety Data Sheets (MSDS) provided
potentially the deeper the lung penetration will be. with the substances.
Liquids and solids are more likely to be dermatitis
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hazards since they are more difficult to inhale. Whilst toxicity data is readily available from the
various sources, e.g., suppliers and
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The solubility of the material in body fluids is an manufacturers, the onus of assessing the risk of
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important characteristic since absorption into the body employees using the substance remains with the
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systems will determine the metabolism (assimilation employer in the circumstances which he intends to
into the body) of the substance. Lipid soluble use the substance.
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substances such as organic solvents can be
deposited in lipid rich areas within the body such as Where more than one chemical is used, the way
beneath the skin, around the kidneys and in the bone in which substances can interact can be
marrow, where they may have a prolonged effect as significant. This could be either:
they are slowly released.
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x Independent, the chemicals act in totally
The shape, of the dust is also important. Dust
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different ways and can therefore be
particles are rarely spherical in shape, yet it is the considered separately, e.g., oil and
aerodynamic diameter which influences the particles’ water;
ability to penetrate the lung tissue. The aerodynamic
diameter is the effective spherical dimension (ESD) of x Additive, the chemicals have similar
the particle. Particles having the same aerodynamic effects on the body, therefore their
diameter may have different dimensions and shapes. effects can be added together, e.g., two
Health Issues
similar solvents such as toluene and
Fibrous materials can be particularly dangerous since xylene; or
the body’s defence mechanisms can cause self-
damage. Respirable fibres tend to be those with an Synergistic - in which the chemicals have a
aspect ratio (length to width) of 3:1 and include natural combined effect which is more dangerous than the
mineral fibres, e.g., asbestos. sum of the individual effects (e.g., drinking alcohol
while on certain medication or working with
asbestos and smoking).
Type and Duration of Exposure
In normal agricultural practice, it is rare to use only
The time period over which the person has been a single pesticide. During the production of a crop
exposed is also significant since a number of several different materials may be used. Each
substances have an immediate or acute effect and pesticide has an exposure level below which they
others may have a cumulative effect resulting in would be considered individually safe. In many
chronic ill-health, e.g., following long-term exposure. cases, a commercial pesticide is itself a
combination of several chemical agents, and thus
Repeated exposure, even at low levels may lead to the safe levels actually represent levels of the
cumulative effects if the substance is deposited in the mixture. In contrast, combinations created by the
body, e.g. effects of chronic lead poisoning. end user, such as a farmer, are rarely tested as
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that combination. The potential for synergy is then
The dose received of a substance is a combination of unknown or estimated from data on similar
the concentration to which individuals are exposed combinations. This lack of information also applies
and the length of time of exposure. Thus, reducing to many of the chemical combinations to which
exposure time has a direct benefit in terms of reducing individuals are exposed, including residues in
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exposure. A work pattern that includes job rotation or food, indoor air contaminants, and occupational
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enforced changes in work activity is one means of exposures to chemicals.

achieving this.
The substance’s inherent toxicity is a key factor to

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consider in the assessment of health risks as is

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therefore the amount of substance used or exposed

to, a few grams of material will be much less
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hazardous than bulk quantities of chemicals.

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Frequency of exposure
A task involving a substance may be infrequent because it is only conducted as part of a periodic
cleaning/maintenance activity, or the substance may be used daily as part of normal task operations. The
frequency of use, together with the type and duration of exposure, can greatly influence risk. Exposure to
some substances may be acceptable as they are infrequent, thus allowing the worker’s body to recover from
the exposure before additional exposures take place.
Effects of Mixture
Some substances when mixed will have synergistic effects. In toxicology, synergism refers to the effect caused
when exposure to two or more chemicals at the same time results in health effects that are greater than the
sum of the effects of the individual chemicals. Antagonism is the opposite of synergism.
It is the situation where the combined effect of two or more compounds is less toxic than the individual effects.
Antagonistic effects are the basis of many antidotes for poisonings or for medical treatments.
The Range of Uses

Hazardous substances are used in many places and in many different ways, including in factories, shops,
laboratories, offices, farms and in the home and garden. The substances used at work may include products
purchased in your core business, or in maintaining equipment, or in general cleaning.
The Thresholds of Exposure

The amount needed to cause harm may be a discernible threshold for some substances, but others may have
no safe level. Exposure to a substance does not automatically mean it is a high risk. It is important to take
account of acceptable exposure thresholds.
The Consequences of Failure of Existing Control Measures

The type of control measure used can greatly influence the level of risk, depending on its effectiveness
Whenever possible, priority to collective (engineering) controls should be given over individual controls
For example, effective LEV instead of reliance on the issue and use of respirators.
The risk assessment should consider the actual effectiveness of existing control measures by determining
exposure levels when they are in use, where possible.
The Results from Health Surveillance and Exposure Monitoring


The results from relevant health surveillance and exposure monitoring will provide information on the
effectiveness of controls. If workers are being exposed to higher than intended levels of the substance, this
can provide an indication of actual risk to their health and indicate areas where controls are not effective
Health surveillance can provide information on actual harm to health and illustrate that there may be a higher
level of risk than was expected.
It can also help identify groups of people particularly at risk.
Other Aspects to Consider

How is the Work Actually Undertaken?
The amount of physical effort involved in carrying out the work is likely to affect the individual’s susceptibility
to substances in the working environment. As the body’s work rate increases so breathing becomes deeper,
increasing the likelihood of inhaling substances or particles deep into the lungs. The pores on the skin open
to maintain the body’s temperature through evaporative cooling. This may increase the likelihood of dermatitis
conditions through skin contact.
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The work methods which are used or likely to be used need to be carefully evaluated. Foreseeable short-cuts
and errors, which could lead to exposure, should be considered as well as levels of supervision necessary to
ensure that individuals comply with the systems of work put in place.
What Could Go Wrong?
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It is important to consider foreseeable emergency scenarios, e.g., a large container of hazardous chemical
splitting and spilling its contents causing widespread uncontrolled exposure to the substance.
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What are the Environmental Conditions?
The risk outdoors can be much less since the contaminant is more likely to be dispersed. Variations in
temperature, relative humidity and airflow can also have a significant influence on the concentration and
exposures to substances, e.g., higher concentrations of vapour from volatile liquids are more likely at
Occupational
elevated temperatures where there is little or no air movement.
Workplace Health
Summary of Hazardous Substance Assessment
The risk assessment should include consideration of:
Health Issues
x The hazardous properties of the substance
x Information on health effects provided by the supplier, including information contained in any
relevant safety data sheet
x The level, type and duration of exposure
x The circumstances of the work, including the amount of substance involved
x Activities, such as maintenance, where there is the potential for a high level of exposure
x Any relevant Exposure Limit
x The effect of preventive and control measures which have been or will be taken
x The results of relevant health surveillance
x The results of exposure monitoring
x The risk of exposures to combinations of substances hazardous to health
x The approved classification of any biological agent, if applicable
Review of the Assessment
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The assessment should be reviewed whenever there has been a significant change in the work to which it
relates or when there is a reason to suspect that it is no longer valid. The review should be incorporated
into a system of management accountability which ensures that control action shown to be necessary by NEBOSH
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the initial assessment is in fact taken.
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Reasons for a Review

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Reasons indicating that assessment might no longer be valid might include:
x
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Complaints by workers of adverse health effects and detection of health impairment

x An accident, dangerous occurrence or incident leading to exposure to hazardous ambient factors
or risks which are different from that quantified in the initial assessment
x Subsequent measurement of exposure levels
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x Availability of updated information on the hazards or risks of hazardous ambient factors

x Plant modification, including engineering control measures, changes in the process or methods
of work and in the volume or rate of production which lead to a change in the hazardous ambient
factors present
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x The review should reconsider all parts of the initial assessment, and in particular, whether it is
now practicable to eliminate any hazardous ambient factors
x Possible to control at source and minimize hazards or risks which had previously required
personal protective equipment
x The review should consider the results of the programme for monitoring of exposure levels and
whether Exposure levels previously considered to be acceptable should now be regarded as too
high in the Light of available and updated information on the hazards and risks of hazardous
ambient factors
x Any control action needs to be taken
x The frequency and type of control will depend on the exposure found in relation to recognized
exposure limits
The results of the review should be recorded and made available in the same way as the initial assessment.
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The Prevention and Control of Exposure to Hazardous

Substance
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The ILO has produced two Codes of Practice ‘Safety in the Use of Chemicals’ and ‘Ambient factors in the
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workplace’ which give very detailed information on working with hazardous substances:
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x The ILO ‘Code of Practice, Safety in the Use of Chemicals at Work’ - Section 6.4 recommends
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elimination as one of the control measures established for safety in the use of hazardous chemicals
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- Section 6.5 recommends further control measures for safety in the use of hazardous chemicals.
x The ILO Code of Practice ‘Ambient Factors in the Workplace’ - Section 4.3 adds that control measures
should extend to spills, leaks and restricting the area of contamination.
Occupational
Hierarchy of Control
Workplace Health
Risk assessment of hazardous substances requires Specific additional requirements should be in place
the prevention or control of exposure to substances for the control of carcinogens and biological agents.
hazardous to health, in accordance with the
following hierarchy: Measures for controlling or preventing exposure are
discussed in more detail:
Health Issues
x Preventing the exposure of employees to
substances hazardous to health or, where Elimination of exposure
this is not possible, adequately controlled.
x Substitution is the preferred option for Clearly the most effective way of controlling the risk
compliance with the duty of prevention, from a hazardous substance is not to use it at all. In
replacing substances hazardous to health most industrial process this is not realistic,
with alternative substances or processes particularly in manufacturing. There may be some
which, either eliminate or reduce the risk to situations however, where a task could be
health; and undertaken by means other than the use of
chemicals. For example, physical means could be
x Where prevention is not possible, used to clear blocked drains rather than using highly
appropriate health protection measures acidic drain cleaning chemicals.
should be applied, including in order of
priority: Substitution
- The design and use of appropriate
work processes, systems and Chemicals vary in the degree of hazard which they
engineering controls and the provision present. Often a chemical with similar properties is
and use of suitable work equipment significantly less hazardous, e.g., benzene is a
and materials; (e.g. arrangements for
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carcinogen, Toluene is a similar solvent, but not
the safe handling, storage and considered carcinogenic. Increasingly, water based
transport of substances hazardous to paints are used instead of solvent based materials.
health (including waste); suitable This is an example of environmental imperatives
maintenance procedures; reducing being in line with health and safety priorities.
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the number of employees exposed,
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the level and duration of exposure, When considering substitution, it is important to

and the quantity of substances ensure that the replacement material really does
hazardous to health present at the present a lower risk overall. For example, a material
workplace; control of the working may have a lower acute toxicity, but be more
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environment, including general

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irritating to the skin and eyes. A consideration of all

ventilation; and hygiene measures the risk factors associated with the way in which a
such as washing facilities). material is used within a process will need to be
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- The control of exposure at source, made.

including adequate ventiation systems
and appropriate organisational
measures; and
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- Where adequate control of exposure

cannot be achieved by other means,
the provision of suitable personal
protective equipment.
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Change of Work Methods
Changing the means of application of a hazardous substance, e.g., painting by hand with a brush, rather than
paint spraying will significantly reduce the generation of airborne contaminants.
Methods of Control
Totally Enclosed Process and Handling Systems
This is the most effective of the engineering controls but is likely to be expensive to achieve and will lead to
clear difficulties with respect to handling materials. However, where particularly hazardous materials are used
(e.g., carcinogens) there is a greater imperative to totally enclose a process.
Examples of full enclosure are outlined below:

x Fully contained reactor vessel and pipework.
x Glove Box.
x Robotic spray paint booth.
x Enclosed powder coating process; and
x Various processes involving filling and emptying of containers can be undertaken under
enclosed conditions if required.
Partial Enclosure, With Local Exhaust Ventilation
Exhaust ventilation or extraction is the key to most engineering controls for hazardous materials. The greater
that the process can be enclosed the more effective the control shall be.
Illustration 12: Fume Cupboard
Examples of partially enclosed systems

include:
x Fume cupboards.
x Spray booths.
x Ventilated work benches/ cabinets;
and
x A range of partially enclosed

processes.
Segregation of the Process

Layout of the workplace to be designed in such a way that it geographically separates people and the hazardous
process areas. This can be achieved by storing and carrying out process activities away from the occupied
premises of the workplace and strictly control access to these areas only by authorized people.
Process Modification
The option to modify the process method or equipment might minimize the exposure to hazardous substance.
This might result in a healthier, safer and possibly less expensive alternative process.
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Since continued advances in technology are being made, even if the use of different equipment is not
immediately a valid option, the possibility should always be considered, especially at the time of the
hazardous substance risk assessment review.
For example, if the process involved high solvent levels from mixing paint preparations in open containers
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at temperatures above ambient. Then the process can be modified by using containers with well-fitting lids
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and with a water cooling system plus the use of curtains or screens to reduce solvent vapours caused by
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draughts.
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ILO Code of Practice – Ambient factors in the workplace also highlights the need for minimize the
contamination area in case of emergency situations like spills and routine fugitive releases, by considering
Controlling
secondary containments/drip trays and arrangement to remove spills safely by having sufficiently planned
‘spill kits’, and regular cleaning and maintenance.
Occupational
Local Exhaust Ventilation
Workplace Health
Where the process cannot be enclosed, ventilation can still be an important control measure. In particular,
Local Exhaust Ventilation (LEV) ensures that the contaminant is reduced, as much as possible, at source,
i.e., before it gets the opportunity to disperse into the wider environment where it may be inhaled by
operators.
Health Issues
Illustration 13: Welding Fume LEV
Examples of Local Exhaust Ventilation include:
x Flexible hoses and captor hoods which can be

positioned to the source of the release, e.g., welding
fume extractors.
x Extraction equipment associated with grinding
wheels, etc. For these it is important that, as far as
possible that the hood is in a position to collect the
dust, within the direction of its movement.
x Lip extraction as used for solvent baths, etc. and
x Soldering extractors, including the tool-tip extraction
systems.
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General Ventilation
For relatively low risk situations involving small quantities of material or relatively low hazard substances, it
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may be sufficient to provide good general (dilution) ventilation within the workplace. This can either be
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natural involving windows and other openings, or more usually in a workplace, forced extraction.
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The technical measures outlined above are sometimes referred to as engineering controls. Control
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measures are not however restricted to such technical fixes, it is important to remember that there are a
number of softer measures which can also be effective in reducing exposure to hazardous materials. Such
measures include:
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The reduction of numbers of employees exposed and exclusion of non-essential access.
x Minimise Numbers exposed - Reduction in the duration and / or frequency of exposure for
employees. Job rotation can ensure that no group of employees in particular is subject to excessive
exposure.
x Cleaning Regimes - Regular clearing of contamination from, or disinfecting of, walls, surfaces,
etc.
x Storage - Provision of mean of safe storage, including segregation of incompatible substances and
disposal of substances hazardous to health.
x Transportation - Care to be taken to avoid/minimise spoils and leaks. Consider transferring to bulk
storage containers through pipeworks.
x Hygiene Practices - Prohibition of eating, drinking, smoking etc. in contaminated areas; and Provision
of adequate facilities for washing, changing and storage of clothing, including arrangements for
laundering contaminated clothing.
x Maintenance of Engineering controls - When engineering controls are provided, employers must
ensure that thorough examination and tests of those engineering controls are carried out. In the case
of local exhaust ventilation this should be at least every 14 months. But the 14-month interval may vary
slightly from country to country.
x Provide personal protective equipment (PPE) - When adequate control of exposure cannot be
achieved by other means, a combination of control measures and personal protective equipment (PPE)
may be applied. Alternatively, PPE may be used on its own. It is important that other, more effective
means of control be considered before resorting to the use of PPE alone
x Signs and Notices - Prohibition signs to prevent unauthorized entries, warning signs to alert about
chemical hazards, notices giving instructions to people and mandatory signs for PPEs must be installed
as per risk assessment.
Information, Instruction and Training

Employers should provide suitable and sufficient information, instruction and training to employees who
undertake work which involves exposure to substances hazardous to health.
The information, instruction and training should include:

x Details of the substances hazardous to health to which the employee is liable to be exposed
including:
- The names of those substances and the risk which they present to health.
- Any relevant exposure limit.
- Access to any relevant safety data sheet, and
- Other legislative provisions or standards which concern the hazardous properties of those
substances.

x The significant findings of the risk assessment.
x The appropriate precautions and actions to be taken by the employee in order to safeguard himself
and other employees at the workplace.
x The results of any monitoring of exposure.
x The collective results of any health surveillance undertaken in a format which prevent those results
from being identified as relating to a particular person; and
x Written instructions and, if appropriate the display of notices, which outline the procedures for
handling biological agents.
Emergency Response Arrangements

The risk assessment should attend to not only the control measures to minimize exposure throughout the
normal usage, but additionally foreseeable emergencies, considering spillages.
The escape of large quantities of a hazardous substance may need the evacuating of the premises and the
bordering location (which could include residential or commercial properties) then communicating with the
emergency services.
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Depending upon the nature of the substance, spillages could cause really high direct exposures of vapours
and also a considerably increased fire risk, especially with volatile organic compounds. PPE is therefore vital
for workers needed to deal with spillages. This has considerable implications for the choice and upkeep of
PPE and also the training as well as guidance of the individuals. First-aid provisions are an important element
of any emergency plan.
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Environmental damages, such as leak into a gutter, ought to also be attended to, spill kits need to be
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prepared to handle spillages; various sets might be required depending upon the compounds involved.
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Health Issues
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9.6 Epidemiology and Toxicology
The Role of Epidemiology and Toxicological Testing

Toxicology
Toxicology is the fundamental science of poisons. It has been defined as: The study of the adverse effects of
chemicals on living organisms (Klassen and Watkins,1999).
An adverse effect is an abnormal, undesirable or harmful effect, the most severe of which is death.
Chemicals include metals, inorganic chemicals and complex organic molecules.
Toxicology is a multidisciplinary science, aiming to apply basic chemical, biochemical, pathological and
physiological knowledge with experimental observation to determine why certain substances cause disruption
to biological systems resulting in toxic effects. (Timbrell, 1995).
Epidemiology has been defined (Last, 2001) as:
“The study of the distribution and determinants of health-related states, or events in specified
populations, and the application of this study to the control of health problems.”
It is therefore focused on groups rather than individuals and will often take a historical perspective or analyse
patterns of illness and their causes. Factors that may be considered include occupation, age, sex and
exposure levels.
The following list provides some examples of how toxicology information may be applied in occupational
health:
x Setting exposure limits

x Classification and labelling of chemicals
x Identifying harmful effects of chemicals – preparation of Safety Data Sheets (SDS)
x Identifying thresholds of effects
x Identifying persons at risk
x Development of biological monitoring methods
x Understanding mechanisms of toxicity – predicting effects of new chemical
x Risk assessment for occupationally exposed humans
x Risk assessment for the public
Article 13 of REACH (EC 1907/2006) requires that information on intrinsic properties of substances may be
generated by means other than tests, provided that the conditions set out in Annex XI are met. In particular,
for human toxicity, information shall be generated whenever possible by means other than vertebrate animal
tests, through the use of alternative methods, for example, in vitro methods or qualitative or quantitative
structure-activity relationship models or from information from structurally related substances (grouping or
read-across).
Human Epidemiology
Epidemiology is the study of factors affecting the health and illness of populations and serves as the foundation
and logic of interventions made in the interest of public health and preventative medicine. It is considered a
cornerstone methodology of public health research and is highly regarded in evidence- based medicine for
identifying risk factors for disease and determining optimal treatment approaches to clinical practice. In the
work of non- and communicable diseases, the work of epidemiologists ranges from outbreak investigation to
study design, data collection, and analysis including the development of statistical models to test hypotheses
and the documentation of results for submission to peer- reviewed journals.
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Epidemiologists may draw on a number of other scientific disciplines such as:
x Biology in understanding disease processes and

x Social science disciplines including sociology and philosophy in order to better understand
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proximate and distal risk factors.
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Epidemiological studies have four main purposes:
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1. Causation – determining the factors that cause disease and adverse health effects in populations.
2. Evaluation of intervention – Randomised Controlled Trials are used to determine the effectiveness
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of wider clinical and public health interventions.
3. Description of health status of populations – descriptive techniques are used to define the health
status and presence of ill-health within populations.
4. Natural history of disease – Epidemiological methods are used to track the course and outcomes
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of ill-health within populations.
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Occupational Epidemiology
In the occupational context, epidemiological studies are used in:
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x Recognising and quantifying occupational ill-health.
x Determining the likely causes of that ill-health.
x Evaluating the effectiveness of workplace interventions.
x Determining Exposure Limits to protect future populations exposed to airborne occupational
contaminants.
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Types of Epidemiological Study

Epidemiological studies can be classified as observational or experimental. The most common are listed in
Table 3.
Table 3: Types of Epidemiological Study

Type of Study Description

Observational Studies
A simple description of the health status of the community using readily

Descriptive
available mortality and morbidity (death and ill health) data
Analytical Studies
Measures the prevalence of disease, simultaneously determining

Cross-Sectional (prevalence)
exposures and effects.
A comparison of a group of individuals with an identified outcome to a
Case-Control (Case-reference)
similar group without that outcome.
A comparison of a group of individuals exposed to a potential cause of ill
Cohort (Follow-up)
health with a similar group that has not been exposed.
Experimental Studies
An experiment to establish the effectiveness of a new preventative or

Randomised Controlled Trials
therapeutic treatment. Patients are randomly allocated to treatment and
(RCT) (Clinical trials)
control groups.
Field Trials Vaccine trials on disease free but at risk populations, in the field.
Community trials (Community Evaluation of the effectiveness of public health interventions where
Intervention Studies) diseases have their origins in social conditions.
Cohort Study
Cohort studies provide the best information about the causation of disease and the most direct measurement
of the risk of developing the disease.
It is used to compare persons exposed to a suspected cause with a similar group who are not exposed.
A cohort study begins by the selection a group of people (population) free of disease (or outcome of concern).
The group should be stable, co-operative and readily accessible. The group is sub-classified according to

exposure to a suspected cause, e.g., smokers and non-smokers, and followed over time to determine the
development of new cases of disease, e.g., lung cancer, in each group. The not exposed sub-group should
be equally susceptible to the disease under study and not exposed to the suspected cause. The groups are
monitored for an adequate period of time and the results analysed.
The incidence rate of disease in both groups can be calculated and the relative risk (RR) of disease in the
exposed group in comparison to the non-exposed group can be determined.
Relative Risk (RR) = Incidence rate in exposed

---------------------------------------------------
Incidence rate in unexposed
The incidence rate of disease in both groups can be calculated and the relative risk (RR) of disease in the
exposed group in comparison to the non-exposed group can be determined.
A relative risk of 3 – 4 (i.e., the exposed group is 3 – 4 x more likely to develop the disease of concern, than
the non-exposed group) is considered to be a good indication of a causal relationship between cause and
effect. However, this is only the first stage of the process (see Flowchart 1).
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Cohort studies may be conducted retrospectively (i.e., using historical data) or prospectively tracking sub-
groups who have been exposed and not exposed to a suspected causal agent into the future. Clearly there
are significant ethical problems with prospective cohort studies. If a cause-and-effect relationship is
suspected an immediate intervention is the appropriate course of action. Individuals would suffer should such
a natural experiment be allowed to run in pursuit of supporting data.
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Flowchart 1: Design for a Cohort Study
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Case- Control Study
A case-control study compares a population of individuals with the disease under investigation (Cases) with
a control group of individuals without the disease (Controls). The past histories of both groups are
established to determine exposure to suspected causal agents and the groups are sub-classified into
exposed and non-exposed groups.
As the study is not based upon a known proportion of the population, incidence rates cannot be calculated,
and risk cannot be directly calculated either. An approximation of the relative risk known as the odds ratio
(OR) can be calculated. This is the ratio of odds of exposure amongst the cases to the odds of exposure
amongst the controls. Data for case-control studies is likely to present itself from health screening /
surveillance activities. An evaluation of historical data is again termed a retrospective study.
Flowchart 2: Design of a Case – Control Study
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Direction of inquiry
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(People with
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Not exposed
Population
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(People without
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Not exposed
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Problems with Epidemiological Studies

The fundamental problem with epidemiological studies is that they cannot prove a causal relationship.
However, a high relative risk can strongly infer causation.
Non-causal explanations, particularly biases and confounders pose particular problems in occupational
epidemiology.
Selection bias, specifically the health worker effect means it is difficult to compare an occupational population
against a similar non-occupational population.
Measurement biases from screening and diagnostic difficulties to over or under reporting of illnesses and
injuries may all affect a studies results.
Confounding factors are difficult to filter out in the occupational context. Workers may be exposed to multiple
agents which may also be associated to each other.
Where a health effect is, dose related, there might be practical difficulties in determining the doses to which
the population is or has been exposed. Individual variations may also account for random errors in study
results.
Diseases with low risk of development (e.g., Weil’s disease) may give rise to a low (and unconvincing) relative
risk.
Diseases with a long latent period, e.g., asbestosis and mesothelioma may require an impractically long study
period that useful data only becomes available retrospectively, after people have suffered ill-heath and death.
The move away from job for life employment means that employees often change employers and even careers
so readily that to obtain a study population over a worthwhile timescale can be difficult.
Ethical considerations mean that a study group could not be exposed (or be allowed to remain exposed) to a
suspected causal agent in pursuit of good data.
Early interventions will also affect study outcomes and hinder the development of collaborative evidence
through repeated study.
Toxicity Testing
Toxicity tests all share certain principles, usually involving exposing experimental animals, plants, or other
living systems to the test substance under controlled conditions. Animal tests are avoided wherever possible.
Extrapolations from animal tests assume that:

x On a body weight basis humans are normally ten times more sensitive than rodents.
x On a body surface area basis humans usually show about the same sensitivity as test animals (i.e.
they respond to the same dose per unit of body surface area).
For existing substances, epidemiological evidence from randomised controlled trials of pharmaceuticals, or
observational studies following occupational or environmental exposure are used.
Many existing chemicals have never been toxicity tested and are therefore reliant on epidemiological data for
risk assessment.
Toxicity tests may be classified as:
x Acute toxicity tests

x Sub-acute toxicity tests
x Chronic toxicity tests
For all three, a selection of dosages, species, strain of animal, route of exposure, parameters measured, and
many other criteria are all vitally important.
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Acute Toxicity Tests (In Vivo)

In vivo testing refers to the experimentation on whole living organisms. It is often used in laboratory test for
toxicity as substances under test are administered to the test animals, usually rats.
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organism, literally ‘in the glass’.
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Acute toxicity tests are designed to determine the effects that occur within a short period after dosing. These
tests usually determine the dose or concentration response relationship. The relationship is theoretically
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(though rarely in practise) a Gaussian curve (See Illustration 14).
Illustration 14: Dose/Concentration Response Curve
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The relationship in Illustration 14 allows for the calculation of the median lethal dose (LD50) or median lethal
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concentration (LC50).
The median lethal dose (LD50) is defined as the statistically derived dose (oral or dermal) of a chemical or
physical agent (usually water for Ecotoxicity testing and gas, vapour or particles in air for toxicity testing)
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expected to kill 50% or organisms in a given population under a defined set of conditions.
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The median lethal concentration (LC50) is the statistically derived concentration of a substance in an
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environmental medium (usually air or water) expected to kill 50% of organisms in a given population under a
defined set of conditions.
The significance of the LD90 / LC90 is that the closer they are to the LD50 / LC50 respectively, indicates a greater
rate of response.
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No Observed Adverse Effect Level (NOAEL)
For some compounds and types of toxic effect there will be a threshold dose below which no effect is
measurable.
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There will further be in any population a dose below which no individual in that population will be affected.
The concept of a threshold dose of toxic effects is important as it leads to a no observed adverse effect level
(NOAEL), which is a generally accepted concept for non-carcinogenic toxic effects.
The NOAEL is important as it is used in setting exposure limits, e.g., Workplace Exposure Limits (WELs) in
the occupational context and Acceptable Daily Intakes (ADIs) of food additives and contaminants.
Table 4: Relative Toxicity Ratings
RelRelative Toxicity Ratings - Based on LD50 determinations in rats
Toxicity Description LD50 (weight per kilogram single oral dose in rats)
Very toxic 25mg or less
Toxic >25 to 200 mg
Harmful >200 to 2000 mg
A British Toxicological Society has developed an alternative fixed dose methodology to determine toxicity.
A small number of test animals (five male, five female) are exposed to a dose of 5 mg per kg and observed
for signs of toxicity. If 90% survive without signs of toxicity a larger dose (50 mg per kg) is employed; if again
90% survive without signs of toxicity a larger dose (500 mg per kg) is used. If more than 90% survive at this
dosage the substance is unclassified. See Table 5.
Table 5: Fixed Dose Method
Fixed Dose Method

Test Dosage Result Action / classification
<90% survival Very toxic
5 mg / kg >90% survival, but toxicity Toxic
>90% survival, no toxicity Retest at 50 mg/kg
Toxic
<90% survival
Test / retest at 5 mg/kg

50 mg / kg

>90% survival, but toxicity Harmful
>90% survival, no toxicity Retest at 500 mg/kg
Harmful
<90% survival, or toxicity
500 mg / kg Test / retest at 50 mg/kg
>90% survival, but toxicity Unclassified
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At the end of toxicity testing all animals are

subjected to post-mortem pathological
examination.
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Sub-Acute Toxicity Tests
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Sub-acute toxicity tests involve exposing animals
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to the substance under test for a period of 28 to 90
days. Exposure is frequent, and usually daily.
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Sub-acute tests provide more detailed information
on toxic effects and are used to identify no
observed adverse effect levels (NOAEL), in
conjunction with other tests; and to establish
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doses for chronic toxicity testing.
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Chronic Toxicity Tests
Chronic Toxicity Tests involve lifetime exposures
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of animals to the substance under test. Clinical
measurements are taken throughout the study to
track changes.
Chronic Toxicity Tests include tests for

teratogenicity and other reproductive effects,
carcinogenicity, mutagenecity, irritancy and skin
sensitisation.
The test animals are subject to spermatoid tests

(micronucleus testing) and tests for primary DNA
damage (chromatid exchange and detection of
adducts in blood / urine). Tissue cells cultured in
an isotonic fluid and effects of adding test
substance observed (tissue culture tests).
Offspring of the test animals are tested for genetic
damage (germ cell mutation testing) and early
infant mortality rates (lethal assay).
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Limitations of sub-acute-toxicity
testing, and the concepts of the
NOAEL and LD50 include:
x They relate to a large dose over a short period,

rather than a low dose over a long period.
x They are based on acute rather than chronic
results and take no account of a slow or delayed
death.
x There may not be a dose / response relationship
or NOAEL, e.g., carcinogens.
x The substance may be a human sensitizer below
an assigned exposure limit.
Limitations of toxicity testing

include:
x It takes time to see the results over the lifetime of
the test subject.
x They are based on an average person, and take
no account of the state of health, human
metabolism, individual diet and biological half-life
(time taken to remove 50% of the substance or
metabolite from the body).
x Laboratory controlled exposure may not relate to
the actual workplace exposure, e.g., use of
control measures, work and breathing rates,
sweat rates, dehydration, etc.
x Exposure may be other than, and as well as, the
route tested / quoted.
x Combination or synergistic effects are not tested,
e.g., exposure to the substance combined with
smoking.
x There may be different reactions in animals than
in humans, e.g., metabolites formed and
susceptibility.
x Varying animal species may give varying results,

e.g., resistance to carcinogens.
x The method of administering the substance can
affect the results, e.g., rats cannot vomit, and
therefore orally administered substances often
have more damaging effects on rodents than on
other species.
There are ethical issues regarding animal testing.
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Alternatives to Animal Testing
Ames Assay (in Vitro)
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The Ames assay (also known as the Ames test, salmonella assay and the bacterial cell mutation assay) is
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the most widely used mutagenicity test.
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It uses specially constructed bacterial strains each having a particular type of mutation in an essential gene.
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Normal bacteria will multiply in a non-histidine (amino acid) environment. Genetically modified salmonella
bacterium, each having a particular type of mutation in an essential gene (only able to multiply in a histidine
medium), are incubated with the suspected mutagen in a histidine deficient environment.
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The assay is conducted by mixing the selected bacterial strain with co-factors and the test chemical in a
soft agar buffer.
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The mixture is poured into a Petri dish, allowed to set then incubated at 37°C for 2 to 3 days.
Microscopic examination allows mutated colonies of bacteria to be counted and compared.
The above assay does not test for mutations caused by metabolites produced from the test substance. To
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test for mutagenicity of metabolites, as a second part of the Ames assay, the test is repeated with the
addition of S9 (animal liver extract).
Predictive Studies
One of the methods used to attempt to predict the possible toxic properties of a substance is to assume that
chemically related substances will show similarities in toxic properties. This method is known as grouping
and read across. This type of study – making use of known information about a related, similar chemical –
where the way that the known chemical interacts with human metabolism, is well understood. The
similarities are used to make predictions about the toxicity of the new substance. These predictions then
have to be tested in vitro or in vivo to ensure that they are correct. This can eliminate or significantly reduce
the need for animal testing.
An alternative is to use a predictive method that models the structure of the chemical in question and
attempts to predict molecular shape, bonds, activity and how the chemical will interact with human
biochemistry. This type of study method, known as Quantitative Structure – Activity Relationship (QSAR),
makes use of computer-based modelling of the three-dimensional structure of the chemical to make
predictions about toxicity and the dose/response relationship. QSAR makes use of the very large database
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of information on known chemicals and human biochemistry. Like read-across, QSAE is quicker and
cheaper than most forms of in vivo testing and epidemiological study.
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9.7 Asbestos and Lead

Asbestos
Asbestos is a fibrous mineral silicate which occurs in several different forms in nature. The three main types
are: White (Chrysotile), Brown (Amosite) and Blue (Crocidolite).
White Asbestos is less likely to cause disease however whenever asbestos dust is generated and may be
inhaled a hazard exists.
There are 3 major diseases by exposure to asbestos and these are:
a. Asbestosis (Lung tissue is replaced by fibrous tissue)

b. Mesothelioma (Causes tumours)
c. Lung cancer (Growth of malignant cells in lung)
The symptoms of asbestos caused diseases are breathlessness, tiredness and coughing and all take many
years to develop after exposure. Examples of workers who can be at risk are maintenance and demolition
workers who may inhale the fibres.
Typical locations where asbestos can be found

Asbestos has been used for many purposes such as:
x Cloth for protective clothing

x Insulation boards for fire protection in buildings
x Insulation boards for equipment
x Pipework lagging
x Asbestos cement boards for building and pipes
x Gaskets, Filters, Brake linings
x Plasterwork in old buildings
x Sprayed on for thermal and acoustic insulation
Workers who may be particularly at risk of being exposed to asbestos when carrying out building maintenance
and repair jobs include:
x Construction and demolition contractors, roofers, electricians, painters

x Decorators, joiners, plumbers, gas fitters, plasterers, shop fitters, heating and ventilation engineers,

and surveyors
x Anyone dealing with electronics, for example, phone and information technology (IT) engineers, and
alarm installers
x General maintenance engineers and others who work on the fabric of a building
General Preventative Methods

The ILO, Safety in the Use of Asbestos, Code of Practice 1984 outlines general preventative measures in the
use of asbestos. The key requirements are listed below.
Alternative Materials
1. Whenever possible, harmful substances should be replaced by substances which offer the same
technical advantages, but which are harmless or less harmful.
2. When safety considerations call for alternative materials, account should be taken of all health
hazards associated with the manufacture, handling, use, transportation, storage and disposal of the
alternatives proposed.
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3. When alternative materials for asbestos are being chosen, primary consideration should be given
to their associated health hazards; and regard should also be paid to the technological and
economic circumstances which determine the need for the alternatives.
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The materials, processes and equipment should be so designed that the exposure of workers to asbestos
dust is eliminated or reduced to the lowest practicable level.
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Local Exhaust Ventilation
1. Where total enclosure of the dust-producing process is not practicable, local exhaust ventilation
equipment should be provided and maintained.
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2. For efficient operation, the exhaust ventilation should be located as close as possible to the source
of dust emission by the use of captor hoods, booths or enclosures.
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3. The local exhaust systems should be designed to collect and remove all dust-laden air.
4. Openings in the enclosures should be as small as possible while still allowing access to the
necessary work operation.
5. In the case of captor hoods and booths, the ventilation equipment should be so constructed that
air turbulence and eddies created by the work process or by the workers do not prevent the
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effective removal of dust.
6. The design of local exhaust ventilation systems for any particular process requires special
expertise and should therefore be referred to a suitably qualified person.
Personal Protection
Provision and use:
1. The use of respiratory equipment should be regarded only as a temporary or emergency measure
and not as an alternative to technical control.
2. A sufficient and suitable supply of equipment should be available in the workplace.
3. Such equipment should be provided for all workers employed in any situation where levels of
airborne asbestos fibre exceed or are liable to exceed the exposure limits.
4. Workers should be informed when concentrations of airborne asbestos fibre reach such levels.
5. When workers have been so informed, they should use the equipment provided.
6. Workers required to wear protective equipment should be fully instructed in its use.
7. Employers should provide supervision to ensure that the equipment is properly used.
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8. All respiratory equipment should be provided and maintained by the employer without cost to the
worker.
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Provision and Use of Clothing

Where personal clothing may become contaminated with asbestos dust, the employer, in accordance with
national regulations and in consultation with workers' representatives, should provide appropriate work
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clothing.
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Cleaning of Premises and Plant

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1. Every employer should ensure, as far as is practicable, that the work premises are maintained in
a clean state and are free of asbestos waste.
2. All machinery, plant and equipment should be kept free from dust, together with all external
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surfaces of exhaust ventilation equipment and all internal surfaces of the building.
3. (1) Cleaning should be carried out as far as is practicable by vacuum cleaning equipment or by
some other means in such a way that asbestos dust neither escapes nor is discharged into the air
of the workplace.
(2) Where required, suitable extension hoses should be fitted to the vacuum-cleaning equipment.
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4. (1) Where cleaning by a dustless method is impracticable, workers undertaking the cleaning should
wear appropriate protective clothing and respiratory equipment.
(2) Such cleaning should be carried out as far as is practicable when no other workers are present.
If it is necessary for other workers to be present, they should also wear protective equipment.
Packaging, Transport and Storage

1. Asbestos fibre should always be packed in impermeable bags.
2. Where water-soluble bags are used, they should not be transferred from one container to another
but should be transported in closed containers.
3. Bags should be closed by either heat-sealing or stitching. If stitched, the stitching should be at not
less than two stitches per centimetre.
4. All bags should be printed with an approved label identifying the contents as asbestos and carrying
a health warning.
Disposal of Asbestos Waste

All asbestos waste awaiting disposals should be adequately identified by markings on the bag or receptacle
and should be stored in such a way that it is not exposed to damage likely to cause spillage.
Asbestos waste should not be mixed with other waste where there are no special disposal requirements.
Where practicable, a special area should be set aside for its storage.
Asbestos waste should not be permitted to remain on floors or other surfaces of the workplace at the end of
the work period.
Before a site is used for the disposal of asbestos waste, care should be taken to establish that the site is both
suitable and acceptable for the purpose.
If wet waste is deposited, it should be covered in the same way as dry waste to prevent the escape of asbestos
dust on drying out.
Use of Specialist Contractors for Removal and Disposal of Asbestos

ILO document ‘Safety in the use of asbestos’ states that:
“The creation of asbestos waste should be minimised by the adoption of the most effective production
techniques”
National legislation and guidance will outline how and when specialist contractors will be required. In the UK,
the duty to manage asbestos is included in the Control of Asbestos Regulations (CAR) 2012.

The HSE provides a range of information in different forms related to different industries, including air
transport, construction, food and drink, oil and gas, railways and textiles. Further information, with regards to
UK standards can be found at http://www.hse.gov.uk/asbestos/essentials/
Health Surveillance
According to CAR, medical surveillance needs to be conducted for employees working with Asbestos and it
is as follows:
“
A medical examination not more than 2 years before the beginning of such exposure; and
periodic medical examinations at intervals of at least once every 2 years or such shorter time as the relevant
doctor may require while such exposure continues, and each such medical examination must include a specific
examination of the chest.”
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Lead (And Compounds)

Work Involving Lead and Lead Compounds
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Young people aged 16 years and above are not at any greater risk from exposure to lead and its compounds
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than anyone else.
One can only identify the specific risk through a risk assessment of the particular circumstances under which
there is exposure to lead or its compounds in your workplace.
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One should bear in mind that young people may not appreciate the dangers to their health and that they
may not understand or follow instructions properly because of their immaturity. Lead and its inorganic
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compounds are known to produce various biological effects in humans, depending on the exposure level.
These range from:
x Minor biochemical changes in the blood, which are unlikely to have adverse health consequences;
to
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x Severe irreversible or life-threatening disruption of body processes, in particular the nervous
system, the blood-forming system and the kidneys.
There are also concerns about the effects of lead on the quality of semen and on the unborn child. The toxic
effects of lead alkyls give rise to symptoms including agitation, insomnia, dizziness, tremors and delirium,
which can progress to mania, coma and death. These symptoms are accompanied by nausea, vomiting
and abdominal pain.
How to avoid the risk
The UK HSE says that employers must pay special attention to the requirements of the Control of Lead at
Work Regulations 2002 (CLAW) for providing young people with:
x Information, instruction and training;

x Proper supervision within a safe system of work.
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Employers must not employ young people for work in certain lead
processes:
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LEAD SMELTING AND REFINING PROCESSES
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Work involving the handling, treatment, sintering, smelting or refining of ores or materials containing not
less than 5% lead.
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x The manipulation of lead oxides;

x Mixing or pasting in connection with the manufacture or repair of lead-acid batteries;
x The melting or casting of lead;
x The trimming, abrading or cutting of pasted plates in connection with the manufacture or repair of
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lead-acid batteries.
Employers cannot employ young people to clean any place where any of the above processes are carried
out.
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The Regulations require employers ensure that the exposure of young people to lead and its compounds is
adequately controlled. For example, where the exposure to lead is significant, employers must ensure that
employees under the age of 18 years are under medical surveillance, and that their blood is monitored every
three months for levels of lead.
If the action level is reached or exceeded but is below the suspension level (40 µg/dl for young men or 25
µg/dl for young women), you must investigate why this has happened and take steps to reduce their exposure
so that their blood lead falls below the action level.
If the level reaches 50 µg/dl for young men or 30 µg/dl for young women (the suspension level), you must
remove them from any work which exposes them to lead until their blood level drops below 50 µg/dl/30 µg/dl
respectively.
(The lower suspension level for female employees is aimed at protecting any foetus which might be
developing. Pregnant women are not always aware of their pregnancy in the early stages.)
Health Surveillance
Lead Workers
The employer should carry out a baseline health assessment of workers who are at risk of exposure to lead.
Lead workers should attend a health assessment of blood lead level test before they begin work. The test
should be carried out again, a month after the worker begins working with lead, to ensure they remain safe
and healthy, and that the control measures are working to protect the workers from exposure.
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9.8 Ventilation and PPE
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There are two types of mechanical ventilation systems:
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Dilution (or general) ventilation reduces the concentration of the contaminant by mixing the
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contaminated air with clean, uncontaminated air.
Local exhaust ventilation captures contaminate at or very near the source and discharge them to the
outside atmosphere.
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Key Issues Relating to Ventilation
General Ventilation
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Natural ventilation through opened windows, doors and wall vents allows fresh air to enter an area resulting
in a diluting effect on airborne contaminants but this method is not under any form of control. The use of
fans to deliver and remove air to and from an area brings about general dilution ventilation and air changes
in the room.
When used to control chemical pollutants, dilution must be limited to only situations where:
- The amounts of pollutants generated are not very high,

- Their toxicity is relatively moderate, and
- Workers do not carry out their tasks in the immediate vicinity of the source of contamination.
Illustration 15: General Ventilation
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Limitations of Dilution Ventilation
There are limitations associated with the use of dilution ventilation to protect workers. These limitations
include:
x Not completely removing contaminants from the air
x Not suitable to be used for highly toxic chemicals

x Not effective for dusts or metal fumes or large amounts of gases or vapours
x Not effective for handling surges of gases or vapours or irregular emissions
Regular fans are sometimes used as a method of ventilation, but these fans typically blow the contaminant
around the work area without effectively controlling or removing it. Opening doors or windows can be used as
dilution ventilation, but again, this method is not reliable since air movement is not controlled.
The air flow rate of dilution ventilation depends on how fast the contaminant enters the air as well as the
efficiency of fresh air mixing with workroom air.
Local Exhaust Ventilation (LEV) Systems
Illustration 16: Typical LEV System

The components of a LEV system include:
1. An inlet (hood) to collect the contaminant

2. Ductwork to convey the contaminant away from the source
3. A filter (or other system) to remove the contaminant from the air in the duct
4. A fan or air moving device and ducting to the outside atmosphere (in some systems the
cleaned air is re-circulated to the workroom)
5. An exhaust or discharge stack to atmosphere
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1. Inlets/Hoods
Inlets to LEV systems are of two major types:
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a. Partial enclosures: Fume cupboards, spray booths, etc.
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The source of the contamination is largely contained inside the enclosure. Air flows from the open
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face of the enclosure and across the source to extract openings in the booth, top, bottom or rear.
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Use can be made of physical properties associated with processes to bring about ventilation. For
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example, hot processes will result in contaminants rising with the heat and can be directed into a
flue to exhaust to atmosphere.
b. Hoods: These vary in size and design depending on the application.
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There are two basic types of Hoods: Receptor and Captor
A Receptor Hood is one where the contaminate is forced towards it in some way, e.g., saw dust from
circular saw is thrown in one direction, fumes from a hot tank rise.
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A Captor Hood is required where the suction at the hood must be sufficient to draw the contaminant into it.
Illustration 17: Hoods
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The inlet is the most important part of an LEV system and requires careful design to be fully effective.
The important factor to consider with inlets is that their effectiveness reduces considerably with distance
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from the source of the contaminant. In fact, the capture velocity at one duct diameter away from the face of
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the hood is about one tenth of the face velocity. Clearly, if the hood is wrongly positioned, this will result in
virtually no capture. For applications such as welding hoods, this puts considerable onus on the operator
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to position the hood correctly and move it as appropriate. This can be a hood or partial enclosure. It is
important to ensure that the suction inlet is as close to the point of emission as possible to capture the
contaminant effectively and as soon as it is generated before it can enter the workplace atmosphere.
This difficulty is addressed to some extent with some types of solder fume extractor which use tool-tip
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extraction whereby a narrow extraction pipe is attached to the soldering iron tip and is moved with it by the
operator.
The capture efficiency is greatly increased by use of a flange. This is increased further the more enclosing
the nature of the flange.
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The illustration that follows illustrates the approximate extent of the capture zone.
0.3 m
Extract air velocity
5m/s at entry to hood
0.3 m
Extract air velocities in
tube region are 0.5 m/s
or greater
0.6 m
Outside this boundary, extract air

velocities are less than 0.5 m/s
(100 ft/min.) and effective capture
is unlikely
Hood will only give

good capture if the
source of
contamination is
inside the effective
capture zone
Outside this zone, it is likely that the motion of machinery, movements of the operator and local random air
movement will generate sufficient turbulence to overcome the capture effect of the inlet. It follows that inlets
should be designed to enclose the source as far as possible if good control is to be achieved.
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Illustration 18: Effect of Enclosing Design on the Airflow Required for Control
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It is important that the extraction inlet is designed to ensure an effective capture velocity. Different
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situations will require different velocities and therefore different solutions. Some examples are listed in
Table 6.
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Table 6: Capture Velocities (Examples)
Source Conditions Typical Situations Capture Velocity (m/s)
Degreasing tanks, paint dipping,

Released into still air 0.25 - 0.5

still air drying
Released at low velocity or into Container filling, spray booths,

0.5 - 1.0
a slow-moving air-stream screening and sieving
Released at a moderate velocity

Paint spraying, welding 1.0 - 2.5
or into turbulent air
Released at high velocity or into Grinding, fettling, abrasive

2.5 - 10
a very turbulent air-stream blasting
The higher the required capture velocity, the greater the necessary suction power of the LEV system as a
whole. This has implications for the design of the ducting and motor as well as cost and energy efficiency.
Where a particular high capture velocity is required, this is only achievable with narrow ducting, thus a low
volume of sampling. Otherwise, the power required would be too great. Such systems are sometimes referred
to as Low Volume-High Velocity (LVHV) systems.
2. Ductwork
Once the contaminant has been captured it needs to be transported along via ductwork to the air cleaner. As
with the captor design the ductwork design should facilitate the efficiency. In particular, the following design
factors need to be considered:
x Ducts should be of a suitable material not to be damaged by the contaminants (e.g., abrasive
particles, corrosives, etc.).
x The system should be as simple as possible with a minimum number of bends, and as short as
possible.
x Branches should join at the sides and not be at an acute angle.
x There should be an adequate number of inspection hatches and inspection points to allow proper
cleaning and inspection. These should be at the top of the ducting.
x Flexible ducting (as opposed to rigid ducting) should be kept to a minimum since it tends to wear
more quickly and offers higher resistance to air flow.
x Noise through ducting can be a serious issue and care should be taken at the design stage to
minimise this; and

x Where there are several inlets to an LEV system, balancing will be required to ensure that there is a
suitable air flow at each inlet. Without balancing, one inlet may have an excessive air flow at the
expense of others which are not adequate. This is often the case where an inlet is closer to the main
branch and motor than outlying inlets where longer pipe runs reduce the velocity of the air inlet.
Balancing is achieved by opening and closing dampers in the ductwork placed at strategic places
before inlets and branches. Where an inlet is not in use, the damper may be closed to increase the
capture velocity at other inlets.
Illustration 19: Bad and Good Ducting Design
It is also critical that the velocity of the air passing

through the ductwork is sufficient to achieve the
required transport velocity and to prevent settling
of material which could create an explosive
atmosphere. Recommended duct velocities
depend on the contaminants transported; typical
minimum values are given in Table 7:
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Table 7: Recommended Minimum Duct Velocities (Examples)
Contaminant Duct Velocity (m/s)
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Vapours, fumes, smoke 5-10
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Light medium dust (e.g., sawdust) 15
Average industrial dusts, e.g., silica, cement, grinding dusts 20
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Heavy dusts, e.g., metal turnings, wood chips >25
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3. Filters or Purifying System
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There are three basic types of filters: Air filter, particulate and fume collectors, and devices to remove
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mists, gases and vapours. For most extraction processes, a filter needs to be installed to protect the fan
and to ensure that environmental contamination is minimised.
A number of different design technologies for extraction equipment are available, it is important that the
correct equipment is chosen for the application of concern. A brief summary of the types of equipment
available is as follows: Efficiencies of dust collection are greater for larger dust particles.
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Illustration 20: In Line Air Filter
In line paper or
fabric filter
Clean air out
Dirty air in
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Capture
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Description Advantages Disadvantages

Efficiency
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These are simple filtration

devices placed in duct work
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Good for ultra-clean

where particles are physically
environments and Limited to relatively
filtered out. High Efficiency
>99% hazardous dusts (e.g., low air flows and dust
Particle Arrestor (HEPA) filters
asbestos and biological concentrations.
can be used to provide effective
agents).
cleaning. Normally used for
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general ventilation systems.
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Illustration 21: Cyclone Dust Separator
Capture
Efficiency
This consists of a simple circular

chamber, tapered at the bottom.
Dirty air is fed into the top of the
chamber, perpendicular to the

main body. The dust then swirls

Low efficiency. Often
around the chamber, throwing 40-70% for Relatively cheap, easy
used in conjunction with
dust particles outwards by 5µm diameter to maintain, no filters to
other devices as a first
centrifugal action where they fall particles. replace.
stage.
into a collection hopper at the
base of the device. Cleaned air
then moves upwards and
passes through a central outlet
at the top of the chamber.
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Illustration 22: Venturi Scrubber
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Capture
Efficiency
Dust-laden air passes through a

venturi throat where water is
injected. The highly turbulent
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conditions around the throat
break down the water into small
Up to 96% for Improved efficiency
droplets which form around the Sludge effluent
50 µm over cyclone, no filters
dust particles. These are then produced.
particles. to change. NEBOSH

separated in a cylindrical
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chamber (scrubber) where the
water and sludge collect at the
bottom and clean air passes
through the top.
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Illustration 23: Self-Induced Spray Collector
Capture
Efficiency
Similar to a scrubber but uses a

93% for As for venturi scrubber
spray-eliminator and baffles to As for venturi scrubber.
5 µm particles. (Illustration 22).
separate out the cleaned air.
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Illustration 24: Bag Filter Unit
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Capture
Efficiency
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Contaminated air is passed
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through a woven or felted

medium containing natural
fibers which physically trap the Filters can become
dust particles. The dust can be Up to 99% for blocked. High
High efficiency.
released by blowing high 5 µm particles. pressures are required
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pressure jets of air back through to maintain air flow.

the filter or by vibratory shaking
devices which pass into a
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hopper.
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124
Illustration 25: Electrostatic Precipitator
Capture
Efficiency
Dust particles are given a NEBOSH International Diploma

charge and attracted to plates of Some materials do not
opposite charge then into a dust charge and will pass
92-98% for Less air-resistance than
hopper. The arrangement through the
5 µm particles. fabric filter.
consists of wires suspended in electrostatic
either vertical tubes or between precipitator.
charged plates.
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1. Ventilation Fans and Motors
The fan is normally placed at the outlet (clean) side of the filter and pulls air through the system. The two
main types of fan are axial and centrifugal. Axial fans are propeller type designs generally placed in roof
units. They can only overcome low resistances to flow.
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Centrifugal fans are able to deliver greater air flows against high resistance and are therefore the favored
choice for LEV systems.
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Factors in the selection of the fan include:
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x Airflow required
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x Total flow resistance of the system
x Type of contaminant
x If a flammable contaminant is present
x Space limitations
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x Method of mounting and type of drive
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x Operating temperature
x Noise level
x Intrinsic safety
x Failure warning devices
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2. Discharge to Atmosphere
The final element of the LEV system is the discharge stack that expels the clean air to the atmosphere. Key
issues to consider regarding the stack include:
x Positioning to avoid air re-entering the building.

x Positioning to ensure that discharge stacks are not discharging to air inlets.
x Ensuring that the stack is discharging at an appropriate height to ensure dispersal of the emissions,
this depends on the material, but typically should be at least three metres above the building height;
and
x Ensuring that the termination of the stack is appropriate to ensure efficient air-flow, prevent ingress
of rainwater and assist fume dispersal.
The common cone termination although keeps rain out of the stack, has a number of disadvantages. In
particular, it directs air back downwards and impedes efficient air flow.
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Illustration 26: Cone Discharge Termination
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Hazards to others, environmental damage and nuisance to others must be taken into account. In addition,
should air be re-circulated directly back into the workplace it must be sufficiently purified.
126
Source Strength and Capture Zones

Factors in LEV design that ensure effectiveness
x Hood design - Hoods should be designed to confine or enclose the contaminant whenever possible
and allow access for inspection and maintenance. Enclosing hoods establish a complete or partial
enclosure around the contaminant, preventing its escape into the workplace and allowing it to be
drawn into the LEV inlet. Receptor hoods are used to direct contaminants that move into the inlet
due to characteristics of the process, for example, upwards due to thermal air movement. Captor
hoods are used to capture contaminant that would not naturally move into the inlet of the system.
They’re particularly important where the contaminant has high velocity and significant mass, as the
contaminant may quickly spread into the workplace. Captor hoods should, whenever possible be
positioned in line with normal contaminant travel. Examples of where captor hoods are used include
rim/lip extraction, downdraught tables and LVHV (low volume high velocity) systems
x Capture velocity of air - The value of the capture velocity necessary for effectiveness will depend
upon:
- The type of process involved
- The characteristics of the contaminant, including velocity and mass
- The mode of dispersion of the contaminant
- The distance from the captor to the contamination and the extent to which gravity may assist
capture
x Transport velocity of air - This is the minimum air velocity to move the contaminant already in the
airstream the required distance through the system. If the transport velocity is not maintained, the
particles will fall out of the airstream. The velocity should be high enough to prevent settlement of the
contaminant particles suspended in the airstream, but low enough to minimise duct losses and
consequently fan power consumption.
x Air cleaners - The type of air cleaning device to be used within a LEV system depends upon the
nature of the contaminant. Examples used to collect dusts and fume include:
- Wet collectors
- Fabric filters
- Cyclone filters
- Electrostatic precipitator
Factors that reduce a LEV system’s effectiveness


x Draughts in the workroom
x Hood design
x Distance of the hood and inlet from the source
x Damaged ducting can lead to leaks
x Leaving too many inlet ports open can lead to loss of suction and air movement at the inlet of
any one of the many ports
x Unauthorised alterations
x Process changes leading to overwhelming amounts of contamination
x Fan strength, air velocity achieved
x Incorrect adjustment of fan
x Too many, or too sharp, bends in ducts can lead to the slowing down of air movement
and deposition of contaminant on the bends
x Blocked or defective filters will inhibit air flow through the system
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Examination and Testing of Local Exhaust Ventilation Systems

It is the employer’s responsibility to ensure that The following checks and tests are
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control measures are maintained in an efficient state,
in efficient working order, in good repair and in a clean recommended as good practice:
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condition. Periodic thorough examination and test of
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LEV and record of tests is established under section Visual examination of all components to ensure that
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11 of ILO Cop, Safety in the Use of Chemicals at there is no damage. Check that components of the
Work. system appear to be in place, e.g. filters are seated
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correctly with no signs of dust or other pollutants on
This relates to the examination and testing of: the clean side of the filter or collector.
x Local Exhaust Ventilation (LEV) systems, Visual inspections can easily be undertaken using
which is a specialist activity involving a a checklist, which determines whether:
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number of physical measurements of
airflows, etc. at regular intervals; and
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x LEV hoods are in good condition
x Respiratory Protective Equipment (RPE), x Air is being effectively drawn into the
other than disposable RPE, at suitable extract booth
intervals. x Any warning devices are operational
x Ducting is intact without holes or splits
It is important to be aware of statutory requirements
Health Issues
that exist in some countries in relation to the x The area is reasonably clean and
examination and testing of engineering controls. For contaminant free
example, in the UK, the interval for thorough x Visualisation of the system in use to
examination and testing for LEV systems is stated as ensure that it appears to be performing
being required at least every 14 months. satisfactorily and that contaminants are
being effectively removed. Techniques for
All control measures must perform as originally this include use of a dust lamp, infra-red
intended, and to continue to prevent or adequately photography and smoke generators or
control exposure. This includes putting right as soon specific chemical tracers (as discussed
as possible any defects found in the controls, which later in this Element)
could result in reduced efficiency, effectiveness or x Measurement of face velocity (capture
levels of protection. speed) at the inlet, e.g., fume cupboard
hood. Typical velocities range from 0.2 –
In addition to this requirement protective equipment 1.5 m/s. For example, the face velocity for
(PPE), needs to be: a fume cupboard is recommended to be
0.5 m/s
x Properly stored
x Measurement of the duct velocity
x Checked at suitable intervals (transport speed) to ensure that the
x Repaired or replaced if found defective system is handling the required air volume
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and whether the velocity is high enough to
Any PPE that is contaminated by a substance convey the pollutant to the collector
hazardous to health should be removed before x Static pressure (total pressure minus
leaving the work area and kept apart from velocity pressure) measurements at
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uncontaminated clothing and equipment. Employers various points within the ducting. This
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should ensure that any such PPE is subsequently would typically be beyond the hood,
decontaminated, cleaned or destroyed. before the dust collector, after the dust
collector and after the fan. Any
significant changes in static pressure will
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give an indication of a fault in the system

which could be a blockage in the ducting,
missing filter, or faulty fan
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x Testing of the filters and if the system is

‘re-circulating’, i.e., passes air back into
the building, monitoring of the return air
quality; and Checks on the air mover,
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which would include checks on the fan and

motor speeds and fan power consumption
128
Competency
Any person carrying out the maintenance of control measures should be competent to do so. This type of
work is usually undertaken by Chartered Engineers or professionally qualified occupational hygienists with
appropriate qualifications and industrial experience. The required qualification is dependent upon the service
being provided, which may include an initial appraisal, or an in-service inspection (through examination and
testing).
The requirements for examinations/inspections
The LEV examiner needs to know the risks from the system under test. These include:
x Health risks from residues within the systems

x Safety risks from mechanical parts of the LEV, work at height, electricity, manual handling and
moving vehicles
x The employer and examiner need to cooperate to ensure minimal risk for both service provider and
employees (operators) who may be affected by the work. The employer should arrange for permits-
to- work (where necessary) and safe access. The employer should also provide information about
personal protective equipment requirements
For statutory thorough examination and test, the examiner should, where available, use the following
information sources:
x The LEV system commissioning report

x The LEV user manual
x The logbook for the system
x The previous LEV system statutory report
x Confirmation that there have been no changes to the LEV, layout or process since the last test
Carrying Out a Thorough Examination and Test

The examination and test procedure and methods are similar to the original commissioning exercise, with
similar qualitative and quantitative methods. Thorough examination and testing of LEV can be considered to
comprise three stages:
Stage 1: Thorough Visual and Structural Examination

To verify the LEV is in efficient working order, in good repair, and in a clean condition.
x A competent person with appropriate knowledge and experience should periodically inspect

ventilation used as an engineering control for any visual irregularities or defects that may be present
x The frequency of the inspection of the equipment will depend on its criticality in providing health and
safety and on the conditions of use that could cause its degradation
This may include, as appropriate:
x Thorough external examination of all parts of the system for damage, wear and tear;
x Internal duct examinations
x Checks that any filter cleaning devices (e.g., shake- down, pulsed or reverse jet) work correctly
x Inspection of the filter fabric. Where filters have built- in pressure gauges, checks on their function
(and that the operating pressure is correct)
x Checks of the water flow and pump condition in a wet scrubber
x Checks that the monitors and alerts/alarms are functioning correctly
x Inspection of the air mover drive mechanism, e.g., fan belt
x Checks for indications of effectiveness. Are there significant deposits of settled dust in and around
the LEV hood? Is any part of the system vibrating or noisy?
129
Stage 2: Measuring and Examining the Technical Performance

To check conformity with commissioning or other sources of relevant information.
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x
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Test points (e.g., indicated in the system documentation). This includes hood faces, branch ducts,
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and the main duct
x Measuring static pressure at suitable test points indicated in the system documentation. This
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includes all hoods, ducting, across the air cleaner and fan
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x Checking the fan speed, motor speed, and electrical power consumption
x Check direction of rotation of the fan impeller
x Checking the replacement or make- up air supply
x Testing alarms, by simulating a failure, and the alarm's ability to detect the failure
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x Measuring air temperatures
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x Testing the air cleaner performance (e.g., a recirculating system)
The examiner should calculate volume flow rates. The next steps are:
x To compare the results of testing with the LEV design specification as reported in system
documentation such as the user manual or other sources of performance standards
Health Issues
x To diagnose the causes of discrepancies. With the employer's consent, the examiner may where
possible, make simple alterations that restore the required performance. An example is where
displaced dampers cause a multi- branch system to be out- of- balance; the examiner may re-
balance the system
x If the system is unsafe, the examination should stop until the system has been repaired and its
original performance restored. The examiner should warn the client promptly
Methods for LEV Testing

LEV captures and transport velocities are required to maintain contaminants in suspension.
A pressure difference is required in LEV systems for air to flow and it will always flow from high to low
pressure. The total pressure (force acting over an area) in a LEV system is the sum of velocity pressure
and static pressure. Velocity pressure is a component of the dynamic (kinetic) energy of a suspension in
motion. Static pressure measurements are usually negative on the suction side of a fan and positive on the
discharge side. Static pressure in a stationary suspension is exerted in all directions. To measure static
pressure in moving suspensions it is necessary to eliminate the effects of velocity by measuring the pressure
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at right angles to the direction of flow.
Instruments for LEV Testing

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There is a wide range of instruments available to measure the various parameters in a LEV system such
as:
x Face velocities at the inlet hood – vane (rotating) and hot wire (thermal) anemometers.
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x Capture velocities at distances up to 1 hood diameter away from the face (inlet hood) – vane and
hot wire anemometers.
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x Transport velocities at various points in the duct – hot wire anemometers (if<3m/s) and pitot static
tubes (if>3m/s); and
x Static pressures – manometers, pressure gauges and pitot static tubes.
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The measurements taken are compared against the design specification and previous readings to ensure
the efficiency of the LEV system is maintained.
These instruments are discussed briefly in the next pages.
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Vane Anemometer
Vane anemometers are suitable for measurements of face and capture velocities in metres per second for
hoods, booths, enclosures and fume cupboards.
Vane anemometers are similar to small windmills usually between 25 and 100 mm in diameter enclosed in a
shroud with the rotating vanes mechanically or electrically coupled to an indicator.
Mechanically coupled vane anemometers are used in conjunction with a stopwatch so that the reading,
number of rotations, on the indicator can be noted over a known length of time. The velocity can then be
calculated in metres travelled (rotation distance) per second.
Electrically coupled vane anemometers are battery or mains operated and give direct velocity readings.
Air velocities in the range 0.12 to 25 ms-1 can be typically measured.
Illustration 27: Vane Anemometer
Illustration 28: Face Velocity Measurement Using a Vane Anemometer

For large ventilation inlets the technique used, illustrated in Illustration 28, is to divide the inlet into imaginary
squares of approximately 150 mm and measure the face velocity at each intersection, ensuring the vanes are
perpendicular to the inlet. An average is taken of the resultant readings, with each reading then compared to
the average to ensure that there is not a wide range variation. Should a wide range be evident the airflow
distribution may require adjustment of baffles to achieve the design specification.
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Hot Wire (Thermal) Anemometer

The rate of heat loss from a heated body is related to the flow of air passing over that body. The hot wire
anemometer uses this relationship and the dependence of electrical resistance on temperature to produce
an air velocity reading on a meter. This device can be used to measure velocities in the range 0-20 ms-1
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and can also be used to measure air temperatures.
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Hot wire anemometers are generally less suited to face velocity measurements, since they are difficult to
direct precisely, and they are also easily subject to damage or fouling. Their advantages however include
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a rapid response to changes in airflow and a small head size, which can be inserted into small orifices, for
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example to measure velocities in ductwork. This device can also be used for the measurement of capture
velocities at the actual point of release of the contaminant. This will indicate whether the positioning of the
LEV hood is correct.
Manometers and Pressure Gauges
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A manometer is a device that measures pressure by the displacement of liquid in a U-tube or inclined gauge
(low pressures). The manometer may be calibrated to measure the static pressure within a LEV system or
to measure the pressure drop across a filter.
Pressure gauges measure the movement of a diaphragm or sprung coil and may be used as an alternative
to manometers.
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Pitot Static Tube
Duct velocities and static pressures are usually measured using a Pitot Static Tube. The instrument
measures velocity pressure within a duct and consists essentially of two concentric tubes. The inner tube
measures the total pressure in the system and the outer one the static pressure. The total pressure at any
point in a system is given by the equation:
Total pressure = static pressure + velocity pressure.
The tubes are connected to either side of a manometer or pressure gauge. This instrument is best for air
velocities above 3 m/s.
Static pressure measurements are taken behind each hood / enclosure and at various points in the ducting
before and after the fan.
Illustration 29: Pitot Static Tube Inserted into Ducting
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Other Parameters
Other parameters used to measure the efficiency of a LEV system include the fan speed, the motor current
and, for systems that recirculate filtered air back into the workplace, the level of contaminant in the air.
Stage 3: Assessment of Control Effectiveness

x Careful observation of processes and sources;

x Assessment of how effective the LEV is at controlling operators' exposure;
x Challenge tests with smoke with the process running, to check for smoke leakage, breathing and
eddying zone encroachment (when smoke testing, the examiner should warn employees and may
need smoke alarms turned off);
x Dust lamp tests with the process running to check for escape of dust or mist;
x Observation of the way operators works, whether the LEV is providing adequate control and
protecting the operators from any contaminants.
Simple Observational Tests

Simple observational tests can be undertaken to identify the effectiveness of hoods and inlets e.g., dust
particles in the air, dust deposits on flat surfaces, inefficient machinery, worker complaints etc.
Smoke Tubes
The movement of air into hoods and inlets can be detected by injecting smoke into the moving airstream. By
slowly moving the smoke tube away from the hood / inlet it is also possible to observe the range of influence
of the hood / inlet. It should be noted however that the smoke might not behave in the same way as dust
particles.
Figure 2: Smoke tube used to test a ventilation system

Dust Lamp
A shaft of light which illuminates a cloud of floating dust is an example of light scattering by airborne particles.
The phenomenon is often termed the ‘Tyndall effect’, after the British scientist (John Tyndall, 1920-93) who
first investigated it. In the 1950’s, engineers and scientists began to us photographic spot lamps to investigate
what happens to dust clouds from industrial processes and to aid the design of exhaust ventilation systems.
Early users were surprised by their observations.
Dust in the respirable range (less than 10 microns diameter) can be seen and photographed when illuminated
by a high intensity beam of light. The dust cloud should be observed by looking up the beam towards the
source of illumination against a dark background.
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In the absence of effective control measures airborne particles are released into the workplace atmosphere
by many industrial processes. Such particle clouds can be invisible under normal lighting conditions but
may be made visible by the use of the high intensity beam of light. This technique is commonly referred to
as the dust lamp.
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Use of the lamp enables the existence of particle release at a process to be simply demonstrated, or the
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performance of an extractor system to be assessed.
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Photography or video recording can be used to make permanent records of the observations. The dust
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lamp can be used in a variety of ways that include:
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x As a tool to investigate work operations and processes to gain an understanding of the potential
for exposure before any air sampling is done.
x After air sampling has demonstrated significant over-exposure, as an aid to understanding how
and why exposure is occurring; and
Occupational
x As a useful tool in investigating the effectiveness of controls during their development in confirming
Workplace Health
effectiveness after installation and as, part of routine monitoring of controls.
Illustration 30: Use of Dust Lamp
Health Issues
The method of operation is shown in Illustration 30. A bright beam of light is shone through the area where
NEBOSH
it is thought a particle cloud may be present. The observer’s eyes are shielded from the main beam by
means of a piece of card, or by using the worker’s body or a convenient piece of machinery as a shield.
The particle cloud should be observed looking up the beam towards the source of illumination, preferably
at a small angle off the centreline of the beam, and, if possible, against a darker background, for instance a NEBOSH
portable curtain.
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Dense clouds can be made visible with the dust lamp under normal lighting conditions, but to see a small
leak, for instance, or to trace the extended movement of a cloud as far as possible, the ambient lighting may
need to be suppressed. Although the dust lamp is a powerful tool, its success depends very much on the
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skill of the user, as it is a tool which requires considerable competence to use effectively.
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Reports/Records of Examination and Testing
Suitable records of examinations, tests and repairs carried out on LEV systems and RPE should be kept.
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In practice, LEV records are generally kept for LEV tests, but less often for RPE examination – an area that
should not be overlooked. The records should provide performance data that enables comparison with the
intended operating performance for adequately controlling the hazardous substance (design specification
or findings of risk assessment).
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It is important that there is a schedule of performance for the LEV system, i.e., some parameters against
which to compare the measurements. If for any reason there are not any, a ‘baseline’ performance should
be established by an initial thorough examination, test and risk assessment (assuming all is working
satisfactorily).
A suitable record should at least contain:

x The name and address of the employer responsible for the plant;
x The identification and location of the LEV system, and the process and hazardous substance
concerned;
x The date of the last thorough examination and test;
x The conditions at the time of the last test and whether this was normal production or special
conditions;
x Information about the LEV system, which shows its intended operating performance for adequately
controlling the hazardous substance and whether the plant is still achieving the same performance
and if not, the adjustments or repairs required. Examples of the information about the LEV system
includes:
a) Enclosure / hoods: The maximum number to be used at any time, location or position, static
pressure behind each extraction point / hood and the face velocity;
b) Ducting: Dimensions, transport velocity and volume flow.
c) Filter / collector: Specification, volume flow, static pressure at inlet, outlet and across the filter;
d) Fan or air mover: Specification, volume flow, static pressure at inlet and direction of rotation;
and
e) Systems that return exhaust air to the workplace: Filter efficiency and concentration of the
contaminant returned to the workplace.
x The methods used to make a judgment;
x The date of the next examination and test;
x The name, job title and the employer of the person carrying out the examination and test;
x The signature, or means of identifying, of the person carrying out the examination and test; and
x The detail of repairs carried out (the effectiveness of which should be proved by a re-test).
Interpretations of Reports
During the analysis of reports, there is a variety of basic issues that must be inspected, to see whether:
x A suitable method and approach of sampling has actually been utilized. Conventional techniques as
well as techniques are published by the HSE and also various other authorities such as WHO. Where
these, exist, they have to be stuck to in order to ensure the scientific as well as legal validity of any

outcome is acquired.
x The tools made use of were appropriately maintained, certificated and calibrated.
x The assessment was performed at a place as well as time that would offer outcomes of a real
workplace conditions (this requires an understanding of the types as well as patterns of work that the
engineer might not have a full appreciation of).
x The outcomes have been appropriately evaluated against the right legal standards. These can be
examined by reference to relevant papers, such as regulations as well as international standards.
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Personal Protective Equipment

x PPE selected must fit the wearer
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correctly, if necessary, after
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adjustments, within the range for which
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it was designed; and
x PPE selected must, so far as is
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possible, be effective in preventing or
controlling the risk involved without
Controlling
increasing the overall risk.
One of the clear principles when determining

control measures for virtually any risk activity is
Occupational
that PPE is a last resort. It has a number of
drawbacks, including the following:
Workplace Health
x It only protects the wearer, not other
persons in the vicinity.
x It relies on the wearer always donning it
when necessary and always wearing it
correctly.
Health Issues
Personal Protective Equipment is often defined as
any equipment designed to be worn or held by a x It generally fails to danger; and
person at work to protect him against one or more x It may need regular inspection and
risks, and any addition or accessory designed to maintenance.
meet this objective, other than:
It is nevertheless a common form of control
x Ordinary working clothes and uniforms measure, particularly for hazardous substances.
not specifically designed to protect the Use of PPE may be justified in the following
health and safety of the wearer. situations:
x Equipment used during the playing of
competitive sports. x For short-term activity where no other
x Self-defence or deterrent equipment; and form of control is reasonably
practicable.
x Portable devices for detecting and
signaling risks and nuisances. x As a supplement to other control
measures, particularly where a
carcinogenic substance or material with
Where risk means any risk to the health or safety an Exposure Limit is in use.
of a person and includes wet or extreme
temperature, caused by adverse weather or x As a temporary measure for a recently
identified risk, while other controls are
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otherwise.
being established, of during temporary
It is the employer’s responsibility to ensure that failure of a control; and
suitable PPE is provided to employees who may be x During certain maintenance
exposed to a risk to their health and safety while at procedures, e.g., cleaning out of an LEV
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work, except where and to the extent that any risk system, which by definition will not be in
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has been adequately controlled by other means use.

which are equally or more effective.
PPE must satisfy the following four criteria before it

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can be considered suitable:
x PPE selected must be appropriate for the

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risk(s), and the conditions where

exposure to those risks may occur.
x Selection must consider the ergonomic
requirements and state of health of the
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person wearing it.
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Respiratory Protective Equipment

Respiratory protective equipment (RPE) can be split into two broad categories:
x Respirators, which are designed to purify air by inhaling it through a filter medium which removes
the contaminants; and
x Breathing apparatus (BA), which supplies pure respirable air from an uncontaminated source.
Criterion for choosing breathing apparatus in preference to a respirator is depicted below, as per Flowchart 3.
Flowchart 3: Environments and Adequate Respiratory Protection
The choice of RPE will depend on:

x The oxygen content in the atmosphere; and

x The toxicity of the hazardous substance. NEBOSH International Diploma
There are numerous types of respirators and breathing apparatus available. The main types are listed in
Flowchart 4 on the next page.
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Flowchart 4: Types of Respiratory Protective Equipment
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Respiratory Protective Equipment (RPE)
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Respirators Breathing apparatus
Filters contamination in the Air in the Provides uncontaminated Air from independent
Occupational
work place before it is inhaled by the wearer source
Workplace Health
Health Issues
Simple Self
Power Power
filtering Fresh air contained
assisted assisted
respirators hose BA breathing
respirators airline
apparatus
Disposable Power Un-

Constant Open
filtering hoods assisted
flow any circuit
face piece helmets and full face
face piece negative
filters mask
demand
full face
Half mask- Power Assisted Negative Open

separate assisted half half or full demand circuit
filter (s) mask and face mask half or full positive
filters face mask demand
full face
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Full face Power Powered Positive Close
mask- assisted full hood or demand circuit
separate face mask half or full positive
helmet
filter (s) and filters face mask face mask NEBOSH

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Respirators
This type of device relies on the wearer drawing air through a filter medium as they inhale.
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There are two main categories: Simple filtering respirators and power assisted respirators.
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Simple Filtering Respirators

These range from disposable filtering face pieces, which are designed to be worn for no more than a shift
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and protect against particulate matter, to half and full face masks with separable filters, which can protect
against a range of vapours and particles.
A full-face mask is likely to provide a greater level of protection as well as including full face protection.
Illustration 31: Full Face Mask
138
Head
Harness
Visor
Adjusters
Inner mask
Check valve
Exhalation valve
Power Assisted Respirators

This type of respirator uses a motor to draw air through a filter (often located on the back of the operator). The
air then blows through a face mask, creating a positive pressure and out. Such masks have the advantage of
increased comfort and generally provide greater protection by virtue of the positive pressure preventing inward
leakage. Powered respirators can also be linked to hoods.
Illustration 32: Power Assisted Respirator with Full Face Mask
Visor
Inner mask
Filter
Motor
Type of Filtering Medium
139
For a filtering respirator, selection of a filtering medium suitable for the type of contaminant is important. In
particular, a mask suitable for dusts will not be suitable for gases, vapours and solvents. A range of filter
types are therefore available and are summarised below:
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Table 8: Filter Types – UK source
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Substance Filter Type Colour
Controlling
Particulate P White
Organic gases and vapours
A Brown
(BP>65C)
Occupational
Organic gases and vapours
Workplace Health
AX Brown
(BP<65C)
Inorganic gases and vapours

B Grey
(excluding CO)
Sulphur dioxide and other acid

C Yellow
gases and vapours
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Ammonia and organic ammonia
K Green
derivatives
NO (must incorporate P3 filter –

Oxides of Nitrogen Blue-white
single use only)
Mercury (Hg) (must incorporate

Mercury Red-white
P3 filter – max use 50 hours)
SX (and name of specific Violet (violet-white if combined

Specific substances
chemical) with P filter)
Breathing Apparatus
These rely on a supply of fresh air, either:
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x From an air hose whose outlet is in an uncontaminated atmosphere and relies on the operator’s
lung power to draw in the fresh air. In low risk situations, a long hose may be used to draw air at
atmospheric pressure from outside a confined space. A bellows or fan may be used to assist in
overcoming the resistance to breathing. NEBOSH

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x From an airline using a compressor to provide a powered supply of filtered breathable air. Air lines
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have the advantage of potentially unlimited length of use but potential concerns regarding
entanglements and obstructions.
x From self-contained breathing apparatus, which may be a.) open or b.) closed circuit.
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a. Open circuit systems supply air to the wearer from a cylinder either worn on a backpack or
from a remote location. A positive pressure system is often used, this ensures that any
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leakage (due to poor face seal for example) will be outwards. The back packs are heavy and
restrict movement but avoid the problem of entangled hoses. A single cylinder allows around
40 minutes of use.
b. Closed circuit systems remove excess carbon dioxide from exhaled air which is then re-
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breathed by the wearer. This type of apparatus is generally only used for emergency self-
rescue purposes.
Illustration 33: Open Circuit Self Contained Breathing Apparatus
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Protection Provided by the Respirator NEBOSH International Diploma

Clearly some designs of respirator are inherently more effective than others. It is important that the level of
protection chosen is appropriate to the application.
The minimum protection required from the RPE is determined using the equation:
Minimum protection = Workplace concentration outside the facepiece of the RPE

required (MPR):
Maximum allowable concentration inside the facepiece of the RPE
The maximum allowable concentration inside the face-piece is determined by consulting guidance and taking
account of in-house limits.
The MPR value is compared with the assigned protection factors (APF) indicated in Table 09, to identify
suitable equipment.
The assigned protection factor (APF) of a respirator reflects the level of protection that a properly functioning
respirator would be expected to provide to a population of properly fitted and trained users. For example,
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an APF of 10 for a respirator means that a user could expect to inhale no more than one tenth of the airborne
contaminant present. Indeed, protection levels below the APF are possible where RPE is unsuitable for the
task, or it is not suited to the wearer and the environment.
Various groups such as NIOSH and OSHA have proposed factors for the different types of respirators
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available, and in the UK APF’s have been published by the British Standards Institution (BS 4275), but serve
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only as a guide, not a hard and fast rule.
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Table 9: Classes of RPE and APF’s – UK source
Controlling
Class of RPE APF
4 10 20 40 100 200 2,000
Filtering half mask FF P1 FF P2 FF P3
Occupational
FF gas
Valved filtering half FF gas +
+ P2 or
Workplace Health
mask P1
P3
Mask + gas
Full face mask and Mask +
Mask + P1 Mask + gas Mask + P3
filter P2
+ P3
Powered hoods TH1 TH2 TH3
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Full face
Half
Fresh air hose mask
mask
Hood
Light duty
LDM1
compressed airline – LDM3
LDM2
BA mask
Negative
Positive
Demand flow demand
demand full
compressed airline full face
face mask
mask
Negative
Positive
Self contained BA demand
demand full
(SCBA) full face
face mask
mask
The real-life performance of respiratory protection will of course depend on how well the mask is fitted. For
particularly hazardous environments, such as work with asbestos, it is strongly recommended that masks
be fit tested to user’s faces, using a Quantitative Fit Testing Device, based on a particle counter.
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Other factors which must be considered when selecting and using RPE include those in Table 10.
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Table 10: Factors to be Considered When Using RPE
Factor Effects Comments and Recommendations

Face masks become uncomfortable
Length of time Provide a choice of RPE to allow wearers to
when worn properly for long periods
RPE is worn select the most comfortable.
(e.g., > 1 hour).
Wearers may be tempted to loosen or Loose-fitting facepieces may be preferred, if

remove RPE. suitable.
Blowing the nose or scratching is not Powered assisted RPE is generally less tiring
possible. to wear for long periods.
Respiratory stress decreases capacity Arrange frequent work breaks in a clean area
to work. to allow removal of RPE.
Powered / assisted RPE is less tiring to wear
than simple respirators.
High breathing rates cause high peak
Physical work
inhalation flows and amplify breathing
rate Compressed-air supply should be able to
resistances of equipment.
provide at least the peak inhalation flow
needed.
Some RPE is heavy to carry and can
Modify the task to reduce heat stress.
cause physical strain.
Overall work capacity will reduce. Arrange adequate rest breaks.
Excessive sweating can cause
Provide active cooling.
facepieces to slip and leak.
The physical size and weight of RPE Eliminate restricted space / modify access
Mobility can restrict movement where there is ways to allow free use of RPE.
limited space. Train users in negotiating tight spaces.
Select less restrictive RPE filtering devices or
SCBA where suitable, rather than types with a
trailing tube / hose.
Keep tube runs as short as possible or

Trailing airlines can drag, snag or can manage effectively.
be tripping hazard.
BA which allows temporary breathing through
a suitable filter on disconnection from the
supply line allows safe exit from the
hazardous area, or movement to another
supply point so that work can resume.
Reduced peripheral vision and ability Use the least restrictive design of facepiece.
Visibility
to see fine detail. Provide adequate lighting in the work area.
Powered / air supplied RPE is more resistant
to internal misting.
Provide and use cleaning materials as

Misting, scratching, abrasion or recommended by the manufacturer.

contamination of the visor due to use.

Some visors may be treated / coated to
reduce misting. Some facepieces may have
additional tear off visors to protect the main
one.
Where possible use integrated protection,
RPE can be incompatible with other e.g., a powered helmet respirator rather than
Other PPE PPE, making either or both ineffective separate head, eye and respiratory protection,
uncomfortable. or an air-fed full suit rather than impervious
unventilated clothing and separate RPE.
Cumulative effects, e.g., combined
Where no integrated RPE exists, consult
weight and heat stress of having to
manufacturers for information on compatible
wear RPE and heat / flame protective
equipment.
clothing.
Devices which hide the mouth, hide lip-
reading clues to speech, though hoods and
All RPE inhibits normal visors may not.
communication (speaking and
Communication
hearing) to some degree, causing Many full-face masks incorporate a speech
difficulty in being understood. diaphragm to make talking more easily
understood.
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Factor Effects Comments and Recommendations

Hoods / helmets can make hearing difficult.
NB warning systems.
Communications systems are available,
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e.g., radio linked, or incorporated into the
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air supply line.
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RPE should be resistant to any chemical,
Work Chemical hazards - solids, liquids,
physical or biological or hazards identified
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environment gases and vapours.
in risk assessment.
Controlling
Physical hazards - heat, flame, Manufacturers will be able to advise on
radiation, impacts and sharp edges. compatibility.
Optional accessories may be required e.g.,
impact-resistant or chemical-resistant visor,
chemical-resistant or general purpose
Occupational
Biological hazards - contamination
supply tube, splash guards.
and infection of equipment and
Workplace Health
wearer.
Intrinsically safe, light, alloy-free, anti-static
equipment will be required in explosive
atmospheres.
Complex types of RPE will require a level of
competence before staff is able to use it
Health Issues
To be effective RPE, as with all
safely and effectively.
Training other types of PPE must be properly
selected, worn and maintained.
Staff may need to be trained to fit, adjust,
inspect and maintain RPE.
Face Fit Testing

If RPE does not fit correctly, it will not provide adequate protection. There are five main factors affecting the
fit between the facepiece and the wearer's skin:
x Facial characteristics - The size and shape of the face can affect the seal. The majority of face-
pieces are only available in one size.
x It is important to check with suppliers and manufacturers regarding the range of sizes available.
x Facial hair - Facial hair tends to lift the mask off of the face and allow air to leak in.
x For those with facial hair, hoods or helmets may be more effective. In high- risk situations, even a
few hours' beard growth (stubble, as opposed to a full beard) can unseat a seal enough to allow
contamination to enter a mask.
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x Where breathing apparatus is used, air leaking out will be wasted and will increase the total amount
of air drawn from the cylinder which will reduce the amount which can be used by the wearer, thus
reducing the working time.
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x Spectacles - The side-arms of spectacles can interfere with a face seal and cause inward leaking
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of contaminated air.
x Face mask designs are available which allow special frames to be fitted inside the visor.
x Some designs of suits or hoods allow conventional spectacles to be worn, but there remains the
x
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Likelihood of lens misting and the spectacles becoming dislodged.

International
x Contact Lenses - If contact lenses become dislodged, the wearer may feel the need to remove the
face-piece and replace the lenses while still in the danger area, exposing them to contaminated
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air.
x Other Accessories Anything that can interfere with the fit or function of RPE should be considered
and minimised.
x It is of vital importance that users do not attempt to modify or alter RPE in an attempt to improve
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their personal comfort.
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Skin and Eye Protection
Gloves
Effective hand protection can only be achieved if the
type of glove selected is suited to the wearer, the

exposure risk and the work task.
Gloves, as with all PPE should only be used where

risk assessments show that they are the best control
option as other methods are not possible.
Because protective gloves cause minimum

disruption to the process, there is a danger that they
might be regarded as a soft option for controlling
exposure to chemical agents and be used in
preference to precaution that control the hazardous
substance at source.
Although some types of glove offer very high levels The limitations of gloves as control measure can be
of protection, no protective glove can provide 100% summarised as:
protection against exposure to hazardous
substances, many studies have shown that levels of x Gloves only protect the wearer – they do not
protection in the workplace are much lower than in remove the contaminant from the workplace
tests under laboratory conditions. environment.
x Gloves may be inconvenient and interfere
As a general rule, glove protection levels can be with the way people work (e.g. be
reduced by up to 75% when the gloves are in active uncomfortable, restrict movement, or affect
use. sense of touch).
x Gloves may introduce new hazards, e.g.
This is not because there is any deficiency in the latex and corn starch allergies.
standard of protective glove manufacture but
because there are many complex issues x Gloves will not afford adequate levels of
surrounding the use of protective gloves in the protection unless they are properly used and
workplace. maintained (they may be affected by physical
and chemical damage, ageing, flexing and
stretching and poor maintenance); and
x Physical and environmental restrictions
imposed on protective glove wearers may
adversely affect work rates.
Chemical protective gloves are available in a wide

range of natural and synthetic materials, but there is

no single protective glove material (or combination of

materials) which gives unlimited resistance to any
individual or combination of chemical agents.
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Table 11 below indicates suitable glove materials for working with a range of industrial chemicals.
Table 11: A Guide to Choosing Glove Materials
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Chemical Group Glove Material
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Natural Nitrile
Neoprene PVC Butyl Viton TM
rubber rubber
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Water miscible
Controlling
substances, weak 9 9 9 9
acids / alkalis
Oils 9
Occupational
Chlorinated
9
Workplace Health
hydrocarbons
Aromatic solvents 9
Aliphatic solvents 9 9
Health Issues
Strong acids 9
Strong alkalis 9
PCB 9
In the EU, EN 374: 2003 Protective Gloves against Chemicals and Micro-Organisms provides valuable
guidance on the three main ways that protective gloves will, at some stage, fail to protect the wearer from
exposure to chemical agents. These are:
Degradation
A deleterious change in one or more properties of a protective glove material may occur due to contact with
a chemical. These changes include flaking, swelling, disintegration, embrittlement, discolouration,
dimensions, appearance, hardening, softening, etc.
NEBOSH
Penetration
Penetration is the movement of a chemical and / or micro-organism through porous materials, seams,
pinholes, or other imperfections in a protective glove material on a non-molecular level.
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Permeation
Permeation is the process by which chemical moves through a protective glove material on a molecular
level. Permeation involves the following:
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x Absorption of molecules of the chemical into the contacted (outside) surface of a material.
x Diffusion of the absorbed molecules in the material; and
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x Desorption of the molecules from the opposite (inside) surface of the material.
Detailed test methods for penetration can be found in standards (EN 374-3), classifying permeation
performance levels based on breakthrough times (the elapsed time between applying the test chemical to
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the external surface of the glove and its subsequent presence on the internal surface).
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Table 12: Permeation Performance Levels
Measured breakthrough time (mins) Permeation performance level

>10 1
>30 2
>60 3
>120 4
>240 5
>480 6
The following table is a brief example showing breakthrough times for common materials with specified
chemicals.
Table 13: Breakthrough Times for Common Materials with Specified Chemicals
Acetone HCl NaOH Toluene Xylene
Rubber 7 min 211 min >8 hr Not Tested Not Tested
Neoprene 12min >8 hr >8 hr 21 min 30 min
Nitrile NR NR NR 20 min 65 min
PVC NR 5hr Not Tested NR NR
Butyl >8 hr >8 hr >8 hr 20 min 65 min

Other factors to be considered when selecting gloves include whether wrist and forearm protection is required
and the likelihood and degree of mechanical damage.
Problems have resulted, for example where dipped plastic gloves have been used for applications involving NEBOSH International Diploma
significant quantities of oil or solvent. These general-purpose gloves are manufactured by dipping a typical
cotton glove in a polymer material which coats most of the glove, but leaves the cuff uncovered. There is a
risk in some situations where the cuff can become soaked in oil and cause skin problems to the wrist of the
wearer.
There is also a risk of dermatitis from prolonged wearing of gloves due to the skin of the hand being unable to
breathe and sweat re-absorption. Such risks need to be balanced.
Skin Creams
These can help to protect the hand. So, called barrier cream can provide some protection against chemicals
and may in particular make hands easier to wash dirt and grease from, which will save the skin from some
aggressive scrubbing. However, claims that barrier creams can offer a high level of protection against
chemicals and be an invisible glove should be viewed with skepticism. After work creams can help to put back
natural oils into the skin, which may have been removed by contact with chemicals or intensive washing. It
must be borne in mind, however that some workers may be allergic to such products.
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Controlling
Occupational
Workplace Health
Eye Protection
Eye protection is primarily designed to protect Conjunctivitis can also be caused by allergic
against three main groups of occupational
Health Issues
reactions to many chemical substances, pollens,
hazards: and biological agents.
x Mechanical Fuel vapours and certain hydrocarbons can

x Chemical and biological reduce the oxygen content in the fluids in the eye
leading to corneal dystrophy – an inflammation
x Radiation of eye and inner surface of the eye–lids.
This element is concerned with chemical and Chemicals may also cause inflammation of the
biological hazards; however, circumstances may optic nerve paths – optical neuritis.
arise where mechanical or radiation hazards are
also present. Therefore, eye protection may well Sources of Chemical Hazards
need to afford protection against a range of
hazards. The sources of chemical hazards are numerous
and include dusts and powders, aerosols,
Harmful Effects of Chemical and liquids, fumes, vapours and gases.
Biological Hazards Fine cement dust entering the eye in small
quantities may not present a serious chemical
hazard, but the strong alkaline bias of such
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The damaging effects on the human eye can
range in severity from minor irritation to total materials can cause severe corneal burns.
blindness.
Aerosols are generated in pest control
Liquid splashes of strong acids and alkalis can operations, paint spraying, varnishing, NEBOSH
lacquering and other treatment processes. Even
NEBOSH
cause serious eye burns leading to blindness.
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Even minute splashes or fine aerosols can cause if the base substance itself is harmless it could
irritation or conjunctivitis. be carried by a more damaging chemical solvent.
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Smoke and fumes generated by combustion are another potential cause of eye irritation and other more
serious damage.
Vapours and gases often have harmful effects on the eye. Acetone, chlorine, formaldehyde, hydrogen
sulphide, sulphur dioxide and toluene are common industrial chemicals which will irritate the eye.
Biological hazards in the medical and dental environment related to splashes of blood and body tissue
containing viruses are another danger that is broadly classified as a chemical hazard.
Table 14: Examples of Chemical Hazards to the Eye, with Occupational Sources:
Example Hazards Example Sources
Bleaching, battery filling, electrolytic plating, degreasing, paint stripping,

Chemical splashes
chlorination processing, cement mixing
Liquid aerosols Crop spraying, paint / lacquer spraying, fumigating
Steam jets Leaking pipework, pressure vessel venting
Fine dusts and powders Cement mixing, wall sanding, lime spreading, powder coating

Fumes, vapours and Varnishing, adhesive bonding, exhaust gas analysis, welding, soldering,
gases fumigation
Biological agents Veterinary work, dental surgery, first aid, medical research, waste management
Classification of Eye Protection

Eye protection is often classified by:
x Intended use: Protection against chemical and biological agents is regarded as other use (the other
identified uses being welding and lasers) and include basic use, impact resistance, liquids, coarse
dust, and gas and fine dusts.
x Style: The three principal styles are spectacles, goggles and face shields. The key features of each
style are outlined in Table 15.
x Type of ocular: Clear, filter or mesh; and
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x Ocular performance: Eye protection oculars (lenses) are also classified by their performance
rating against a range of criteria including corrective effect, optical class, and resistance to
scratching and resistance to fogging.
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Table 15: Features of Eye Protection
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Style Key Features
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Spectacles
May be twin type ocular (conventional spectacle
Controlling
frame) or single ocular (eye shield).
Twin type oculars may incorporate prescription

lenses.
Occupational
Eye shields may be worn over corrective
Workplace Health
spectacles.
Both types protect the eyes but offer limited

protection to the orbital cavities.
Side shields or deep side arms afford limited lateral
Health Issues
protection to the orbital cavities.
Goggles
May be box type (single oculars) or cup type (twin
oculars). Both types are held in place with a
headband and protect both the eyes and orbital
cavities.
Both types may be worn over corrective

spectacles, cup type cannot.
Ventilation may be incorporated to address

problems of misting.
Face Shields
Comprises a moulded visor attached to a brow
shield and headband.
Provides protection to all, or part of the face, as

well as the eyes.
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May be integrated with safety helmets.
May be worn over corrective spectacles.

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The Storage and Maintenance of PPE

x Secure and clean storage, separately housed from personal clothing, should be provided for RPE
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issued to users.
x RPE, along with other PPE, should not be worn in areas set aside for meal breaks; local temporary,
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clean storage facilities should be provided, as required adjacent to canteens and welfare facilities,
to prevent contamination of ‘clean areas’
x Where RPE (other than disposable RPE) is provided, the employer must ensure that a thorough
examination, and, where appropriate, testing of that equipment is carried out at suitable intervals.
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x All maintenance work should be carried out by properly trained people, using spare parts supplied
by the manufacturer of the RPE
150
Training in Use, Maintenance and Storage of PPE

The ILO Cop, Section 9 of ‘Safety in the Use of Chemicals at Work requires that workers who wear PPE be
assured of the following:
x All wearers are given full information and instruction on use of PPE
x All protective equipment necessarily provided should be maintained in good condition and
replaced, at no cost to the worker, when no longer suitable for its purpose.
x The protective equipment should not be used longer than the time indicated by the producer.
x Workers should make proper use of the equipment provided, and maintain it in good condition, as
far as this is within their control.
x Respiratory protective equipment, other than one-shift disposable respirators, should be cleaned,
disinfected and thoroughly examined either (depending on which is first) each time it is reissued
or after a period specified by national laws or by national or international standards approved or
recognised by the competent authority, or specified as part of the employer’s control measures.
x A record should be kept of the cleaning, disinfection and examination of such respiratory protective
equipment, and of its condition and any defects, in accordance with national law and practice.
x The record should be authenticated by the person carrying out the test, who should be properly
trained for the purpose.
x Employers should provide for the laundering, cleaning, disinfection and examination of protective
clothing or equipment which have been used and may be contaminated by chemicals hazardous
to health.
x It should be prohibited for protective equipment which may be contaminated by chemicals
hazardous to health to be laundered, cleaned or kept at workers’ homes.
x When a contract laundry is employed, care should be taken to ensure that the contractor fully
understands the precautions necessary for handling contaminated clothing.
151
Summary
The control of hazardous substances is in accordance with basic hierarchical principles. Prevention is better
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than protection, and safe place strategies take priority over safe person strategies.
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Elimination of the hazardous substance is the best option, followed by substitution of materials or work
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processes.
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Local Exhaust Ventilation is often a key component of systems for the control of airborne contaminants. To
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be effective it must be properly designed, installed and maintained.
Personal protective equipment is the weakest option as: it does nothing to prevent or reduce the hazard
itself, but looks to protect the wearer from the consequences of the harmful event; it is heavily dependent
upon management controls for the selection and maintenance of appropriate equipment and the training
Occupational
and supervision of the wearers; it relies heavily on the competence and good will of the wearer and thus its
effectiveness can be effected by the range of human factors; it if fails it can only fail to danger and the
Workplace Health
wearer will be harmed.
Ultimately the level of risk will determine the nature of the precautions to be taken and often a combination
of control measures is required.

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152
9.9 Hazardous Substance Monitoring
Occupational Exposure Limits (OEL) for Airborne

Harmful Substances
Concept of Exposure Limits

The purpose of occupational exposure limits is to assist in the assessment of risk and control of exposure of
workers to a variety of substances that can have harmful effects on health. The ILO Code of Practice for
‘Safety in the Use of Chemicals at Work’ requires that exposure to hazardous substances should be prevented,
where reasonably practicable
The Glossary to the Annex of the ILO Code of Practice, ‘Occupational Exposure to Airborne Substances
Harmful to Health’ states:
³([SRVXUHOLPLW (/ LVWKHFRQFHQWUDWLRQLQWKHDLU
believed in the light of present scientific knowledge, cause adverse health effects - including
long-term effects and effects on future generations - in workers exposed for eight to ten hours
per day and 40 hours per week; such exposure is considered acceptable by the competent
authority which establishes the values, although concentrations below the exposure limit may
not completely guarantee protection of the health of all workers; the exposure limit therefore
does not constitute an absolute dividing line between harmless and harmful concentrations but
merHO\VHUYHVDVDJXLGHIRUWKHSUHYHQWLRQRIKD]DUGV
The exact definition and intended application of ELs vary widely from one country to another and the
underlying definitions and assumptions and the requirements of the appropriate competent authority must be
taken into account if they are used. For example, some authorities have specified in legal standards ELs which
are used as legally permitted “safe” levels of exposure and are intended to protect against “injury”, not against
every health effect. Other authorities provide for limits which are intended as guidelines or recommendations
in the control of potential workplace health hazards.
An important example of the caution to be applied in using ELs is provided in the introduction to the annual
publication Threshold Limit Values (TLVs) of the American Conference of Governmental Industrial Hygienists
(ACGIH):
7/9V³UHSUHVHQWFRQGLWLRQVXQGHUZKLFKLWLVEHOLHYHG
exposed day after day without adverse health effects. Because of wide variation in individual
susceptibility, however, a small percentage of workers may experience discomfort from some
substances at concentrations at or below the threshold limit; a smaller percentage may be
DIIHFWHGPRUHVHULRXVO\´
Consequently, any EL represents a risk which is felt to be acceptable based on a particular criterion, and NEBOSH International Diploma
where such limits are given legal status there is usually an additional requirement to keep exposure as low as
practicable, rather than simply below the EL.
It is also important to consider the averaging period for which the limit is intended. Some limits are ceiling
values to be continuously applied; others apply to average exposures over a period of up to several years. A
short-period limit requires stricter control than a longer-period limit at the same exposure value. For example,
a limit applying to a month might allow the exposure to range above the value for days at a time, provided
there was a compensating period of low exposure which maintained the monthly average. If the same value
were applied to 15-minute averages, the control would have to be good enough to keep every 15-minute
average below the value.
ELs generally limit exposure of the individual, and measurements to be compared with the EL must therefore
be taken close to the individual (“personal exposure”), unless the EL in question is clearly stated to be
applicable to the general value in the workplace environment. A measurement result sometimes depends on
the measurement method, and quality control of measurements is often important; employers should consult
the occupational health service on these issues.
153
Some authorities issue lists of values to be used in biological monitoring (analysis of exhaled breath, urine,
etc.) or in biological effect monitoring (analysis for metabolites). As with ELs, different lists are derived from
different assumptions and are intended to be used in different ways. They include lists of values which are
believed to be safe, and values which are not necessarily safe, but which represent an acceptable standard
of control.
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Long-Term and Short-Term Exposure Limits
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In the United Kingdom, TLV’s were originally published as guidance for setting standards. It was however
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recognised that the UK had different philosophies for managing some chemicals and so a different
framework of limits was developed within the UK.
HSE guidance note EH40 outlines a Workplace Exposure Limit as;
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Occupational
rdous
to Health Regulations (COSHH) 2002 (as amended) in order to help protect the health of
Workplace Health
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specified period of time referred to as a time-weighted average (TWA). (HSE, 200 ´
Table 16: Examples of Workplace Exposure Limits
Health Issues
LTEL (8hour TWA) STEL (15 minute TWA)
Substance ppm mgm-3 ppm mgm-3
MMMF (Man Made Mineral
Fibre) 5 and 2 fibres /
- - -
HSC/E Plans to review the limits millilitre
for this substance
Styrene
HSC/E Plans to review the limits 100 430 250 1080
for this substance
Trichloroethylene
HSC/E Plans to review the limits 100 550 150 820
for this substance
Ozone - - 0.2 0.4
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LTEL is Long Term Exposure Limit
STEL is Short Term Exposure Limit
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154
WEL’s in Practice
In the UK, health and safety law (Control of
Substances Hazardous to Health Regulations
COSHH) requires employers (without prejudice to
prevent exposure) to adequately control exposure

by:
x Applying 8 principles of good practice for

the control of substances hazardous to
health (regardless of whether a substance
has an exposure limit);
x Ensuring that the Workplace Exposure
Limit (WEL) is not exceeded; and
x Ensuring that exposure to substances that
can cause occupational asthma, cancer, or
damage to genes that can be passed from
one generation to another, is reduced to a
level which is as low as is reasonably
practicable. Units for Workplace Exposure
Limits
Principles of Good Practice
The limits are expressed in parts per million (ppm)
for gases and vapours and milligrams per cubic
The eight principles of good practice for the control metre of air (mg/m-3) for airborne particles, dust,
of exposure to substances hazardous to health are fume, etc.
set out in Schedule 2A of the COSHH Approved
Code of Practice and are reproduced below: Fibres such as man-made mineral fibres are
measured in fibres per millilitre of air
1. Design and operate processes and (fml-1).
activities to minimise emission, release and
spread of substances hazardous to health.
2. Consider all relevant routes of exposure Time Averaged Concentrations
inhalation, skin absorption and ingestion
when developing control measures.
Workplace Exposure Limits apply to airborne
3. Control exposure by measures that are concentrations of substances only. The limits refer
proportionate to the health risk. to concentrations of hazardous substances in the
4. Choose the most effective and reliable air averaged over specific time periods know as
control options which minimise the escape Time-Weighted Averages (TWA). These are long-
and spread of substances hazardous to term exposure limits (LTEL’s) which are averaged
health. over 8 hours and short-term exposure limits
5. Where adequate control of exposure (STELs) averaged over 15 minutes.

cannot be achieved by other means,
provide, in combination with other control The long-term limit is intended to protect against
measures, suitable personal protective chronic effects, to reduce the accumulation of
equipment. harmful substances in the body or would enhance
a disease risk with continuing contact.
6. Check and review regularly all elements of
control measures for their continuing
effectiveness.
7. Inform and train all employees on the
hazards and risks from the substances with
which they work, and the use of control
measures developed to minimise the risks.
8. Ensure that the introduction of control

measures does not increase the overall
risk to health and safety.
155
Graph 1: Time Varying Concentrations
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20
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18 LTEL TWA
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16
14
12
Occupational
10
Workplace Health
8
Actual Exposure
6
4
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2
1 2 3 4 5 6 7 8
Time (hours)
Graph 1 illustrates how the concentration of a 8hr TWA = (C x T)/8

hazardous material may over time and how this
can be compared with an exposure limit. Where C is the average concentration and T is
the associated exposure time in hours.
The Time-Weighted Average criteria mean that an
exposure concentration can be higher than the If the 8-hour exposure is broken down into results
exposure limit for some of the assessment period, from a number of measurement periods, then the
provided that the average concentration remains exposure can be calculated as follows:
below the level.
TWA Exposure = (C1 x T1) + (C2 x T2) +… + (Cn x Tn)
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There are no stated maximum exclusions above 8
the TWA level, however the HSE Guidance
Document HSG 173 Monitoring Strategies for Example 1
Toxic Substances, suggests that exposure
excursions greater than one and a half times the

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An operator works for eight hours on a process in
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exposure limit require urgent attention. which he is exposed to a substance hazardous to
health. The average exposure during that period
Clearly where there is a short-term limit in place as it measured as 0.15mgm-3.
well as a long-term limit, this will help to prevent
significant excursions. The 8-hour TWA therefore = 0.15 x 8
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8
Average exposure can normally be determined
using measuring equipment which can calculate TWA = 0.15 mgm-3
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the average exposure automatically, or by use of

gravimetric sampling in which the total amount of
substance sampled over a known reference period
is determined and the average concentration
calculated by knowing the volume sampled and
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sampling time.
If sampling time is less than the TWA reference

period, an extrapolation is made (assuming the
sampling period is representative).
156
Example 2
Working periods may be split into several sessions for the purpose of sampling to take account of rest and meal
breaks, etc.
Working Period Exposure mgm-3 Duration of sampling (hours)

0800 - 1030 0.32 2.5
1045 – 1245 0.07 2
1330 – 1530 0.2 2
1545 – 1715 0.1 1.5
Exposure is assumed to be zero during the periods 1030 to 1045, 1245 to 1330 and 1530 to 1545.
The 8-hour TWA therefore = (0.32 x 2.5) + (0.07 x 2) + (0.20 x 2) + (0.10 x 1.5) + (0 x 1.25)
8
TWA = 0.80 + 0.14 + 0.40 + 0.15 + 0

8
TWA = 0.19 mgm-3
Example 3
Where an operator is exposed to styrene vapours as follows:

x For the first two hours, the concentration is 50 ppm.
x For the next hour, the concentration is 200 ppm; and
x For the next 5 hours, the concentration is 30 ppm.
Then the 8-hour TWA Exposure = (50 x 2) + (200 x 1) + (30 x 5)

8
TWA 8 = 450/8
TWA 8 = 56.25 ppm
The WEL 8-hour TWA for styrene is 100 ppm (EH40) and therefore exposure is within the limits, however
further controls should be considered to further reduce exposure.
A short-term exposure limit (STEL) is designed to prevent against acute effects such as:
x Excessive irritation.

x Irreversible tissue damage; and
x Narcosis to the extent that it could impair the worker such that they have an increased accident-
proneness.
When undertaking airborne monitoring to determine a STEL, normally a 15-minute measurement period should
be used. A shorter period could be used, if it could be assured that there is no exposure during the time not
used, e.g., a short job only lasted for 5 minutes, then it would be acceptable to monitor for only that time and
average the result over 15 minutes. It is not acceptable however to sample for a longer period and divide the
result down. Clearly the highest 15-minute peak could easily be missed.
Where an STEL is applied and no LTEL exists, there is no ceiling on the frequency or number of peak
exposures, provided that within any 15 minute window the STEL is not exceeded.
Many substances have both long-term and short-term limits, which reflect the different hazardous effects which
that material has on the body.
157
Dust Concentrations
All dust is potentially hazardous in substantial concentrations, particularly where it can penetrate the lungs.
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In the UK, a substantial concentration of dust is defined as:
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x 10 mgm-3 total inhalable dust (i.e., all particles sizes that can be inhaled, some of which will be
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trapped in the nose, etc.).
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x 4 mgm-3 respirable dust (i.e., particles that are small enough to enter the alveoli of the lungs).
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Both the above measurements are based on an 8-hour time weighted average (TWA) and therefore is a
substance hazardous to health.
Therefore, in the absence of any specific limit for a particular material, these general limits for dust should
Occupational
apply.
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158
International Examples of Exposure Limits

A large number of international and national authorities have published lists of legal or recommended ELs of various
sorts, but usually only for chemicals. The most wide-ranging is the ACGIH TLV list, updated annually, which includes
recommended EL values for:
The International Programme on Chemical Safety (IPCS) produces IPCS International Chemical Safety Cards, which
are peer-reviewed assessment documents. International organisations, such as the International Organisation for
Standardisation (ISO) and the International Atomic Energy Agency (IAEA), produce technical standards on the
measurement and control of several ambient factors with the objective of them being transferred to regional or
national legislation.
ELs for solids and non-volatile liquids are usually in mg/m3, that is, milligrams of the chemical in a cubic metre of air.
ELs for gases and vapours are usually in ppm, that is, parts of the substance in a million parts of air, by volume, and
also in mg/m3 at a specified temperature and pressure. There are a smaller number of lists of limits for biological
monitoring.
Many authorities have issued lists of ELs for airborne chemicals, on various assumptions. The International
Occupational Safety and Health Information Centre (CIS) of the ILO maintain a database of the limits from different
parts of the world. At the time writing, peer reviewed IPCS International Chemical Safety Cards are available for
around 1,300 chemical substances.
Different countries have adopted various frameworks for setting upper permissible concentrations for airborne
substances within the workplace. The first standard list of exposure limits was put together in the former Soviet
Union in the 1930’s. In the USA, the ACGIH (American Conference of Governmental and Industrial Hygienists) was
formed in 1941 and formed a Threshold Limit Values Committee (TLV). A range of limits was set known as hygiene
limits and has been widely used as the basis for determining limits elsewhere.
Recent developments of a new framework in the UK included the introduction of eight principles of good practice for
the control of exposure to hazardous substances to health, and introducing a single standard, Workplace Exposure
Limits, (WEL’s).
The HSE Guidance Document EH40 “Workplace Exposure Limits”, lists all the new WEL’s, with their numerical
values and associated time frame. It is revised and republished annually by the Health and Safety Executive.
Permissible Exposure Limits

The Permissible Exposure Limit (PEL or OSHA PEL) is a legal limit in the United States for exposure of an
employee to a substance, usually expressed in parts per million (ppm), or sometimes in milligrams per cubic
metre (mg/m3). Permissible Exposure Limits are established by the Occupational Safety and Health
Administration (OSHA).
A PEL is usually given as a time-weighted average (TWA), although a few Limits are Ceiling Limits. A TWA is
the average exposure over a specified period of time, usually a nominal eight hours. This means that, for
limited periods, a worker may be exposed to concentrations higher than the PEL, so long as the average
concentration over eight hours remains lower.
A Ceiling Limit is one that may not be exceeded and is applied to irritants and other materials that have NEBOSH International Diploma
immediate effects.
Table 17: Contrasting standards
Comparison data for Trichloroethylene

TWA STEL
ppm mg-m-3 ppm mg-m-3
ACGIH (USA) 50 270 200 1080

SCOEL (Europe) 10 54.7 30 164.1
EH40 (UK) 100 550 150 820
NOHSC (Australia) 50 270 200 1080
JSOH (Japan) 25 135 - -
159
The exact definition and intended application of ELs vary widely from one authority to another and the
underlying definitions and assumptions, and the requirements of the appropriate competent authority, must
be considered if they are used. As an example, table shows the variation from country to country that has
resulted from variations in the interpretation of scientific data and regulation methodologies.
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Information Included within UK EH40
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The following extract from Table 18 (list of approved workplace exposure limits) of EH40 illustrates the
information included for hazardous materials within the document.
Controlling
CAS (Chemical Abstracts Service) Number
Chemical Abstracts is a regular publication which contains a summary of significant chemical literature
Occupational
produced during that period. The numbering protocol for chemicals developed by this publication has gained
quasi-official status.
Workplace Health
Table 18: Extract from EH40/2005
Workplace exposure limit
Health Issues
Substance CAS Number LTEL 8-hour ref STEL 15 min ref Comments
ppm mg.m3 ppm mg.m3
Carc
Sk
R45, 11,
23/24/25, 37/38,
Acrylonitrile 107-13-1 2 4.4 - -
41, 43, 51/53
HSC/E plans to
review the limit
for this substance
Aluminium alkyl
- 2 - - R14, 17, 34
compounds
Aluminium metal
Inhalable dust 7429-90-5
- 10 - -
Respirable dust
- 4 - -
Sk
R23/24/25, 40,
Aniline 62-53-3 1 4 - -
41, 48/23/24/25,
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68, 50
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160
Strategies, Methods and Equipment for the Sampling

and Measurement of Airborne Harmful Substances
The International Occupational Hygiene Association (IOHA) defines

occupational hygiene as
³2FFXSDWLRQDO +\JLHQH LV WKH GLVFLSOLQH RI DQ

recognising, evaluating and controlling health hazards in the
working environment with the objective of protecting worker
health and well-being and safeguarding the community at
ODUJH´
Occupational Hygiene was recognised as a distinct discipline within health and safety. Occupational Hygiene
uses the application of science to assess and monitor occupational health hazards, providing a useful link
between occupational health departments and traditional Safety Officer. The role of the occupational
hygienist often embraces such issues as the environment, ergonomics, and occupational stress, however
apart from some of the larger chemical, oil, and pharmaceutical companies, many organisations now do not
employ occupational hygienists, rather they prefer to extend the portfolio of the health and safety advisor to
include occupational hygiene issues and call in specialists as necessary. Most Occupational Hygienists
therefore now work as consultants to industry or have moved into mainstream health and safety.
Occupational health requirements differ widely across the world, with many countries having little or no
provisions in place to protect workers from occupational health hazards. Within the UK, there are stringent
requirements in place enshrined by the Control of Substances Hazardous to Health Regulations 2002, which
place an obligation on the employer to carry out a suitable and sufficient assessment of all exposures to
hazardous substances at work. These regulations augment the more general duties outlined within the Health
and Safety at Work etc, Act 1974.
At an international level, the ILO continues to play an active role in promoting the ultimate goal of placing
occupational safety and health at a high level in the national and global agendas.
The ILO Convention on Occupational Health Services in 1985 really set the ball rolling. It advised that
occupational health services should aim to prevent the occurrence of work-related ill health and provide
guidance relating to:
1. "The requirements for establishing and maintaining a safe and healthy working environment which
will facilitate optimal physical and mental health in relation to work.
2. The adaptation of work to the capabilities of the workers in the light of their state of physical and
mental health.
The biggest problem within many countries is that there are no mandatory requirements in place relating to NEBOSH International Diploma
occupational health. This issue was addressed by the Committee on Safety and Health at Work during the
International Labour Conference in Geneva, June 2006. The Committee adopted a Convention accompanied
by a Recommendation, namely the Promotional Framework for Occupational Safety and Health Convention
2006 and the Promotional Framework for Occupational Safety and Health Recommendation 2006.
The Convention was adopted almost unanimously by the Conference Plenary of the International Labour
Conference (with only one country voting against it). Article 4 of the Convention is probably the most significant
and relates to each member having to ‘establish, maintain, progressively develop and periodically review a
national system for occupational safety and health.’
161
The Roles and Functions of Occupational Health Specialists

There is now a clear recognition of the need to
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maintain the health and efficiency of a skilled
workforce. This is best achieved with a multi-faceted
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team of professional who are closely attuned to the
needs of the organisation and the individuals within
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it.
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Although traditionally, as with any health service, the
key professional is regarded as the doctor and nurse
(Occupational Physician and Occupational Health
Advisor), there are a number of other professionals
who may, depending on the size and nature of the
Occupational
organisation, have a key role to play.
Workplace Health
These include Occupational Hygienists, Toxicologists, Physiotherapists, Ergonomists, Microbiologists,
Psychologists, and Health Physicists, the roles and functions of these shall be discussed later.
Traditionally organisations would have included occupational health departments whose staff would be
direct employees of the organisation. Increasingly however, as with many non-core activities, occupational
Health Issues
health Departments are contracted out and there are a number of organisations who can provide an
occupational health service.
Doctors and Nurses

Occupational Physicians and Nurses should be experienced professionals who have obtained occupational
health qualifications in addition to their general medical qualifications. Both, however, need to be aware of
their clinical limitations and refer to other experts as necessary. They must also be aware that the employee
is another physician’s patient. Typical activities of these health professionals include:
The Role of Other Health Related Professionals

Occupational Hygienists have an important role to play in providing technical support with respect to the
assessment of occupational health issues, assessing the working environment whereas occupational health
professionals assess the individual workers. Close liaison between the two groups of professionals can
target adverse conditions early, e.g., routine health surveillance may highlight problems with hand-arm
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vibration within a particular category of staff. An Occupational Hygienist can then undertake some
workplace monitoring.
Ergonomists can help with assessment of musculoskeletal risks and general layout of displays and NEBOSH
controls.
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Physiotherapists can assist with the rehabilitation of staff following injury. Any organisations have found
that use of a fast-track physiotherapy service can save money in terms of shortening sickness absence.
Health Physicists Where there is a risk from Ionising radiation, are an integral part of the occupational
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health team, assessing radiation doses.
Laboratory staff also has a support role with biological monitoring.

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Depending on the size and nature of the organisation, other ancillary services can be provided such as
dentistry, dieticians, and other therapists.
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There may also be access available to specialists from regulatory bodies that exist within individual
countries.
162
Interpretation of a Hygienist’s Report

It is important that the report prepared by an occupational hygienist contains all appropriate information such
as the methods, frequency and equipment used to gather samples to carry out the analysis. The hygienist
should also refer to relevant HSE guidance such as Methods of Determining Hazardous Substances (MDHS).
Reliability of the report depends very much on the competency of the hygienist. In all instances, a hygienist
should apply the correct and suitable strategy and methods to gather information and that the results are
valid, reliable, representative of the actual risk of exposure to the worker, is relative to any workplace exposure
standards and written in a format that is understandable by the reader.
Monitoring Strategy
Introduction
Exposure to substances hazardous to health should be prevented or, where this is not possible,
adequately controlled. Once control measures have been implemented it is important to ensure that they
are and continue to be effective.
Maintenance and monitoring activities are essential to demonstrate management control and to identify
management weaknesses that require further means for control of exposures.
This Element is concerned with the ‘technical’ aspects of controlling hazardous substances, including
typical activities that could be undertaken by an Occupational Hygienist. Both maintenance and
monitoring aspects of the topic relate to the following issues:
x Monitoring of exposure at the workplace in accordance with suitable procedures at regular intervals
or where there is significant change that may affect exposure. Monitoring of exposures may be
necessary based upon risk assessment findings. Suitable records of the monitoring should be
kept.
x Health surveillance needs to be undertaken, where appropriate, for the protection of employee
health.
x Employers and employees share obligations with respect to ensuring the use of control measures.
x Control measures, with respect to engineering controls (ventilation systems), need to be
appropriately maintained, incorporating a ‘thorough examination and test’ of performance (velocity
flow rates, pressures, etc.) undertaken at suitable intervals.
Why Monitor?
Monitoring of exposures at the workplace should be carried out where the risk assessment indicates that:
x It is requisite for the maintenance of adequate control of exposures; or NEBOSH International Diploma
x It is otherwise requisite to protect the health of employees.
A hazardous substance assessment may determine that the air monitoring of hazardous materials should be
undertaken. This will not always be required, particularly where exposure by the airborne route is not
significant e.g., for low hazard water-based components. However, in many instances this will be advisable,
many hazardous materials have Exposure Limits assigned to them and in order to determine whether
exposure is within the limits, some form of monitoring shall be required.
In particular, monitoring is required where:
x The material is carcinogenic, mutagenic, harmful for reproduction or sensitising. Such materials have
Exposure Limits for which exposure ‘as low as is reasonably practicable’ should be achieved.
x Assurance is required that a control measure is working correctly.
x There is a significant change in process and some assurance is sought that exposure to staff is at
an acceptable level.
x It is specified within legislation or standards.
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How Often?
Monitoring of exposures should be undertaken at regular intervals and where any change occurs that may
affect exposures.
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The following factors for consideration when setting exposure monitoring frequencies:
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The processes and substance present.
x The control measures used and how they are tested and maintained; and where appropriate,
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x How close the exposure is to an exposure limit?
Controlling
Sometimes a single ‘one-off’ monitoring session may be all that is required to ensure that control measures
are operating satisfactorily, and that exposure is not significant. It must be borne in mind that a single
monitoring exercise may not be representative on a statistically significant basis on which to establish control
measures. The UK HSE Guidance document HSG 173 ‘Monitoring strategies for Toxic Substances’
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suggests that only if exposure is less than one quarter of the exposure limit can control be considered
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satisfactory.
If monitoring is required if should be undertaken on a regular basis as an ongoing confirmation of control.

The more hazardous the process, the greater the re-assurance required that controls are operating
satisfactorily.
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How long?
The sampling period will depend upon the method used. Grab sampling involves the collection of samples
over a period of a few seconds up to several minutes. Continuous, or integrated, involves the collection of
samples over longer periods (sampling techniques are discussed later in this Element). Therefore, following
factors should be considered when determining the sampling period for monitoring:
x The nature of the hazard, e.g., does the substance have a long or short-term exposure limit?
x The frequency of exposure, e.g., is exposure continuous or periodic?
x The duration of work activity, recognising physical activities may increase the inhalation rate, e.g.,
how long and strenuous is the activity?
Record Keeping
Employers need to keep and maintain a suitable record of
monitoring of:
x Personal exposures. In some countries, there will be

legislation relating to time periods, for example in the UK
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records relating to personal exposure must be kept for at
least 40 years from the last date of entry; or
x Workplace (static) monitoring. Again, legislation may
also prescribe time periods relating to this information

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(UK requirement – 5 years from the last date of entry).
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Where an employee is under health surveillance, an individual

record should be maintained in respect of that employee. Once
given reasonable notice by the employee the employer should
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allow him / her access to their personal monitoring record.
Maintaining records is an important part of the monitoring process

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since ongoing monitoring of control measures can refer to

previous records and performance of the controls can be
assessed over time. In relation to personal monitoring information
health records should be kept for up to 40 years. The long latency
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period between exposure and ill health effect can make workplace
diagnosis difficult in many circumstances. Furthermore, the
information gathered of a longer period of time can serve to
enhance knowledge of the chronic ill health effects of many
substances as well as highlighting possible accumulative and
synergistic effects.
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Undertaking Air Monitoring
Determining a Monitoring Strategy

The following sections describe in more detail the various approaches that can be taken to monitoring. The
UK HSE Guidance Document HSG 173 provides a good starting point. It outlines a systematic approach
to undertaking a survey as illustrated in Flowchart 5.
Flowchart 5: Approach for Assessing Hazards to Health by Inhalation

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Initial Appraisal Detailed Survey

At first an initial appraisal of the hazards and risks Where required, this may use a number of the
need to be undertaken, considering all of the relevant techniques, qualitative, semi-qualitative and
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factors such as: quantitative. Inevitably there will be a balance
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x Substances used. resources available. In an ideal world, it would be
possible to undertake large numbers of samples
x Physical forms and properties.
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over several days, however, as with most health
x Processes involved. and safety considerations, the availability of
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x Points of release. resources balanced against the level of risk must
be considered.
x Persons who could be affected.
x Work practices. Before any monitoring is undertaken, it is
important that sufficient ‘groundwork’ establishes
x Means by which substances could be
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the situation. The following should be sought:
released.
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x Whether RPE or other forms of PPE is worn x Existing risk assessments.
and its effectiveness or ergonomic concerns;
and x Procedures and workplaces.
x Relevant Exposure Limits. x Maintenance procedures.

x Existing engineering controls and their
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From this information and some qualitative suitability.
observations, a decision can then be made regarding x Existing PPE and its suitability.
the need for monitoring and if so the type of work to x Previous monitoring results.
be undertaken.
x Any health surveillance results; and
x The extent of information, instructions
Basic Survey and training given to staff, including
young persons.
This is recommended, although in practice this stage
is sometimes missed out or amalgamated with the Further details on undertaking a survey may be
main full survey as discussed in the following section. found in relevant guidance. In the UK, there is a
large number of specific guidance documents
A basic survey, however, has value in terms of helping available from the HSE in a series called ‘Methods
to define the scope of the full survey and ensuring that for the Determination of Hazardous Substances’,
monitoring resources are effectively targeted at the abbreviated to MDHS. These give details of the
high risks. sampling as well as the analytical methods used
to assess hazardous substances in the
The approach taken to a basic survey is to select an atmosphere. Some examples are listed below:
area which is likely to give a worst-case scenario and
x
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undertake a quick qualitative or semi-qualitative MDHS 24/3: General methods for
assessment of exposure using a technique such as a sampling and gravimetric analysis of
gas stain indicator tube or Tyndall beam to identify the Respirable and inhalable dust.
likely exposure. A more detailed survey can be
x
MDHS 17: Benzene in air: Laboratory

planned based on the findings from the initial
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method using charcoal adsorbent Tubes,
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assessment.
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solvent desorption, and gas

chromatography.
x MDHS 39/4: Asbestos fibres in air:
Sampling and evaluation by Phase-
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Contrast Optical Microscopy (POCM)

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x MDHS 70: General methods of sampling

airborne gases and vapours.
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All these titles are aimed at qualified competent Occupational Hygienists, analytical laboratory technicians,
etc. When undertaking monitoring, it is advisable to ensure that the MDHS method is used, where one is
available. The results are less likely to be questioned, when evidence is required of compliance with limits, or
otherwise, when the monitoring has been undertaken using a recognised method.
Where a specific method is not available, a monitoring protocol should be developed using the professional
judgment of competent hygienists in conjunction with laboratory personnel as appropriate. The more general
MDHS documents such as MDHS 14/3 and MDHS 70 contain general guidance for such situations.
Reappraisal
Reappraisal should be conducted once remedial actions have been implemented following the survey/s to
assess if the control measures are working effectively and the risk to workers have been reduced.
Reappraisal is also appropriate if the risk factor is high such as working with carcinogens.
NIOSH Manual of Analytical Methods Series

In the United States, the National Institute for Occupational Safety and Health (NIOSH) publish guidance in
the form of the NIOSH Manual of Analytical Methods (NMAM), in a similar fashion to the UK MDHS series
previously discussed.
NMAM is a collection of methods for sampling and analysis of contaminants in workplace air, and in the blood
and urine of workers who are occupationally exposed. These methods have been developed or adapted by
NIOSH or its partners and have been evaluated according to established experimental protocols and
performance criteria. NMAM also includes chapters on quality assurance, sampling, portable instrumentation,
etc.
The methods are intended to promote accuracy, sensitivity, and specificity in industrial hygiene analysis.
However, NIOSH make it clear that there will be situations where users of the NIOSH methods will need to
modify them (e.g., to accommodate interfering compounds from the workplace, to take advantage of special
capabilities of the laboratory, or to make possible the analysis of a single sample for several contaminants).
Each method consists of three major parts:
x Front page. The first page of each method concisely summarises sampling and measurement
parameters and gives estimates of limits of detection, working range, measurement precision and
interferences. References to other methods are also given, e.g., the ILO also publishes a wide
range of analytical methods.
x Instructions. The second page of each method begins with a list of reagents and equipment. The
user of the method is responsible for assuring the accuracy of the results. Special precautions are
also referred to in this section, including safe practices to be observed during sampling and
measurement. Next are the step-by-step instructions for sampling, sample preparation, calibration
and quality control, measurement, and calculations.

x Supporting information. Laboratory and field data relating to the method are summarised in the
evaluation of method section and on the summary page, along with pertinent references.
ISO Standards
The International Organization for Standardization is an international standard-setting body composed of
representatives from various national standards organisations.
The organisation makes known worldwide proprietary, industrial, and commercial standards. They have
published analytical methods which can be employed when determining the content of samples taken in the
workplace.
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Personal and Static Sampling

Sampling can be by personal and / or static (area) sampling and
can be undertaken as a part of a monitoring regime, for which two
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methods can be used:
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x Active Sampling, where the contaminant is pumped through
a suitable detector, media or filter, either giving a direct
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reading or providing a sample for laboratory analysis
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(indirect reading); and
x Passive Sampling, where the contaminant diffuses onto a
suitable collection media, which either gives an indication of
the presence of the contaminant or more commonly is then
analysed in a laboratory.
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Personal Sampling involves a sampling device being attached to a
person, with the sampling head or probe placed, as far as can be
realistically achieved, within the operator’s breathing zone, often on
the lapel. This device is worn by the operator and should produce a
measurement close to the actual exposure of the operator. Thus, it
is an ideal method for assessing whether an exposure limit has been
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exceeded.
Disadvantages of personal sampling include the possibility of

operator interference. Unless watched continuously, there is a risk
that the operators may attempt to manipulate the reading for their
own interest. They could seek to lower the result by blocking the inlet,
or exaggerate the reading by deliberately standing in a discharge
plume, or sprinkling dust into the sampling head. Often discussions
with the operators prior to sampling can help gain their full co-
operation, and monitoring over an extended period with several
different samples can help to eliminate any rogue results. The
operator may also inadvertently block the sampler, turn the sampler
head to the wrong direction (to face his or her body for example),
cause any flexible pipes on the sampler to kink or become detached.
Illustration 34: Operator Wearing Gravimetric Personal Dust
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Monitor
Ideally, an operator should be watched while wearing a sampler to ensure no interference (intended or
otherwise) occurs. The sampling device can then be checked at regular intervals to ensure that it is still
operating effectively. This will also give an opportunity for the activity to be observed and any significant
issues noted. Observation is an important element of monitoring; the assessor’s eyes, ears and nose are
important tools.
Grab Sampling
Air Sampling can also be divided between Grab Sampling and Long-Term or Time-Weighted Average
sampling.
Grab Sampling is a technique that enables a single sample to be taken of the concentration of a gas or vapour
in the atmosphere. Usually this will involve some form of direct reading device such as a gas indicator tube.
The main application for this type of technique is as part of a basic survey or quick check to see whether there
is a problem or not.
Alternatively, there may be a transient contamination for which there is not time to gain a significant sample
by long-term measurement, which requires a certain sample time to obtain a meaningful result. In such cases
a sample of air will be collected in a vacuum flask or flexible plastic container (e.g., tedlar bag) and sent to a
laboratory for analysis by gas chromatography, infra-red spectrometry, atomic absorption or other method.
This is a relatively uncommon form of sampling since it is rather cumbersome.
Stain Tube Detectors are the most common form of Grab Sampling. A hand pump that draws a specific
volume of air through a detector tube filled with crystals of a substance, which will react with the gas or vapour
being sampled and change colour. The extent of the stain against the scale on the tube will give an indication
of the concentration.
Illustration 35: Stain Detector Tube Pump

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The gas or vapour present needs to be identified before this method is used, as the specific tube for the
substance must be obtained. There are over 200 tubes available and include oxygen, carbon monoxide,
sulphur dioxide, hydrogen sulphide and acetone.
Once a specific tube for the substance is selected, the glass tips at each end of the tube are carefully broken
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off. The tube is then inserted into the hand pump suction port. The hand pump is then operated, normally in
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the breathing zone. For each pump stroke the pump bellows is fully compressed and allowed to re-open
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under internal spring pressure. The required number of strokes of the pump varies depending upon the
contaminant, which is indicated within the tube packaging. An extension tube is available to permit sampling
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in a confined space without the person having to enter the space.
Controlling
Illustration 36: Stain Detector Tubes
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The upper stain detector tube, shown in Illustration 35, is filled with crystals of a substance that reacts with
the contaminant (gas or vapour) being sampled. The crystals change colour in the presence of the
contaminant such that the level of contaminant (parts per million ppm) can be read directly from the graduated
scale.
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The lower stain detector tube, shown in Illustration 36, is similar, however it contains a liquid reagent in a
breakable ampoule rather than being filled with crystals. Breaking the ampoule releases the liquid, which
will then react with the contaminant of interest and the level of contaminant (parts per million ppm) can be NEBOSH
read directly from the graduated scale.
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It is a useful method to provide an initial indication of the concentrations present. It also enables non-
technical persons to quickly gain an impression of the concentrations of material present.
The following considerations also need to be borne in mind:
x
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The pump must be tested for leaks prior to use by depressing the pump then ensuring it does not
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re-inflate by covering the inlet.

x The tube ends should be sufficiently removed to ensure the correct flow rate and the tube must be
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correctly inserted to prevent bypass leakage.

x The pump bellows must be fully depressed on each stroke, ensuring that the correct number of
strokes are used.
x The reading is a snapshot at the time of measurement and may not be truly representative.
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x The colour changes are not always sharp and clear, so may be difficult to read.
x Some chemicals can cause interference, thus giving a false reading.
x The tubes have a shelf-life which must not be exceeded; and
x The precision can be poor (typically ± 30%).
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Direct Reading instruments can also be used for grab sampling; these are discussed further in the next
section.
Time Weighted Average (Long-Term) Sampling

Long-term in this context does not necessarily refer to a long-time period, but unlike grab sampling which just
measures an instantaneous concentration, long-term sampling enables a Time-Weighted Average (TWA)

concentration to be determined, which could be based on a few minutes of sampling or several days. This is
in many respects a greater relevance when comparing against occupational hygiene standards since these are
expressed at TWA’s.
These methods can be further divided in terms of direct reading and indirect reading.
Both types are available for some applications as personal sampling or static sampling equipment.
Direct Reading Instruments
Direct reading instruments will give a continuous reading of levels of a specific gas or vapour in the
atmosphere.
Some of these instruments will provide a printout of the various levels during the sampling period as well
as converting the reading to the Time-Weighted Average (TWA), that is the average level over the period
sampled. UK guidance EH 40 publishes limits for 8 hour (LTEL) TWA and 15 minute (STEL) TWA. For
comparison against the EH40 limits where the sampling period differs from these time periods any results
obtained will need to be extrapolated to the relevant EH40 time period.
Direct reading portable instruments are available for oxygen level, carbon monoxide, hydrogen sulphide,
chlorine, and a number of other gases. These instruments are small enough to be carried into confined
spaces or can be used as static samplers. Some instruments monitor for more than one of these gases.
Permanent direct reading static sampling equipment is used in some industries. This is more properly
defined as Monitoring Equipment. These will normally give an alarm if certain levels of oxygen or a toxic
gas are encountered and do not provide any facility for a direct reading of concentration in air; these are
also used for monitoring during work rather than evaluation of levels.
There is a range of direct reading instruments available to indicate the levels of flammable gas or vapour
in air, sometimes termed Explosimeters.
These will either be set for the specific Upper Flammable Limit or Upper Explosive Level (UFL / UEL) and
Lower Flammable Level or Lower Explosive Level (LFL / LEL) of the particular gas or vapour, e.g.
methane. Explosimeters are usually set to warn at 25% LFL / LEL, or in more sophisticated versions can
be set for different levels and will provide direct reading of the percentage of the LFL in air that is present.

Commonly direct reading instruments used in industry include three in one or four in one multi-gas
instruments, which continually measure oxygen level, flammable gas and one or two toxic gases such as
carbon monoxide and / or hydrogen sulphide. This type of instrumentation can be used to monitor
atmospheres for work within confined spaces.
Equipment is also available for the monitoring of aerosols (dusts and mists), which works by measuring
the light scattering effect of particles. These devices are not as accurate as a gravimetric sampler, which
weighs the dust actually present in the air. Rather, they are calibrated using a specific type of dust. This
will give different results for particles of different densities and aerodynamic characteristics. They do
however have the advantage over gravimetric sampling of giving a real-time variation of dust
concentration over time, using a date logger, which records a reading at regular intervals.
For all direct reading instruments, it is important that calibration takes place at regular intervals as
recommended by the manufacturer. Clearly this is particularly important where the monitoring is for a
safety critical application such as a confined space.
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More sophisticated instruments can be programmed to detect a range of different gases or vapours, e.g., the
Miran infrared analyser which can quantify material by looking at the strength of absorption at a particular
infrared frequency specific to that substance.
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The advantages of direct reading instruments are:
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x An instant indication of the level of contamination
can be achieved. There is no delay as laboratory
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results are awaited.
Controlling
x It is helpful in communication to staff - showing
them a direct readout can be reassuring.
x The instant readout also makes them useful as a
detection (sniffer) device to establish where the
highest concentration of a contaminant may be
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located. Thus, gas leaks or the location of a spill
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can be located.
x They are generally easy to operate; and
x A real-time variation of exposure over time can
be obtained. Data can be downloaded to a
spreadsheet and graphs obtained. Peaks in
exposure can be viewed and compared with
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short-term limits.
The main disadvantage of a direct reading instrument in that the reading may not always be accurate, but
relies on a detecting mechanism, which will introduce a source of error. This is particularly the case for
direct reading dust monitors. For dust, only a gravimetric reading can give a true indication of the exposure
level. Thus, where reliable data is required, indirect methods are preferred.
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Personal Sampling for Solid Particles
General Method for Sampling and Gravimetric Analysis of Dusts

The total inhalable dust fraction can be collected and assessed by use of a pre-weighted filter, weighed on an
accurate microbalance. This is then placed inside a sample head and attached to a sample pump, with a
typical flow rate of 2 litres / minute. The sampling head is selected in accordance with the media being
sampled.
In the UK, there are three inhalable dust sampling heads recommended by MDHS 14/3, which are the Institute
of Occupational Medicine (IOM) inhalable sampler, the multi-orifice (or seven hole) sampler and the conical
inhalable sampler (CIS). The IOM inhalable sampler is usually the preferred method of sampling due to its
performance over a range of workplace conditions.
It is also important that the correct filter medium is selected for the material being assessed. Typically glass
fibre is the usual medium for gravimetric determinations, however for certain applications silver membrane
filter and PVC can be used.
Illustration 37: IOM Inhalable Sampler


Illustration 38: Multi-Orifice Total Inhalable Sampler
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Illustration 39: Conical Inhalable Sampler
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Following sampling, the filter is carefully removed and then reweighed. Knowing the flow rate of the sample
pump, the sample time and the mass change in the filter, the concentration of particulate (mgm-3) in the
atmosphere sampled can be calculated.
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In addition to measuring total dust, the filter used can be analysed by a suitable technique, for any specific
component, e.g., cadmium, nickel, silica. Typical analytical techniques would be atomic absorption
spectroscopy or x-ray fluorescence.
A modified device can be used for assessment of the respirable dust fraction of a particulate dust cloud.
The respirable fraction is the component of the inhalable dust that passes through to the alveoli. Typically,
this is composed of particles of less than 10 microns in diameter. These devices consist of a vertical
cyclone that spins in the air. In the cyclone, larger particles are thrown outwards and collected in the grit
pot, the respirable fraction being collected on the filter.
Illustration 40: Respirable Dust Cyclone Sampler
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Asbestos Sampling
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A measured volume of air is drawn through a membrane filter of mixed esters of cellulose or cellulose nitrate,
preferably with square gridlines printed on, although ungridded filters may be used. An open-faced filter
holder fitted with an electrically conducting cylindrical cowl should be used for sampling. This type of holder
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is designed to protect the filter, while still permitting uniform deposit. The cowl points downwards when
sampling. A cap is used to protect the filter from contamination during transport.
After sampling the filter is treated with a solution of acetone and triacetin to make the filter transparent. The
fibres on a measured area of the filter are counted using phase-contrast optical microscopy (POCM) and the
number or concentration of fibres in the air is calculated. Not every fibre is counted, a statistically significant
number of microscope fields (usually about 0.15%) is viewed and the number of fibres within a graticule viewed
through the eyepiece are counted. Only fibres of a certain size and shape are counted.
Illustration 41: Cowl Sampler
There are various other rules governing fibre counting which is a specialist activity. Operators need to be
trained and then maintain their competence via regular quality assurance schemes in which they count known
standard slides – a scheme know as RICE (Regular Inter-Laboratory Counting Exchange).
In the UK, the Control of Asbestos Regulations 2012 (CAR) provides for the measurement of the control limit
by the 1997 World Health Organisation (WHO) recommended method, set out in the publication Determination
of airborne fibre concentrations. A recommended method, by phase-contrast optical microscopy (membrane
filter method), WHO Geneva 1997 (ISBN 92 4 154496 1). Asbestos air sampling, analysis and fibre counting
should only be undertaken by laboratories which meet specific quality assurance requirements.
Personal Sampling for Vapours


Passive Sampling
The indirect methods mentioned above rely on a known volume of air being pumped through a collection
medium. Passive sampling relies on the material of interest diffusing into the collecting medium, which may
either be a tube or badge. The badge has a flat permeable membrane supported over a shallow layer of
sorbent. The tube type sampler has a smaller permeable membrane supported over a deep metal tube filled
with sorbent. Alternatively, a glass tube open at each end with a porous membrane can be used.
The contaminant of interest diffuses through the sample medium at a calculated rate. When sampling is
completed, the tubes are returned to the laboratory for analysis in the same way as for a pumped sorbent
tube. Thus, knowing the exposure time, a TWA concentration can be calculated. Sampling starts when the
ends of the tube or cover in the case of a badge are removed.
The advantage of this method is that no pump is required, and the sampler can be left for several days or
weeks if necessary. Personal sampling is much easier too, with no pumps and tubing to encumber the
operator. There is however some doubt regarding the accuracy of the method. The scientific community
seems divided on the issue. One view is that without knowing a precise volume sampled there is probably
more margin for error, particularly with factors such as wind speed affecting the amount of material absorbed
onto the filter.
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This method is particularly effective for long-term sampling, e.g., nitrous oxide gasses in a workplace over
several days or weeks.
Illustration 42: Passive (Diffusive) Samplers
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Active Sampling
This method relies upon a known volume of air being pumped through a collection medium over a measured
time period. Indirect reading instruments provide methods of sampling the atmosphere, which is then
analysed in a laboratory to determine the amount of material collected. Various forms of equipment are
used depending on the material being sampled.
Gases and vapours are sampled by drawing a known quantity of air (by means of a small pump) through
an adsorbent or absorbent material, which collects the sample on (adsorb) or in (absorb) the material. It
can then be analysed later in a laboratory by using an appropriate analytical technique such as gas
chromatography, high performance liquid chromatography, mass spectrometry or infra-red spectroscopy.
A range of sorbent materials are available, the most common is probably charcoal which is effective in
absorbing a range of organic solvents.
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Illustration 43: Activated Charcoal Sampling Tube
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Air is drawn through a sorbent tube relatively slowly, typically at rates between 40 and 200 ml/minute. If the
air passes through too quickly, the component of interest may pass straight through the tube without being
absorbed. This does mean however that the technique is not suitable for short term monitoring – if the pump
is run for only a few minutes, there is unlikely to be enough material absorbed to analyse. Conversely, if too
much material is absorbed the result will not be accurate. To predict whether this has occurred, sorbent tubes
usually contain two sections. A section used to collect the sample, separated by a form of porous barrier (e.g.,
foam) from a smaller section of sorbent, situated downstream of the sample collection area. Should any of
the substance being analysed be collected on the smaller section, breakthrough is said to have occurred and
the result will be an under-estimate and should be discarded.
Illustration 44: Midget Impinger
An alternative method of collecting an airborne sample is by use of an impinger. This is in effect a midget-
dreschel bottle containing a liquid through which the atmosphere being sampled is bubbled. The liquid is
designed to react with or collect the analyte of interest. For example, distilled water could be used for acid
mist collection. This is not a popular method and is only used when necessary. It is also messy as the content
of the impinger can spill out, particularly for personal samples.
Dusts, mists, fumes, etc. are sampled by drawing air through a filter to collect the contaminant, which is then
analysed in a laboratory

Measurement Principles
Gaseous pollutant monitoring can be accomplished using various measurement principles. As an example,
sulphur dioxide monitoring can be accomplished with dynamic samples for average concentrations over a 24-
hour period and with static samples for longer periods, e.g., 30 days. Some of the most common techniques
to analyse gaseous pollutants include:
x Spectrophotometry,
x Chemiluminescence,
x Gas chromatography- flame ionization detector (GC- FID),
x Gas chromatography- mass spectrometry (GC- MS), and.
x Fourier transform infrared spectroscopy (FTIR).
With all sampling and analysis procedures, the result is quantitative data. The validity of the data depends
on the accuracy and precision of the methods used in generating the data. Accuracy is the extent to which
measurements represent their corresponding actual values, and precision is a measurement of the variability
observed upon duplicate collection or repeated analysis.
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To ensure the validity of data, various quality control measures are employed for each reference method.
The primary quality control measure is calibration.
Calibration checks the accuracy of a measurement by establishing the relationship between the output of a
measurement process and a known input.
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Each of the reference methods has precise calibration procedures that must be followed to ensure accurate.
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results.
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Calculation of Time-Weighted Averages (TWA)
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Where a material has a known Exposure Limit, a calculated TWA exposure can be used as a direct
comparison. Where a gravimetric or an absorbed sample is collected, a calculation needs to be performed
to obtain the TWA exposure. For example, a sampler is set to 2 litres per minute (0.002 m3/min) and the
Occupational
atmosphere is sampled for Cadmium dust for 2 hours. The laboratory identifies that 0.09 mg of cadmium
was collected. The TWA exposure could then be calculated as follows:
Workplace Health
2 hour TWA = Mass of sample collected/sample volume mg/m3
Sample volume = flow rate of pump x sample time m3
NB The Sample time must be in the same units as used in the sampler flow rate, i.e., minutes.
Health Issues
Therefore:
2 hour TWA = 0.09/(0.002X120)
2 hour TWA = 0.375 mgm-3
If a separate test indicated that a TWA exposure for cadmium for the next three hours was 0.2mgm -3 but no
more exposure took place that day, and 8-hour TWA may be calculated as follows:
8 hour TWA = (0.375 x 2) + (0.2 x 3)

8
8 hour TWA = 0.169 mgm-3
This should them be compared with the EL for Cadmium (if applicable).
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9.10 Biological Agents

The types of biological agent which are significant from an occupational health perspective are:
x Bacteria
x Viruses
x Fungi
x Protozoa
Bacteria
Bacteria are single-celled organisms and are found everywhere, in soil, on and in people and animals, in air,
water and on/in food. Bacteria or more commonly germs are microscopic, i.e., cannot be seen with the naked
eye which can see objects of around 75µ. Salmonella bacteria have a length of about 3µ. A microscope with
the ability to magnify up to around 1000 X would be needed to examine in detail such an object, if a fly were
magnified to the same extent, it would be around 9 m in length! (Sprenger, 1991).
Bacteria come in many shapes and sizes, rod shaped known as bacilli, spherical shaped known as cocci and
spiral shaped known as spirochaetes. Within the different groups of bacteria there are also a number of other
characteristic features which define the various bacteria including the ability to survive and thrive in the
absence of oxygen.
Bacteria are killed by antibiotics, certain viruses (bacteriophages) and high temperatures for a sustained
period. Many food products are heat treated (pasteurised) to kill off bacteria to improve the shelf life of the
food product, e.g., milk is pasteurised at 72°C for 15 seconds and ultra-heat-treated milk (UHT) is subjected
to 132°C for 1 second, destroying much of the bacteria naturally present in the milk.
Certain groups of bacteria, notably Bacillus anthracis, the causative agent of anthrax, have the ability to
produce ‘spores’. This is a dormant state for the bacteria which effectively provides a protective jacket around
the bacteria to protect it from adverse environmental conditions allowing the bacterium to survive high
temperatures, disinfection and other destructive techniques. This allows the bacteria to survive long periods
of time and return to an active state when conditions once again become favourable.
Viruses
Viruses are smaller than bacteria and are visible only with an electron microscope. They are made up
principally of protein molecules, have no DNA (genetic makeup) and can only reproduce within a living cell.
Each type of virus requires a specific host cell to infect and subsequently multiply. Once they have infected a
cell they reproduce rapidly and spread to other cells, destroying them as they go. Antibiotics are not effective
against viruses, although vaccines exist for some. Viruses can also be destroyed by disinfecting chemicals
such as bleach. There are many different types of viruses known and can cause a range of infections from

those which are inconvenient, e.g., the common cold, to those which are deadly, e.g. Ebola infection, rabies,
cancer, AIDS, etc.
Examples of types of viruses significant for occupational health include:
x Human Immunodeficiency Virus (HIV), which is a blood borne virus and the causative agent of
Acquired Immunodeficiency Syndrome (AIDS).
x Hepatitis A, which is a food or water borne viral infection associated with poor sanitation and living
conditions; and
x Hepatitis B and C, which are blood borne viral infections with particular significance in the health
care sector.
Fungi
Fungi are plants but lack chlorophyll, the essential element for photosynthesis, and must have organic matter
as part of their food. They include yeasts (ovoid in shape with budding cells) and moulds (growing as branching
filamentous tubes). They can cause disease in plants and animals and cause food to decay. They also have
benefits as food (mushrooms) and medicines (e.g., penicillin is produced from a genus of mould called
penicillium).
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Fungal spores (reproductive seeds) often cause respiratory diseases such as extrinsic allergic alveolitis,
e.g., farmer’s lung is caused by the inhalation of the spores from mouldy hay and a condition known as
bagassosis from exposure to mouldy sugar cane.
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Protozoa
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Protozoa are single cellular animals of relatively large size single such as amoeba. Most are harmless and
they live in seas, soil, sewage and on dead matter. Some, particularly those found in plants and animals
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can cause disease. Examples include:
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x Cryptosporidium, often water borne, parasitic infection of the gut; and
x Entamoeba bisholytica: water born parasitic infection causing amoebic dysentery.
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Sources and Methods of Infection
Workplace Health
Modes of Transmission
Most biological agents are largely static and require to be transferred from a source via a vehicle or vector
to the individual. Vehicles responsible for this ‘cross contamination’ may be hands, food, water, dust, etc.
Health Issues
however the principal modes of transmission of biological agents are the same as for any other agent,
including:
Inhalation. Airborne biological agents may be inhaled into the respiratory system, e.g., legionella
bacteria which may become airborne in an aerosol. Person to person spread of infectious agents may be
carried out this way, e.g., airborne droplets as a result of sneezing which contains the infectious agent may
be spread by droplets and close contact between persons, e.g., tuberculosis and meningitis.
Ingestion. The introduction of pathogenic bacteria into the digestive system can give rise to severe
symptoms of food poisoning (diarrhoea, vomiting, fever, cramps, etc.) Food and water borne infections
include cholera, typhoid, salmonella and E-coli.
Cutaneous infection/skin contact. A condition known as ‘orf’ may be contracted because of

contact with infected animals. Orf is recognisable by the presence of pustular lesions on the skin, usually
on the hands. Similarly, a form of anthrax affects the skin following contact with infected materials. Also,
infection may be contracted following absorption across the mucous membranes or conjunctiva.
Injection. Biological agents may be introduced directly into the blood stream (circulatory system) due to
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injection via a hypodermic either intentionally or accidentally via needle-stick injury or through an open
wound or cut on the skin. Non-occupational methods of transmission of blood borne infections, e.g.,
Hepatitis B and C and HIV are much more common (e.g., unprotected sexual activity) than occupational
factors. Some infections are ‘vector-borne’, i.e., spread by an intermediate organism, such as malaria which NEBOSH
is spread by mosquitoes. Lyme disease is a tick-borne disease that affects deer and rodents and can be
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spread to humans who are bitten by the same infected ticks.
Once inside the body, the organism will typically attack a ‘target organ’ or tissue, e.g.:
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x Hepatitis attacks the liver;

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x Food poisoning bacteria affect the gastrointestinal tract; and

x
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Legionella bacteria and influenza virus affect the respiratory system.
Bacterial and fungal infections often owe their pathogenicity to the production of toxins and the subsequent
damaging effect on the surrounding tissue or organ.
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Toxins fall into four categories:

x Endotoxin, a toxin which is produced / released from dead bacteria. Since the body’s defences
may kill invading bacteria this may cause the toxin to be released. Such toxins may have the effect
of damaging cell structures and causing reduction in blood pressure.
x Exotoxin is a toxin which are released from the surface of live bacteria. Where the toxin is released
into the bloodstream then a toxaemia (blood poisoning may occur) which can have far reaching
systemic effects. In staphylococcal food poisoning the bacteria release the toxin onto the food as
they grow. Subsequent removal of the bacteria leaves the toxin which then has an immediate effect
following consumption, i.e., vomiting; and
x Mycotoxins, certain species of mould, e.g., penicillium produce mycotoxins as they grow and, in
some instances, these can be harmful to humans, causing liver and kidney damage.
x Enterotoxin is a general term for toxins which cause gastroenteritis and includes both endotoxins
and exotoxins.
Viruses cause cell damage by destruction of the cell during replication. Where the damaged cell is
part of essential organs then failure of the organ may ensue. As the virus replicates and infects other
cells so the damage spreads causing, in some cases extensive cell failure.
Sources of Infection
All biological agents have a place in the ecosystem. The natural place of biological agents is known as the
reservoir. Where exposure to the reservoir of infection is such that an infective dose is received then the
individual may suffer symptoms of the infection.
Man is the natural reservoir for many types of bacteria, which if moved from their natural site may become
pathogenic, e.g., Escherichia coli (E-coli) is naturally present in the gut of humans but its presence on food
can indicate faecal contamination and causes food poisoning symptoms by releasing an enterotoxin in the
intestines.
Other reservoirs may include animals such as cattle and sheep for anthrax, aquatic environments for legionella
bacteria and rats for Leptospira bacteria.
Special Properties of Biological Agents
Rapid Mutation
Bacteria and viruses can mutate rapidly.

For example, influenza viruses are notorious for their rapid mutation and unpredictable behaviour. Every year
new strains of influenza develop through mutation which is foreign to human immune systems leaving people
highly vulnerable, especially to those with already weakened immune system due to illness, age, medical
treatment, or drug use.
The immune system is a complex network of cells and organs that work together to defend the body against
attacks by “foreign” invaders. This is one of the body's main defences against infection and disease.
Incubation Period
The incubation period is the time taken between exposure to an infective agent and the first appearance of
the signs of disease associated with the infection. This is affected by many variables, including the agent, the
route of entry, the dose and specific characteristics of the host.
Infectious
Biological agents that are infectious may be transmitted directly or indirectly. For example, direct contact
between an infected and an uninfected person, or it may be mediated through inanimate material that has
become contaminated with the agent, such as soil, blood, bedding, clothes, surgical instruments, water or
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food. There may also be airborne or vector-borne secondary transmission. Airborne transmission can occur
through coughing or sneezing, which may disseminate microbial droplets or aerosol. Vector-borne
transmission (primary or secondary) can occur via biting insects such as mosquitoes.
The distinction between types of transmission is important when methods for controlling contagion are being
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selected.
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Direct transmission can be controlled by good hygiene practices and taking general precautions when
handling of infected persons.
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Indirect transmission requires other approaches, such as adequate ventilation, boiling or chlorination of
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water, disinfection of surfaces, laundering of clothing or vector control.
Rapid Multiplication
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Many biological agents colonise humans. Most are harmless but some are infectious and pathogenic.
Workplace Health
Biological agents are living organisms which can multiply and change rapidly, some may cause
disease/damage, if they are of the harmful type. They can be transmitted from person to person and are not
always easily detectable.
Infection with pathogenic biological agents can provoke either a rapid (acute) onset of symptoms, or a slower
(chronic) and more long-term response where the symptoms (if they are present) may last for years.
Health Issues
Many bacterial infections can be treated successfully with antibiotics, but these are useless against viral
infections.
Signs and Symptoms of

Diseases
There is usually a time lag between infection
with a biological agent and the presentation of
outward symptoms of infection. This time period
is known as the ‘incubation period’ and can vary
between agents from a few hours, for exposure
to anthrax to ten years or more for HIV infection
to develop into AIDS. The time of incubation
depends largely, as with other agents, on the
individual factors such as age, health, etc. as
well as the dose of the agent received. In many
cases a minimum amount / number of bacteria
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are required prior to causing symptoms in
humans, this is known as the infective dose.
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The manifestations of disease will be many and varied and will of course depend on the infectious agent in
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question and the target organ, e.g.:

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x A lung infection may cause pneumonia leading to breathing difficulties and lack of lung function
(e.g., legionellosis).
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x A liver infection (known as hepatitis) may cause fever, jaundice (yellowing of the skin) nausea and
abdominal pain (e.g., hepatitis B).
x A digestive tract infection will usually lead to nausea, vomiting and diarrhoea (e.g., Salmonella
food poisoning); and
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x Skin infections will result in visible skin damage such as ulceration of hands and face (e.g.,
cutaneous anthrax).
Many infections will be accompanied by acute symptoms of fever, nausea, headaches and general malaise
as the body’s defences work to protect it from the invading organisms.
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Biological Sensitisation
Some occupational diseases, which result from biological agents, are not as a result of infection, but rather
from the toxic effect of a substance emitted from a biological agent. Typically, this can have an effect on
the lungs and cause sensitisation.
Occupational asthma may be caused by prolonged exposure to a variety of airborne contaminants, most of
which are organic in origin. The underlying cause of asthma is an abnormal immunological response to foreign
agents which act as antigens. The inhalation and absorption of the antigen provokes the production of specific
antibodies which, in turn, set in motion a series of events culminating with the release of histamine and other
active materials from cells which leads to bronchial constriction, causing difficulty in breathing.
The agents causing occupational asthma are often (somewhat arbitrarily) divided into two groupings:
x High molecular weight protein antigens, many of which result from biological agents such as rodent
urine, shellfish protein, flour, mite faeces; and
x Low molecular weight chemicals such as isocyanates, platinum salts, anhydrides, colophony plicatic
acids (from wood).
Agents in the former group are more likely to affect persons who are atopic, i.e., who have a past history of
asthma or eczema. Atopy is not a risk factor for the latter group. Asthmatic reactions can occur within minutes
of exposure or take several hours to develop. Biological materials known to cause occupational asthma
include:
x Proteolytic enzymes, e.g., pancreatic secretions.

x Bird feathers.
x Amoebae (humidifier fever).
x Beetles, cockroaches, locusts and grain mites.
x Fungi; and
x Laboratory animal dander.
Animal dander is old skin cells which are constantly shed by the animal. Older animals produce more dander
than young ones due to drier skin. Animal dander is extremely light-weight and around 2.5 microns in size.
Consequently, it can be inhaled and can stay airborne for a number of hours.
Extrinsic allergic alveolitis is a similar disease to asthma, caused by the body’s adverse reaction to inhaled
materials. However, whereas asthma causes a constriction of the bronchioles, extrinsic allergic alveolitis
affects the alveoli and inhibits gas transfer across the blood-gas barrier. Most of the agents that cause this
condition are fungal spores. The most common of which is known as ‘Farmer’s Lung’. In Farmer’s Lung, the
active allergens are Micropolyspora faeni and Thermoactinomyces vulgaris. The condition can follow repeated
exposure to mouldy hay. Symptoms typically appear 4 to 8 hours following exposure to mouldy hay after which
time the patient develops flu-like symptoms, i.e., fever, headache, chills, myalgia and respiratory irritation.
Shortness of breath can occur as well as an unproductive cough, although there is none of the wheeziness

which is typical of asthma symptoms.
There are a number of similar diseases to farmer’s lung including:
x Bird Fancier’s Lung, caused by a protein in bird droppings.

x Bagassosis from mouldy sugar cane.
x Cheese Worker’s Lung from mouldy cheese; and
x Animal Handler’s Lung from serum and urine proteins from animal dander and dried urine.
Zoonotic Diseases
Infections, which are carried by vertebrate animals and transmissible to humans under natural conditions, are
known as zoonoses. There are many examples of zoonotic infections the most significant of which from an
occupational health perspective are:
x Anthrax: which is associated with work activities involving close contact with animals such as in an
abattoir, agriculture and tannery works.
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x Brucellosis: which is carried by cattle, pigs, sheep and goats and occasionally dogs can be
transmitted to farm workers and shepherds by contact with contaminated blood or more commonly
consuming raw milk from an infected animal.
x Orf: a viral condition of, principally, sheep and goats which is contracted by skin contact with infected
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material leading to pustular lesions on the skin.
x
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Psittacosis: which affects mainly birds and poultry. It is spread by contact with contaminated
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droppings and feathers.
x Q fever: the disease affects sheep goats and cattle and is transmitted through airborne droplets
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and contact with contaminate meat; and
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x Rabies: which is a viral condition carried by domestic and wild animals and transmitted through
virus carrying saliva.
x Cryptosporidiosis: This is a disease caused by cryptosporidium parvum, a protozoan organism
which is found in a wide range of animal faeces. A common route of infection to humans is from
calves. This can be by faecal-oral transmission or via contaminated drinking water or milk. Bottle
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feeding a newborn lamb is a particularly high-risk activity.
Workplace Health
Occupational zoonoses are diseases, which can be acquired by humans during the course of their work,
from animals.
Vector-Borne Diseases
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Vectors are living organisms that can transmit infectious pathogens between humans, or from animals to
humans. Many of these vectors are bloodsucking insects, which ingest disease-producing microorganisms
during a blood meal from an infected host (human or animal) and later transmit it into a new host, after the
pathogen has replicated. Often, once a vector becomes infectious, they are capable of transmitting the
pathogen for the rest of their life during each subsequent bite/blood meal.
x Malaria is a parasitic infection transmitted by Anopheline mosquitoes. When an infected mosquito

bites a human, the parasites are transmitted into the bloodstream.
x Dengue is the most prevalent viral infection transmitted by Aedes mosquitoes. When an infected
mosquito bites a human, the virus is transmitted into the bloodstream.
x Other viral diseases transmitted by vectors include chikungunya fever, Zika virus fever, yellow
fever, West Nile fever, Japanese encephalitis (all transmitted by mosquitoes), tick-borne
encephalitis (transmitted by ticks).
Blood-Borne Viruses (BBVs)
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BBVs are viruses that some people carry in their blood, and which may cause severe disease in certain people
and few or no symptoms in others. The virus can spread to another person, whether the carrier of the virus is
ill or not.
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The main BBVs of concern are:
x Hepatitis B virus (HBV), hepatitis C virus and hepatitis D virus, which all cause hepatitis, a disease of
the liver.
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x Human immunodeficiency virus (HIV) which causes acquired immune deficiency

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syndrome (AIDS), affecting the immune system of the body.

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These viruses can also be found in body fluids other than blood, for example, semen, vaginal secretions and
breast milk. Other body fluids or materials such as urine, faeces, saliva, sputum, sweat, tears and vomit carry
a minimal risk of BBV infection, unless they are contaminated with blood. Care should still be taken as the
presence of blood is not always obvious.
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Cryptosporidiosis
This is a disease caused by cryptosporidium parvum, a protozoan organism which is found in a wide range
of animal faeces.
Method of Infection
A common route of infection to humans is from calves. This can be by faecal-oral transmission or via
contaminated drinking water or milk. Bottle feeding a newborn lamb is a particularly high-risk activity.
Signs and Symptoms

After an incubation period of 1 to 12 days, the victim suffers with acute diarrhoea and may also develop flu-
like symptoms, i.e., fever, headache, chills, and respiratory irritation.
Workers at Risk
Farm workers, vets, laboratory personnel and anyone who handles young animals or may come into contact
with animal faeces are particularly at risk. This could also include park workers and grounds maintenance staff
as well as carers of infected persons.
Precautionary Measures
Good hygiene measures can minimise the likelihood of infection, i.e., frequently washing hands and exposed
skin thoroughly especially after work and prior to eating, drinking or smoking. PPE such as rubber gloves
should be worn where appropriate. Where water contamination is suspected then boiling drinking water will
reduce likelihood of infection.
Malaria
This is an infectious disease caused by species of the Plasmodium parasite, passed on via the bite of an
infected mosquito. Widespread in tropical regions of Asia, Africa, and Central & South America.
Method of Infection
Malarial parasites are carried by the female anopheles mosquito. When an infected mosquito bites a human,
the parasites are transmitted into the bloodstream.
The disease can lie dormant following infection but reactivate and cause symptoms years later. The incubation
period (the time between the mosquito bite and the onset of symptoms) ranges from 8 to 30 days depending
on the parasite species.
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Signs and Symptoms

Malaria is characterised by fever, shivering, chills, generally feeling unwell, headache and sweats, but it can
present as a respiratory or gastrointestinal illness. In severe cases, it could lead to kidney failure, liver failure,
coma and death.
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Malaria is usually diagnosed with a blood test that screens for the presence of malaria parasites.
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Workers at Risk
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Infants, the elderly, and those with lower levels of immunity are at greater risk. Pregnant women are also at
risk. While it is relatively rare for malaria to pass from infected mother to unborn child, the disease increases
the risk of miscarriage or premature labour.
Occupational
Workplace Health
Education on sources of infection. In malarial areas, avoid mosquito bites by wearing long, loose clothing,
using insect repellents, take anti-malarial medications and avoiding outdoors at dusk and dawn.
Effective treatment relies on early diagnosis and specific anti-malarial medications
Health Issues
Snake Bites
Snake bites can be potentially fatal. It is a wound inflicted by the fangs of a snake. Immediate medical
assistance should be sought for all cases of snakebite.
Snakes come out of hibernation during the warmer months of the year and will inevitably move into, or near
places where people live and work in search of food.
Snakes can generally be found in cool, dark protected areas such as under buildings and near sheds,
around rubble and stored materials, and in long grass.
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Method of Infection
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Snake venom is injected into the skin via a pair of fangs. The venom spreads quickly and efficiently through
the lymphatic system.
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Signs and Symptoms

Most snake bites, whether by a venomous snake or not, will have some type of local effect. There could be
minor pain and redness depending on the site of the bite.
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Bites by venomous snake may be extremely painful, with the local area sometimes becoming tender and
severely swollen within 5 minutes. The bite area may also bleed and blister and may include lethargy,
weakness, nausea, and vomiting. Over time may develop more life-threatening symptoms such as low
blood pressure, rapid breathing, severe tachycardia (heart beats very fast) and breathing difficulty or
breathing stops.
The risk of snake bites depends on many factors. These include:

x The species and size of the snake

x The toxicity and amount of venom injected
x The number of bites
x The localisation of the bites (bites in the head or on the body are most dangerous)
x The weight of the victim (most dangerous for children)
x The general state of health of the victim
x Individual sensitivity to the venom and/or allergies of the person bitten
Workers at Risk
Agricultural & forestry workers, bush and park rangers, zookeepers, trekkers and even pest control workers.
x Minimise the food sources for snakes by removing anything that may attract rodents or frogs.
x Reduce rubbish/materials where a snake could shelter.
x Wear gloves and boots when moving stored materials and rubbish.
x Carry a stick when working in long glass. Use the stick to move the grass to give snake a chance to
move away.
x When trekking through forests or mountains remain on marked tracks.
x Education to increase awareness of the dangers associated with snakes.
Psittacosis (Ornithosis, Parrot Fever)

This is a disease which mainly affects birds and poultry and is caused by chlamydia psittaci.
Method of Infection
The organism is present in dusts from desiccated bird droppings and feathers. The main method of contracting
the disease is via inhalation of infected dust. The organism may survive for many months in dry dust.
Signs and Symptoms NEBOSH International Diploma

The disease produces flu-like symptoms, i.e., fever, headache, chills and respiratory irritation often developing
into pneumonia. The disease is rarely fatal and has an incubation period of around 4 to 15 days.
Workers at Risk
Poultry workers, pet shop staff, zoo workers, taxidermists and to a lesser extent building and maintenance
workers who may have to enter spaces where there is an abundance of bird droppings and feathers.
Removal of birds from the area may be appropriate in some situations, although for many workers exposure
is unavoidable. Regular cleaning of infected areas will minimise accumulation and drying out of bird droppings.
Suitable PPE such as dust masks may be appropriate as well as practising high standards of personal
hygiene. There are clinical methods of detection and prophylaxis is readily available.
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Q Fever (Query Fever)

This is a disease caused by the ‘Coxiella burnettii’ organism that mainly affects sheep, goats and cattle.
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Method of Infection
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The organism can be transmitted to humans by droplet infection, or through direct contact with infected meat, birth
fluids from animals or contaminated wool, straw or milk.
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Signs and Symptoms
The disease usually produces mild flu-like symptoms, i.e., fever, headache, chills and respiratory irritation and can
result in liver and heart damage, meningitis, hepatitis, renal failure and pneumonia if left untreated.
Occupational
The incubation period is usually around 2 to 3 weeks.
Workplace Health
Workers at Risk
Abattoir workers, laboratory personnel, wool processors, vets and farmers where exposure to infected animals or
animal tissues is likely.
Health Issues
Education of persons on sources of infection and hygiene standards to be applied along with pasteurisation of
milk and milk products is effective. Separate enclosures for calving and lambing should be provided due to the
high risk of infected body fluids, particularly placental tissue, use of gloves and aprons in abattoirs and vaccination
of high-risk staff such as those working in research laboratories.
Anthrax
This is a disease caused by the bacterium bacillus anthracis, which can be found in animal hides. The causative
agent has the ability to form spores and resist unfavourable conditions for long periods of time.
Method of Infection
Spores from the bacterium may be present in the hides, hair, bone, fur, wool or horns of animals and may be
inhaled by the victim leading to pulmonary anthrax or may affect the skin leading to cutaneous anthrax. Rarely
the bacteria can be ingested and affect the gastrointestinal tract.
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Signs and Symptoms
Skin contact leads to the formation of ulcerative legions termed ‘eschars’. The eschar appears as a pustule with
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a ring of blisters and a marked swelling. The lymph glands become inflamed, and a fever is common. Untreated,
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cutaneous anthrax is fatal in 5-20% of cases.
Inhalation of viable bacteria or spores leads to a severe pneumonia type illness and is often fatal within 3-5 days
of the initial symptoms appearing.
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Intestinal anthrax is rare and difficult to recognise. It often occurs in outbreaks following consumption of infected
meat. Abdominal distress is followed by fever, septicaemia (blood poisoning) and death.
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The incubation period for anthrax is up to 7 days although commonly 48 hours. Early diagnosis is essential for
antibiotic treatment to be effective.
Workers at Risk
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The incidence of anthrax infection is very rare in the United Kingdom and in developed countries animal hides are
treated before export. Workers most at risk are those working with animal hides including abattoir workers, vets,
butchers, taxidermists, etc. Textile workers are also at potential risk from handling materials made from animals.
Some contaminated land presents a potential risk from anthrax thus construction workers could be affected .
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The main precaution for anthrax is staff awareness of the possible risk
and gaining information, e.g., a contaminated land survey on a former
abattoir may look for anthrax spores. Removal by specialists should then
ensue.
The antibiotic penicillin can be used to treat anthrax infection since it is

bacterial in origin although early action is required. Immunisation is also
available for workers at risk.
Diseases Caused by Biological

Agents
Leptospirosis (Weil’s disease)

Is a disease caused by a bacterium known as Leptospira icterohaemorrhagiae which passes from rats to
humans? A similar infection Leptospira hardjo can be contracted from cattle and is sometimes known as dairy
fever.
Method of Infection
This is an infection that can be transmitted from rats to humans via their urine, or water, which has been
contaminated by it. Typically, this occurs where an infected rat urinates in an area where a human comes into
contact with that urine or standing water where rats have inhabited. This could include construction sites,
animal laboratories, lakes, canals or fish farms.
The main route of entry for leptospirosis is via broken skin or mucous membranes. The bacterium remains
active for 2-3 weeks in cold water, particularly where the water has not been exposed to strong sunlight. The
bacterium is NOT active in seawater.
Signs and Symptoms

This condition usually has an incubation period of between 4 and 19 days. The disease produces flu-like
symptoms, i.e., sudden onset of fever, headache, chills, myalgia (aching muscles), rash leading to meningitis,
pneumonia and may lead to jaundice and kidney failure. It is fatal in approximately 20% of cases.
The condition is often misdiagnosed as meningitis or encephalitis.


Workers at Risk
Any person who can come into contact with rat’s urine, an area which is frequented by rats or standing water
is at risk. Examples of occupations at risk include canal workers, construction workers, animal laboratory
staff, farmers, sewage workers and leisure / water sport workers. There is the potential for a serious outbreak
in the event of sewage system failure or flooding of areas with a high-water table.
Preventative and Precautionary Measures

Improved pest control to minimise the incidence of rats in the vicinity thereby reducing the reservoir of infection,
also good housekeeping and the elimination of food waste, etc. can reduce the likelihood of rats inhabiting an
area.
Good hygiene measures can minimise the likelihood of infection, i.e., frequently washing hands and exposed
skin thoroughly after work and prior to eating, drinking or smoking. Covering up of any cuts or grazes with a
waterproof plaster is also important; PPE such as rubber gloves and eye protection should be worn where
appropriate.
Education of staff in the risks, control measures and signs and symptoms of the disease is also important.
Many organisations also issue a pocket card to workers listing signs and symptoms of the disease and
precautionary measures. It is recommended that this is issued to ‘at risk’ workers. If they experience any of
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the early symptoms of the disease, they should contact their doctor and show his or her pocket card. Early
diagnosis of the disease is particularly important and often difficult due to the similarity of many of the
symptoms with other infections.
Vaccinations are available although its use varies throughout the world.
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Hepatitis
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This is a generic term for a range of viral infections that cause liver disease. The principal forms are A, B, C
and D.
Controlling
Method of Infection
This varies between the different forms. Hepatitis A is food borne and can be transmitted through faeces.
Occupational
The other forms of hepatitis (B, C and D) are blood borne. The disease is spread by contaminated blood
Workplace Health
entering the victim’s blood stream through broken skin or ‘needle-stick’ injury.
Hepatitis B may also be transmitted via sexual intercourse.
Signs and Symptoms
Health Issues
Inflammation of the liver leading to abdominal discomfort, from which a full recovery can be made, or the
disease can be fatal, or lead to chronic life-long carrier status where the patient is symptom free but can pass
the condition on to contacts.
Other symptoms include fever, malaise, anorexia and nausea after an incubation period of 15 to 50 days for
hepatitis A and 45 to 180 days for hepatitis B and 14 to 180 days for hepatitis C.
Workers at Risk
The main occupational groups are hospital, laboratory and health care staff for the blood borne infections.
Cleaning and maintenance staff may also come into contact with contaminated body products, e.g., wound
dressings and contaminated sharps.
Risk assessment should identify particular occupational hazards and help to develop effective systems of work
to minimise the risk of infection. Disinfecting and sterilisation of any blood or faecal spillage is important. In
hospitals, effective autoclave (sterilising) techniques should sterilise equipment as well as the use of
disinfectants such as hypochlorite and glutaraldehyde (although these can introduce occupational risks of their
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own).
Cuts or abrasions should be covered with waterproof dressings and appropriate PPE used, e.g., gloves to
avoid contact with blood and other body fluids. NEBOSH

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Prevention of the spread from infected carriers is particularly important within hospitals. Where a staff member
is known to be a carrier, they should not undertake exposure-prone activities where the gloved hand maybe
in contact
with sharp instruments inside a patient’s body cavity, wound or confined anatomical space. However, there is
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also a danger of stigmatising such sufferers and lower risk activities such as taking of blood, setting-up and
maintaining intravenous lines, minor surface suturing, incision of abscesses and uncomplicated endoscopies
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should not normally be restricted activities for infected staff.
An effective vaccine is under development for hepatitis A, while commercially available vaccines for hepatitis
B do exist.
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Acquired Immune Deficiency Syndrome (AIDS)

This disease is caused by an organism known as the Human Immunodeficiency Virus (HIV). HIV can remain
dormant with no clinical features in the infected person or may progress to the clinical syndrome AIDS.
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Method of Infection
From an occupational perspective, infection is likely to be similar to hepatitis, via needle-stick injury or splashes
of infected blood. Although there is much public concern about the transmission of HIV from infected health-
care workers, this is in fact a very rare occurrence, the risk of hepatitis being greater. The only known cases
of such an infectious route are from an HIV-positive dentist in Florida infecting several of his patients and an
orthopaedic surgeon in France transferring infection to a patient during surgery.
Signs and Symptoms

The HIV virus affects the human immune system making the body susceptible to infection. In particular, there
is a greater risk of lung infections such as pneumonia and skin malignancy (Kaposi’s sarcoma). Initial
symptoms are non-specific and include weight loss, diarrhoea, fever and fatigue. The incubation period for
developing the syndrome is from around 2 months to 10 years or longer.
Workers at Risk
As for blood-borne hepatitis i.e., those in the care industries and those likely to come across infected material,
e.g., first aiders dealing with trauma incidents. The HIV virus is far less infectious than hepatitis since the virus
only survives for a short time outside the body.
The lethal potential of HIV/AIDS requires that universal precautions be applied. This means that any
suspected risk of exposure to a bodily fluid is treated as a positive risk. Features of universal precautions
include:
x Use of PPE (barrier methods), e.g., gloves, protective clothing, goggles, etc. to avoid transmission.
x Careful handling of sharps, e.g., scalpels, needles, etc.
x Infection control techniques, e.g., covering open wounds.
x Effective decontamination and disposal protocols. These include cleaning and decontamination to
remove all traces of bodily fluids, etc. safe disposal of needles, sharps, etc. and sterilisation of
equipment and the workplace:
- Spillages should be absorbed into paper towels or cloths and disposed of in clinical waste plastic
bags.
- The area of spillage should be cleaned with hot water and detergent and then disinfected.
- Laundry should be washed at 70°C; and
- Sharps, needles, etc. should be either autoclaved or disposed of using suitable sharps
receptacles.
x Reporting procedures to deal with any accidental exposure that requires appropriate testing; and
x Provision of information, training, instruction, and supervision on the precautionary measures.

Universal precautions are also a prudent measure against hepatitis B.
Internal guidance on HIV infection for employees should be provided, which should be practical and non-
alarmist, dispelling any misconceptions about the virus and the methods of infection. It should give advice on
the risk of contracting HIV, its latency period, how it is transmitted, associated health effects, e.g., pneumonia,
skin cancer, AIDS, etc.
Other aspects to be included within the guidance are:
x Risk assessment findings of particular work activities, including the tasks involved, sources of HIV
infection and identification of those at risk, e.g., clients (patients), social workers, care workers,
injured persons, first-aiders and ‘spillage’ of bodily fluids.
x Control measures, e.g., use of protective clothing, treatment and disposal of clinical waste / sharps,
ways to avoid contact with body fluids and training; and
x Procedures for reporting after possible contact with body fluids / infected material and HIV testing,
including requirements for confidentiality, counselling services.
Also, health education is a key strategy to reducing the incidence of the disease in the population and therefore
the risk of contracting the condition.
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There is presently no effective vaccination or treatment for HIV / AIDS, although a number of drugs are
available which can address some of the symptoms.
Legionnaire’s Disease
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This is the name given to a potentially fatal form of pneumonia caused by a bacterium known as ‘legionella
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pneumophila’. The organism was described following an outbreak of severe pneumonia, which resulted in the
death of several American ex-Legion members who were attending a convention at the Bellevue Stratford
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Hotel in Philadelphia in 1976.
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Method of Infection
The source of the first known outbreak of the disease was traced to a naturally occurring bacterium that can
be located in soils and pools of water. It causes lung diseases amongst victims thus transmission occurs by
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inhalation of contaminated water droplets.
Workplace Health
Risk factors that increase the likelihood of infection include:
x Water between 20°C and 45°C, which provides the optimum conditions for propagation of the
bacteria. The bacteria favour human body temperature, the rate of growth is most rapid at about
37°C. Above 46°C, the death rate exceeds the growth rate and the organism cannot survive above
60°C. Below 20°C the organism does not appear to multiply.
Health Issues
x Prevalence of stagnant water, which gives bacteria the opportunity to multiply. This could include
water tanks or water pipes where water is not regularly drawn from. For example, ‘dead legs’ where
an installation has been removed and the pipe terminated.
x Dirty water which contains organic contaminants which can ‘feed’ the bacteria. These nutrients
could include dead insects, algae, or even materials such as rubber and wood.
x Likelihood of aerosol formation. The organism is only infectious by inhalation; thus, the water needs
to become airborne. Thus, any process which involves droplet formation presents a risk; and
x The presence of susceptible persons must be considered, e.g., at a hospital or care home the risk
may be greater.
Signs and Symptoms

The incubation period is typically between 2 and 10 days when affected patients present with fever, non-
productive cough, headache, myalgia, malaise, pneumonia and ultimately death. The disease tends to affect
susceptible persons such as the aged, and hospital patients who are immunosuppressed.
The condition is fatal in around 12% of cases (HSC, 2004).
A similar condition called ‘Pontiac fever’ which is non-fatal, has also been associated with legionella bacteria.
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Recovery from this condition is spontaneous within 2-5 days.
Workers at Risk
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Anyone who is at risk from the inhalation of contaminated water droplets, which could be workers, but more
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often are customers, or members of the public who could be in the vicinity of the source of infection. Men are
more susceptible than women, as are smokers over 45 years old, alcoholics, diabetics and those with cancer
or chronic respiratory or kidney disease.
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Installations of Concern
Any installation that can cause infected water to become airborne is of some concern. Cooling towers and
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showers are obvious examples, but even water from a tap as it hits a surface can generate an aerosol which
may be inhaled.
One of the greatest risks is associated with cooling towers and evaporative condensers. These devices use
water to assist with cooling, which results in water droplets being heated up, often to the ideal temperature for
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the bacteria as well as being in a form easily inhaled. In addition, the water is often dirty due to contamination
picked up from the air.
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Typically, wet evaporative condensers for air conditioning plant are situated on the roofs of buildings. Water
is sprayed onto cooling coils with risks arising from spray drift. The people at most risk are not the building
occupants, but passers-by.
Installations such as tanks where water is stored for extended periods are potential breeding grounds for
bacteria. Mains water can generally be considered as treated and therefore legionella-free and it is generally
delivered at less than 20°C. However, once in a storage tank where dirt ingress is possible and temperatures
increase, the risk of legionella becoming established increases.
Large hot water boilers may not always heat all of the water thoroughly leading to patches of lukewarm water.
During periods of high usage lukewarm water, with the greatest risk of contamination, is most likely to be
drawn off.
Showers are a source of risk where warm water droplets are inhaled. The risk is particularly high where the
showers are not frequently used, and bacteria can reproduce in the stagnant pipework. Dead legs in water
distribution pipework and intermittently used systems may provide an environment suitable for bacterial
growth.
Other at-risk systems include atomising humidifiers and spray-type air washers. Vehicle washes are a risk,
particularly where the water is recycled. Decorative fountains are a source of risk. Spas and whirlpool baths
can also present a risk of exposure to legionella.
Fire/sprinkler systems present a low risk in relation to the risk of fire, although the testing of such systems
should be designed to minimise the risk of aerosol generation and the numbers of persons exposed.
Most of the advice relating to Legionnaire’s disease focuses on prevention by minimising as many of the risk
factors as possible. A suitable and sufficient assessment of the risks must be undertaken for all workplace
buildings and installations.
Cooling Towers
Cooling towers and evaporative condensers should be positioned as far away as is possible from air-
conditioning and ventilation inlets. The risk from cooling towers and evaporative condensers can be minimised
by good design and maintenance. The materials of construction should be such that they do not support
microbiological growth. Corrosion of steel should be inhibited as it may lead to conditions which encourage
the growth of legionella. The design should allow disinfection, prevent spray drift and minimise dirt ingress.
Drift eliminators, made of plastic or metal, should be installed in all towers. Rather than eliminate the drift of
spray as their name suggests, drift eliminators are designed to reduce aerosol drift. The cooling tower sump
should be sloping and fitted with a drain valve. The area above the cooling tower sump should be as well
enclosed as possible to reduce the effects of wind.
A full water treatment system should be integrated into the system design, with provision made for sampling,
chemical dosing, bleed and drain points. Regular treatment of cooling water with a biocide is essential with

regular testing of the water for total bacteria and legionella species. The composition of the make-up and
cooling water should be routinely tested to ensure the effectiveness of the treatment programme. To ensure
that dosage and bleed rates are correct the minimum recommended frequency is once a week.
Microbiological activity should be tested at least once weekly. The most common method used to measure
microbiological activity within a cooling system is to use a dip slide. Should the dip slides indicate a high result
then water samples should be analysed by an accredited laboratory. The treatment and testing activities
should be undertaken by specialists.
Disinfection then chemical and manual cleaning of cooling towers should be undertaken at least twice per
year, but more frequent cleaning may be required depending on local environmental conditions. The system
should be refilled and chlorinated (disinfected) after cleaning.
Hot and Cold Water Services

Hot and cold water systems should be designed to aid safe operation by preventing or controlling conditions
which permit the growth of legionella and to allow easy cleaning and disinfection. Low corrosion materials,
e.g., copper, plastic and stainless steel should be used where possible. Materials to avoid in domestic water
systems include natural rubber, hemp, linseed oil based jointing compounds and fibre washers.
For water systems within buildings an effective regime of temperature control is the best means of ensuring
that bacteria do not thrive. Cold water should remain below 20°C and hot water heated to above 60°C and
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delivered to outlets at above 50°C. Volumes of stored water should be minimised. As a general principle, no more
water should be stored than can be used in 24 hours.
Hot water systems should be designed to accommodate the normal daily fluctuations in hot water use without any
drop-in temperature. The calorifier (heat exchanger) should thoroughly heat all of the water to at least 60°C. If the
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calorifier is of excessive capacity for the installation, a smaller replacement should be considered, or ‘instant’ heaters
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installed at sink locations. Calorifiers should be lagged (thermally insulated) and subject to an annual inspection,
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and if necessary, regularly cleaned.
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The hot water circulating loop should be designed to give a return temperature of 50°C or above. Where necessary
a ‘shunt pump’ can minimise temperature stratification by circulating the water around the boiler. Regular thermal
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disinfection should be considered where it cannot be guaranteed that all the water dispensed is above 50°C. This
would typically involve heating water to 60°C for an hour a day (when the building is unoccupied).
The hot water distribution system should also be lagged. Extended non-circulatory hot water pipe runs should be
avoided and any ‘dead legs’ removed back to the recirculation loop. Pipe branches of individual hot taps should be
Occupational
of sufficient size to allow the water in each tap to reach 50°C within 1 minute of turning on the tap. If this cannot be
achieved, then trace heating should be provided in non-circulatory hot water distribution pipework. Thermostatic
Workplace Health
mixing valves (TMVs) should be positioned as close as possible to the point of use. Multiple showers served by a
single TMV by should be frequently flushed.
Cold water storage tanks should be situated in a cool place, covered, lagged and screened from insects and general
dirt ingress. They should be inspected annually and regularly cleaned out. Piping should be insulated and kept
away from heat sources to prevent a temperature rise of more than 2°C.
Health Issues
All water services should be routinely checked for temperature, water demand and inspected for cleanliness and
use. The frequency of inspection, and maintenance, will depend upon the system and the risks it presents. All
inspections and measurements should be recorded. Hot and cold water system plans should be checked annually
to ensure that they are correct and up to date.
Biological monitoring of hot and cold water systems using dip slides is not necessary where the water is supplied
from a potable source, i.e. drinking water. However biological monitoring should be carried out on a monthly basis
in water systems that are treated with biocides where storage and distribution temperatures are reduced from the
recommended levels. This frequency should be reviewed after a year and may be reduced when confidence in the
efficiency of the biocide regime has been established.
Hot, and exceptionally, cold water services should be cleaned and disinfected if routine inspection shows it to be
necessary, or if the system has been substantially altered or entered for maintenance purposes in a manner that
may lead to contamination.
Other Risk Systems

Spas and whirlpool baths can present a risk of exposure to legionella. Careful attention to the design,
maintenance, and cleaning of equipment, e.g., filters, and regular water treatment to prevent/control the risk
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of legionella is required.
Atomising humidifiers and spray-type air washers may use water from reservoirs or tanks where the water
temperature exceeds 20°C. Unless regularly cleaned and maintained, they can become heavily NEBOSH
contaminated, especially in industrial environments. The risk can be prevented by using humidifiers which
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do not create a spray, e.g., steam humidifiers.
Action in the Event of an Outbreak

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As part of the outbreak investigation and control, the following steps should be taken:
x
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Shut down the suspected process.

x Take water samples.
x Emergency disinfection.
x Provide staff health records to identify any further undiagnosed cases of illness and prepare case
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histories of the people affected; and

x Ensure the investigation addresses all key issues, e.g., tracing pipework runs, provision of any
records and providing statements, e.g., from operatives, managers and water treatment providers.
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If a cooling water system is implicated in the outbreak, then the fan should immediately be switched off, water
samples taken, and the system decommissioned as soon as is practicable. People should also be kept clear
of the tower.
Typically, with the fan off, there then follows a regime of chlorination and water circulation, biodispersant
addition, de-chlorination and water draining, manual cleaning, refilling, chlorination and water circulation, de-
chlorination and water draining, refilling and water circulation and finally taking water samples for testing. The
system can only be re-commissioned when test results detect no legionella.
Emerging Health issues
Norovirus
Noroviruses are a group of viruses that frequently cause intestinal infection. They are highly infectious and
may cause outbreaks in settings such as schools, childcare centres, aged care facilities, cruise ships and
hospitals.
The incubation period is 24-72 hours. This is the time between catching the virus and developing symptoms.
Norovirus is very infectious and can be spread easily from person to person. Both faeces and vomit are
infectious.
Norovirus is contracted in several ways:
x Consuming contaminated food or drinks.

x Touching surfaces or objects contaminated with norovirus and then putting hands or fingers into the
mouth.
x Having direct contact with another person who is infected e.g., sharing food or eating from the same
utensils as someone who is infected.
x Aerosol spread (when vomiting disperses virus particles into the air).
Illness often begins suddenly about one or two days after exposure to the virus. The symptoms of the illness
include nausea, vomiting, diarrhoea, stomach cramps, headache, fever, chills and muscle aches.
Symptoms usually last for one or two days but during that brief time the person can feel very sick and vomit
many times a day.
There are no long-term effects from norovirus and most people make a full recovery.
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Additional Control measures for Exposure to Biological Agents

x Avoid exposure where possible e.g., use of remote cameras for sewer work
x Appropriate training for relevant workers
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x Implement suitable disinfection procedures
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x
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Arrangements for safe collection, storage, transport and disposal of contaminated waste
x Vaccinations for known biological agents that could cause zoonotic diseases
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x Hygiene measures to prevent or reduce the accidental transfer of a biological agent including:
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- provision of appropriate and adequate washing and toilet facilities
- prohibition of eating, drinking, smoking and application of cosmetics in areas where
biological agents are likely to be present
x Use of appropriate PPE.
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Workplace Health
General Hierarchy of Control for Biological Agents
The general hierarchy of control should be followed for biological, as well as other agents, together with the
specific control measures identified below:
Health Issues
1. Elimination
Where possible, the presence of biological agents should be removed, or work undertaken in a manner which
avoids contact with biological agents, e.g., where maintenance work needs to be undertaken in an area
where there is an excess of bird droppings, the area should be cleaned up and sanitised first.
Local authorities have a statutory duty to inspect and treat their areas for the presence of rats with a view to
preventing the rat population proliferating disease.
2. Substitution
For intentional work, it may be possible to replace a biological agent with one of lower virulence (lower hazard
class) or reduce the quantities present. Similarly, a change of work method to minimise or suppress
generation or aerosols may be appropriate.
3. Containment Levels
Biological agents should be isolated in containers during transportation. For laboratories, animal rooms and
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industrial processes, where the risk cannot be eliminated, special measures are required to ensure that the
agents are not transmitted to workers or released outside the containment facility.
A containment level is therefore assigned to biological agents which matches the hazard classification of the NEBOSH
group. Thus, laboratories which work with infectious material, but it is unlikely that group 3 or 4 agents are
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present, should achieve containment level 2 as a minimum.
For each containment level, there is a list of necessary precautions which should be undertaken. Invaluable
guidance has been published by the UK Advisory Committee on Dangerous Pathogens (ACDP) who
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produces relevant publications such as:

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x Classification of pathogens according to hazard and

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categories of containment; and

x The management, design and operation of microbiological
containment laboratories.
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Biosafety Levels Control Approach

The following tables include some examples of containment measures and levels which should be adopted.
Table 19: Containment Measures for Health and Veterinary Care Facilities, Laboratories and Animal
Rooms
Containment Level
Containment Measure Hazard Group Hazard Group Hazard Group
2 3 4
The workplace should be separated
1 from any other activities in the same No Yes Yes
building
Input air and extract air to the
Yes, on Extract Yes, on input and
2 workplace area to be filtered using No
Air double on extract
HEPA* or equivalent
Access should be restricted to Yes, via air-lock
3 Yes Yes
authorised personnel only key procedure
The workplace is to be sealable to
4 No Yes Yes
permit disinfection
5 Specified disinfection procedure No Optional Yes
The workplace is to be maintained at
6 an air pressure negative to No Yes Yes
atmosphere.
Efficient vector control e.g., rodents Yes, for animal Yes, for animal
7 Yes
and insects. containment containment
Yes, for bench
Surfaces impervious to water and easy and floor (and Yes, for bench
8 Yes, for bench
to clean walls for animal walls and ceiling
containment)
Yes, for bench
Surfaces resistant to acids, alkalis, and floor (and Yes, for bench
9 Yes, for bench
solvents, disinfectants walls for animal walls and ceiling
containment)
Yes, secure
10 Safe storage of biological agents Yes Yes
storage

An observation window, or alternative,
11 is to be present, so that occupants can No Yes Yes
be seen
A laboratory is to contain its own Yes, so far as is
12 No Yes
equipment practicable
Infected material, including any animal, Yes, where Yes, where
13 is to be handled in a safety cabinet or aerosol aerosol Yes
isolator or other suitable containment produced produced
Incinerator for disposal of animal
14 Accessible Accessible Yes, on site
carcasses
*HEPA is an acronym for High Efficiency Particle Arrestor, a filter medium used to achieve a level of filtration
of 99.97% of particles from 0.3 microns, for cabinets where hazardous agents are processed.
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Table 20: Containment Measures for Industrial Processes
Containment Level
Containment Measure Hazard Group Hazard Group Hazard Group
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2 3 4
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Viable micro- organisms should be in a
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system which physically separates the
1 Yes Yes Yes
process from the environment (closed
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system)
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Exhaust gases from the closed system Minimise Prevent
2 Prevent release
to be treated so as to: release release
Sample collection, addition of materials
to a closed system and transfer of Minimise Prevent
3 Prevent release
viable micro-organisms to another release release
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closed system, should be performed to:
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Inactivated by
Bulk culture ﬂuids should not be Inactivated by Inactivated by validated
4 removed from the closed system unless validated validated chemical chemical or
the viable micro-organisms have been: means or physical means physical
means
Health Issues
5 Seals should be designed so as to: Minimise Prevent
Prevent release
release release
Closed systems should be located Yes, Purpose
6 Optional Optional
within a controlled area: built
a Biohazard signs should be posted Optional Yes Yes
Access should be restricted to

b Optional Yes Yes, via airlock
nominated personnel only
Personnel should wear protective Yes, a

c Yes, work
clothing Yes complete
clothing
change
Decontamination and washing facilities

d Yes Yes Yes
should be provided for personnel
Personnel should shower before leaving

e No Optional Yes
the controlled area
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Effluent from sinks and showers should
f be collected and inactivated before No Optional Yes
release
The controlled area should be NEBOSH

g adequately ventilated to minimise air
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Optional Optional Yes
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contamination
The controlled area should be
h maintained at an air pressure negative No Optional Yes
to atmosphere
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Input and extract air to the controlled

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i No Optional Yes
area should be HEPA filtered
The controlled area should be designed
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j to contain spillage of the entire contents Optional Yes Yes

of the closed system
The controlled area should be sealable
k No Optional Yes
to permit fumigation
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Inactivated by
Inactivated by Inactivated by
l Effluent treatment before discharge validated
validated validated chemical
physical
means or physical means
means
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Biological Safety Cabinets

Biological safety cabinets are divided into 3 classifications, Classes III, II and I.
Class III Safety Cabinet

The class III microbiological safety cabinet (often referred to as a glove box) is a highly specialised product
designed for the most hazardous work, typically carried out in a containment level 3 or 4 facility.
This class of cabinet provides a high degree of protection for both the user and product. Class III cabinet
protection to the user is provided by means of barrier protection with the user working through gloves or
gauntlets and protection to the material within the cabinet by means of the air being HEPA (high efficiency
particulate air) filtered.
The inside of the cabinet operates at a negative pressure to the surrounding environment with the exhaust air
being vented through a HEPA filter to atmosphere.
Class II Safety Cabinet
More commonly known as hood, flow hood, safety cabinet or tissue culture cabinet, the class II safety cabinet,
unlike the class I safety cabinet provides protection to both the user and the material within the cabinet’s
working area. Protection for the user is provided by means of a simple inflow air curtain whilst the material in
the cabinet is protected from the dirty laboratory environment by a constant stream of HEPA filtered air.
As the performance is dependent on a continuing closed-loop cycle of inflow and down flow air being
maintained it is very important that the cabinet is sited in a suitably location within the laboratory and that
wherever possible the cabinet is not cluttered with items that disrupt the down flow air patterns.
Illustration 45: Class II Biological Safety Cabinet

Class I Safety Cabinet

A class I safety cabinet has a front aperture through which the operator can carry out manipulations inside the
cabinet, and which is constructed so that the worker is protected. The escape of airborne particulate
contamination generated within the cabinet is controlled by means of an inward airflow through the working
front aperture and filtration of the exhaust air.
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The class I safety cabinet provides a wide performance envelope for the user from aerosol hazards and other
particulates within the cabinets work area.
All extract air is exhausted through HEPA filtration generally to atmosphere, although recirculation models
are also available.
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Illustration 46: Class I Biological Safety Cabinet
Controlling
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Workplace Health
Health Issues
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4. Sharps Control
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Biological agents can be passed directly into the body by injection. They can be injected by needles or other
sharp objects, which form part of the work equipment. Injection can also occur when glass gets broken and
is handled.
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Careful disposal of sharps is necessary to prevent accidental injection. Sharps containers should be provided
and used so needles and syringes are not left lying about
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5. Warning Signs
These should be positioned as necessary to alert persons to the dangers therein. It is good practice to
display the ‘Biohazard’ sign wherever there is a risk of exposure to biological hazards.
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Illustration 47: Biohazard Sign
6. Personal Hygiene Measures

Personal Hygiene Measures are particularly important for work with biological agents. For opportunistic
infection, staff should be made aware of potential risks and the need for good hygiene practices such as
washing, covering up of cuts and grazes with waterproof dressings. Hand washing before and after going to
the toilet is also an important consideration.
It is important that appropriate washing and toilet facilities be provided. For hospital and laboratory staff, wash
hand basins have ‘lever’ taps that can be operated with the elbow, to avoid contamination by dirty hands.
For staff working at remote sites, e.g., staff working on contaminated land appropriate hygiene facilities such
as:
x A supply of soap and hot and cold running water.
x Hand drying facilities; and
x Decontamination facilities should be provided.
Prohibition of eating, drinking, smoking and the application of make-up should be prohibited in working areas
where there is a risk of contamination / infection from biological agents.

7. Disinfection and Waste Disposal
Clinical waste, or medical waste, comprises human or animal tissue, blood and other body fluids,
microbiological cultures, drugs, wound dressings and contaminated syringes, i.e., biological agents which are
no longer useful, but which inevitably create a safety and environmental concern as the waste is infectious
and can spread disease.
In the UK, there are five categories of clinical waste (A-E) depending on the nature of the product and the
nature of the risk. The definitions of each Group of wastes are provided in the Health and Safety Commission’s
document ‘Safe Disposal of Clinical Wastes’. They are as follows:
Group A
x Identifiable human tissue (which must be incinerated), blood, animal carcasses and tissue from
veterinary centres, hospitals or laboratories,
x Soiled surgical dressings, swabs and other similar soiled waste; and
x Other waste materials, for example, from infectious disease cases, excluding any in groups B-E.
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Group B
x Discarded syringe needles, cartridges, broken glass and other contaminated disposable sharp
instruments or items.
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Group C
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x Microbiological cultures and potentially infected waste from pathology departments (laboratory and
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post-mortem rooms) and other clinical or research laboratories; and
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x Hazard level 4 biological agents are subject to stringent requirements for disposal.
Group D
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x Drugs or other pharmaceutical products; and
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x Prescription only medicines are also subject to high level requirements for disposal. This
requirement will extend to any used syringes and needles which may be contaminated with
Prescription Only Medicines.
Group E
Health Issues
x Items used to dispose of urine, faeces and other bodily secretions or excretions assessed as not
falling within Group A. This includes used disposable bed pans or bed pan liners, incontinence pads,
stoma bags, and urine containers.
Various systems operate around the world with respect to the colour coding of bags and containers for clinical
waste. The UK approach is outlined below and represents good practice for clinical waste management:
x Yellow for Group a Clinical Wastes.

x Yellow with black stripes for non-infectious clinical wastes
x Light blue for wastes that are awaiting autoclaving; and
x Black for waste that has been treated and rendered harmless.
Prior to waste disposal, sterilisation of the material using an autoclave procedure may render it harmless for
disposal as normal household or industrial waste.
Where disinfection procedures are carried out these should be validated methods which take into account
the most appropriate disinfectant, the shelf life of the disinfectant, the required contact time, etc. Disinfection
is widely used for the treatment of liquid wastes prior to disposal, or for solid wastes which cannot be
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autoclaved.
Clinical waste is generally disposed of by incineration either on site or at a municipal facility. This is an
expensive means of waste disposal. Sometimes in hospitals staff may too readily dispose of non-hazardous NEBOSH
items as clinical waste (although this is not specifically a safety issue).
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Control of ‘sharps’ is very important in terms of managing the risk from biological agents. Objects, such as
used hypodermic needles and contaminated scalpel blades, provide a potential means of injection of
biological agents into the blood stream. Special ‘sharps containers’ should be used.
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Contaminated sharps are fed into a receptacle (usually a plastic or metal container with appropriate
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‘Biohazard’ labelling) for disposal as clinical waste. Careful handling of sharps is also important to prevent
accidental cuts and subsequent contamination, the use of heavy-duty gloves may be necessary.
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8. Personal Hygiene Measures
Personal hygiene to prevent spread of disease will require segregation of domestic and work clothing and,
as a minimum, regular hand washing (using a prescribed technique for a minimum of 30 seconds).
Normally workers will use an apron, which is impervious and disposable. It may be necessary to shower
before and at the end of a shift or exposure period.
Eating and drinking should not be allowed in exposed areas. Smoking should be prohibited in the workplaces
9. Personal Protective Equipment (PPE)

The requirement to use PPE should be identified by the risk assessment process. PPE should generally not
be the only method of protection since the hierarchy of control discussed previously should be considered.
Hand Protection
Heavy-duty gloves may be necessary when there is a risk of contaminated sharps or when handling sacks of
clinical waste. Disposable plastic or latex gloves should be worn to avoid contact with potentially infectious
material, e.g., while cleaning up spillages. The risk of latex allergy should be borne in mind when allocating
gloves.
Eye and Face Protection

Goggles or face visors may be required where there is a risk of splashing contaminated liquids or body fluids.
Respiratory Protection (RPE)

This may be required in addition to containment measures or when outside of a controlled environment. The
correct type of RPE should be selected.
Body Protection
In extreme cases, full suits with positive pressure RPE may be required to prevent ingress of hazardous
biological agents. Disposable aprons will more commonly be used to provide protection against splashing
and when cleaning up spillages. Impermeable, non-slip footwear may also be a necessary item.
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10. Immunisation/Vaccination
For some work situations, the risk assessment may identify that immunisation is a necessary precaution.
Vaccinations are available for many of the biological agents of concern to the safety practitioner.
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In addition to other measures designed to prevent or control the risk of exposure to biological agents, it is good
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practice to make arrangements for vaccination, free of charge, to employees who are considered vulnerable
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to the biological agents to which they are exposed or likely to be exposed at work. In addition, it is also
recommended that employers keep a vaccination record.
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Employers and employees have responsibilities to protect others who might be put at risk from a work activity,
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e.g., patients, visitors, their families, and members of the public. Vaccination of employees can help prevent
the spread of infection to such individuals.
Employees should be informed of the benefits and drawbacks of both vaccination and non-vaccination.
Protection against serious illness is the most obvious benefit; protection against spread of infection to patients
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and other members of the public is also important. Drawbacks include the possibility of adverse reactions to
the vaccine, and any potential effects on health should be explained to the individual. Having considered the
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risks and benefits, where appropriate, employers should recommend vaccination to their employees.
Assessing employees’ immunity before or after vaccination will provide the employer with an indication of
their fitness to work with a particular biological agent.
Routine testing for antibodies or the taking of specimens to attempt to isolate infectious agents is not
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generally appropriate unless there is an indication that infection may have occurred. If an employee is found
to be suffering from an infection or illness which is suspected to be the result of exposure at work, other
employees who have been similarly exposed should be placed under suitable surveillance until it is
established that they are not affected.
Where there are early symptoms of disease that employees themselves may be able to recognise, an
effective measure is to provide instruction and information that will enable them to do so, and systems for
symptom reporting, though this is not in itself health surveillance.
The results of health surveillance, and particularly any adverse results, should lead to some action which will
benefit employees’ health. Therefore, before health surveillance takes place, the employer should decide:
x The options and criteria for action; and
x The method of recording, analysing and interpreting the results.
Example - Control Measures for a Pathology Laboratory

Avoidance of biological hazards is not an option within a pathology laboratory where tissue samples, etc. are
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required to be analysed, therefore precautionary measures are required, including:
x The laboratory should be easy to clean. Bench surfaces should be easy to clean and disinfect and
be impervious to water and resistant to acids, alkalis, solvents and disinfectants NEBOSH
x
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Maintaining a negative pressure in the laboratory by general ventilation. It is preferable to maintain
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an inward air flow while work is in progress by extracting room air to atmosphere via a HEPA filter
x The laboratory door should be closed when work is in progress
x Restricting access to the laboratory
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x Suitable systems and equipment for storage and transport of samples

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x Use of biological safety cabinets

x
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Systems of work that minimise release of aerosols

x Forbidding mouth pipetting
x Decontamination and disinfection regimes
x Provision of hand washing facilities that are operated by ‘lever’ taps
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x Provision of PPE, e.g., gloves, lab coats and eye protection. Personal protective equipment must
be stored in a well-defined place, checked, and cleaned at suitable intervals and when discovered
to be defective, repaired or replaced before further use. Contaminated PPE must be removed on
leaving the working area, kept apart from uncontaminated clothing and decontaminated and cleaned
or, if necessary, destroyed
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x Safe disposal of waste. Contaminated materials, whether for recycling or disposal, should be stored
and transported in robust and leak proof containers without spillage. All waste material, if not to be
incinerated, should be disposed of safely by other appropriate means
x Provision of emergency procedures and equipment, e.g., emergency eye wash and shower,
disinfectants available for immediate use in the event of spillage
x Displaying biohazard signs
x Provision of information and training

x Personal hygiene measures, e.g., no smoking, eating, drinking or application of cosmetics and
regular washing of hands
x Vaccinations
x Health surveillance
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9.11 Noise
Definition of Noise
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Noise is defined as unwanted sound. Physically there is no difference between noise and sound. Sound is a
physical sensation perceived by the individual and resulting from pressure variations in the air. Invariably
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these pressure variations are produced by a vibrating source which may be solid (loudspeaker) or resulting
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from turbulence in the air, such as created through exhaust emissions. Noise then is often and simplistically
described as unwanted sound, or sound which is especially disturbing (Collins, 1993).
Sounds and noises are important in everyday life. At moderate levels they are harmless, but if they are too
loud, they can permanently damage hearing. The risk of injury being dependent on loudness, frequency and
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exposure time. Hearing damage may build up gradually and may go unnoticed from one day to another, but
once the damage is done there is no cure.
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High levels of occupational noise remain a problem in all regions of the world. In the United States of America
(USA), more than 30 million people are exposed to hazardous noise (NIOSH 1998). In Germany, 4 to 5 million
people (12 – 15% of the workforce) are exposed to noise levels defined as hazardous by the World Health
Organisation (WHO 2001).
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The situation is improving in developed countries, as more widespread appreciation of the hazard has led to
the introduction of protective measures. Data for developing countries is scarce, but available evidence
suggests that average noise levels are well above the occupational level recommended in many developed
nations.
Basic Concepts
Amplitude (Volume or Loudness)

The magnitude of the pressure change is measured by the amplitude (loudness). When measuring sound
energy minute pressure changes above and below the atmospheric pressure of air are measured. Pure noise
energy is therefore a unit of pressure and is measured in Pascals (Pa).
Sound Pressure
Atmospheric pressure has a typical value of 100,000 Pa whereas typical sound pressures are a small fraction
of a Pascal (as low as 0.00002 Pa at some frequencies). The range of human hearing is from 20 µPa, the
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threshold of hearing, to 200 Pa, the threshold of pain.
Sound Intensity
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The intensity of sound is a measure of its strength and is defined as the sound energy (watts) flowing per
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second through one square metre. The range of intensities that can be heard by the human ear is extremely
wide, from 10-12 Wm-2 (the threshold of hearing) to 100 Wm-2 (the threshold of pain).
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Table 21: The Decibel Scale
Unfortunately, because a logarithmic scale is used decibels cannot be directly added, multiplied,
averaged, etc,
70dB + 70dB ≠ 140dB

But: 70dB + 70dB = 73dB
The Rule of 3
If every 1 Bel (10 dB) increase is 10 times more intense, then every 1 dB increase means that the sound is
1.26 times louder. (Multiply 1.26 x 1.26 ten times over, it equals 10).
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Now try multiplying 1.26 x 1.26 x 1.26 three times (i.e., 3 dB). It works out to 2.
(1.26 x 1.26 x 1.26 = 2 therefore an increase of 3 decibel means double the intensity).
For those who find maths a challenge, just remember that the decibel scale is a logarithmic scale and that
a noise level increase of 3 dB means double the noise intensity (but would not seem like double the
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loudness).
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When adding decibels, it is necessary to use a logarithmic scale or calculate the intensities to add the raw
figures and then recalculate the sound pressure level (SPL).
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Example – Equal Sound
50 dB + 50 dB = 10 log (1050/10 + 1050/10)
50 dB + 50 dB = 10 log 200,000
50 dB + 50 dB = 53 dB
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Example – Unequal Sound
What is the average of: 50 dB, 60 dB, 70 dB and 80 dB?
Average = 10 log (1050/10 + 1060/10 + 1070/10 + 1080/10)/4
Average = 10 log (27,775,000)
Average = 74 dB
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Frequency Response (Weighting Curve)
The hearing mechanism does not respond to all frequencies of sound in the same way, it is more sensitive
to certain frequencies and less sensitive at other frequencies. In order to account for this variation in
sensitivity to frequencies the measuring equipment is modified to respond in a similar fashion. This is done
by using ‘weighing scales.
The term weighting scale or network refers to an electronic filter which is used on the sound level meter to
pre-select certain frequencies. There are a number of such scales in use in noise measuring instrumentation
known as the A, B and C weighting scales. These filters can be used in specific measuring methods:
x The A weighting filter for example, mimics the response to the various frequencies of the
human ear and any readings taken for the purpose of determining noise exposure should be
taken using this filter.
x The B filter removes from the spectrum less low frequency noise than the A filter and is
sometimes used to measure sounds with a dominant low frequency content; and
x The C filter actually offers very little frequency filtration and only at the higher frequencies. For
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most purposes the C filter can be considered as linear and is commonly used to measure
peak levels.
Graph 2: Weighting Scale Graph

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The term dB refers to an unweighted noise reading and is often written as dB(lin) although it is not uncommon
to drop the (lin). Where a filter has been used then the information should be shown as dB(A) or dB(B) or
dB(C) as appropriate.
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Concept of Equivalent Noise Dose

Noise dose is referenced over an eight-hour period. If the noise dose is below the nominated lower action
value, the risk of harm to the health of the average person is unlikely. The employer has a general duty of
care to ensure that the dose is as far below the action value as is reasonably practicable even though harm
is unlikely.
The dose concept includes the product of both the noise level and the time of exposure. Therefore, the same
amount of deafness will follow from the exposure to a very intense sound for a short period as to a lower
sound for a proportionally longer period.
NIOSH and the ACGIH methods recommend a 3dB exchange rate for the calculation of personal noise dose
measurements in a similar manner to the ISO method. This means an increase of 3 dB represents a doubling
of sound energy. Comparing the noise dose of 80 dB over an 8-hour period a worker would be allowed 83
dB (A) for 4 hours, 86 dB (A) for 2 hours.
Behaviour of Sound
Sound, just like light can be reflected and in the same way the angle of incidence, i.e., the approach angle,
is equal to the angle of reflection, i.e. the angle at which the sound leaves the reflecting surface. From this it
can be seen that the propagation of sound in a room will depend significantly on the structure, i.e., the
absorbing and reflecting properties of the room.
Reverberation Time
Reverberation is the characteristic of sound to reflect off structures and subsequently decay by 60 dB. Sound
produced in a room will not die away as soon as it is produced but will continue to be heard as a result of
reflections from walls, floors, ceilings and other structures within the room, this is reverberant sound. The
perception of reverberation by the individual will instil a sense of being and depth from the cavernous or
hollow sounding cave to the dull oppressive sound in an almost anechoic room (no sound reflections present)
such as a padded cell.
Work areas with long reverberation times will appear noisier than those with short since the sound continues
to be heard in conjunction with direct sound being produced.
Effects of Exposure to High Noise Level

There are three main types of hearing loss, mainly conductive, sensory and cortical.
Conductive Hearing Loss

This is due to the defects in the parts of the ear which are responsible for conducting the sound wave in air
to the inner ear, for example calcification of the bones of the ear, damage to the tympanic membrane or a
blockage in the auditory canal. This type of hearing loss is generally limited to 50 to 55 decibels due to
conduction of the sound through the skull. Consequently, people affected with conductive hearing loss may
still be able to ‘hear’ loud sounds.
Blast Deafness/Instantaneous Hearing Loss

The sensitive system of sound amplification and transmission has a built-in defence system against loud
sounds, which are likely to cause damage. Two muscles, the tensor tympani attached to the tympanic
membrane, and the stapedius, attached to the stapes, control the efficiency with which sound is transmitted
through the middle ear. A potentially damaging loud sound causes these muscles to tense, thereby
preventing the tympanic membrane reaching the full amplitude of the sound wave and reducing the ability of
the bones to move. This response is known as aural reflex and has a latent response time of around 30
milliseconds. Consequently, it cannot protect from instantaneous sounds such as a gunshot, which may
cause damage to the ear.
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Sensory Hearing Loss

This is normally associated with a loss of sensitivity of the sensory or hair cells within the cochlea. This type
of hearing loss is different for all frequencies.
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This type of hearing defect is not always permanent. A condition known as ‘temporary threshold shift’ is
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generally caused by exposure to loud noise. Following exposure to the noise source the threshold of hearing
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is temporarily raised and is often accompanied by ‘ringing’ in the ears or tinnitus. The removal of the noise
source and an adequate quiet rest period will usually restore hearing sensitivity. The rest period required to
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restore sensitivity varies in accordance with a number of factors, e.g., duration of exposure, intensity,
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frequency, etc.
Although the most susceptible frequencies to threshold shift are between 3 and 6 kHz, it should be noted that
repeated exposure to noise sources causing temporary threshold shift will often result in the similar but
permanent condition of permanent threshold shift. This permanent threshold shift is usually associated with
noise induced hearing loss and is characterised by a reduction and sensitivity to noise of around 4 kHz (normal
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speech).
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A condition known as presbycusis is associated with hearing loss due to age. The symptoms are generally
a reduction in sensitivity at high frequencies.
Another common effect of sensory hearing loss is loudness recruitment whereby the sensory cells, which
detect quiet sounds, are damaged. A person suffering from this condition may hear loud sounds well enough.
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Cortical Deafness
This is a neurological condition and not associated with transmission for detection of sounds. The aural part
of the brain is defective and is unable to convert the electrical nerve impulses to sounds.
Table 22: Acute and Chronic Effects of Noise Exposure
Acute Effects Chronic Effects

(result of short-term exposure) (result of long-term exposure)
Tinnitus (temporary) Tinnitus (permanent but spasmodic)
Temporary Threshold Shift Noise Induced Hearing Loss
Blast Deafness (damage to the ossicles or the Presbycusis
drum)
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Annoying Effects
Other Effects of Noise Exposure

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As can be seen from the above descriptions, the determination of sound is a complex process. In addition to
this, sound that is normally heard is complex and made up of several sounds, or of sounds occurring at the
same time as other sounds, known as background noise. Consequently, the reception of sound may be
‘masked’ if the background noise is sufficiently loud in comparison to the noise of interest. Inability to hear
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instructions or warning signals and the misunderstanding of verbal communication can all have serious
consequences.
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Very high levels of noise have been found to cause muscular tension, tightening of blood vessels, raised heart
rate and effects on the digestive system.
Noise can contribute to other work-related stress causing irritability, loss of sleep, loss of concentration,
fatigue, tension and other ill health effects associated with stress. Stress symptoms may also result from low
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levels of noise in some circumstances.
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Measurement and Assessment of Noise

Exposure
Principles of Noise Risk Assessment

British HSE’s L108: Controlling noise at work regulation says:

An employer who carries out work which is liable to expose any employees to noise at or above a lower
exposure action value shall make a suitable and sufficient assessment of the risk from that noise to the health
and safety of those employees, and the risk assessment shall identify the measures which need to be taken
to meet the requirements applicable local/international regulations.
In conducting the risk assessment, the employer shall assess the levels of noise to which workers are
exposed by means of:
a) Observation of specific working practices
b) Reference to relevant information on the probable levels of noise corresponding to any
equipment used in the particular working conditions
c) If necessary, measurement of the level of noise to which his employees are likely to be
exposed, and the employer shall assess whether any employees are likely to be exposed
to noise at or above a lower exposure action value, an upper exposure action value, or an
exposure limit value
The risk assessment shall include consideration of:
a) The level, type and duration of exposure, including any exposure to peak sound pressure
b) The effects of exposure to noise on employees or groups of employees whose health is at
particular risk from such exposure
c) As far as is practicable, any effects on the health and safety of employees resulting from
the interaction between noise and the use of ototoxic substances at work, or between noise
and vibration
d) Any indirect effects on the health and safety of employees resulting from the interaction
between noise and audible warning signals or other sounds that need to be audible in order
to reduce risk at work
e) Any information provided by the manufacturers of work equipment
f) The availability of alternative equipment designed to reduce the emission of noise
g) Any extension of exposure to noise at the workplace beyond normal working hours,
including exposure in rest facilities supervised by the employer
h) Appropriate information obtained following health surveillance, including, where possible,
published information

i) The availability of personal hearing protectors with adequate attenuation characteristics
The risk assessment shall be reviewed regularly, and forthwith if:

a) There is reason to suspect that the risk assessment is no longer valid; or
b) There has been a significant change in the work to which the assessment relates,
and where, if as a result of the review, changes to the risk assessment are required,
then those changes shall be made.
The employer shall record:

a. the significant findings of the risk assessment as soon as is practicable
after the risk assessment is made or changed; and
b. the measures which he has taken and which he intends to take to meet the requirements
of regulations
The purpose of the risk assessment is to enable you as the employer to make a valid decision about whether
your employees are at risk from exposure to noise and what action may be necessary to prevent or
adequately control that exposure.
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Managing Noise Risks – Assessment and Planning for

Control
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Assess Risks Due to Noise
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The process of assessing risks to health and safety due to noise exposure is in five stages:
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Stage 1 Is there risk due to noise?
Stage 2
Who might be harmed and how?
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Stage 3
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Evaluate the risks and develop a plan to control them.
Stage 4 Record the findings.
Stage 5 Review the risk assessment.
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Stage 1 Is there risk due to noise?
x Understand the work going on
x Understand how risks can arise from noise exposure
x Be able to identify potentially problematic noise sources
x Be able to obtain and understand noise information from machinery suppliers
Stage 2 Who might be harmed and how?

x Understand all work going on
x Understand and be able to identify potential for harm and factors which influence risk
Stage 3 Evaluate the risks and develop a plan to control them
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x Be able to estimate noise exposure and make judgements on likely exposure
x Understand exposure action and limit values and know what legal duties apply
x Obtain and understand good practice and industry standards for noise control
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x Be able to prioritise controls and tackle immediate risks

x Recognise where specific skills are required, and be able to access further competent advice
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Assess Exposure to Noise

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To assess a worker’s daily personal noise exposure, you need information on the average noise level (LAeq)
to which the worker is exposed during the tasks which make up the working day; and the length of time the
worker spends on each of the tasks.
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Interpretation and Evaluation of Results

Through the application of a formula, the measured LAeq can be combined with the duration of exposure during
a working day to ascertain the daily personal noise exposure, L EP,d,
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In the UK, the HSE have produced a simple method for determining daily and weekly personal noise
exposure using ‘ready-reckoners’ based on the level of noise and duration of exposure, within HSE Guidance
Note ‘Controlling Noise at Work’, L108. It provides a way of working out ‘noise exposure points’ for individual
noise exposures that can be combined to give the total exposure points for a day, hence the daily exposure.
The left section of Table below shows how noise level and duration of exposure are combined to give noise
exposure points. The right section is used to convert total exposure points to daily personal exposure.
Use of Noise Calculators to Determine Mixed Exposures

The UK’s HSE on-line calculator and ready reckoner helps users to work out the daily noise exposure, weekly
noise exposures, and estimate the performance of hearing protection.
Follow the on-line instructions for calculation of exposures. The noise exposure ready-reckoners allow you
to estimate daily or weekly noise exposure. To use the daily exposure ready-reckoner you will need to know
the levels of noise and durations of exposure which make up a person's working day. For weekly noise
exposure, appropriate where somebody's noise exposure varies markedly from day to day, you will need to
know the daily noise exposure for each day in the working week. These ready-reckoners can be printed for
completion by hand from the UK’s HSE website.
Worked Example 1, using a SLM
An employee has the following work pattern and noise exposures:
1. 5 hours at 80 dB(A).
2. 2 hours at 86 dB(A).
3. 45 minutes at 95 dB(A).
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L Aeq (dB) Time Notes Exposure Points

80 5 hours 16 + 4 = 20
86 2 hours 32
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95 45 minutes 65 + 32 =97
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Total Noise Exposure Points 149
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Using right hand section of the Table, LEP,d is: Between 86 and 87
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dB(A)
Worked Example 2, using a dosemeter
An employee wears a dosemeter for 2½ hours between breaks and the recorded dose is 1.3 Pa 2h. The noise
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during the measurement period was typical for that work, but the employee is normally exposed to this noise
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for 6hours per day.
Step 1: Multiply Pa2h value by 100 to obtain noise exposure points for that dose:
1.3 x 100 = 130 points.
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Step 2: To obtain noise exposure points for the normal duration of exposure, multiply by exposure
duration/measurement duration (6/2½):
130 x 6/2½ = 312 points.
Result: This task contributes 312 exposure points to daily personal noise exposure.
Comparison with Legal Limits

The level of noise and/or duration of exposure should not exceed the limits established by the competent
authority or other internationally recognized standards.
The UK Control of Noise at Work Regulations 2005, regulation 4 sets out exposure limit values and action
values.
1. The lower exposure action values are:

- a daily or weekly personal noise exposure of 80 dB (A-weighted); and
- a peak sound pressure of 135 dB (C-weighted).
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2. The upper exposure action values are:
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3. The exposure limit values are:
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4. Where the exposure of an employee to noise varies markedly from day to day, an employer may
use weekly personal noise exposure in place of daily personal noise exposure for the purpose of
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compliance with these Regulations.
Are the risks as low as is reasonably practicable? If NOT then, develop an action plan for investigating and
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introducing noise-control and risk-reduction measures.
Stage 4 Record the findings

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You should record the major findings of your risk assessment, and your action plan.
A minimum adequate record will include details of:

x The workplaces, areas, jobs or people included in the assessment, including a description
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of the work going on; n the date(s) that the assessment was made
x The daily personal noise exposures of the employees or groups of employees concerned
x The peak noise exposure levels of the employees or groups of employees concerned
x The information used to determine noise exposure
x If noise measurements have been made, relevant details of the measurements, including
the person(s) responsible for carrying them out

x Any further information used to evaluate risks
x The name of the person(s) responsible for making the risk assessment
x Your action plan to control noise risks
Stage 5 Review the risk assessment

Your risk assessment should be reviewed if:
x there is any reason to think that it does not reflect the current noise risk in your workplace
x you become aware of new ways of working or improved noise-control techniques
x you have introduced noise-control measures following a previous assessment and need to
determine their impact on employees’ exposure
x health surveillance shows that employees’ hearing is being damage
Controlling Noise and Noise Exposure
The Hierarchy of Noise Control

The hierarchy of control is a sequence of options which offer you a number of ways to approach the control
of hazards.
Work your way down the list and implement the best measure possible for your situation. Notice that the
use of protective equipment is the last resort, to be used when all other control measures have been ruled
out in the short term.
Eliminate the Hazard

If possible, remove the cause or source of the noise, by eliminating the machine, task or work process.
If this is not practical, then:

Substitute the Hazard with a lesser risk
Use a less-noisy machine for the task or introduce a less-noisy work process. If this is not practical, then:
Isolate the Hazard

Separate the noisy process or equipment from the workers by relocation or by changing the hours of
operation so that the noisy task is carried out when the majority of workers are not in the vicinity. If this is
not practical, then:
Use Engineering Controls

Introduce enclosures and barriers around the noise source or between the source and the workers to modify
the sound pathways and dampen the source of the noise.
Improve maintenance procedures to ensure the effectiveness of sound damping and muffling equipment.
If this is not practical, then:
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Use Administrative Controls

Use strategies such as rest breaks, pause exercises and job rotation. Establish hearing protection zones
and use signage to warn workers of noise risks. If this is not practical, then:
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Use Personal Protective Equipment
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Provide protective equipment appropriate to the risk. Provide training information and supervision to ensure
that personal hearing protection is fitted, used and maintained appropriately
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Controlling
Noise Sources
There are three broad classifications of noise sources:
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Vibrating surfaces: Noise emitted from, e.g., machine panels.
x Aerodynamic noise: Noise produced by direct disturbance of the air itself, e.g., by an air release
Workplace Health
associated with a fan, jet or pump; and
x Impact noise: Noise generated by the impact itself and the subsequent ringing of the components.
Like other forms of pollution, noise can be controlled by following the hierarchy of noise control with attention
to the following three factors:
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x The Source: Relocation, redesign, maintenance.
x The Path: Providing barriers to the transmission of noise through isolation and enclosures; and
x The Person: Acoustic havens and ear protection.
Another important control is the introduction of a low-noise purchasing policy for new equipment.
Noise Control at Source
Change of Process / Machine

In many instances it may well be appropriate to remove the noise producing process or machine in its entirety
and replace it with a quieter one. Examples include:
x Improve the quality of manufacturing to avoid later rework with potentially noisy processes, e.g., more
accurate cutting of steel plate may eliminate noisy reworking with grinders or air chisels.
x
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Use hydraulic pressing of bearings into a casting instead of being driven in by hammering.
x Replace manual lathes on repetitive production with computer controlled automatic machines, which
often have guards that offer some noise reduction and mean the operator needs to spend less time
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x Replace noisy compressed air tools with hydraulic alternatives.
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Damping
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Vibrating surfaces should be minimised by reducing the size of panels or fitting material to the panels which
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reduces the flexibility and consequently the ability of the panel to move (damping).
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Damping is the process of removing the energy from a system and converting it to heat. By moving in
conjunction with vibrating panels the internal frictional forces reduce the amount of energy which can be used
to compress the air around the panel and create noise.
Damping material tends to be visco-elastic in nature (rubbery) and can be applied using adhesives or even
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sprayed onto a panel and allowed to set, e.g., mastic treatment.
For specific work pieces then, specific solutions can be used, e.g., machining of hollow metal castings or
riveting of metal drums can create a great deal of ringing sound energy. The simple approach of ‘clamping
and damping’ can produce considerable noise reduction.
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Enclosure
Noisy machines can be enclosed fully, or a partial enclosure or an acoustic cover can be placed around a
noisy part of a machine. Enclosing machinery is likely to increase the temperature of the air inside the
enclosure, therefore adequate ventilation and cooling should be provided. An efficient noise enclosure may
consist of:
x A good quality dense insulating barrier to stop the noise from escaping, e.g., steel, brick, etc.
x Sound-absorbing material on the inside to reduce the reflections and therefore reduce the build-up
of noise in the enclosure.
x Double-glazed viewing windows.
x Good seals around openings, as small leaks can dramatically reduce the effectiveness of the
enclosure.
x Self-closing devices on any doors.
x Absorbent-lined cooling ducts.
x Absorbent-lined inlets and outlets for materials and services.
Isolation
Isolation involves separating the machine from its surroundings. Flexible isolators made of rubber or springs
can be used to reduce the spread of structure-borne sound through a machine frame, e.g.:
x Isolate the bearings from a gearbox case to reduce the transmission of gear noise; and
x Mount machines on anti-vibration mounts to reduce the transmitted vibration into the structure of
the workplace.
Illustration 48: A Compressor Unit with Isolation under the Machine and on the Outlet Pipework
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There are a number of materials which are suitable for use in isolating equipment from the structure of the
workplace, e.g., cork, felt, foamed plastic for relatively high vibrational frequencies and metal springs for the
lower end frequencies. Clearly the operating environment needs to be considered when choosing an
appropriate material since, for example rubber is attacked by oil and solvents and is only appropriate at
certain temperatures.
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Active Noise Cancellation (ANC)
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Also known as noise cancellation, or active noise reduction (ANR), is a method for reducing unwanted sound
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by the addition of a second sound specifically designed to cancel the first.
A noise-cancellation speaker emits a sound wave with the same amplitude but with inverted phase (also
known as antiphase) to the original sound. The waves combine to form a new wave, in a process called
interference, and effectively cancel each other out - an effect which is called destructive interference.
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Graphical depiction of active noise reduction
Workplace Health
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Avoiding Impacts
Noise generated by impacts, including components falling into chutes, bins and hoppers, and impacts
generated by tooling can be considerable. Noise reduction can be achieved by using lower transfer speeds
and/or heights of falling objects, avoidance of impacts, or making arrangements to cushion falling materials,
e.g.:
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Fitting buffers on stops and rubber or plastic surface coatings on chutes, to avoid metal-to-metal
impacts; and
x Using conveyor systems that prevent the components being transported from impacting against each
other, e.g., by use of screw conveyors. NEBOSH

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Silencing
Silencing air emissions by reducing the release of turbulent air into the workplace or by using silencing
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methods such as baffles on exhaust outlets can reduce the presence of aerodynamic generated noise.
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Illustration 49: A Porous Silencer for Use on Compressed Air Exhausts
Workplace Design
The way work processes are planned, organised and laid out can have an effect on the noise exposure of
individual employees. When considering a new workplace or modifying an existing one, noise emissions
and noise exposures should be considered.
The noise source may be re-sited to a less noise sensitive position, i.e., where there are no employees or
environmentally sensitive circumstances.
Maintenance
Machine maintenance can be critical in reducing noise. Machines deteriorate with age and use, and if not
maintained are likely to produce more noise due to factors such as worn parts, poor lubrication and loose
panels vibrating. Maintenance can, if carried out periodically, limit the increased noise emission due to
wear.
Regular inspections should be carried out to check that the noise-control features have not deteriorated or NEBOSH International Diploma
been removed.
The Path
The noise travels from the point of origin to the receiver in a number of different ways, using different
transmission paths:
1. Reflected airborne transmission (reverberation).

2. Direct airborne transmission; and
3. Structure borne transmission.
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Illustration 50: Noise Paths
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Illustration 51: Noise Control
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In Illustration 51 the noise path is interrupted using absorbing ceiling mounted acoustic tiles to reduce
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reflections (reverberant sound), an acoustic absorbing barrier to control the direct airborne sound and resilient
mounts for the noisy machine to reduce structure borne sound.
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Absorption
The effectiveness of a material at absorbing sound energy can be measured and is described as the
‘absorption coefficient’. This numerical rating of the efficiency of the material is commonly defined as:
³«WKHIUDFWLRQRIQRQ
-UHIOHFWHGVRXQGHQHUJ\WRWKHLQFLGHQWVRXQGHQH
ters and Owen, 1996).
The absorption coefficient for material is determined in a laboratory under specific conditions, e.g., the
absorption coefficient of brickwork at 125 Hz is 0.02 and for carpet on a joist or board and batten floor is 0.2,
i.e., a carpeted floor is more absorbent than brickwork.
Sound absorbing material can be used to control reflections (reverberant sound) within workrooms. Absorbing
material fitted at a distance from the noise source (e.g., ceiling treatment) will have little effect on the sound
pressure level close to the source but does reduce sound pressure levels further away. Treatment is more
effective when the reflecting surface is close to the noise source, e.g., if a machine stands against a wall,
applying sound-absorbing material to the wall area behind the machine can significantly reduce the reflected
sound.
Absorbing material can also be useful for treating reflecting surfaces close to a person, e.g., when a worker
sits against a reflecting wall. Even where sound absorbing material will not produce a significant reduction in
sound pressure level it can sometimes provide a psychological benefit by reducing the high frequencies more
than the low ones, and by suppressing reverberant sound, which is more unpleasant than sound radiated
directly from machines.
While selecting the material, two particular qualities of the materials which be used to assist in selection are
the ‘Sound Reduction Index’ and ‘Sound Absorption coefficient’.
Sound Absorption Coefficient

Is defined as:
Intensity of sound absorbed by material
Intensity of sound incident on same area of material
This is an indication of how well the material absorbs the sound incident on it. The higher the co-efficient the
more sound is absorbed and the less is reflected or transmitted through.
For example, glass fibre (75mm thick) has an absorption coefficient of 0.99 at 500Hz. Which means 99% of
the sound falling on the glass fibre will be absorbed and only 1% will transmit through.
Sound Reduction Index

SRI indicates the level of attenuation (sound reduction) of noise when it passes through the material. It is an
idealised laboratory measurement which can vary in real life environment. For example, a wall made of 20cm
hollow concrete block has SRI of 58dB at 2KHz. Which means the sound level will be reduced by 58db when
it passes through the material.
Porous Absorbers
This type of sound absorber is usually material such as fibreboard, mineral wool, and insulation blankets,
etc., notably they all have the same characteristic of interlocking air pockets and work by converting the
sound energy into heat. Sound absorption is more effective at high frequencies than low frequencies due to
the wavelength of the incident sound penetrating the absorbing material. Typically, the thicker the absorbent
the better the absorption at low frequencies and this can be further improved by mounting the absorbent with
an air space behind.
Membrane or Panel Absorbers

A panel absorber is much better suited to low frequency attenuation although is very frequency dependant
typically 50 to 500 Hz. Often panel absorbers may take the form of large windows or suspended ceilings and
may be deliberate or accidental.
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Helmholtz or Cavity Resonators

This type of absorber is characterised by a cavity opening at a small neck and works on the principle of air
movement within the cavity reducing the noise energy. This type of absorber is frequency specific, and a
large number are required at varying frequency responses to be effective.
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Walls or Screens
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Walls or screens can be placed between the source of the noise and a receiver to stop the direct sound (and
to a lesser degree the reflected sound) from reaching the receiver. Such barriers or screens should be
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constructed from a dense material (i.e., brick or sheet steel) to interrupt the noise transmission path. The
maximum performance of a screen will only be achieved when the area in which it is located has little or no
reflective sound. Covering the barrier or screen with absorbent material on the side facing the noise source
will have the added advantage of reducing the sound reflected back into the area containing the noise source.
Those workplaces which have already been treated with sound absorbing material will help to create acoustic
Occupational
conditions which will allow the screen or barrier to perform to its maximum potential.
Workplace Health
Active Noise Cancellation (ANR)
This is a method of reducing the noise emitted by a piece of equipment or machinery. The principle relies on
electronic equipment detecting the sound pressure waves being created by the machine and then generating
exact opposite sound pressure waves so that he two pressure waves counteract or cancel one another. ANR
Health Issues
equipment usually consists of one or several microphones mounted in or on the machinery, an electronic
control unit and one or several speakers to generate the ‘anti-noise’.
This technology is not generally widespread but is being used in car design (to reduce occupants exposure
to low frequency engine noise) and in some industrial machinery. The one application where this technology
is very widespread in anti-noise headphones and hearing protection devices.
Diffusion
Noise levels decrease rapidly with distance since the energy is dissipated spherically (i.e., in all directions).
If the distance away from the source is doubled then the intensity is reduced to one quarter of its previous
value, this is because the area over which the energy flow is shared is increased to four times the original.
Compressor rooms and test bays, for example should be located well away from other work areas.
Job Design
Noisy devices should only be used when they are actually needed. For example, the pneumatic ejector on a
power press need be on only for the short time required to eject the product. The air supply should be ‘pulsed’
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to operate only when the product needs removing.
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Job Rotation and Reducing Exposure Time

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Where some employees do noisy jobs all day, and others do quieter ones, job rotation should be considered.
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The introduction of job rotation may require the training of employees to carry out alternative work.
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Table 23 illustrates the principle of equal energy, which demonstrates that a trade-off between noise level
and time of exposure can be made. The table shows the noise dosages that are equivalent to an action
level of 85 dB(A) for eight hours, the level above which it is recognised that further exposure can bring about
noise induced hearing loss (NIHL).
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dB(A) Duration of
Exposure Table 23: Noise Dosages
85 8 hours Where workplace sound levels are above 85 dB(A) the daily personal noise
exposure (LEP,d) can be kept below 85 dB(A) by reducing the exposure
88 4 hours
time. One method of achieving this is job rotation.
91 2 hours
94 1 hour
97 30 minutes
100 15 minutes
103 7.5 minutes
106 3.75 minutes
Acoustic Havens
These are noise-reduced enclosures for the isolation of people. Noise refuges can be a practical solution in
situations where noise control is very difficult, or where only occasional attendance in noisy areas is
necessary. The design of refuges will be similar to that of acoustic enclosures, although since the purpose
is to keep noise out rather than in, lining the inner surfaces with acoustic absorbent material will not be
necessary. The refuge should:
x Be fitted with effective door and window seals.

x Be fitted with self-closing doors.
x Be of dense construction materials, with sufficient acoustically double-glazed windows.
x Be isolated from the floor to reduce structure vibrations.
If machine controls are brought into the refuge, and thought is given to allowing remote monitoring or viewing
of machinery and processes, it should be possible to maximise the amount of time that workers have to spend
outside the refuge, thus maximising the benefit of having the refuge. For example, a refuge that is only used
for half of an 8 hour shift will achieve no more than 3 dB reduction in noise exposure.
Refuges must be acceptable to employees. This means they must be of a reasonable size, well-lit and
ventilated and have good ergonomic seating.
Figure 3: Acoustic haven

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Health Surveillance
Appropriate health surveillance should be conducted for all workers whose noise exposures reach a certain level
prescribed by national laws and regulations or by national or internationally recognized standards above which
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health surveillance should be carried out.
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x Periodical medical examinations at intervals prescribed as a function of the magnitude of the
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exposure hazards too:
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- Detect the first symptoms of occupational disease;
- Detect the appearance of any unusual sensitivity to noise and signs of stress due to noisy
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working conditions;
Audiometry
Occupational
Audiometry is a technique for evaluating the degree of hearing loss or impairment over the range of frequencies
most necessary for normal conversation (4-6 kHz).
Workplace Health
For occupational purposes, audiometry can be used for the early detection and the assessment of the degree of
noise induced hearing loss.
Employers should consult their workers or their health and safety representatives before introducing audiometric
health surveillance.
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With no hearing defect the results would be similar to Graph 3 below.
Graph 3: Audiogram for Normal Hearing
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Graph 4 shows characteristic reduction in hearing sensitivity as a result of exposure to noise. Where the
subject has some hearing defect the levels of sound need to be raised above the normal threshold of hearing
for the subject to hear them, this is indicated as a dip on the graph. A classic pattern of occupational noise
induced hearing loss is in the range of 4 to 6 Khz region.
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Graph 4: Audiogram Showing Noise Induced Hearing Loss (NIHL)
Hearing Protection
Personal Protective Equipment - as always, should be the last choice because:
x It is not effective if not worn correctly or is not maintained.

x It needs constant management attention to ensure its use.
x It may introduce secondary risks (failure to hear alarms, instructions, vehicles).
Where there is no practicable alternative, PPE should be:
x Properly selected - technically suitable, comfortable, compatible with other PPE such as hard hats,
spectacles etc.
x Properly maintained - kept in clean and efficient order; and
x Properly used - training and instruction and supervision will be necessary.
Types of Hearing Protectors

Circumaural canister type ear defenders will generally provide up to about 20 dB(A) attenuation, or noise NEBOSH International Diploma
reduction for the wearer, whilst inserts will generally provide between 5 and 10 dB(A) attenuation.
Each type has their own particular advantages and disadvantages and must be properly prescribed, used and
maintained throughout the noise exposure period.
Care is needed when recommending re-usable plugs for two reasons:
x Hygiene. There may be problems associated with keeping the plugs clean enough for re-use,
especially when removed and replaced frequently.
x Comfort. They may be uncomfortable to wear, as the ear canal has to deform to their shape to be
fully effective. In order to achieve the acclaimed attenuation, they must make good contact with the
skin of the ear canal and must therefore be of the correct size to fit.
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Disposable plastic foam plugs are often more comfortable to wear as the foam expands to fill the cavity of the
ear canal. Users must be trained to insert the plugs in the correct manner to obtain the desired fit.
Re-use of disposable plugs should be discouraged on the grounds of hygiene and the increased risk of
infection. On no account should disposable plugs be shared between users.
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x They can be worn without interference from glasses / safety spectacles, helmets, earrings or long
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hair.
x
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They are normally comfortable to wear in hot environments.
x They do not restrict movement when working in confined spaces.
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x They are normally cheaper than earmuffs; and
x On a unit cost basis, ear plugs cost less than earmuffs.
The disadvantages of earplugs include the following:
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Workplace Health
x The amount of protection they provide can be less and more variable than an earmuff provides.
x Wearing of ear plugs is difficult to monitor because they are not easily visible.
x Contaminated ear plugs can cause infections in the ear canal.
x Ear plugs can be inserted incorrectly in the ear canal; and
x Ear plugs should be worn only in healthy ear canals.
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Ear Defenders
Externally worn earmuffs or defenders, present the user with different problems. The effectiveness of the
defenders is very much dependent on the seal achieved around the ears, which in turn depends upon the
cups being pressed against the head. The achieves the seal to the head, which can be virtually destroyed
by loosening the headband by bending it, wearing certain types of spectacles or even long hairstyles, which
may interfere with the seal. The relationship between comfort and performance is often therefore a trade-
off, taking into account the environmental conditions within the workplace.
Graph 5: Comparison Between Attenuation of Typical Earplugs / Muffs
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SNR (Single Number Rating)

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The SNR provides a single, overall protection value offered by a particular plug or muff. To find the effective
level of noise exposure the noise level is measured as a C-weighted Leq. In general, ear defenders offer
better protection for high frequency sound rather than low frequency. If the sound source is predominantly
low frequency, it is easy to underestimate the amount of protection and over expose the employee.
For SNR numbers 4dB should be subtracted from the value given on the data sheet.
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HML (High, Medium, Low) Methods
The HML assessment method offers a more accurate prediction as it uses a measurement of both ‘A’ & ‘C’
weighted sound levels providing some indication of low frequency noise present. For HML numbers the
predicted noise reduction PNR should be reduced by 4dB.
An Example
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9.12 Vibration
Meaning of Vibration
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Vibration is the movement of a body back and forth around a fixed point. The distance travelled away from
the central or fixed point is known as the displacement. The average displacement for a vibrating object is
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usually zero since it moves in equal and opposite cycles. In the field of occupational health persons may be
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subject to vibration exposure either in terms of hand transmitted vibration or whole-body vibration.
Hand transmitted vibration is usually associated with the use of handheld equipment where the vibration
energy is transferred to the subject because of them holding the equipment.
Occupational
Whole body vibration (WBV) is more often associated with persons whose body is supported by a vibrating
surface, e.g., sitting in a vibrating seat such as a moving vehicle.
Workplace Health
Workplace vibration may be described in terms of displacement, amplitude velocity or acceleration, where
displacement is measured in either, millimetres (mm) or microns (µm), velocity is measured in metres per
second (m/s) or millimetres per second (mm/s) and acceleration is measured in metres per second per
second (m/s2).
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x Amplitude is the measure of the displacement experienced by the vibrating object.
x Velocity is defined as the rate at which displacement changes with time.
x Acceleration is the rate of velocity change.
Since the vibrating object moves back and forth around a fixed point, its rate of movement is not uniform, but
changing constantly as it accelerates to from each extreme position to the mean position and then
decelerates to the opposite extreme. This constant acceleration and deceleration are a useful measure of
the magnitude of vibration.
The displacement, velocity and acceleration can be demonstrated as a sine wave with the velocity out of step
or phase with displacement and acceleration by ¼ and acceleration out of step with displacement by ½. See
Graph 6.
Frequency of vibration, as with noise, is measured in Hertz and is the number of complete oscillations
occurring each second. Frequencies of below around 0.5 Hz can be the cause of motion sickness. For WBV
frequencies of between 0.5 – 100 Hz are significant whereas up to around 1,000 Hz may have consequences
for hand arm vibration exposure.
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Graph 6: Graphs Representing Displacement, Velocity and Acceleration
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The magnitude of the vibration is expressed in terms of the average acceleration experienced by the
vibrating object through its motion cycle, this is usually the root mean square (rms) value, i.e., m/s2 rms.
The rms value is calculated by dividing the peak value by √2.
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Occupational Vibration Exposure

The occupations in which workers are exposed to vibration include machinery operators, drivers, technicians
and trades workers and labourers. The industries in which workers are exposed to vibration include
agriculture, forestry, fishing, transport, storage and construction. The exposure to hand, wrist and arm is
generally from use of handheld vibration equipment. The exposure to whole body vibration is through contact
with a structure such as in the processing of coal and the seat of a vehicle. Occupational vibration sources
include chain saws, pneumatic drills, grinder, compactor, floor polishing machine, mower, etc.
Vibration Dose
The vibration dose received by a worker over a typical working day will depend on the characteristics of the
exposure such as duration and frequency as well as the vibration magnitude. In order to account for the
varying patterns of exposure the dose should be adjusted or ‘normalised’ to a standard reference period of
8 hours, the nominal working day (A (8)). When comparing exposures to vibrational energy it is important to
ensure that the same reference periods are used for comparative purposes.
In the European Union, the Physical Agents Directive has established obligations upon member states to
manage the risks from noise and vibration. In the UK, legal requirements in relation to the control of vibration,
include exposure action values and exposure limit value levels. Table 24 below provides the average
vibration levels over the working day which will cause an A8 of 2.5 m/s 2 and 5 m/s2.
Table 24: Exposure Action Values and Exposure Limit Values (UK)
Total exposure duration 16 8 4 2 1 ½

(hours)
Exposure Action Values 1.8 2.5 3.5 5. 7 10
Exposure Limit Values 3.5 5 7 10 14 20
Any exposure limit relating to the assessment of vibration should take into account current international
knowledge and data. A number of international consensus standards describe useful methods for quantifying
vibration severity, for both hand arm vibration (ISO 5349: 1986) and whole body vibration (ISO 2631-1: 1997).
Whole-Body Vibration (WBV)

Whole-body vibration has more widespread effects and is not particularly clear as the body does not have one
receptor for this energy as for example the ear is for noise, but effects are manifested far and wide in the body
and may be mistaken for a number of other common ailments.
The most pronounced and common effect is lower back pain which is caused by various mechanisms of NEBOSH International Diploma
vibration on the Musculo-skeletal system of the body, namely the degeneration of the intervertebral discs,
which leads to an impairment of the mechanics of the vertebral column allowing tissues and nerves to be
strained and pinched leading to various back problems.
The nutrition of the discs is also affected by long periods of sitting aggravated by vibration exposure, which
causes tissue nutrients needed for growth and repair of the discs to flow out of the discs by diffusion instead
of inwards where they are required, and this leads to increased wear and reduced repair of the discs. The
vertebral bodies are also damaged by the vibration energy that leads to an accumulation of micro fractures at
the end plates of the vertebral bodies and associated pain. Muscle fatigue also occurs as the muscles try to
react to the vibrational energy to maintain balance and protect and support the spinal column, but these are
often too slow as the muscular and nervous system cannot react fast enough to the vibrational shocks and
loads being applied to the body.
Other health effects that have been associated with whole-body vibration and especially the driving
environment are piles, high blood pressure, kidney disorders and impotence.
Vibration is a complex hazard that does not have one control measure that will solve all problems and requires
a holistic approach using sound occupational health and safety principles of control taking into account the
control measures included under the areas of engineering and administrative control. Personal protective
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equipment can be used such as anti-vibration gloves to reduce the transmission of vibration to the hand-arm
system, but care should be taken when using an unproven device such as a kidney or back belt for whole-
body vibration as this remains a controversial means of “protecting” the back and spinal system against this
type of hazard and this practice is not used or recommended in any other country in the world except South
Africa and is a controversial topic even when used for manual lifting activities.
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Groups of workers at risk
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Workers at a higher risk are regular operators and drivers of off-road machinery such as:
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x Construction, mining and quarrying machines and vehicles, particularly earthmoving machines such
as scrapers, bulldozers and building site dumpers;
x Tractors and other agricultural and forestry machinery, particularly when used in transportation,
tedding (turning hay), primary cultivation and mowing.
Occupational
Workplace Health
Physiological and ill-health effects from exposure to WBV
Whole-body vibration can cause fatigue, stomach problems, headache, loss of balance and "shakiness"
shortly after or during exposure. The symptoms are similar to those that many people experience after a long
car or boat trip. After daily exposure over a number of years, whole-body vibration can affect the entire body
and result in a number of health disorders. Studies of bus and truck drivers found that occupational exposure
Health Issues
to whole-body vibration could have contributed to a number of circulatory, bowel, respiratory, muscular and
back disorders. The combined effects of body posture, postural fatigue, dietary habits and whole-body
vibration are the possible causes for these disorders.
Hand-Arm Vibration Syndrome

Hand-arm vibration can cause a range of conditions collectively known as hand-arm vibration syndrome
(HAVS), as well as specific diseases such as carpal tunnel syndrome.
Other possible soft tissue damage may lead to pain and stiffness in the hands and joints of the wrists, elbows
and shoulders. These forms of damage and the factors contributing to them are less well understood than
the vascular and neurological effects and individual susceptibility is variable.
Workers at Risk: HAV is caused by the use of work equipment and work processes that transmit vibration
into the hands and arms of employees.
It can be caused by:

x Hand-held power tools such as hammer drills, sanders, grinders, concrete breakers;
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x Hand-guided equipment such as powered lawnmowers, chainsaws, hedge trimmers; or
x By holding materials being processed by machines such as bench-mounted grinders, pedestal
grinders etc.
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Long-term, regular exposure to HAV is known to lead to potentially permanent and debilitating health effects
known as hand-arm vibration syndrome (HAVS), such as vibration white finger and carpal tunnel syndrome.
HAVS affects the nerves, blood vessels, muscles and joints of the hand, wrist and arm.
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Physiological effects and Risk Factors

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Vibration with a frequency between about 2 to 1,500 Hz is potentially damaging and more serious at between
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5 and 20 Hz. However, the risks depend significantly on the vibration magnitude.
The strength of the grip and other forces used to hold and guide vibrating tools or work pieces may affect the
severity of the exposure since the tighter the grip the more likelihood of transferring vibrational energy from
the workpiece to the hand.
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The length of exposure and the frequency of exposure to the vibrating workpiece and associated rest periods
make it rise to accumulative effects. Similarly, the nature of the contact between the work equipment and the
hand is significant since there may be more transparent of vibrational energy to the hand. Other factors which
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might affect blood circulation such as ambient temperature and smoking will affect individuals’ susceptibility
to vibrational energy as may other individual characteristics including age, health and general wellbeing.
The health effects of the use of vibrating tools are either acute or chronic and the symptoms are:
Acute effects: tingling or pins and needles in the hands and extremities.
Chronic effects are:

x Numbness and blanching of fingers

x Swollen painful joints
x Reduction in manual dexterity
x Reduction in sensation of touch
Risk Factors
The factors that can contribute to the risk include:
x The frequency of the vibration equipment
x Magnitude of energy
x Strength of grip required to hold tools
x Length of time of exposure
x Frequency of exposure
x Low temperature
x Individual factors e.g., health, age etc.
Vibration White Finger (VWF)

Exposure to vibrating handheld machinery can give rise to vascular disorders commonly known as ‘vibration-
induced white finger’ (VWF) which causes impaired blood circulation and blanching (whitening) of affected
finger segments and parts of the hand. Neurological and muscular damage may also occur which may lead
to numbness and tingling in the fingers and hands, reduced grip strength and dexterity, and reduced sensitivity
both of touch and to temperature.
The acute symptoms of vibration injury may give rise to the worker experiencing tingling or pins and needles
in the hands and extremities. These symptoms would be most noticeable to the employee following a period
of exposure to vibration. During cold weather the sufferer may experience an attack where the finger begins
to change colour when exposed to the cold. As the condition worsens blanching of the whole finger down to
the knuckle may occur. These colour changes to the finger are brought about by the difficulties in circulation
following vascular damage to the extremities and are often accompanied by an uncomfortable throbbing.
In more severe cases the attacks may occur during exposure to cold conditions, and they last for periods of

up to an hour causing the sufferer extreme pain resulting in loss of manual dexterity, clumsiness and reduced
strength in the hands. In extreme cases however rarely, circulation to the extremities maybe permanently
impaired leading to necrosis or gangrene in the fingers.
A circulatory disorder known as Raynauds syndrome can lead to a predisposition to VWF.
Classification of HAVS symptoms

The classification scheme known as the modified Stockholm Workshop scales should be used to
classify neurological and vascular symptoms (see below picture).
A system for allocating a weighted numerical value to each phalange affected and calculating an overall score for
finger blanching in each hand is used in the Griffin method outlined in HSE Contract Research Report (CRR)
197/98.
This system is a useful method in practice for monitoring progression of symptoms in individual fingers. It does not
take account of the frequency of attacks, which may be more relevant in assessing functional disability. Attacks
can lead to a variable degree of blanching. In this case, the worst distribution should be recorded.
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Figure 4: Numerical Scoring of Vascular Symptoms of HAVS
Modified Stockholm Workshop Scales

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In the numerical scoring system for vascular HAVS, the blanching for each part of each digit is given a score
as shaded on the diagram in Figure 4. A total value for each hand can be arrived at by summing the digit
scores. In the figure, the score for the left hand is 16 and that for the right hand is 4.
Stage 2 sensorineural is broad, ranging from less severe neurological symptoms to those with persistent
sensorineural loss. Therefore, stage 2 should be divided into early and late phases to assist with management
of stage 2 cases.
Assessing Vibration Risk and Planning for Risk Control
Vibration Risk Assessment

The vibration risk assessment should identify the ways in which vibrating tools are used, and determine in
particular whether:
x High-risk uses can be eliminated;
x Workers have been appropriately trained in the use of the tools;
x Their use can be improved by supports.
The vibration risk assessment follows a five-step approach:
1. Identify who might be harm and how.
2. Identify the hand arm vibration risks comparing against exposure limits – Exposure Action Value
(EAV) and Exposure Limit Value (ELV)
3. Evaluate the existing controls and decide if more needs to be done to monitor and reduce the risks
4. Record the significant findings and any measures taken to reduce risks
5. Review the assessment when there are any changes such as equipment, work process, after an
incident or after a passage of time.
Note: Further recommended reading on the risk assessment of HAV and WBV: The UK HSE has published
two guides: 1) L140 which outlines an employer’s duties under the Control of Vibration at Work Regulations
2005 2) L141 which deals with whole-body vibration).
Evaluation of Vibration Risk and Daily Vibration

Exposure
The daily vibration exposure is an indication of the level of risk to health. If the exposure is likely to exceed

the ELV (5 m/s2 A(8)), the risk is high and the Vibration Regulations require you to take immediate action to
prevent further exposure above this level.
When exposure is likely to reach or exceed the EAV (2.5 m/s2 A(8)), you have duties to have a formal
programme of measures to minimise risk, including exposure controls, health surveillance and training. The
risk must be controlled, so far as is reasonably practicable, at any level of exposure.
A person‘s daily vibration exposure depends on: (a) the vibration magnitudes to which they are exposed; (b)
how long the exposures last.
A person’s daily vibration exposure is, like the vibration magnitude, expressed in acceleration units of m/s2.
The daily exposure can be thought of as the average vibration spread over a standard working day of eight
hours, adjusted to take account of the actual total exposure duration (i.e., contact time or trigger time). To
avoid confusion with vibration magnitudes, it is conventional to add A(8) after the units when quoting a daily
vibration exposure; for example, 2.5 m/s2 A(8).
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Example vibration magnitudes and exposure times required to reach the EAV of 2.5 m/s 2 A(8)
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The HSE ready-reckoner
Table above is a ‘ready-reckoner’ for calculating daily vibration exposure from vibration magnitude and
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exposure time information. The ready-reckoner covers a range of vibration magnitudes from 1 to 40 m/s²
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and exposure times from 5 minutes to 6 hours.
The exposure values in the following table are given as points rather than m/s² A(8) values. You may find
the exposure points system easier to work with than A(8) values:
a) exposure points change simply with time: twice the exposure time, twice the exposure points
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b) exposure points can be added together, for example, where a worker is exposed to two or
more different sources of vibration in a day
c) the EAV (2.5 m/s² A(8)) is equal to 100 points
d) the ELV (5.0 m/s² A(8)) is equal to 400 points
The cells in Table are colour-coded with:

a) red for exposures above the ELV
b) green for exposures below the EAV
c) yellow for exposures between the two
Ready-Reckoner for Vibration Exposure Points
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Two further colours have been included to account for the uncertainty introduced by estimating
exposures:
a) light green representing exposures (between 64 and 100 points) which should be considered as
likely to be at or above the EAV
b) orange representing exposures (between 255 and 400 points) which should be considered as
likely to be above the ELV
If your exposure time does not appear on Table, you can add points from different columns. For example: for
1 hour and 15 minutes of exposure, add values in the 1-hour and the 15-minute columns; for 8 hours’
exposure, double the 4-hour exposure points values.
Example: Use of partial vibration exposure
A heavy fabrication company has a regular contract to refit and paint steel barges. They use a vacuum-
blasting system to strip paint and corrosion from the hulls. But this does not reach into all of the corners so
they must use needle scalers. They also clean and dress small areas with angle grinders prior to carrying out
weld repairs before repainting. They have a workforce of painters and welders.
The company has its own needle scalers and angle grinders which have served it well for these tasks. The
tools are well maintained, and the workforce are trained in correct use. The needle scalers have a vibration
magnitude of about 12 m/s2 and the angle grinders 8 m/s2. They estimate daily use of about three hours for
the angle grinders and 30 minutes for the needle scalers.
Having succeeded in eliminating a lot of vibration by introducing the vacuum-blasting system, the company
uses the ready-reckoner to review and further manage vibration exposure. The company is considering
getting the welders to do all the
needle scaling and weld preparation work and the painters to do the vacuum-blasting and to paint. The daily
vibration exposure for the welders would therefore comprise two partial exposures:
Angle grinder (8 m/s2 for 3 hours): 385 points

Needle scaler (12 m/s2 for 0.5 hour): 145 points
Total vibration exposure: 530 points
With this approach the ELV (400 points) would be exceeded.
HSE’s Hand-Arm Vibration Exposure Calculator

HSE’s exposure calculator for HAV is a popular tool for calculating daily exposures quickly and easily. The
calculator is shown in Figure 5 and is available in the hand-arm vibration section of the HSE website at
www.hse.gov.uk/vibration.

Figure 5: HSE vibration Exposure Calculator
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Figure 6: The Calculator in Use
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Figure 7: Whole Body Vibration Calculator
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Comparison with Legal Limits

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Exposure Limits (Specified by National Laws)

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Europe and UK - EXPOSURE ACTION VALUE (EAV)
The exposure action value is the amount of daily exposure to whole-body vibration above which an employer
is required to take action to reduce risk.
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In the UK it is set at a daily exposure of 0.5 m/s2 A(8).
Whole-body vibration risks are low for exposures around the action value and only simple control measures
are usually necessary in these circumstances.
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Europe and UK - EXPOSURE LIMIT VALUE (ELV)
The exposure limit value is the maximum amount of vibration an employee may be exposed to on any single
day.
It is set at a daily exposure of 1.15 m/s2 A(8).

Operators of some off-road machines and vehicles may exceed the limit value but this will depend on the task,
vehicle speed, ground conditions, driver skill and duration of the operation.
The UK Regulations allow a transitional period for the limit value until July 2010 (or until 2014 for the
agricultural and forestry sectors).
This only applies to machines or vehicles first supplied to employees before July 2007.
The exposure limit value may be exceeded during the transitional periods as long as employers have complied
with all the other requirements of the Regulations and taken all reasonably practicable actions to reduce
exposure as much as you can.
Practical Control Measures to Prevent or Minimise Exposure to

Hand Arm Vibration
Part 2 of the UK HSE’s guide L140 on Hand Arm Vibration hierarchy for control to minimize the risk from hand
arm vibration exposure, in order of priority, is as follows:
a) Eliminate vibration exposure by changing the work processes

b) Reduce exposure by mechanisation
c) Reduce exposure by good process control
d) void high-vibration tools, machines and accessories
e) Maintain machines and accessories
f) Reduce the transmission of vibration into the hand
g) Reduce the durations of exposure (including job rotation)
h) Keep warm and dry
a) Eliminate Vibration Exposure by Changing the Work Processes

x Design (or redesign) work processes to prevent exposure of workers to vibration.
x Re-engineer industrial processes such as production methods before putting in place changes.
x Designers and managers should plan working methods to avoid exposing employees to vibration
b) Reduce Exposure by Mechanisation
Reduce exposure to vibration by introducing robotics, remote control other forms of automation:
(a) Replace hand operated jack-hammers with backhoes or other mobile plant-mounted breaking
tools
(b) Substitute manual fettling using hand-held grinders with robotic fettling machines.
c) Reduce Exposure by Good Process Control

Good process control can help ensure product quality, production improvement and reduction in exposure
to vibration. For example, by making a component correctly and accurately the first time will avoid the need
for reworking, which will mean less exposure to vibration.
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Avoid High-Vibration Tools, Machines and Accessories

Work equipment is likely to be replaced over time as it becomes worn out, and it is important the replacement
chosen be, so far as is reasonably practicable, suitable for the work, efficient and of lower vibration.
x
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Discuss the requirements with a range of suppliers.
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x Check with suppliers that their equipment is suitable and will be effective for the work, compare
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vibration emission information for different brands/models of equipment, ask for vibration information
for the way you plan to use the equipment, and ask for information on any training requirements for
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safe operation.
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x Get the employees to try the different models and brands of equipment and take account of their
opinions before deciding which to buy.
x Find out about the equipment’s vibration-reduction features and how to use and maintain the
equipment to make these features effective.
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x Make sure the organisation has a policy on purchasing suitable equipment, taking account of
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vibration emission, efficiency and specific requirements.
Maintain Machines and Accessories

Power tools and other work equipment should be serviced and maintained in accordance with the
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manufacturer’s maintenance schedules. This maintenance may include:
Maintenance of machines and accessories will ensure they remain safe, and usable condition, and the
vibration magnitude stays within the design intended limit. Maintenance include:
- Service power tools and equipment in accordance with manufacturers recommendation

- Lubricate moving parts to maintain performance.
- Remove dust and grime to prevent power tools to malfunction
- Sharpen all cutting tools to reduce friction and vibration
- Replace worn parts and calibrate equipment
- Tuning and adjusting engines to enhance performance
Reduce the Transmission of Vibration into the Hand

Transmission of vibration into the hand can be controlled by minimizing grip, push and guiding forces such
as:
a. Using jigs and anti-vibration mounts to avoid the need to grip vibrating surfaces
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b. the correct positioning of the hand on the machine, handle or workpiece
c. Ensuring vibrating equipment is suitable for the work to be done and is in a well maintained
and safe condition
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Reduce the Durations of Exposure (Including Job Rotation)
Following implementation of engineering controls to eliminate or reduce exposure to vibration, further

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controls in the form of administration controls (reducing exposure and frequency with job rotation,
supervision to ensure safe work practices, introduction of tool timing devices to log the duration of machine
use) can help keep exposures below the ELV.
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Keeping Warm and Dry

Low hand or body temperature causes a reduction in blood circulation which can increase the risk of finger
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blanching. Suitable gloves and clothing can help keep vibration-exposed workers warm and dry. However,
it is important that these additional clothing items do not introduce a new risk to the worker, such as
entanglement with moving parts of a machine.
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Information and Training for Operators and Supervisors

For vibration control measures to be effective, it is important to gain the buy-in and co-operation of the
workforce. This can be achieved by ensuring that information about the risks from vibration is shared with
the supervisors and operators. The supervisors and workers should also be given the necessary
instructions and training on how to maintain and operate the equipment safely.
Practical Control Measures to Prevent or Minimise Exposure to

Whole Body Vibration
Part 3 of the UK HSE’s guide L141 on Whole Body Vibration - The control of vibration at work, provides
guidance on how to minimize the risk from whole body vibration exposure. This includes:
Inform drivers of:
x The risk of musculoskeletal disorder such as back pain from exposure to shocks and jolts
caused by vehicle poor suspension and driving over rough terrains, manual handling of vehicle
parts and material, and poor driving posture.
x The sources of hazardous vibration and associated risks such as severity and duration of
exposure
x How to recognize WBV symptoms and early reporting of symptoms or injuries/ill-health.
x Relevant findings from risk assessments, and consult with the drivers on actions to be taken to
eliminate/reduce exposure to WBV to be below action limit values
x Their role in helping to reduce exposure and to minimize/control WBV risks.
x Proposed health monitoring schemes and consult with them prior to implementation.
Train drivers to:
x Adjust the driver weight setting on their suspension seats, where it is available, to minimise
vibration and to avoid the seat suspension ‘bottoming out’ when travelling over rough ground
x Adjust the seat position and controls correctly, where adjustable, to provide good lines of sight,
adequate support and ease of reach for foot and hand controls
x Be aware of higher exposure activities
x Adjust vehicle speed to suit the ground conditions and to avoid excessive bumping and jolting
x Steer, brake, accelerate shift gears and operate attached equipment, such as excavator buckets,
smoothly
x Follow worksite routes to avoid travelling over rough, uneven or poor surfaces

x Avoid potholes, bumps etc. As well as generally driving safely
x Reduce speed if such obstacles cannot be avoided
x Use techniques to minimise WBV, particularly shocks and jolts, when carrying out tasks such as
excavating, loading or travelling off-road
x Avoid twisted posture, particularly when exposed to shocks and jolts
x Look out for and report excessive WBV
x Look out for and report bouts of back pain
Use the right vehicle for the job
Drivers should ensure to only use vehicles that are fit for purpose and should check that the vehicle:
x Load capacity is adequate and meets the requirements of the load to be carried
x Wheels and tyres are suitable and designed for foreseeable obstacles
x Can travel at required speed
x Is suitable and has the capacity for tasks such as excavation and heavy field work
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Check suspension seats if fitted
The employer should ensure:
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x The suitability of the seat and that the vibration specifications of the vehicle match the seat design as
specified in the manufacturer’s manual.
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x The seat suspension is mechanically sound and in good working condition.
x The seat is adjustable to match the driver’s weight.
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x Regular maintenance of suspension systems
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Replace solid tyres on machines such as fork-lift trucks, sweepers and floor scrubbers before they
reach their wear limits.
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Plan work site routes to take account of vibration risks as well as safety factors:
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x Regularly maintain paved surfaces, tracks and site roadways and remove potholes, debris,
bumps and ridges on your premises
x Assess work patterns to minimise time spent in vehicles/plant by individuals, e.g., introduce rotas
x Agree an ongoing system for early reporting of back pain symptoms with the employees and safety
or employee representatives
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x Arrange for the employees to complete a health questionnaire (HSE UK recommends once a year)
x Encourage employees to report any symptoms of back pain which they think may be caused or
made worse by work (note that back problems may have been caused by other activities in previous
jobs or by non-work activities, but could be aggravated by WBV)
HSE UK recommends employer to set up a simple system of health monitoring (see below Part 5, item 204)
for drivers or mobile machine operators whose jobs carry a higher than average risk of back pain.
Part 5: Health Monitoring: When would health monitoring be appropriate?

(Item 204) Health monitoring could play an important part of the overall strategy to manage the risks of
developing back pain in drivers in the workplace. The risk assessment (see Part 3) will indicate whether or
not there is a problem with back pain in drivers. Examples of situations where the risk to drivers’ health may
be considered high are:
x significant manual handling of loads by drivers

x having to stretch and twist to operate machinery
x driving on badly prepared surfaces in vehicles with poor suspension
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x static postures (ie remaining in the same position for long periods)
x driving off-road, too fast, over rough terrain or with inappropriate vehicles.
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Advantages and Disadvantages of Wearable Technologies

Wearable technology is a sensing device worn on different parts of the body such as the arms, wrists, etc
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which provides information to the wearer.

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Wearable technology includes accelerometers, gyroscopes, sole sensors, and barometric pressure sensors.
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They are designed with specific purpose such as to monitor physiological and biochemical properties, posture,
vibration and motion.
The information collected from the sensors enables managers to identify specific risks, improve measures to
reduce injuries, develop a safety culture and education of workers.
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Wearable technologies may be used to enhance the vibration risk assessment.
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Advantages
x Portable, ease of use, wireless connectivity
x Monitors worker exposure continuously (entire working day), thus reducing any uncertainties
associated with the measurement (magnitude and time)
x Devices are relatively low in price compared to vibration measurement equipment
x Identification of specific risks related with machinery, tools and vehicles with high vibration magnitude
Limitations
x Lack of precision
x Limited frequency/magnitude range
x Needs calibration
x Employee may not cooperate/can manipulate the results
x Data overload
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9.13 Radiation
Types of Ionising and Non-Ionising Radiation
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Introduction
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This Element will examine:
x The basic physics of ionising and non-ionising radiation; and

x The effects on health from exposure to, measurement and control of ionising and non-ionising
radiation
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Distinction between Ionising and Non-Ionising Radiation
x Non-ionising radiation is electromagnetic e.g., visible light, ultra-violet light, infrared light, radio
waves or microwaves, may deposit thermal energy in the body or have no effect at all.
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x Ionising radiation is not electromagnetic but is particulate, e.g., alpha, beta, gamma, neutron and x-
ray radiation, has sufficient energy to cause chemical changes to biological molecules, which can
lead to ill-health effects. A large exposure to ionising radiation may damage cells or tissues.
Sources of ionising radiation are radioactive materials and x-ray machines.
Ionisation
Ionising radiation is the energy produced from natural and man-made radioactive materials. It is present in
the environment because of naturally occurring radioactive minerals remaining from the very early formation
of the planet earth. This leads to exposure to gamma rays and radioactive radon gas from certain rocks and
from radioactive material in food and drink. Exposure also occurs from natural ionising radiation that passes
through the atmosphere from outer space, the so called ‘cosmic radiation’.
There are three main sources of man-made ionising radiation. Firstly, it is used in medicine for treating cancer
and for the diagnosis of many diseases. Secondly, radioactive materials are used in industry, primarily for
measurement purposes and for producing electricity. Both medical and industrial uses of radiation produce
radioactive waste. Thirdly, it is present as fallout from previous nuclear weapon explosions and other
accidents / incidents worldwide.
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The damaging effects of ionising radiation come from the packages of high energy that are released from
radioactive material. Different types of ionising radiation have different patterns of energy release and
penetrating power.
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Finally, it is important to know that the radiations in the environment that come from sunlight, power lines,
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electrical equipment and mobile phone systems do not have enough energy to produce ionisation. Therefore,
they are called non-ionising radiations.
The Electromagnetic Spectrum

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The electromagnetic spectrum is the range of all possible frequencies of electromagnetic radiation.
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The "electromagnetic spectrum" of an object is the characteristic distribution of electromagnetic radiation

emitted or absorbed by that particular object.
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The electromagnetic spectrum extends from low frequencies used for modern radio communication to gamma
radiation at the short-wavelength (high-frequency) end, thereby covering wavelengths from thousands of
kilometers down to a fraction of the size of an atom.
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It is for this reason that the electromagnetic spectrum is highly studied for spectroscopic purposes to
characterize matter.
The limit for long wavelength is the size of the universe itself, while it is thought that the short wavelength
limit is in the vicinity of the Planck length, although in principle the spectrum is infinite and continuous.
Illustration 52: The Electromagnetic Spectrum
Since electromagnetic radiation is dependent upon wavelength, the wavelength of the radiation determines
its location in the spectrum. The above illustration illustrates the range of possible wavelengths. The longer
waves consisting of sound and microwaves are to the left and the shorter wavelengths including x-rays and
ultra-violet light are to the right.
The electromagnetic spectrum consists of all forms of electromagnetic radiation, each corresponding to a
different section, or band, of the spectrum. For example, one band includes radiation that our eardrums
use to interpret sound. While another band, visible light, consists of radiation our eyes use to ‘see’ light.
Notice how small the visible band is compared to the rest of the spectrum.
Illustration 53: Features of Waves

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The wave is the basic component of electromagnetic radiation and is described by the following basic terms:
x Trough: The lowest point of the wave.

x Amplitude: Half the height of the wave as measured between the trough and the crest.
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x Wavelength: The distance between two identical points on the wave.
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x Period: The time it takes for a wavelength to pass a stationary point.
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x Crest: The highest point of the wave.
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x Frequency: The number of wavelengths that pass a point in a set period of time.
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What is Radiation?
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Radiation may be defined as the process of emitting energy as waves or particles. In the context of potential
hazards, radiation has become confined to ‘Ionising Radiation’ and ‘Non-Ionising’ Radiation. This radiation
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can also be split into ‘particulate’ and ‘electromagnetic’ according to its nature.
Illustration 54: Examples of Ionising Radiation

Nuclear Power Station X-Ray Machine
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Ionising radiation is either particle radiation or electromagnetic radiation that carries enough energy to ‘ionise’
an atom or molecule by completely removing an electron from its orbit. If sufficient ionisations occur, ionising
radiation can be very destructive to living tissue, and can cause DNA damage and mutations.
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The most common particles of ionising radiation are alpha, beta and neutron.
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The Nature and Types of Ionising Radiation

Some atoms are unstable. Their nuclei rearrange to form more stable atoms and at the same time give out
radiation. These atoms are radioactive and are called radioisotopes.
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Ionising Radiation can be defined as radiation that produces ionisation in matter.
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This can be electromagnetic (as with X-ray and Gamma) or particulate (as with Alpha and Beta particles);
Ionising Radiation has the ability to enter the atomic structure of matter.
Ionising Radiation includes:

1. Alpha, Beta and Gamma radiation (as emitted by radio-active materials)
2. X – Radiation (generated by electrical devices)

3. Neutron Radiation (as emitted in fission)
Radiation is very easy to detect, using special instruments such as Geiger counters. Even tiny amounts of
radiation can be detected. A Geiger counter counts every particle which enters it.
Types of Ionising Radiation

Alpha (Particulate)
A particle radiation consisting of two protons and two neutrons bound together. Penetration is approximately
2 cm in air. Used for smoke detection.
Beta (Particulate)
A particle radiation consisting of high-speed electrons. Penetration is approximately 800 mm in air. Used
for thickness measurement equipment.
Gamma (Electromagnetic)
A ray consisting of high energy electromagnetic wave emissions. Penetration is approximately 30 metres
in air. Used for Radiation Photography (Non-Destructive Testing).
X-Rays (Electromagnetic)
X-radiation is emitted when certain changes occur in the energy levels of the orbiting electrons. It is very
similar to Gamma radiation in its properties because it is pure electromagnetic energy but generally has
lower energy than Gamma rays. Used for Medical Photography.
Neutrons (Particulate)
Neutrons are elementary particles with unit atomic mass and no electric charge. The most powerful source
of neutrons is a nuclear reactor. Neutrons are very penetrating but can be stopped by very thick layers of
concrete or water. By-product of a Nuclear Reaction.

The Nature and Types of Non-Ionising Radiation
Non-ionizing radiation is the term given to radiation in the part of the electromagnetic spectrum where there
is insufficient energy to cause ionization. It includes electric and magnetic fields, radio waves, microwaves,
infrared, ultraviolet, and visible radiation. They are all defined according to wavelength.
Ultra-Violet Radiation (UVR)

Ultra-violet radiation is produced naturally by the sun and artificially by processes such as welding. The two
main hazards of ultra-violet radiation are effects upon the skin and eyes. Sunburn is a common example
and can range from simple reddening to severe blistering of the skin depending on exposure. Long
exposure to UVR, especially in fair skinned people, can lead to skin cancer.
Exposure of the eyes to UVR will produce inflammation and conjunctivitis and is extremely painful. This is
often observed in the welding industry and causes the condition known as ‘arc eye’.
All workers exposed to UVR must wear the correct type of eye protection and protective clothing. During arc
welding precautions must be taken for the protection of passers-by.
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Sources of ultra-violet include arc welding, plasma-torch cutting, unshielded tungsten halogen lamps, food
and water sterilisation lamps, and artificial tanning ‘sun beds’.
Infra-Red Radiation (IRR)
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Infra-red radiation is emitted by a large variety of sources such as the sun, furnaces, heated metals, welding
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arcs etc. The primary effect of IRR is heat and although skin burns are possible the skin usually provides a
warning mechanism. However, the eye does not have such a warning mechanism and work associated with
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the intense sources of IRR such as glass making carries the risk of cataracts. Control measures should be
the correct type of eye protection with correct filtration. Shields which deflect the heat away from the worker
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may also be used.
arcs.
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Microwave
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Microwaves are very high frequency radio waves which possess sufficient energy to cause modular vibration
(heat) in certain materials including tissue. Microwaves are used in radar and certain drying processes as
well as the common microwave oven. Human exposure to such radiation may cause ‘cooking’ of the exposed
human and the risks of burns to the skin and eyes.
The only acceptable control measure is total enclosure adequately shielded and this is relatively simple as
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microwaves cannot penetrate thin metal.
The methods to protect workers from the effects of non-ionising radiation include:
x Shielding
x Distance between source and the person
x Reducing duration of exposure
x Personal protective equipment
x Protective creams
Sources of microwave are from radar and certain drying processes as well as the common microwave oven.
Radio Wave Radiation (RWR)

Radio waves are electromagnetic radiation with wavelengths as short as a few millimetres (tenths of inches)
and as long as hundreds of kilometres (hundreds of miles). A radio wave has a much longer wavelength than
visible light. Radio waves are extensively for communications for example, television and FM and AM radio
broadcasts, military communications, mobile phones, ham radio, wireless computer networks etc.
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Particulate Ionising Radiation
Particulate ionising radiation is radiation energy carried by moving particles.

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Radioactive decay transforms material to emit three different types of radiation: alpha, beta and gamma. All
of these are emitted from the nucleus as it seeks stability.
For example, an unstable bismuth-210 atom will eventually spontaneously change or ‘decay’, to become more
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stable, by emitting radiation. There are only certain ways it can do this. As it emits radiation, the old bismuth
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atom becomes an atom of thallium-206. Thallium-206 is more stable, but it is also radioactive. It will decay
again to become a completely stable atom of lead.
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Non-Ionising Radiation
Non-ionising radiation is radiant energy that does not have sufficient energy to cause ionisation in matter.
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It consists only of electromagnetic radiation, from wavelengths above 10 -7 m, and no particulate radiation
is involved (unlike ionising radiation).
Non-ionising radiation is radiated energy that cannot cause changes in the electrical charge of an atom or
molecule. It can nevertheless cause damage to human tissue through burning. Normal routes of entry to
non-ionising radiation are through unprotected skin and mouth.
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The radio-frequency radiation from sources such as power lines, radar, communications networks, and
microwave ovens, photocopiers and laser printers are non-ionising, and for many years only high doses of
such radiation were known to be harmful, causing burns, cataracts, temporary sterility, and other effects.
In recent years, however, with the proliferation of such devices, the possible effects of long-term exposure
to low levels of non-ionising radiation began to be a matter of scientific concern. Subtle biological effects
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have been observed, but their health significance is thus far not certain.
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The most common effect of ultra-violet radiation on the eye is called ‘kerato conjunctivitis’. This is more
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commonly known by several other names, e.g., ‘arc eye’, ‘welder’s eye’, ‘welder’s flash’ and ‘snow
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blindness’. The symptoms of the condition are pain and discomfort which gives the feeling of having grit
in the eye and an aversion to bright light. The cornea and conjunctiva become inflamed.
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Non-Ionizing radiation originates from various sources: Natural origin (such as sunlight or lightning
discharges etc.) and man-made (seen in wireless communications, industrial, scientific and medical
applications). The NIR spectrum is divided into two main regions: optical radiations and electromagnetic
fields.
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Non-ionising radiation includes energy radiated across a wide range of frequencies from long wave radio
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waves to visible laser light. Depending on the frequency, the effects can be either photochemical or thermal.
Table 25: Examples of the Commercial Use of Non-Ionising Radiation
Type of Non-Ionising Radiation Example of Commercial Use
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Microwaves Signal transmission, food preparation.
Infra-Red Heating and Brazing.
Ultra-Violet Commercial tanning, curing of glues, inks, etc., arc
welding, dental procedures such as hardening of
fillings in tooth cavity.
Lasers Bar code readers, surveying, cutting.
Radio frequencies Radio transmissions, radar, welding of plastics (RF
welding).
Exposure Routes
Normal routes of exposure to non-ionising radiation include direct exposure to unprotected skin and eyes
or reflections from shiny surfaces and mirrors. Exposure to high levels of microwaves may lead to the
radiation passing through the skin and causing harm to the internal organs of the body.
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Risks may be increased if the radiation is concentrated through a lens increasing the power density and
heating effect significantly
Ultra-Violet Light
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Ultra-violet light is a component of sunlight, which has become

more problematical with depletion of the ozone layer and the
loss of some of its filtering effect. Other sources of ultra-violet
include arc welding, plasma-torch cutting, unshielded
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tungsten halogen lamps, food and water sterilisation lamps,

and artificial tanning ‘sun beds’.
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Where ultra-violet radiation is produced, the radiation can be

contained in screened areas, interlock systems can be fitted
to lamp-housing and all surfaces can be made dull or matt
black to prevent reflections. Welders should wear full body
covering (overalls, etc. and tinted eye protection). People in
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the vicinity should always be prevented from looking at the

direct or indirect ultra-violet light (by means of screens).
Similar precautions apply to outdoor workers. Sun creams
are no substitute for covering up.
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www.safenviro.com
|©
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Effects of Exposure
The two main hazards of ultra-violet radiation are effects upon the skin and eyes. Sunburn is a common
example and can range from simple reddening to severe blistering of the skin depending on exposure. Long
exposure to UV induces degenerative changes in cells of the leading to skin premature skin aging,
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photodermatoses and actinic keratoses. In fair skinned people, it can lead to skin cancer.
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Exposure of the eyes to UVR will produce inflammation, cataracts and conjunctivitis and is extremely painful.
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This is often observed in the welding industry and causes the condition known as ‘arc eye’.
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Controlling
Naturally
Sunlight can be a major occupational hazard especially in countries such as Australia where 30% of the
population will suffer some form of skin cancer during their lifetime. The process of ageing is indicated by a
decrease in the elasticity of dermal tissue resulting mainly from the degeneration of collagen fibres.
Occupational
Workplace Health
Visible Light
Health Issues
The visible spectrum is the portion of the
electromagnetic spectrum that is visible to the human
eye. Electromagnetic radiation in this range of
wavelengths is called visible light. Sources of visible
light in the workplace include: lasers, spotlights, flash
lights used in photography, intense reflected light
from polished surfaces and water.
Effects of Exposure
When the intensity of light is increased, either with a magnifying glass or created with a laser, then the light
can cause objects to burn. Lasers, if they are energetic enough, can burn through tissue. Laser light can
also be particularly hazardous to eyes. The light beam is so narrow and intense that it can easily pass through
the pupil of the eye and burn the retina. This causes permanent damage. Older people and those who had
cataract surgery are more sensitive to exposure due to the impairment of the lens to filter light. Visible light
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in the form of stroboscopic light can cause fits in susceptible people.
Infra-Red Light
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arcs etc. These wavelengths can penetrate the skin and cornea.
Effects of Exposure
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Acute effects from exposure to infra-red are burns. However, the sensation of heat typically prevents serious
injury where workers can remove themselves from exposure. A further hazard from exposure to
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infrared radiation is heat stress on the body and pigmentation of the skin.
Chronic exposure can cause cataracts of the eyes e.g., from exposure to intense heat of glass making. The
heating effect also causes the lenses to lose their transparency.
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Microwaves
Microwave radiation covers the wavelength region between about 1 mm and 1 m. Biological harm is caused
by the process of heating, the heat being generated by the vibration or rotation of water molecules.
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Microwaves generated for cooking or for heating materials in furnaces cause materials to heat internally.
The problem with this is that there is no sensation of heat due to the absence of nerve cells in the internal
organs. Microwave systems used in communications and security systems have been thought to be
harmless, but this might be questionable. The main precaution is enclosure of the waves by engineering
design (interlocked doors, etc.).
Effects of Exposure
Microwaves can have a number of effects on the body. One effect is the heating action on the water in the
body. This can affect the eyes in particular as there are no blood vessels in the front of the eye to take the
heat away. Acute effect includes localised or spot heating. Increased in temperature can damage tissue
especially the lens of the eye which has poor temperature control. Chronic effect includes cataracts.
Researchers suspect that there may be other health effects from long-term, low-level microwave exposure.
Effects include insomnia, depression, headaches, miscarriages, male infertility, leukaemia.
Radar / Radio Frequencies

Radio frequency (RF) is a rate of oscillation in the range of about 3 kHz to 300 GHz, which corresponds to
the frequency of radio waves.
Effects of Exposure
Radio frequencies can cause burns and are suspected of being associated with leukaemia. Close proximity
to powerful transmitters should be avoided by means of strict isolation procedures (permit systems, etc.).
Precautions include the establishment of clearly defined physical exclusion zones around base station
antennas and the adoption of the international standard for the assessment of specific absorption rate (SAR)
values from mobile phones. As with Microwaves, researchers suspect that there may be other health effects
from long-term, low-level radio frequency exposure. Effects include insomnia, depression, headaches,
miscarriages, male infertility, leukaemia.
Lasers
LASER is an abbreviation for ‘Light Amplification by Stimulated Emission of Radiation’. Laser light is highly
monochromatic (narrow range of frequencies) and is highly directional. These features bring two hazards,
firstly the light can travel great distances, and secondly, extreme optical intensities can be achieved with
relatively small energy sources. This narrow beam of light can focus on the retina to cause severe burns.
Since some lasers operate at non-visible frequencies, the eye may not have the natural protection of the
blink response.
There are various classifications for lasers according to their potential for harm. The potential depends on
both their frequency and their energy.
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Typical Sources in the Workplace
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INDUSTRY SOURCES IN THE WORKPLACE
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Cutting, welding, laser marking, drilling, photolithography.
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Materials processing/manufacturing Lasers can deliver enough power to heat and melt metal joints.
Controlling
Used for a wide range of work applications including cutting,
alignment of structures (bridges, tunnels, etc.) and printing. These
systems contain high power lasers but are operated in a controlled
environment.
Occupational
Distance measurement, surveying, high speed imaging, particle
Optical measurement
sizing
Workplace Health
Ophthalmology refractive surgery, photodynamic therapy,
dermatology, laser scalpel, vascular surgery, neurosurgery,
microsurgery, dentistry, medical diagnostics
Medical
Health Issues
Laser beams delivered via flexible optical fibres allow surgeons to
reach inside the gut, for example, and seal a bleeding ulcer. One of
the most publicised uses of lasers is in eye surgery to treat disease
and, increasingly, improve bad eyesight.
Communications Fibre, free-space, satellite
Lasers are used in retail outlets as barcode scanners. Photocopier,

Retail/Commercial laser printers, DVD players, scanners are widely used in the
commercial operations.
Lasers are used in various scientific research including

Research spectroscopy for substance identification, plasma physics and
chemistry.
Holography Entertainment, information storage
Laser shows, laser pointers
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Entertainment (These lasers typically emit many watts of visible light. They are
potentially very dangerous if system safety features fail during
operation.)
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Detailed guidance on specific issues is given in ‘The Use of Lasers in the Workplace’, ILO Occupational
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Safety and Health Series No. 68.
Hazard Classification of Lasers

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Figure 8: Warning sign ±laser

Lasers are classed according to their power output. The
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classification scheme is specified within IEC/EN 60/825-1: Safety of

laser products Part 1: Equipment, classification, requirements and
users’ guide (International Electrotechnical Commission, 1998).
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Class 1 and 1M
This class is safe for viewing directly with the naked eye but may be hazardous to view with the aid of optical
instruments. In general, the use of magnifying glasses increases the hazard from a widely diverging beam,
e.g., light emitting diodes (LEDs) and bare laser diodes, and binoculars or telescopes increase the hazard
from a wide, collimated beam, e.g. those used in open-beam telecommunications systems.
Radiation in classes 1 and 1M can be visible, invisible or both.
Class 2
These are visible lasers. This class is safe for accidental viewing under all operating conditions. However,
it may not be safe for a person who deliberately stares into the laser beam for longer than 0.25s, by
overcoming their natural aversion response to the very bright light.
Class 2M
These are visible lasers. This class is safe for accidental viewing with the naked eye, as long as the natural
aversion response is not overcome as with Class 2 but may be hazardous (even for accidental viewing)
when viewed with the aid of optical instruments, as with class 1M.
Class 3R
Radiation in this class is considered low risk, but potentially hazardous. The class limit for 3R is 5x the
applicable class limit for Class 1 (for invisible radiation) or class 2 (for visible radiation). Hence visible lasers
emitting between 1 and 5 mW are normally Class 3R.
Class 3B
Radiation in this class is very likely to be dangerous. For a continuous wave laser, the maximum output into
the eye must not exceed 500mW. The radiation can be a hazard to the eye or skin. However, viewing of
the diffuse reflection is safe.
Class 4
This is the highest class of laser radiation. Radiation in this class is very dangerous and viewing of the
diffuse reflection may be dangerous. Class 4 laser beams are capable of setting fire to materials onto which
they are projected.
Exposure Routes for Lasers

Normal routes of exposure to lasers include direct exposure to unprotected skin and eyes or reflections from NEBOSH International Diploma
shiny surfaces and mirrors.
Risks from exposure to lasers may be increased if the radiation is concentrated through a lens, increasing
the power density and heating effect significantly.
Effects of Exposure to Laser Radiation
Effects on the Eye

The type of eye damage will depend on the particular tissue affected which will in turn depend on the ocular
transmission characteristics of the type of laser used. Infrared (1400 nm – 1 nm) and far ultraviolet (200
– 295 nm) radiation will affect only the cornea at the front of the eye. Near ultraviolet radiation (295 – 400
nm) will penetrate as far as the lens. Exposure can produce varying degrees of photochemical damage to
the cells of the retinal macula (photoretinitis) without a significant increase in the temperature of the tissue.
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Effects on the Skin

Acute exposure to laser radiation from class 4 lasers may cause skin damage which range from mile
erythema (skin reddening) through to deep burns (tissue charring)
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Units and Methods of Measurement, Power Density
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Power Density
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A Radio Frequency (RF) can be characterised by means of the power density. Power density is defined as
power per unit area. For example, power density can be expressed in terms of milliwatts (one thousandth of
a watt) per square centimetre (mW/cm2) or microwatts (one millionth of a watt) per square centimetre
(W/cm2).
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Workplace Health
Specific Absorption Rate
The quantity used to measure how much RF energy is actually absorbed by the body is called the Specific
Absorption Rate or SAR. The SAR is a measure of the rate of absorption of RF energy. It is usually expressed
in units of watts per kilogram (W/kg).
Health Issues
Exposure Limit Values
The use of the ELVs for non-coherent optical radiation is generally more complex than for laser radiation.
This is due to worker exposure potentially being to a range of wavelengths instead of a single wavelength.
In general, a medical examination should be made available to a worker if:
• The worker has been exposed to levels of artificial radiation which exceed the exposure limit values.
• The worker has contracted a disease or adverse health effects to the skin as a result of exposure
to artificial optical radiation.
Exposure to Ultraviolet Radiation
Exposure limit value

The exposure limit values for occupational exposure to ultraviolet radiation on the skin and eye are measured
over an 8-hour period.
Exposure of the eye NEBOSH

UVR falling on the eye is absorbed by the cornea and lens. Spectrum region of radiant exposure:
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x 180 – 400 nm incident upon the unprotected eyes should not exceed 30 Jm -2
x 315 to 400 nm should not exceed 10 4 Jm-2
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Exposure of the skin

For sensitive skin the exposure spectral region is 180 – 400 nm and should not exceed 30 Jm-2
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Methods of measurement
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Instruments used: photoelectric cells, photo conductive cells, photo chemical detectors. Most instruments
have a filter system. Radiometers are used to measure intensity of ultraviolet radiation. In addition to
wavelength range, radiometers carry specifications such as sensor diameter, power range, accuracy,
resolution, operating temperature range and humidity range.
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Exposure to Visible Light Radiation
Exposure Limit Value

The ICNIRP Limit for the protection against blue light photochemical retinal hazard is within a wavelength
range of 380 nm to 700 nm:

Exposure Limit is 100 W m-2 sr-1 within an 8 -hour working day.
Methods of Measurement
The intensity of visible light is measured using two sets of quantities and units: radiometric and photometric.
Radiometric quantities are physical quantities that are used to describe the radiant energy of light, i.e., they
are related to the absolute measurement of optical radiation. Exposure limits are expressed in terms of
radiometric quantities.
Instruments used: Photometric sensor is used to measure lighting conditions such as illumination of work
areas, interior lighting, television screens.
Exposure to Infrared Radiation

Infrared heat is energy that is able to heat objects without having to heat the air in between the source of
the heat and the recipient. One example of infrared heat is the light of the sun.
Infrared rays are divided in three types:
IR-A: short wave infrared
IR-B: medium wave infrared
IR-C: long wave infrared
Penetration is strongly dependent upon water absorption.
Exposure Limit Value

Without any physical work, a maximum exposure of 300 Wm–2 may be tolerated over eight hours under
certain environmental conditions, but this value decreases to approximately 140 Wm–2 during heavy
physical work.
Exposure of the Eye NEBOSH International Diploma

IR-A affects the retina due to the transparency of the ocular media. For short exposure periods, heating of
the iris from the absorption of visible or near IR is considered to play a role in the development of opacities
in the lens. Damage to the lens occurs in wavelengths below 3 μm (IRA and IRB).
Absorption in the IR-B and IR-C regions is primarily in the cornea and in the aqueous humour. Beyond 1.9
μm, the cornea is effectively the sole absorber.
In the IR-C band the exposure can cause burn to the cornea similar to that on the skin.
To avoid thermal injury of the cornea infrared radiation should be limited as follows:
The ACGIH and ICNIRP recommend a maximal daily corneal exposure of 10 mW/cm2
total irradiance for wavelengths 770-3,000 nm (EIR-only) for day-long, continuous exposures, which could
be applied to the sum of the average irradiance of all of the infrared LEDs is:
EIR-only = 0.01 W cm-2 average for t > 1,000 (lengthy exposure)
EIR-only = 1.8 t -3/4 W cm-2 for t < 1,000
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Exposure of the Skin

Exposure of the skin to very strong IR may lead to local thermal injury.
The effects on the skin depend on the optical properties of the skin, such as wavelength-dependent depth of
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penetration. Especially at longer wavelengths, an extensive exposure may cause a high local temperature
rise and burns. The threshold values for these effects are time dependent, because of the physical properties
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of the thermal transport processes in the skin.
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To protect the skin from thermal injury in the wavelength range of 400 nm to 3 μm the radiant exposure H,
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for duration less than 10 seconds should be limited to H = 2t ¼ Jcm -2
Controlling
Methods of Measurement
Radiometers are used to measure infrared radiation
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Workplace Health
Exposure to Laser
Limits on exposure have been adopted for exposure of the eyes and skin at levels which individuals may be
repeatedly exposed without adverse health effects.
Health Issues
The exposure limit values (ELVs) apply directly to workers and members of the public exposed to artificial
optical radiation (AOR). For laser radiation, the standards of the IEC should be applied. For non-coherent
radiation, the standards of the IEC and the recommendations of the CIE and CEN should be followed. Where
exposure is due to artificially produced AOR in an occupational environment, engineering and administrative
controls are the preferred measures for exposure control.
ELV for laser (coherent) radiation are set out in Annex II of Directive 2006/25EC of the European Parliament
and of the Council on the minimum health and safety requirements regarding the exposure of workers to
risks from exposure to artificial optical radiation.
The ELVs set out in the Directive take account of the biological effectiveness of the optical radiation at causing
harm at different wavelengths, the duration of exposure to the optical radiation and the target tissue. The
ELVs are expressed in terms of irradiance (W m-2) or radiant exposure (J m-2), Annex II provides ELVs for
short duration eye exposure (< 10 seconds), longer eye exposure and skin exposure. The time of exposure
will depend on whether it is accidental or not. For accidental exposures of the eye 0.2 s is taken as the time
of exposure for lasers in the wavelength 400 to 700 mm (the visible light part of the electromagnetic spectrum)
because of the natural aversion reaction.
For all other wavelengths and exposure of the skin it is taken to be 10 or 100 s; the duration before pain will
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cause a response
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Radiation Risk Assessment to Consider
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Detailed guidance on specific issues given in the use of lasers in the workplace, ILO Occupational Safety
and Health Series No. 68 (Geneva, 1993); and Visual display units: Radiation protection guidance, ILO
International
International
Occupational Safety and Health Series No. 70 (Geneva, 1994) gives specific information to help employers,
workers and competent authorities apply the general principles to workplaces where there is hazardous
exposure to optical radiation – ultraviolet (UV), visible light and infra-red (IR) – as a result of work activities,
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or where lasers are being used.

In carrying out an assessment, employers should take into consideration in the application of the provisions
of the Code as follows: (Source: Ambient factors in the workplace. An ILO code of practice)
x
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Employers should assess equipment and activities likely to give rise to hazardous exposure to
optical radiation. The assessment should include outdoor work which exposes workers to the sun.
x Employers should seek information from the suppliers of equipment about expected hazardous
emissions and precautions to be taken in installation, labelling and use. Where this is not
practicable, employers should obtain information:
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— by comparison with other similar workplaces and equipment
— from the occupational health service or a competent body
x Employers should assess the hazard and risk:
(a) by characterizing the level of hazard and risk including by comparing the real exposure levels
with exposure limits following measurements by a technically competent person using appropriate
and properly calibrated equipment, designed to assess hazard to health of UV, IR radiation or
visible light, as applicable. Laser hazard evaluation should preferably be carried out by appointed
laser safety officers;
- by seeking advice from the competent authority about the exposure limits to be applied
and measures for assessment
- from misuse or misunderstanding of safety precautions (such as violations of enclosures
and of access restrictions)
For Laser
Where class 3 or class 4 lasers are to be used outdoors, employers should assess:
a. The maximum range for which the beam can be hazardous (this is likely to be limited only by
effective absorption)
b. The risk of reflection from glass or other highly polished surfaces, including the risk of such
material being brought near the beam (for example by motor vehicles being driven into the beam
or into an area where a reflected or scattered beam may be present)
c. The risk of diffuse scattering, particularly for lasers in the visible or near infra-red range
d. The stability of the laser mounting and the maximum deviation of the beam due to deliberate or
accidental movement of the mounts
e. Ways in which workers and others might wander into the vicinity of the beam, and preventive
measures to be applied
f. The effectiveness of warning notices, notably for people with different reading or language
abilities
Practical Control Measures to Prevent or Minimise

Exposure to Non-Ionising Radiation
The general control of non-ionising radiations can be summarised as following the hierarchy of control
measures:

Elimination: Avoid exposure to non-ionising radiation.
Substitution: The magnitude of the risk from non-ionising radiation can often be reduced by aiming
to operate at the lowest power levels possible in order to reduce the level of radiation.
Engineering Controls:
Can be used to prevent accidental exposure to non-ionising radiation in the form of interlocks like key control
systems and shielding such as flight tubes for lasers to enclose the raw beam.
‘Piggy backing’- Using a low powered laser to align a high-powered laser beam can be used.
Protective housings that require a tool to remove them. where laser hazard warning signs and laser aperture
warning labels are displayed are helpful.
Beam stops: Absorbing materials placed at the end of the laser path to absorb excess energy and prevent
stray reflections.
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Warning signs can be provided to indicate that the beam is energised particularly with non-visible beams.
Equipment can be re-designed to control hazardous optical radiation at the source.
Provision of emergency stops that have a fast response and will stop all services in the hazard zone.
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Trip switch can be located around any moving parts which sense unexpected proximity such as a toggle
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switch, safety bar or rod.
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Organisational control measures, e.g., provision of safe systems of work, information and training, should
also be provided, and consideration given to appointing a laser safety officer, i.e. a person who is
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knowledgeable in the evaluation and control of laser hazards and has responsibility for oversight of the control
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of laser hazards.
Administrative Controls:
Occupational
Safe systems of work to limit access, use of interlocks, signage, decontamination facilities are often the main
Workplace Health
control used to determine the safe routine operation of non-ionising radiation generating equipment and also
for maintenance operations. The provision of information, training, instruction and supervision in particular
on hazard awareness, use of hazard controls, and importance of exposure limits.
Health Issues
PPE is used where other methods have not reduced the risk of exposure to an acceptable level.
Protection for the skin: Protective gloves for hands, forearms can be protected by use of long sleeves made
from poplin or flannelette. Barrier cream containing UV filter.
Protection for the eyes: PPE usually in the form of eye protection can be used particularly when it is not
possible to use engineering controls such as the use of a class 4 laser for surgery when the beam is used
by the surgeon as a scalpel. Eye protection includes UV glasses, face shields and goggles offering protection
during welding.
Ionising Radiation
Ionising radiation is either particle radiation or electromagnetic radiation that carries enough energy to ‘ionise’
an atom or molecule by completely removing an electron from its orbit. If sufficient ionisations occur, ionising
radiation can be very destructive to living tissue, and can cause DNA damage and mutations. The most
common particles of ionising radiation are alpha, beta, gamma, x-radiation and neutrons.
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Workplace Sources of Ionising Radiation
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Man-Made Sources
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Man-made sources of radiation account for approximately 14 per cent of the average annual personal
radiation dose in the UK and are dominated by the use of radiation in health care. Radioactivity is also present
in our environment due to nuclear weapons testing, accidents at nuclear facilities and the authorised
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discharge of radioactive wastes from nuclear and other facilities.

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An increasing variety of uses for ionising radiation are being developed for the workplace.
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Nuclear industry
Ionizing radiation is widely used throughout the working environment. The most obvious place is in the
nuclear industry.
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It is also used for non-destructive testing (NDT), thickness/level measurement, security equipment, in smoke
detectors, archaeological dating, baggage inspection, research and teaching and for a variety of medical
purposes, including diagnosis, treatment and sterilization of medical appliances.
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Common Sources of Radiation

Radiography (X-rays)
Tracing
Ionisation effect smoke detectors

Thickness gauges, flow gauges and level gauges

Non-destructive testing
Sterilisation
Research
Moisture/density gauges
Radioactive materials
Luminous dials, badges, gauges and markers
Natural Sources of Ionising Radiation
Radon
Radon occurs naturally from decaying uranium, and it is particularly abundant in regions with granite
bedrock. Exposure is high in Cornwall, Devon and Somerset, because of these counties’ underlying
geology, and there are also ‘hotspots’ in Wales, the Cotswolds and the Pennines.
However, the gas disperses outdoors so levels are generally very low. Radon enters buildings from the
ground and can sometimes build up to unacceptable levels.
Once inhaled into the lungs, the gas decays into other radioactive isotopes of lead, bismuth and polonium.
Some decay products emit alpha particles that, when breathed in, can cause harm to the sensitive cells of
the lungs. Radon is the term used as shorthand to describe Radon gas’s short-lived decay products
(isotopes).
Radon is the second most common cause of lung cancer in the UK, tobacco smoking being the most
common cause.
Cosmic Radiation
The earth is continuously bombarded by high-energy radiation from either the sun (solar radiation) or from
outside the solar system (galactic radiation). Collectively this is termed cosmic radiation.
Radiation doses from cosmic radiation are greater at higher altitudes and those who fly regularly, such as
air crew, receive an additional dose. Radionuclides of uranium, thorium and potassium are relatively
abundant in rocks and soils. Radiation emitted from these radionuclides gives a gamma radiation dose.
Illustration 55: Distribution of natural and man-made ionising sources NEBOSH International Diploma
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Nature and Types of Ionising Radiation
Alpha Particles
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An alpha particle is the ionising radiation ejected from a disintegrating nucleus of an unstable isotope and
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consists of two neutrons and two protons, hence is positively charged. The remaining isotope, or fission
fragment, may be unstable and disintegrate again.
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Illustration 56: Alpha Decay
Occupational
Workplace Health
Health Issues
The health effects of alpha particles depend heavily upon how exposure takes place. External, or direct,
exposure (external to the body) is of far less concern than internal exposure as alpha particles is slow moving,
therefore have a short range. They are stopped by several centimetres of air, by water, a sheet of paper and
the outer dead layer of the skin.
However, sensitive living tissue can be subjected to local radiation and damage if alpha emitters have been
inhaled, ingested, or absorbed into the bloodstream, e.g., via a wound. The resulting biological damage
increases the risk of cancer. In particular, alpha radiation is known to cause lung cancer in humans when
alpha emitters are inhaled.
Radon-222 is produced by the decay of the unstable isotope radium-226, which is present wherever uranium
is found. Since radon is a gas, it seeps out of uranium-containing soils and may concentrate in well-sealed
homes. Radon gas is a cause of lung cancer, and often the single largest contributor to an individual's
background radiation dose.
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Alpha emitters are used in smoke detectors and industrial anti-static devices. They are contained in a
sealed, encapsulated source so that the energy is released but the material is not. Americum-241 is used
in smoke detectors. It is a very low activity radioactive isotope that emits alpha particles. Smoke passing
into the smoke detector is ionised, which is then detected by an electronic sensor, sounding the alarm. NEBOSH
Polonium has no stable isotopes. The alpha emitter polonium-210 is used to eliminate static charges, e.g.,
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in the production of paper, plastics and synthetic textiles, by placing it, in a sealed ribbon-shaped source,
close to the process material. It is also used to remove dust during photographic film processing.
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Beta Particles
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A neutron can become a proton by emitting an electron. A nucleus with too many neutrons is unstable and
will disintegrate to become more stable by emitting a high-speed electron, or negatively charged beta
particle. The fission fragment has one more proton but one less neutron than before. Hence, its atomic
mass is effectively unchanged.
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Illustration 57: Beta Decay
Beta particles have virtually no mass and move at nearly the speed of light. They are unlikely to collide with
other atoms, so can travel long distances. High energy beta particles will penetrate paper or skin but will
be stopped by a 2 to 3-millimetre thickness of aluminium.
External, or direct, exposure to beta particles is a health hazard, because the emissions from high energy
sources can penetrate the skin, causing erythema (reddening of skin) and burns. However, emissions from
inhaled or ingested beta particles are the greatest concern. Beta particles released directly into living tissue
can cause damage at the molecular level, which can disrupt cell function. Because they are smaller and
have less charge than alpha particles, beta particles generally travel further into tissues. As a result, the
cellular damage is more dispersed, however the total ionisation is less intense than that caused by alpha
particles.
Beta emitters have many uses, especially in medical diagnosis, imaging and treatment. Radioactive ‘tracers’
can be injected into the bloodstream so that its flow can be tracked, and the function of various organs
monitored. Iodine-131 is used to treat cancer and other disorders of the thyroid.
Carbon-14 is a very reliable tool in the dating of organic matter up to 30,000 years old. Beta emitters are
also used in a variety of industrial instruments, e.g., thickness gauges, using their weak penetrating power
to measure very thin materials. Beta particles are also used in quality control to test the thickness of an
item, e.g., paper, coming through a system of rollers. Some of the beta radiation is absorbed while passing
through the product. If the product is made too thick or thin, a correspondingly different amount of radiation
will be absorbed. A computer program monitoring the quality of the manufactured paper will then move the
rollers to change the thickness of the final product.
Gamma Rays
After a nucleus has emitted an alpha or a beta particle, it may be left in an excited state. It ‘de-excites’, or
loses excess energy, by emitting electromagnetic energy called gamma rays. Gamma rays have no electrical

charge, but are high frequency, high energy, short wavelength, electromagnetic radiation.
Gamma radiation does not change the nucleus to produce a new element in the way that alpha and beta
radiations do.
Illustration 58: Gamma Emission
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Due to their high-energy content, gamma rays are able to cause serious damage when absorbed by living
cells. Gamma rays are also able to penetrate dense materials. Shielding for gamma rays requires large
amounts of mass. The material used for shielding takes into account that gamma rays are better absorbed
by materials with high atomic number and high density, e.g., lead or concrete.
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Both external or direct and internal exposure to gamma rays is of concern. Gamma rays can travel much
further than alpha or beta particles and have enough energy to pass entirely through the body, potentially
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exposing all organs. Gamma rays do not directly ionise atoms in tissue, but because gamma rays have more
penetrating power than alpha and beta particles, the indirect ionisations they cause generally occur further
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into tissue. Gamma radiation, however, largely passes through the body without interacting with tissue as, at
the atomic level, the body is mostly an empty space and gamma rays are small in size. By contrast, alpha
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and beta particles inside the body lose all their energy by colliding with tissue, causing damage. X-rays
behave in a similar way to gamma rays but have slightly lower energy.
Due to their tissue penetrating property, gamma rays and x-rays have a wide variety of medical uses such
as in CT scans and radiation therapy. However, as a form of ionising radiation they have the ability to effect
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molecular changes, giving them the potential to cause cancer when DNA is affected. Gamma rays penetrate
many materials, but do not make them radioactive. The radionuclides most used are cobalt-60 and caesium-
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137.
Cobalt-60 is used for:
x Sterilising medical equipment in hospitals.
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x Pasteurising certain foods and spices.
x Cancer treatment.
x Gauging the thickness of materials.
Caesium-137 is used for:
x Cancer treatment.
x Liquid flow measurement and control.
x Investigation of subterranean strata.
x Soil density measurement.
x Level indication, to ensure the correct fill level for food, drugs and other products.
x Non-destructive testing.
Despite their cancer-causing properties, gamma rays are also used to treat some types of cancer. Multiple
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concentrated beams of gamma rays are directed on the growth in order to kill the cancerous cells. The
beams are aimed from different angles to focus the radiation on the growth while minimising damage to the
surrounding tissues. The powerful nature of gamma rays makes them useful in the sterilisation of medical
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Gamma rays are also used to kill bacteria and insects in foodstuffs, to maintain freshness and extend shelf-
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life.
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X-Rays
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Like gamma rays, x-rays are also high frequency, high energy, short wavelength, electromagnetic radiation,
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but differ in the way they are produced. Gamma radiation is emitted continuously by radioactive decay. X-
rays are generated in special electrical equipment by bombarding a metal target with electrons.
Consequently, an x-ray beam only exists while the machine is switched on, whereas gamma radiation is
emitted continuously. X-rays can be stopped by lead or concrete shielding.
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The penetrating power of electromagnetic radiation depends upon its energy and the properties of the matter
through which it passes. Hence, x-rays are able to pass right through the human body. X-rays are somewhat
less penetrating than gamma rays, though their effects are similar, and can ionise atoms in living tissue as
they pass through the body.
X-rays are mainly used for radiography in medical diagnosis and non-destructive testing, and to treat cancer.
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Neutron Sources
Neutrons are uncharged particles that are usually produced by fission or from nuclear reactions between
alpha particles and materials with a low atomic number.
Neutrons are created as a by-product from the fission. The neutrons produce further fissions, and the
energy can be used in nuclear power stations and in nuclear weapons. Refined uranium-238 (contains
uranium-235) is most widely used in nuclear power stations, which generate 20% of the electricity in Britain.
Californium-252 decays partially by spontaneous fission and is a useful portable source for the production
of neutrons. Neutrons can also be produced in a nuclear reaction, the most common of which is the
bombardment of beryllium with alpha particles.
Neutrons have the power to render other materials radioactive. This feature is important when designing
neutron shields, where hydrogenous materials are usually chosen, e.g., water or paraffin wax.
Neutrons are uncharged, unaffected by electrical fields around atoms and therefore have great penetrating
power. The penetrating power of neutrons is approximately 10% of that for x-rays. They can produce
ionisation directly and can cause great harm as they pass through the body.
Neutron sources are unlikely to be encountered outside the nuclear industry, other than in their use to
measure the water content of strata in geophysical exploration and in research applications.
Routes of Exposure
INTERNAL EXPOSURE
Exposure can occur through inhalation, ingestion, injection and absorption. Airborne radioactive material
can be inhaled and absorbed by the lungs. Food, drinks and other consumable may be contaminated and
ingested, drink or other consumable items and is ingested. Spillage of radioactive material may come into
contact with the skin and absorbed or enters through cuts or scratches. Accidental stabbing by
contaminated needles, plus internal deposition may also result from contaminated hands, with subsequent
eating or rubbing of eyes.
EXTERNAL EXPOSURE
External exposure includes absorption of ionizing radiation from cosmic rays, the sun, background radiation
from historic weapon testing, nuclear accidents, power generation, burning of fossil fuels, industrial and
medical use such as industrial and clinical x-ray, mining and conduction activities.
PENETRATION POWER & CONTROL

Alpha does not have the penetration to pass through the dead outer layers of skin on the body. Therefore,
outside the body it does not present a hazard.

Beta will penetrate soft tissue up to approximately 12 mm dependent on power. Can be shielded by thin
layers of metal, glass or water; plastics offer the best protection.
Gamma can penetrate most types of matter but can be screened by a sufficient thickness of concrete (300
mm), steel (150 mm) or lead (75 mm).
Neutrons are very penetrating but can be screened by thick layers of concrete or water.
Effects of Exposure to Each Type of Radiation

Ionising radiation interacts with living tissue by transferring energy to molecules of cellular matter. Cellular
function may be temporarily or permanently impaired as a result of such interaction, or the cell may be
destroyed. The severity of the injury depends on:
x The type of radiation.

x The absorbed dose.
x The rate at which the dose was absorbed.
x The sensitivity of the tissues involved.
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Damage to cellular function following irradiation causes effects that are classified as:
x Somatic effects; or
x Genetic or hereditary effects.
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Some effects of ionising radiation are dose dependent and only occur if the dose received is above a certain
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level. These are termed non-stochastic and stochastic effects.
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Somatic Effects
Somatic effects are concerned with symptoms produced only in the irradiated person and which result from
direct damage to body cells. They are divided into two classes which have been named ‘early’ and ‘late’
effects. In general toxicology, they would be termed acute and chronic.
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Early Effects
Early, or acute, effects produce clinical symptoms within hours, days or weeks after short duration exposure
to high doses of radiation.
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Where gross irradiation occurs, absorbed dose in units of Gy is used in preference to dose equivalent in units
of Sv, which is more concerned with radiation protection and for controlling particular radiation sources and
their effect upon people.
Survival largely depends on whether the absorbed dose is sufficient to cause extensive damage to the bone
marrow. Acute effects include:
x Erythema (reddening of the skin)

x Radiation sickness (nausea, vomiting and diarrhoea)
x Weight loss
x Hair loss
x Death (death can occur as a result of gastrointestinal damage or from damage to the central
nervous system)
Radiation sickness, with symptoms of nausea, vomiting and diarrhoea, can occur after a few hours. It
results from an absorbed dose of approximately 1 Gy and is related to cell damage in the intestines.
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Higher absorbed doses of between 3 and 10 Gy cause depletion of white blood cells and a reduction in the
body's defence mechanism. Death usually results within about a month, generally by secondary infection.
An absorbed dose higher than 10 Gy may be lethal within about five days and generally result from severe
damage to the lining of the intestines followed by massive invasion of the body by bacteria. With higher NEBOSH
doses, death occurs within a few days with symptoms consistent with damage to the central nervous system
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(CNS).
Late Effects
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Late or chronic effects of radiation result in eye cataracts and carcinogenic effects.
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Genetic Effects
Genetic effects of radiation result from damage to male or female reproductive cells. Such a reproductive
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change is called a genetic mutation. Not all mutations produce harmful effects but following irradiation of
reproductive organs the possibility of malformation or diseases in offspring is increased. The effects
resulting from a mutation can occur in subsequent generations of offspring.
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Methods of Measuring
The electronic personal dosimeter (EPD) is a modern electronic dosimeter for estimating uptake
of ionising radiation dose of the individual wearing it for radiation protection purposes.
The electronic personal dosimeter has the advantages over older types that it has a number of sophisticated
functions, such as continuous monitoring which allows alarm warnings at pre-set levels and live readout of
dose accumulated.
It can be reset to zero after use, and most models allow near field electronic communications for automatic
reading and resetting.
They are typically worn on the outside of clothing, such as on the chest or torso to represent dose to the
whole body. This location monitors exposure of most vital organs and represents the bulk of body mass.
These are especially useful in high dose areas where residence time of the wearer is limited due to dose
constraints.
PIN Dosimeter
PIN diodes are used to quantify the radiation dose for military and personnel applications.
MOSFET dosimeters
MOSFET dosimeters are now used as clinical dosimeters for radiotherapy radiation beams.
Assessment of Ionising Radiation Risks

Section 5.2. International Labour Office, Ambient Factors in the Workplace on assessment states the following:
x A prior radiological evaluation of hazards and risks and prevention and control measures should, in
consultation with workers and/or their representatives, be the first step in establishing a radiation
protection programme. The degree of effort, formalities and details of the evaluation and the scrutiny
to which it is subjected should be in line with the magnitude of normal and potential exposures and
the probability of the latter.
x The prior radiological evaluation should include for all aspects of operation:
(a) an identification of the sources of normal and reasonably foreseeable potential exposures
(b) a realistic estimate of the doses
(c) an identification of the radiological protection measures needed to meet the optimization
principle
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x Prior evaluation should be used to help determine what can be achieved at the design stage of
installation to establish satisfactory working conditions through the use of engineered features,
including the provision of shielding, containment, ventilation and interlocks. These considerations
should aim to minimize the need for relying on administrative controls and personal protective
equipment for protection and safety during normal operation.
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x Where authorization by registration or licensing is required, the legal person applying for the
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authorization should make an assessment of the nature, magnitude and likelihood of the exposure
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and, if necessary, make a safety assessment. Such a safety assessment should contribute to the
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design of the radiation protection programme. The safety assessment should include, as appropriate,
a systematic critical review of:
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(a) the nature and magnitude of potential exposures and the likelihood of their occurrence;
(b) the limits and technical conditions for operation of the source;
(c) the ways in which structures, systems, components and procedures related to radiation
protection or safety might fail, singly or in combination, or otherwise lead to potential
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exposures, and the possible consequences of such failures;
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(d) the ways in which changes in the environment could affect protection or safety;
(e) the ways in which operating procedures related to protection or safety might be erroneous,
and the consequences of such errors;
(f) the protection and safety implications of any proposed modifications.
x The safety assessment should be documented and reviewed. Additional reviews should be
performed as necessary to ensure that the technical specifications or conditions of use continue to
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be met whenever:
(a) significant modifications to a source or its associated plant or its operating or maintenance
procedures are envisaged;
(b) operating experience or other information about accidents, failures, errors or other events that
could lead to potential exposures indicates that the current assessment might be invalid;
(c) any significant changes in activities, or any relevant changes in guidelines or standards are
envisaged or have been made.
Protection Strategies for Ionising Radiation

Radiation protection strategies for ionising radiation are more specific and reflect the principles and
recommendations made by the International Commission on Radiological Protection (ICRP).
The three basic principles of radiological protection are:
1) Justification of activities that could cause or affect radiation exposures
2) Optimisation of protection in order to keep doses as low as reasonably achievable
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3) The use of dose limits.
The recommendations of the ICRP include establishing responsibilities, assessing risk, establishing
prevention/control measures and conducting health surveillance. NEBOSH

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Responsibilities
Employers should take all necessary steps to restrict so far as is reasonably practicable the extent to which
workers are exposed to ionising radiation. Those with responsibilities under the radiation protection
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programme should be assigned responsibilities in writing. A radiation protection advisor/officer should be

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appointed to assist the employer with the radiation protection program.

The ILO Code “Radiation Protection Workers (ionising radiation) states the following requirements:
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2.2 Duties and responsibilities of employers:

2.2.1 The responsibility for providing adequate protection of workers against radiation rests with the
employer, even if the employer is a sub-contractor
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2.2.2. (1) When two or more employers undertake activities simultaneously at one workplace, they should
collaborate in order to ensure compliance with national regulations. This collaboration does not
relieve the employer of the duty to secure the health and safety of his workers.
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Radiation Protection Advisers
At least one radiation protection adviser (RPA) should be appointed in writing by employers using ionising
radiation. The number of RPA appointed should be appropriate to the risk and the area where advice is
needed to be stated.
Employers should consult the RPA on:

x The implementation of controlled and supervised areas
x The prior examination of plans for installations and acceptance into service of new or modified
sources of ionising radiation in relation to any engineering controls, design features, safety features
and warning devices provided to restrict exposure to ionising radiation.
x The regular calibration of equipment provided for monitoring levels of radiation and the regular
checking that such equipment is correctly used and maintained.
x The periodic examination and testing of engineering controls, design features, safety features and
warning devices and regular checking of systems of work provided to restrict exposure to ionising
radiation.
Adequate information and facilities should be provided by the employer to the RPA in order to allow them to
carry out their functions.
Assessment
The employer should make an assessment of work involving exposure to radiation and use the assessment
to contribute to the design of a radiation protection programme. The assessment should include
consideration of the following:
x Limits and technical conditions for the operation of the radiation source
x Ways in which technical, procedural and behavioural measures related to radiation protection might
fail and lead to potential exposures, and the possible consequences of such failures.
x Nature and magnitude of potential exposures and the likelihood of their occurrence.
Arrangements
The employer should follow the procedures for notification, registration or licensing that are laid down by the
competent authority.
The requirements of the ILO Code “Radiation Protection Workers (ionising radiation)” for
arrangements include:
2.2.4 The employer should make the administrative and organisational arrangements necessary for
controlling the exposure of workers to radiation and radioactive materials. He should therefore
appoint the appropriate staff, provide the necessary protective equipment, including radiation-

measuring systems, maintain building, installations and workplaces, and organise work in such a
way as to ensure that the radiation exposure of each worker, including his internal exposure, is
controlled and complies with the provisions of this code.
2.2.5 The employer should structure the administration and organisational arrangements in such a way
that they operate in a smooth manner and that an effective safety programme consistent with the
requirement of this code is implemented.
2.2.6 The employer should establish a policy for the protection of the health and safety of workers,
comprising appropriate measures, during planning and operation, to prevent any unnecessary
exposure in the installation under his control.
Principles of Prevention and Control
The Radiation Protection Convention (No 115) and Recommendation (No 114) 1960, lay down basic principles
and establish a fundamental framework for radiation protection of workers.
Detailed guidance on ionising radiation is given in the ‘International basic standards for protection against
ionising radiation and for the safety of radiation sources and the ILO code of practice ‘Radiation protection of
workers (ionising radiations)’.
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Control of External Radiation
Radiation protection measures should be commensurate with the nature and extent of the risks. The following
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precautions are commonly applied:
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Illustration 59: Time, Distance, Shielding
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Exposure Time Limitation
The length of time that persons are exposed to ionising radiation must be kept to the minimum. One of the
main control measures for radiation is to ensure that the dose to which persons at risk have been exposed
is constantly monitored. Once the dose limit has been reached, they must be removed from exposure.
Maintain a Distance
Most forms of radiation used in industry will only travel short distances, therefore barriers, restricted areas
and other controls are required particularly to protect those not involved in the actual operation. In the case
of beta radiation for example, the use of tweezers or forceps to handle sources will greatly reduce the
exposure.
Shielding
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Illustration 60: Examples of Shielding
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Properties of Alpha, Beta and Gamma Radiation

An alpha particle is slow moving and will be stopped by a few sheets of paper or even human skin.
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A beta particle travels at much greater velocity. It will penetrate paper or skin but will be stopped by a 2-3
millimetre thickness of aluminium.
Gamma radiation has the greatest penetrative power and is stopped by thick shields of lead or concrete.
X-rays are similar but as man made by removing the power source stops the generation of radiation. If
generation is required, then shielding as for gamma radiation is appropriate.
Control of Internal Radiation

Internal radiation stems from radioactive materials which have been deposited in the body (by inhalation,
ingestion, injection or absorption through the skin) and are continually irradiating internal organs and tissues
from within.
Once a radionuclide has entered the body, it is difficult, if not impossible, to limit personal exposure. If the
substance is taken up by the body, then it will pass into the bloodstream and from there all parts of the body
will receive a dose. The substance may not accumulate in specific target organs as it is metabolised,
delivering a greater dose to these organs (e.g., Polonium 210 accumulates in the liver and kidneys).
Even if the substance is not taken up by the body but is simply deposited in the lungs or gut, these organs
do not possess thick epidermal cell structures; they are made of delicate epithelial tissue that will receive
the radiation dose. So even an alpha particle emitter that would be virtually non-hazardous outside the body
becomes extremely hazardous if swallowed or inhaled.
The control of exposure to internal radiation sources is therefore based entirely on keeping the radioactive
material out of the body. This is done using standard methods appropriate for toxic substances and
biological agents, such as:
x Containment of unsealed radioactive material within ventilated glove boxes.
x Partial containment in fume hoods under negative pressure.
x Respiratory protective equipment.
x Other PPE to prevent skin contamination.
x Prohibition of eating, drinking and smoking.
x Good hygiene practices such as routine hand washing after source handling.
Hierarchy of Control
To prevent external and internal radiation from such routes as inhalation, ingestion, injection or absorption the
following control measures will be relevant.
Restriction of Exposure
One of the first considerations is whether the risk of exposure to ionising radiation can be avoided by choosing
an alternative technique that does not involve its use.

The next consideration is to restrict exposure. In general, the lower the radioactivity of the source, the easier
it will be to restrict exposure. Restriction of exposure, for example to x-rays, can be achieved by:
x Device selection, e.g., operating voltage and current.
x Design, e.g., shielding, beam filtration and beam width shields (beam collimation); and
x Reducing exposure time and maintaining a distance, e.g., remote operation.
Young persons should not be exposed to ionising radiation unless it is necessary for their training, he / she is
supervised by a competent person and the risk is reduced as low as is reasonably practicable.
Enclosure
Containment of unsealed radioactive material prevents its dispersal and ingestion or inhalation by workers.
Where possible radioactive substances should be in a sealed source, the design and construction of which
should take account of the actual work done. For example, if used in wet or aggressive conditions, the
possibility of corrosion should be taken into account. Where appropriate and identified by risk assessment,
the sealed source should be leak tested at least every two years, e.g., it is not necessary to leak test smoke
detectors.
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Engineering Controls and Design Features

The design and construction of facilities or devices where internal exposure may occur should be such that
exposure is restricted. This can be achieved by suitable containment and shielding of sources and the
design of control systems. Examples include:
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x
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Processing of radioactive materials in ventilated glove boxes or fume cupboards under negative
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pressure, which serve to contain radioactive contamination.
x Beam collimation, local shielding and ventilation.
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x Key locks on controls, door interlocks, fail to safety and warning devices.
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x Emergency exposure controls (emergency stop controls).
Work involving exposure to external radiation should be done in a room, enclosure or cabinet which is provided
with adequate shielding. In many cases the shielding forms part of the equipment, e.g., covers, shutters and
collimators, or enclosure. In other cases, local shielding should be used, e.g., free-standing screens, covers,
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drapes and bags of lead shot.
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When working with unsealed sources suitable fume cupboards, sterile cabinets, glove boxes, ducting, fan
assemblies, filtration units and other components in the ventilation system should be selected. This will ensure
that all such equipment is constructed to facilitate safe maintenance, including safe disposal of filter media,
cleaning and decontamination.
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Safe Systems of Work
Controlled Areas, Supervised Areas and Local Rules are an important aspect of managing the risk from
radiation. Local Rules should set out the safe working practices and precautions to be followed including
wearing and disposable of PPE, monitoring arrangements, etc. Safe systems of work to control exposure
may include:
x Restricting access, limiting the number of people exposed and the time that they are exposed.
x Locating clinical staff away from high dose rate areas, preferably behind a shielded screen.
x Segregation of different radioactive sources in storerooms.
x Permit-to-work systems, especially for maintenance activities.
x Monitoring radiation levels.
x Providing adequate support for staff, e.g., site radiography will normally require the support of an
assistant to patrol the boundary of a controlled area.
x Cleaning and decontamination of worktops, floors, etc.
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x Use of portable warning notices and audible and visual alarms.
x The provision of information, training, instruction and supervision.
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Gloves and overalls prevent exposure from low energy beta emitters and prevent skin contact. High density
materials such as lead are used to provide shielded body protection for persons at risk, such as
radiographers, from penetrating radiation. Eye protection, possibly using high density lenses, may be used
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to protect the eyes if the head is at risk from exposure to beams of radiation. Respiratory protective
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equipment may be needed as an additional precaution to prevent inhalation of radioactive contamination.

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Radiation Protection Codes of Practice

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Categorisation/Classification of Workers
The ILO Code “Radiation Protection Workers (ionising radiation) states the following requirements:
4.1.1. For the purpose of this code there are two categories of workers:
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(a) Workers engaged in radiation work.
(b) Workers not engaged in radiation work, but who might be exposed to radiations because of
their work.
4.1.2. Workers engaged in radiation work are workers to whom the dose limits given in paragraph 5.4.3
apply.
4.1.3. Workers not engaged in radiation work should be treated, so far as restricting radiation exposure
is concerned, as if they were members of the public.

4.1.4. No person under the age of 16 should be considered to be a worker engaged in radiation work for
the purpose of this code.
4.1.5. No worker, student, apprentice or trainee under the age of 18 should be allowed to be engaged in
radiation work in radiation working condition A (see paragraph 4.3.1) such persons may only
therefore work in working condition B.
Workers engaged in radiation work are usually called classified workers, relating to their classification under
work conditions A or B.
The ILO Code sets out the two working conditions expressed for classified workers, working A and
working condition B.
4.3.1. For the purpose of this code there are two classes of working conditions for workers engaged in
radiation work:
a) Working Condition A – where the annual exposure might exceed three-tenths of the dose limits (given
in paragraph 5.4.3)
b) Working Condition B – where it is most unlikely that the annual exposures will exceed three-tenths
of the dose limits (given in paragraph 5.4.3)
In summary, prevention and control of radiation exposure should include:
- Categorisation / classification of workers

- Dose limitation, including arrangements for monitoring workers’ exposure and radiation levels in the
workplace. A system for recording and reporting information related to the control of exposures.
- Designation of controlled or supervised areas
- Local rules of classified workers and the supervision of work
- Information and training programme.
Ionising Radiation Dose Limitation

The ILO Code “Radiation Protection Workers (ionising radiation) states the following requirements for
dose limitation:

2.2.8 The employer should take all necessary steps to restrict occupational exposures resulting from
justified practices so that they are "as low as reasonably achievable, economic and social factors
being taken into account", and within the constraint of individual dose limits.
The basic principles of radiological protection expressed by the ICRP require employers to use dose limits
and ensure optimisation of protection in order to keep doses as low as reasonably achievable. This involves
the use of dose limiting systems, the ILO Code expects workers to have dose limiting systems and to work to
dose limits for those engaged in radiation work (classified workers).
5.1 Dose limitation system

5.1.1. During normal operating conditions, the exposure from sources or practices should be restricted by
the application of the dose limitation system which includes justification of the practice, optimisation
of radiation protection and establishment of the annual dose equivalent limits.
Dose limitation for workers engaged in radiation work (classified workers)

The dose limits for workers engaged in radiation work expressed by the ILO Code “Radiation Protection
Workers (ionising radiation) correspond with the ICRP’s international recommended standards.
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The ICRP/ILO dose limits for workers engaged in radiation work is an annual effective dose equivalent of 50
mSv in any one year, and no more than 100 mSv over a period of five consecutive years. This makes the
effective dose averaged over a five-year period 20 mSv per year, which means that if a worker exceeds 20
mSv in one year their exposure will need to be controlled so that it is lower than 20 mSv in following years.
In practice this means the worker is removed from radiation work for a period to ensure the effective average
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dose is met.
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The ILO Code recommends that specific action to be taken to control the dose of pregnant radiation
workers.
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5.4.4. The employer should make provisions to ensure that a pregnant woman does not work under
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Working Condition A. Recent information showing that there is a risk of inducing mental retardation
confined to a limited period of pregnancy makes it necessary that no substantial irregularities to the
dose rate occur for pregnant women working under Working Condition B.
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Dose limitation for workers not engaged in radiation work
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The employer has the same obligations towards workers not engaged in radiation work as far as restricting
the radiation exposure is concerned as if they were members of the public. The dose limits for these workers
should be those applied to individual members of the public. The ICRP recommends an annual dose limit for
general public of 1 mSv.
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Classified areas – controlled and supervised areas
Areas where a worker might receive radiation dose in excess of the recommended annual dose limit set for
the general public are called classified areas. These are subdivided into controlled and supervised areas
to reflect the level of radiation dose that a worker may receive. Controlled areas usually taken to be areas
where workers may receive a radiation dose more than three-tenths of the annual dose limit of 30 mSv
(working condition A).
Supervised areas are areas where workers are unlikely to receive a radiation dose more than three-tenths
of the annual does limit of 20 mSv but might receive a dose above the recommended annual dose limit set
for the general public (working condition B). Controlled areas should be subject to special rules for the
purpose of radiation protection. The boundaries of controlled areas should be defined, including by signs
warning of radiation hazard. Access to controlled areas should be restricted. It is recommended that
supervised areas should be identified.
Competent Advice
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The ILO Code (Radiation Protection Workers (ionising radiation) sets out the following requirements
for controlled and supervised work areas:
4.7. Requirements of controlled and supervised areas
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4.7.1. The employer should ensure, in consultation with the radiation protection officer, that:
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a) Access to established controlled areas is adequately controlled;

b) The appropriate radiation surveillance is carried out;
c) The working procedures and instructions appropriate to the radiation risk are available, are
updated as necessary and are adhered to by all concerned;
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d) The appropriate display signs, inscriptions or information indicating the sources and levels of
radiations are properly posted;
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e) The appropriate radiation-measuring instruments are provided, and are regularly maintained and
calibrated;
f) Safety features such as interlocks and filters are checked by qualified experts.
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When ionising radiation work is conducted, an employer should appoint one or more radiation protection
supervisors (RPS) for the purpose of securing compliance with National legislation and ‘local rules’ for work
in controlled or supervised areas.
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Their area of work should be defined, and they must be trained so that they understand the requirements
of national legislation and local rules. They also need to understand the reasons for the precautions that
need to be taken in their area of work, and they should command the respect of those they supervise.
Training and Information

As part of the radiation protection program, the employer should establish a training and information
program.
The program should ensure that all workers receive adequate information on the:
1) Health risks due to their occupational exposure to radiation

2) Significance of their actions and how they may affect radiation protection measures.
All radiation workers should receive adequate training on radiation protection. Those assigned
responsibilities in the radiation protection program for example, the Radiation Protection Advisor or
Radiation Protection Supervisor, should receive appropriate information and training.
Appropriate management should receive training on the basic principles of radiological protection, their main
responsibility regarding radiation risk management and the principal elements of the radiation protection
program.
Specific information should be provided to female workers who are likely to enter controlled or supervised
areas on the risk to the embryo o foetus due to exposure to radiation and on the importance of a female
worker notifying the employer as soon as she suspects her pregnancy.
The Role of Monitoring and Health Surveillance
The role of radiation monitoring is to ensure that radiation working conditions in workplaces exposed to
radiation are kept under review and that current levels of radiation exposure of workers are known.
The main functions of monitoring are to:
x Check that areas have been correctly designated for the hazards that exist.
x Identify any changes to radiation exposure levels so that appropriate control measures for restricting
exposure can be proposed.
x Detect breakdowns in controls or systems, so as to indicate whether conditions are satisfactory for
continuing work in that area.
x Ensure workers use the controls provided and report any defects.
x Ensure workers use personal protection where its use is designated as mandatory.
x
Provide information on those who may be at risk and in need of health surveillance.
The role of health surveillance is to provide the identification of symptoms and early detection of ill health
arising from exposure to occupational sources of radiation.
Health surveillance can be part of a prevention strategy, allowing interventions to be made that limit further
exposure beyond acceptable limits.
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9.14 Musculoskeletal Issues and Manual

Handling
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The basic human sciences involved are anatomy, physiology and psychology; these sciences are applied
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by the ergonomist towards two main objectives:
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x The most productive use of human capabilities.
x
Controlling
The maintenance of human health and well-being.
Adverse health effects associated with poor ergonomics may be psychological or physiological. This
element is concerned with the physical aspects of ergonomics and the physical consequences of poorly
designed equipment and tasks.
Occupational
Physical ergonomics is the specific aspect of ergonomics concerned with human anatomical,
Workplace Health
anthropometric, physiological and biomechanical characteristics. Areas of application include working
postures, material handling, repetitive movements, workplace layout and safety and health.
A range of musculoskeletal disorders, notably Work-Related Upper Limb Disorders (WRULDs) can be
caused if work equipment, environment and task impose postures and movements upon the body and stress
the muscles, ligaments and joints.
Health Issues
This element will consider:
x The causes and control of work-related upper limb disorders.
x The health problems associated with display screen equipment and their control.
x The effects of manual handling and their control.
The Human Musculoskeletal System

The main functions of the spine are support, mobility, housing, protection, and control.
It supports the skull, the shoulders, and ribs and distributes the nervous system to the lower body. Injuries
associated with manual handling accidents are primarily sprains and strains, though contusions (bruising),
lacerations, fractures and superficial injuries are also significant.
Ideally the shape of the spine viewed from behind is straight, from the side a gentle ‘S’ curve. This curved
shape is important as it allows for increased strength and gives the ability to absorb compressive forces.
The spine is made up of 33 small bones, 24 vertebrae which are connected by intervertebral discs (soft
jelly-like pads), muscles and ligaments. Each vertebra has two joints (facet joints), which enable them to
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move with respect to each other - it is this movement that gives the spine its flexibility.
The vertebrae are divided into five groups, the Cervical, Thoracic, Lumbar, Sacral and Coccyges.
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Illustration 61: Five Groups of Vertebrae

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These are the smallest group of vertebrae

and support the smallest amount of weight.
They cradle the skull and provide movement
and rotation due to the shape of the vertebrae
and small controlling muscles.
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Thoracic (The Mid Back)
These vertebrae support twelve pairs of ribs. The ribs form a cage, which protects organs such as the heart,
lungs and liver. The rib cage can move to aid breathing, but due to their protective role, the ribs restrict the
movement in this part of the spine.
Lumbar (The Lower Back)

This area is often referred to as the ‘weak link’ in the back. This is because it is under the most strain carrying
all of the weight of the upper body. However, the vertebrae provide good movement.
(The ability of the cervical and lumbar spine to provide good movement means that sudden movements or
impacts will affect the lumbar and cervical regions more readily).
Sacral
The sacrum is made up of five vertebrae that are fused together forming a ‘wedge shape’ which fits into the
pelvic girdle.
Coccyges
These groups of bones are very small and are collectively known as the coccyx. There are many theories as
to their use, the most common being that they are the remnants of a tail.
Spinal Curves
These vertebrae form themselves into gentle curves and are held together by two ligaments running up the
front and back of the spine.
The four curves of the spine (cervical, thoracic, lumbar and sacral) represent the best working position of the
whole spinal structure. Deviations from this position place extra stress upon the spine. This will generally not
cause excessive forces or problems. However, if these unnatural postures are assumed repeatedly or whilst
carrying loads, then more severe damage can be sustained.
The term ‘straight back’ has often led people to believe that a rigid and upright position is the best conditions
for lifting. This is not so. A relaxed and natural posture will help to protect the vertebrae and intervertebral
discs.
The Inter-Vertebral Disc

The inter-vertebral discs have 3 main functions:
x To act as a hydraulic shock absorber, cushioning vibration and compression stresses and
spreading the load out evenly over the surface of the vertebral bodies.

x To form a strong connecting link between vertebrae.
x To allow movement between each vertebra whilst at the same time, controlling the extent of the
movement in conjunction with other ligaments.
The discs are made up of a gel-like centre called the nucleus, surrounded by layers of tough fibres, the
annulus. The discs are firmly attached to the vertebrae, above and below. When the spine moves, the
discs change their shape to absorb the stress. This is particularly important in the lumbar section of the
spine, which is subjected to the greatest weight bearing demands.
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Illustration 62: The Inter-Vertebral Disc
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Controlling
Occupational
Workplace Health
Health Issues
Muscles (Skeletal)
Muscles are located throughout the body and are designed to produce movement. Constructed from
bundles of fibres, muscles receive messages from the brain, which cause them to contract or relax, resulting
in movement of joints. The ends of the muscles are connected to the bones by means of a band of tissue
known as a ‘tendon’. When a muscle contracts, the bones are drawn closer together and when relaxed they
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return to their original position. A damaged muscle is called a ‘strain’.
Muscles rarely work in isolation. The muscles of the human body tend to work ‘antagonistically’, e.g., the
biceps and triceps will work against each other to allow the forearm to elevate or descend.
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Most muscles are continually ‘switching on or off’ to allow the body to maintain a certain position or balance.
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This does not usually present problems as humans are ‘dynamic’ and muscles are made to keep moving.
Many of the problems that cause muscle damage is associated with people assuming a position for a
prolonged period.
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Abdominal Muscles
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The abdominal muscles control the lower part of the spine. When air is inhaled, the diaphragm moves down
and the abdominal muscles contract. The pressure inside the abdomen increases to provide a structural
support for the front of the spine, which is not as closely supported by muscles as the back of the spine.
Adequate abdominal pressure can reduce the stress on discs by 40%. The ability to develop this ‘pressure-
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splintage’ depends very much on the condition of the abdominal muscles, which are vital to back care. Thus,
people who are obese especially with the typical ‘beer belly’, and women who are in the later stages of
pregnancy are more vulnerable to back strain because the effect of the abdominal muscles is reduced.
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Ligaments
Ligaments are made of strong fibrous tissue. They have a small degree of elasticity and are used to hold
bones together. A ligament can be damaged if stretched too far and torn, or if it is held under tension for long
periods – resulting in permanent elongation. A twisted ankle often results in torn ligaments whereas a stooped
back posture results in stretched ligaments, which weaken it and cause pain. A damaged ligament is called
a ‘sprain’.
Nerves
The nervous system consists of millions of nerve
fibres, which transmit electrical impulses between
the brain and the rest of the body. The vertebrae
enclose and protect the spinal cord as it passes
down the back. Nerves branch out from the spinal
cord to other parts of the body and emerge between
the vertebrae. When a nerve is irritated, the effects
can be felt along the length of the nerve. In the case
of a particular irritated nerve in the lower back, pain
can be all the way down to the foot. This condition
is known as sciatica.
Types of Injury and Ill Health Conditions

There are 4 main causes of back pain:
1) Degeneration (Wear 3) Cumulative Stress

and Tear) This is probably the most common cause
of back pain but the least recognised.
The normal ageing process produces
‘wear and tear’ in all the weight-bearing As the term implies, cumulative stress
joints including the spine. occurs gradually. Poor sitting and
standing postures, poorly designed work
The degree of ‘wear and tear’, however, environments, obesity and poor muscle
varies from individual to individual and condition can all result in twinges of back
may be accelerated by other factors. For pain. These twinges are an indication
example, the repeated vibration and that the spine is being subjected to ‘minor

shocks on the spine experienced by a stresses’ and an accumulation of these
lorry or tractor driver, or the additional small incidents may lead to a significant
stresses placed upon the spine of an episode of back pain.
over-weight person.
4) Psychological
2) Traumatic Injury
Psychological pain with no physical
Traumatic injury is caused by sudden, symptoms may occur in cases of
violent stresses applied to the spine. This hysteria, depression or acute anxiety. It
can result in damage to the muscles, has been shown that stress may be
ligaments and, in exceptional cases, predisposing factor to the likelihood of
damage to the inter-vertebral discs or the back injury through an accident. Chronic
vertebrae. back pain sufferers may become
depressed and experience exaggerated
pain perception
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Prolapsed Disc
Discs rarely get damaged by a single action but usually through cumulative abuse. Research now shows
that repeated stresses caused by twisting and stooping actions can cause microscopic tears in the fibres of
the disc wall (annulus), which may then lead to a weakness. These tears in the annulus gradually crack
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open allowing part or the entire gel-like centre (nucleus) to ‘prolapse’ or ‘seep out’.
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This usually occurs at the back of the disc, close to where the spinal nerves emerge from the spinal cord.
The bulging nucleus may press on nearby structures such as nerve roots and ligaments, causing symptoms
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such as numbness, pain and pins and needles. The pressure created by this situation can cause severe
Controlling
pain and can incapacitate an individual for some time.
The common term ‘slipped disc’ is misleading as it implies movement of the disc, which does not usually
occur.
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Illustration 63: Discs
Workplace Health
Health Issues
The discs increase in size further down the spine to accommodate the extra weight they must carry. During
movement, a disc distorts and its internal pressure changes. The disc pressure is lowest when the spine is
horizontal. In this position, the upper body weight is removed from the lower discs. In the standing position
disc pressure is low due to minimal distortion. However, when the spine is bent or twisted, the internal
pressure can be doubled. It is now believed that increased forces placed repeatedly on discs can eventually
result in their damage.
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Chart 1: Spinal Pressure
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When sitting, the shape of the spine changes. In a slouched position the pressure inside your lower back
discs is increased. Lifting heavy items from the floor from a sitting position can triple the pressure in the
lower discs. In the sitting position the powerful leg muscles cannot aid in any lifting operations and,
therefore, any stresses are focused on the back.
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Work Related Upper Limb Disorders

(WRULD)
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Cause and Effect
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Links between work activities and
Controlling
upper limb disorders have long been
recognised. In the modern workplace,
increasing automation has reduced
the incidence of certain disorders but
led to similar problems in other
Occupational
activities.
Workplace Health
A number of musculoskeletal
disorders exacerbated by work factors
have been identified. Some disorders
are clearly defined diseases and
others appear as a loose grouping of
Health Issues
symptoms that may indicate an
underlying problem.
There is no universally accepted framework for classifying the range of WRULDs though the evidence
suggests grouping in four main categories, whilst acknowledging that the conditions are not mutually exclusive,
and that the categories are not definitive or precise:
x Inflammation of the tendon (tendonitis), muscle tendon junction or the tendon sheath (tenosynovitis).
x ‘Beat conditions’ - inflammation of tissues due to constant bruising or friction.
x Compression of the peripheral nerves, e.g., carpal tunnel syndrome.
x Temporary fatigue - stiffness or soreness of the muscles following unaccustomed exertion.
The ILO (1996) identified the most common injuries and diseases caused by repetitive or poorly designed
work as per Table 26.
Table 26: Common Work-Related Upper Limb Disorders
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INJURY SYMPTOMS TYPICAL CAUSES
Bursitis: Inflammation of the bursa Pain and swelling at the site of Kneeling, pressure at the elbow,
(sack-like cavity) between skin and the injury. repetitive shoulder movements.
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bone, or bone and tendon. Can
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occur at the knee, elbow or

shoulder. Called ‘beat knee’, beat
elbow’ or ‘frozen shoulder’ at these
locations.
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Carpal tunnel syndrome: pressure Tingling, pain and numbness Repetitive work with a bent wrist.
on the nerves, which pass up the in the thumb and fingers, Use of vibrating tools.
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wrist. especially at night. Sometimes follows tenosynovitis

(see below).
Cellutitis: infection of the palm of the Pain and swelling of the palm. Use of hand tools, like hammers
hand following repeated bruising, and shovels, coupled with
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called ‘beat hand’. abrasion from dust and dirt.
Epicondylitis: inflammation of the Pain and swelling at the site of Repetitive work, often from
area where bone and tendon are the injury. strenuous jobs like joinery,
joined. Called ‘tennis elbow’ when it plastering, bricklaying.
occurs at the elbow.
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Ganglion: a cyst at a joint or in a Hard, small, round swelling, Repetitive hand movement.
tendon-sheath. Usually on the back usually painless.
of the hand or wrist.
Osteo-arthritis: damage to the joints Stiffness and aching in the Long-term overloading of the
resulting in scarring at the joint and spine and neck, and other spine and other joints.
the growth of excess bone. joints.
Tendonitis: inflammation of the area Pain, swelling, tenderness and Repetitive movements.
where muscle and tendon are redness of hand, wrist, and /
joined. or forearm. Difficulty in using
the hand.
Tenosynovitis: inflammation of Aching, tenderness, swelling, Repetitive movements, often

tendons and / or sheaths. extreme pain, difficulty in non-strenuous can be
using the hand. brought on by sudden
increases in workload or by
introduction of new
processes.
Tension neck or shoulder: Localised pain in the neck or Having to maintain a rigid
inflammation of the neck and shoulders. posture.
shoulder muscles and tendons.
Trigger finger: inflammation of Inability to move fingers Repetitive movements.

tendons and / or tendon sheaths of smoothly with or without pain. Having to grip too long, too
the fingers. tightly, or too frequently.
The main sites affected are fingers and hands, wrists, elbows and shoulders.
The most notable symptoms are pain, restriction of joint movement and soft tissue swelling. The sense of
touch, the ability to grip, and manual dexterity generally may be affected. The onset of symptoms may be
gradual, causing adaptation of working practices to avoid further pain, and often leading to further problems.
WRULDs may lead to chronic ill-health and permanent disability.
Activities giving rise to WRULDs invariably involve movements including forceful, repetitive gripping, twisting
reaching and moving.
Occupational factors can be grouped into three areas:

x Force – the application of undesirable manual force.
x Frequency and duration of movement – excessive work rates and / or overly repetitious
movements, and lack of rest / recovery time.
x Posture – awkward positioning of the hand, wrist, arm or shoulder.

In assessing the risk of WRULDs, the occupational factors are considered together with:
x Personal factors, e.g., age, gender, physical fitness, previous injuries.
x Environmental factors, e.g., cold rooms, special constraints, etc.
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Preventive Measures
Effective control of WRULDs is delivered through
Mechanisation and Automation
a process of risk assessment and management. Specialised tools with ratchets or power drivers
can be used to reduce repetition, in extreme cases
Specific risk factors: force, frequency / duration, automation may well be the most effective option
posture, personal and environmental factors need though the expense and technical difficulties will
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to be established, prioritised and addressed in have a bearing upon its practicability.

accordance with the principles of prevention.
Ergonomic approaches to the design of work

equipment, working environments and systems of
Reduction of Machine Pace
work (work design) and the selection and control ‘Self-paced’ systems return control to the operator
of workers (organisational approaches) are and may well improve stress and fatigue related
utilised together to deliver effective controls. problems.
Work Design Postural Changes

Work design approaches focus on reduction of Static postures, requiring work to be done with
force and repetitive movements, and postural arms reaching forward or above and movements
changes. requiring excessive stooping or reaching are all
known to cause WRULDs.
Postural problems can be designed out in a

Reduction of Force Levels number of ways:
Examples of approaches to reduce undesirable
x Redesigning or modifying the process.
exertion of force include:
x Changing the operators’ position relative
x Reducing the force required by keeping to the process.
cutting edges sharp; ensuring
equipment is generally well maintained; x Modifying tools or equipment (e.g.,
using powered equipment rather than bending a tool handle rather than the
manual effort; using clamps to hold work wrist).
pieces. x Moving the part rather than the hand,
x Spreading the force required, e.g., thus keeping the wrist straight.
designing controls for a power grip
rather than a pinch grip.
x Gaining better mechanical advantage, Organisational Approaches
e.g., longer handled tools increase
leverage. Organisational approaches look to ensure that the
correct individual is ‘fitted’ to the correct task. Key
x Ensuring that hand protection provided
issues include personnel selection, training and
does not exacerbate the problem.
managing job rotation strategies.
x Ensuring staff are properly trained and

competent.
Reduction of Highly Repetitive

Movements
Generally, approaches rely on task analysis
techniques to identify movements of concern,
culminating in control through the restructuring of
work methods to reduce repetitive elements in
work cycles and limiting the duration of continuous
work.
Job enlargement approaches providing

employees with larger and more varied number of
tasks to perform.
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Personnel Selection x Ensure skill levels can be maintained

post training.
Issues such as general physical fitness, strength, x Minimise other work pressures that
stamina, agility and dexterity may well need to be may degrade newly acquired skills.
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considered in relation to a specific task or tasks. x Ensure management and supervisory
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Age, gender, size, height, disability or previous support.
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related injuries or illness may all preclude an
x Ensure an appropriate balance of
employee from undertaking a particular task.
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training and supervision for new
Attempts, to date at developing a health-screening
employees.
Controlling
test to predict susceptibility to WRULDs have not
been effective.
Job Rotation
Training
Occupational
Many manufacturing processes consist of a
number of operations linked in series or
Workplace Health
Training processes should be competency operating in parallel. Although each sub
focused. It is recommended that training operation may be similar, the variation may be
requirements be determined and implemented in sufficient to make consideration of job rotation
accordance with the following principles: worthwhile.
x Analyse existing jobs. Broadening employee skills may well afford a
Health Issues
x Identify undesirable postures/ number of business benefits including increased
manoeuvres using ergonomic/ employee satisfaction and plenty of cover in
biomechanical guidelines. case of sickness or other absence.
x Modify existing methods.
The time and effort necessary to develop job
x Develop training objectives. rotation systems may well have an adverse
x Communicate new skills to the workforce effect on production in the short term, may affect
using appropriate techniques. management and supervisory arrangements
and impact upon performance-based incentive
x Provide opportunity for practise with
schemes. In isolation, the impact upon risk
immediate feedback to address
exposure may be minimal
failings.
Display Screen Equipment
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Health Problems
Health problems are not always work-related, although they could be affected by display screen work. In
some cases, it may be a sign that the users are not working correctly.
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The health problems associated with display screen equipment work are mainly related to the fixed posture
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and repetition of finger movement and include:
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Upper limb disorders (including pains in the neck, arms, elbows, wrists, hands, fingers) are collectively known
as musculoskeletal disorders such as carpal tunnel syndrome.
Controlling
Other concerns include:
x Temporary eyestrain (but not eye or eyesight damage) and headaches.
x Fatigue and stress.
Occupational
x Photosensitive epilepsy.
Workplace Health
x Dermatitis.
Upper Limb Disorders

The causes may not always be obvious and can be a combination of factors. But enough is known about the
Health Issues
importance of basic precautions especially good posture and variation of work activity (no posture is healthy
if it is held for prolonged periods). In order to accommodate the varying dimensions of different individuals it
is necessary to make provision for adjustability in the design of workstations.
Illustration 64: Illustration 64: Carpal Tunnel Syndrome
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Symptoms of carpal tunnel syndrome include pain, which progresses from a dull ache to an intense pain
during movement, numbness and tingling of the hands. These sensations are usually felt in the first three
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fingers and the base of the thumb.
Tendons in the wrist and hand are surrounded by a sheath containing a lubricating fluid. With unaccustomed
overuse, the lubricating fluid in the tendon sheath may be diminished causing friction, which signals the onset
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of inflammation. Repeated episodes of acute inflammation thicken the tendons and can impede movement,
establishing a permanent or chronic condition.
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Temporary Eyestrain
Visual discomfort from display screen equipment may be experienced in a number of ways, such as dry,
running or burning eyes, blurred sight, drowsiness, headaches, difficulties with contact lenses, etc.
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Eye fatigue and headaches are the greatest sources of discomfort amongst DSE users. Problems can arise
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from a number of sources but may often arise from pre-existing eyesight defects. It is believed that up to
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30% of the general population have uncorrected defects of sight. It is quite common for the use of display
screen equipment (or extensive reading for that matter) to heighten awareness of a pre-existing problem.
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These problems need to be corrected by the use of spectacles etc. in order to prevent fatigue and
Controlling
headaches.
Wearers of contact lenses may have a greater susceptibility to visual discomfort. This is often due to a
reduced blink-rate, a perfectly normal consequence of increased concentration, which results in drying of
the lens. The drying effect is less of a problem to other users who wear spectacles.
Occupational
Workplace Health
Photosensitive Epilepsy
Working with Display Screen Equipment does not cause epilepsy and has not been known to induce an
epileptic attack. However, people who suffer from photosensitive epilepsy (mostly children and young
adults) may react adversely to flickering lights and striped patterns and the possibility of a poorly adjusted
screen causing an attack should be considered.
Health Issues
Facial Dermatitis
The combination of central heating systems, air conditioning
and the presence of electrical equipment, such as visual display
units (VDUs) and printers, can lead to a relatively warm
environment with a low relative humidity. This may affect the
skin, the eyes and the respiratory system. Static electricity and
the individual’s susceptibility can be a contributing factor, dry
skin becomes itchy, and scratching can lead to dermatitis often
presenting itself as a rash (erythema) to the side of the face and
neck.
Stress
It is not uncommon for display screen workers to suffer stress
symptoms in addition to upper limb or visual problems.
Disorders of the skin and digestive system are often associated
with stress as are conditions such as anxiety and
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sleeplessness. Underutilisation of skills sustained high-speed
working and social isolation are all likely to increase stress to an
unhealthy level.
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Musculoskeletal Fatigue
Poor posture can cause backache and pain in the neck /
shoulders, mainly due to sitting incorrectly and working for long
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periods in an awkward position. Although it may seem easy to

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sit correctly, it can take time and effort to break old habits.
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Radiation
Display screen equipment will produce measurable levels of ionising radiation in the form of ‘soft’ x-rays.
There is currently no scientific evidence that the low levels of radiation emitted from display screen
equipment present a risk to health.
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Concerns are often expressed regarding the possible effects of DSE use on the developing foetus. To date
no epidemiological studies have discerned a possible causal link between DSE usage and spontaneous
abortion (miscarriage).
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No evidence has been found to date to suggest that DSE use can cause cataracts. Research is continuing
into the possible health effects of extremely low frequency electromagnetic radiation (non-ionising) such as
that produced by display screen equipment. Stray magnetic fields often cause interference when two or more
screens are placed together. However, present indications suggest that any health hazard is of a very low
order and there is no evidence that users are put at risk. In the meantime, it is sensible to avoid positioning
the rear of terminals (the point at which such emissions occur) directly in front of users.
The types of ill-health conditions resulting from sitting for long periods and
how these can be controlled/managed
Injuries resulting from sitting for long periods are a serious occupational health and safety problem. Workers
in sedentary work such as taxi drivers, call centre operators, long distance lorry drivers, typing pool office
workers, etc are all at risk of a gradual deterioration in their health if they sit for long periods without any
exercise. The most common injuries from prolonged sitting are to muscles, bones, tendons and ligaments
which affects the neck and lower back regions. Other adverse health effects of prolonged sitting include
cardiovascular disease, mental ill-health and diabetes, and in more serious injury - the formation of blood
clot also known as Deep Vein Thrombosis (DVT).
Preventive Measures
By introducing some basic control measures, employers can reduce the risk of sedentary work. Examples
of control measures include:
- Design jobs that require workers to break up their sitting time
- Ensure the provision of ergonomically designed chairs and workstations (desk with adjustable
height) that support good posture and prevent musculoskeletal disorders.
- Provide training on importance of good posture, risk of prolonged sitting, and how to carry out DSE
risk assessment.
- Introduce activities and exercise, such as paying or subsidising fees for workers to attend gym
classes during lunch break.
Analysis of Workstations to Assess and

Reduce the Risks
All workstations should be risk assessed by a competent person.
Workstation means an assembly comprising:

x Display screen equipment (whether provided with software determining the interface between the
equipment and its operator or user, a keyboard, or any other input device).
x Any optional accessories to the display screen equipment. NEBOSH International Diploma
x Any disk drive, telephone, modem, printer, document holder, work chair, work desk, work surface or
other item peripheral to the display screen equipment.
x The immediate work environment around the display screen equipment.
Display screen equipment means any alphanumeric or graphic display screen, regardless of the display
process involved.
The risk assessment must be:

x Systematic.
x Appropriate to the level of risk.
x Comprehensive – covering organisational, job, workplace and individual factors.
x Recorded.
x Reviewed in the light of change or experience (e.g., major changes to the display screen
equipment, furniture, or software are made; new users start work, or change workstations;
workstations are re-sited; or the nature of the work changes considerably).
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Manual Handling and Poor Posture

Manual handling is described as:
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“Any transporting or supporting of a load (including the lifting, putting down, pushing, pulling, carrying or
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moving thereof) by hand or by bodily force”.
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This includes supporting a load in a static posture and using other parts of the body, such as the shoulder.
Controlling
Also included are the intentional throwing and dropping of a load.
It does not include turning handles, using switches or levers, pulling or lashing rope, operating clutches,
brake pedals, etc.
Occupational
Ergonomic Design and MSDs
Workplace Health
Ergonomics is the science of designing the workplace, keeping in minds the capabilities and limitations of
the worker. Poor worksite design leads to fatigued, frustrated and hurting workers. This rarely leads to the
most productive worker. More likely, it leads to a painful and costly injury, lower productivity and poor product
quality. A systematic ergonomics improvement process removes risk factors that lead to musculoskeletal
injuries and allows for improved human performance and productivity.
Health Issues
By making improvements to the work process, barriers to maximum safe work performance can be removed.
It will help providing workers with a job that is within their body’s capabilities and limitations. Done well, an
ergonomics improvement process can be a key contributor to your company’s competitiveness in the
marketplace and provide a better work experience for your people.
Manual Handling Operations

Effective risk management for manual handling operations should be in accordance with the following
hierarchy:
x Avoid hazardous manual handling operations, so far as is reasonably practicable.

x Assess operations that cannot be avoided.
x Reduce the risk of injury from those operations so far as is reasonably practicable.
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Avoidance of Manual Handling

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Where possible, employers should look to avoid the need for employees to undertake any manual handling
operations at work which involve a risk of injury.
The first consideration should be whether the particular manual handling activities are necessary at all, and
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whether the desired result could be achieved in an entirely different way. An example might be wrapping
of a load carried out in site rather than moving it to wrap it.
Also, manual handling activities may be the result of poor planning or time/space restraints, and could be
avoided or at least reduced if the restraints are removed and / or the activity planned more carefully.
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For example, deliveries arriving to a store or office area may routinely be placed on the floor and then removed
to cupboards or shelves at a later time. This requires them to be handled twice. With more planning the items
may be transferred directly to the storeroom or shelves, or even delivered on a trolley from which they do not
need to be moved at all.
Some manual handling operations may be able to be automated or mechanised, although it should be
remembered that these options may create other, different risks.
Manual Handling Risk Assessment

Where it is not possible to avoid the need for employees to undertake a manual handling operation involving
a risk of injury, a ‘suitable and sufficient’ assessment must be made. The British HSE’s publication Manual
handling guidance on regulations (L23) provides suitable approach on manual handling assessment.
The regulation requires employers to:
x Avoid the need for hazardous manual handling, so far as is reasonably practicable
x Assess the risk of injury from any hazardous manual handling that cannot be avoided
x Reduce the risk of injury from hazardous manual handling, so far as is reasonably practicable
Those responsible for carrying out the assessment must be competent to do so and be able to:
x Identify the hazards and assess the risks from the type of manual handling activity being carried out.
x Draw valid and reliable conclusions from the assessments and be able to identify appropriate steps
to reduce the risks.
x Make a clear record of the assessment and communicate its findings to those who are required to
take action, and to the workers concerned.
Risk Factors
A number of questions in several categories, including the task, the load, the working environment and
individual capability (often referred to as the ‘LITE factors’) facilitate an effective approach to risk assessment.
Load - Is the Load?

x Heavy – heavier loads will inevitably place greater stresses on the body
x Bulky / unwieldy – if the load is awkward to handle the risks of injury are increased.
x Difficult to grasp – e.g., if they are wet or rounded or without hand grips.
x Unstable or its contents liable to shift – movement of the load or its contents will place changing and
possibly unexpected stresses on the body.

x Hot, sharp or dangerous – these characteristics are likely to affect the grip and may make us hold
them away from the body, resulting in an increased risk of injury.
Individual - Does the Job?

x Require unusual strength, height, etc. – the task
should be suitable for the ‘normal’ working
population and not rely on height, strength, etc.
x Create a hazard to those who are pregnant or have
a health problem.
x Require special knowledge or training for its safe
performance.
Task - Does the Task Involve?

x Holding the load at a distance from the trunk – this increases the stresses on the lower back.
x Twisting the trunk – this should be avoided when lifting or supporting a load and is particularly harmful
if carried out when seated.
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x Stooping – this increases the stress on the lower back, which must support the weight of the upper
body as well as the load.
x Reaching upwards – this place higher stresses on the back, shoulders, and arms especially if the
reaching is prolonged or repetitive.
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x Excessive lifting or lowering distances – the ideal range for handling a load is around waist height.
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Lifting or lowering a load outside of this range requires greater physical effort.
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x Handling whilst seated – many movements from a seated position will inevitably involve a degree
of stooping and / or twisting, and the leg muscles do not assist with the movement placing high
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stresses on the lower back.
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x Excessive carrying distances – the risk of injury increases if a load is carried more than about 10m
even if the load is not difficult to handle itself.
x Excessive pushing or pulling of the load – the risk of injury is increased if the movement is jerky or
the pushing / pulling is carried out with the hands below knuckle height or above shoulder height.
x The Repetitive handling – this can pose a risk of injury even when the load is not particularly heavy
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or awkward.
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x Insufficient rest or recovery periods – this will result in physical and mental fatigue and is especially
problematic with repetitive tasks.
x Work rate imposed by a process – this is related to the above point where the worker has no
discretion over the speed of the activity.
x Team handling – although used to reduce some risks, team handling can introduce other risks,
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particularly in relation to good planning and co-ordination of the task.
Environment - Are There?

x Space constraints preventing good posture – such as restricted headroom or obstacles.
x Uneven, slippery or unstable floors – increase the risk of slipping or tripping whilst handling loads.
x Variations in levels of floors or workstations.
x Extremes of temperature or humidity - which cause rapid fatigue, impairment of grip and loss of
manual dexterity.
x Strong air movements – which will greatly increase the risk of injury when handling large loads.
x Poor lighting conditions – increase the risk of collision or tripping.
Additionally, any special clothing or personal protective equipment that needs to be worn need to be
considered so that they do not restrict safe movement and good posture.
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Psychosocial Factors
A ‘suitable and sufficient’ assessment should also consider psychosocial factors that may be present in the
workplace, such as tight deadlines or excessive workloads, and lack of control over the work and work NEBOSH
methods.
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Psychosocial risk factors can lead to stress and can contribute to the onset of musculoskeletal disorders.
Undesirable features of the work organisation include:
x Workers have little control over their work, work methods and shift patterns.
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x Workers are unable to make full use of their skills.

x Workers are not usually involved in decisions that affect them.
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x Workers are expected to carry out repetitive, monotonous tasks.

x Work is machine or system paced.
x Work demands are perceived as excessive.
x
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Payment systems encourage working too quickly or without breaks.
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Within some countries numerical guidelines exist for lifting and lowering, pushing and pulling, and seated
tasks. These guidelines may provide an initial filter to help identify those manual handling operations which
require a more detailed assessment.
Due to the wide range of individual physical capability, even among those fit and healthy enough to be at work
the guidelines should not be regarded as ‘safe’ levels. Even loads lying within the boundary mapped out by
the guidelines should be avoided or made less demanding wherever it is reasonably practicable to do so.
The guideline figures may be exceeded where a more detailed assessment shows that it is appropriate to do
so. However, even for the minority of fit, well-trained individuals working under favourable conditions, any
operations which would exceed the guideline figures by more than a factor of about two should come under
very close scrutiny.
For the general working population, the guideline figures will give reasonable protection to nearly all men and
between one half and two thirds of women.
The UK Guidelines for Lifting and Lowering

Basic guidelines for manual handling operations involving lifting and lowering are set out in Chart 2. The chart
is used to identify low-risk tasks. It is assumed that the load is can be easily grasped with both hands and
that the operation takes place in reasonable working conditions with the handler in a stable body position.
Chart 2: Lifting and Lowering simple risk filter
The guideline figures take into

consideration the vertical and horizontal
position of the hands as they move the
load during the handling operation, as well

as the height and reach of the individual

handler. It will be apparent that the
capability to lift or lower is reduced
significantly if, for example, the load is
held at arm’s length, or the hands press
above shoulder height.
If the hands enter more than one of the

box zones during the operation the
smallest weight figure should be used.
The transition from one box zone to
another is not abrupt; an intermediate
figure may be chosen where the hands
are close to a boundary. Where lifting or
lowering with the hands beyond the box
zones is unavoidable a more detailed
assessment should be made.
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Twisting
The basic guideline figures for lifting and lowering should be reduced if the handler twists to the side during
the operation. As a rough guide the figures should be reduced by about 10% where the handler twists through
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45° and by about 20% where the handler twists through 90°.
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Chart 3: Assessing Twist
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Controlling
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Frequent Lifting and Lowering
The basic guideline figures for lifting and lowering are for relatively infrequent operations - up to approximately
30 operations per hour - where the pace of work is not forced, adequate pauses for rest or recovery are
possible and the load is not supported for any length of time. They should be reduced if the operation is
repeated more frequently. As a rough guide the figures should be reduced by 30% where the operation is
repeated once or twice per minute, by 50% where the operation is repeated around five to eight times per
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minute and by 80% where the operation is repeated more than about 12 times per minute.
Guidelines for Carrying

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Basic guideline figures for manual handling operations involving carrying are similar to those given for lifting
and lowering, though carrying will not normally be carried out with the hands below knuckle height.
It is also assumed that the load is held against the body and is carried no further than about 10m without
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resting. If the load is carried over a longer distance without resting the guideline figures may need to be
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reduced.
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Where the load can be carried securely on the shoulder without first having to be lifted (as for example when
unloading sacks from a lorry) a more detailed assessment may show that it is acceptable to exceed the
guideline figure.
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Guidelines for Pushing and Pulling

The following guideline figures are for manual handling operations involving pushing and pulling, whether the
load is slid, rolled or supported on wheels.
The guideline figure for starting or stopping the load is a force of about 25 kg (i.e., about 250 Newtons). The
guideline figure for keeping the load in motion is a force of about 10 kg (i.e., about 100 Newtons) (see Chart
4).
It is assumed that the force is applied with the hands between knuckle and shoulder height; if this is not
possible the guideline figures may need to be reduced. No specific limit is intended as to the distance over
which the load is pushed or pulled provided there are adequate opportunities for rest or recovery.
Chart 4: Measuring Pulling Force
Guidelines for Handling While Seated

The basic guideline figure for handling operations carried out while seated is given in Chart 5 and applies only
when the hands are within the box zone indicated. I f handling beyond the box zone is unavoidable or, for
example, there is significant twisting to the side a more detailed assessment should be made.
Chart 5: Handling While Seated

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When to Do a More Detailed Assessment

A MAC/RAPP (or equivalent) or full risk assessment should be carried out when any of the following
conditions apply:
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x Lifting or lowering takes place outside the box zones, such as with very large forward reaches,
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lifting below floor level or lifting above head height
x The handling is more frequent than one lift every two minutes
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x The handling involves torso twisting
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x Team handling occurs
x The activities are complex (twisting, stretching and stooping)
x The load is difficult to grasp or handle
x Aspects of the working conditions are not favourable (space restriction, uneven floor, etc)
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x Carrying happens with the load not held against the body causing stress to lower back
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Use of Specific Assessment Tools
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Manual Handling Assessment Charts (MAC)
In the UK, the MAC Tool was originally designed to help HSE, and Local Authority inspectors assess manual
handling risks in the workplace; however, it can be used within organisations to facilitate the assessment of
manual handling operations. The tool and all its supporting guidance can be accessed at:
www.hse.gov.uk/msd/mac.
The MAC uses a numerical score and a traffic light approach to indicate the level of risk and can be used
to address three types of distinct operation:
x Single lifting operation
x Single carrying operation
x Team handling operation
The operations are divided into the different manual handling factors and presented as a flow chart. The
flow chart leads the user step-by-step, through each factor of the manual handling operation, enabling them
to evaluate and grade the degree of risk.
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Each operation is supported by an assessment guide or aide memoir. These discuss each factor of the
flow chart giving helpful pointers to assist in scoring the task being observed. To enable calculation of the
risk for the load and frequency of a lifting / carrying operation, a graph is supplied with the flow chart.
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The MAC is not appropriate for some manual handling operations, e.g., those that involve pushing and
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pulling, and it is not intended to assess risks from workplace upper limb disorders.
Additionally, the MAC alone does NOT constitute a full manual handling risk assessment. It does however
help to identify certain aspects of a manual handling task that need to be looked at more closely. It may
also help in prioritising a programme of necessary manual handling risk assessments.
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Variable manual handling assessment chart (V-MAC) tool

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The V-MAC is a tool for assessing manual handling operations where load weights vary. It should be used
in conjunction with the MAC tool.
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The MAC tool was designed for assessing handling operations where the same weight is handled over the
workday/shift. However, in practice, load weights are often variable (such as in order picking, parcel sorting,
trailer loading/unloading, and parts delivery in manufacturing). The V-MAC was developed to help assess
these kinds of jobs.
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HSE Art Tool

The Assessment of Repetitive Tasks (ART) is a tool designed to help assess repetitive tasks involving the
upper limbs. It assesses some of the common risk factors in repetitive work that contribute to the development
of upper limb disorders.
The ART tool is a method that helps to:

x Identify repetitive tasks that have significant risks and where to focus risk reduction measures
x Prioritise repetitive tasks for improvement
x Consider possible risk reduction measures
x Meet legal requirements to ensure the health and safety of employees who perform repetitive work
The ART tool uses a numerical score and a traffic light approach to indicate the level of risk for twelve factors.
These factors are grouped into four stages:
A. Frequency and repetition of movements
B. Force
C. Awkward postures of the neck, back, arm, wrist and hand
D. Additional factors, including breaks and duration
The factors are presented on a flow chart, which leads you, step-by-step, to evaluate and grade the degree of
risk. The tool is supported by an assessment guide, providing instruction to help you to score the repetitive
task you are observing. There is also a worksheet to record your assessment.
Practical Control Measures - Repetitive DSE work
Workstation Requirements
Illustration 65: Minimum Requirements for Workstations

There are a number of minimum requirements that all workstations are expected to meet.
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Table 27: Workstation Requirements
Workstation Requirements
1 Lighting
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Satisfactory for the type of work and visual requirements of the user.
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2 Contrast / glare Contrast between screen and background.
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Suitable screen positioning to prevent discomforting glare and reflections.
Controlling
3 Noise Able to hear and be heard at normal speech levels. No distractions.
4 Leg room See seating posture diagram (Illustration 65).
5 Window cover Window blinds, etc. must be provided where natural light causes glare or
reflections.
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Suitable for the task and easy to use. Adaptable to the working pace and
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6 Software
knowledge of the user. No performance monitoring without the operator’s
knowledge.
Information displayed in a suitable format and at a suitable pace.
Ergonomically sound.
7 Screen
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Large enough to enable information seen clearly.
Swivel and tilt easily and freely.
Height adjustable.
Adjustable brightness and contrast.
8 Keyboard Manufactured in accordance with relevant standards.

Separable from the screen.
Tiltable.
Legible, contrasted keys.
9 Work-surface Sufficient area to accommodate equipment.
10 Work chair Stable and comfortable.

Height adjustable.
Able to swivel.
Height / tilt adjustable backrest.
11 Footrest To be provided on request.
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Illustration 66: Seating and Posture for Typical Office Tasks
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Consider:
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1. Seat back adjust.

2. Good lumbar support.
3. Seat height adjust.
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4. No excess pressure under thighs.

5. Foot support if needed.
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6. Space for posture change.

7. Forearms horizontal.
8. Minimal extension, flexion or deviation of
wrists.
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9. Head position: screen.

10. Space for hand / wrist support.
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Work with Portable Display Screen Equipment

Portable DSE, such as laptops and notebook computers are subject to the DSE Regulations if in prolonged
use.
Some aspects of the design of portable DSE (such as smaller keyboards, integral screen and base, integral
mouse) may make it difficult to achieve a comfortable working posture.
As it is not practicable to carry out risk assessments for all the environments in which portable DSE is used, it
may be preferable to provide the users with sufficient training and information in order to make their own risk
assessment and control risks whenever they set up their portable. This assessment should be recorded, for
example, on a checklist if the portable is in lengthy or repeated use in the same location.
The employer should ensure that general risk assessments are carried out relating to the manual handling of
the equipment between locations, the possible risk to the users’ personal safety when carrying the equipment.
Practical points to consider when selecting a portable computer:

x Computer of minimal weight, e.g., 3kgs or less, and minimal accessories.
x Screen as large and clear as possible.
x Detachable or height-adjustable screen where possible.
x Long battery life to minimise the need to carry cables and transformer.
x Lightweight carrying case with handle and shoulder straps.
x Tilt-adjustable keyboards where possible.
x Facilities to use a docking station, external mouse or keyboard.
x Effective friction pads underneath portable to prevent sliding.
x Sufficient computer memory and speed to minimise use and reduce stress.
x Integral wrist-pad between keyboard and front edge of casing.
Work with a Mouse, Trackball, or other Pointing Device

The most common input devices other than the keyboard are the mouse and the trackball. These can be
referred to as ‘pointing devices’ and other types include joysticks, touch-pads and touch-screens.
The mouse will be the most suitable pointing device in most situations. However, an alternative device may
be more suitable in some situations or may be preferred by the user.
Selecting a Pointing Device


Factors to consider are as follows:
The environment in which it will be used:

x Adequate space.
x Suitable surface.
x Fixed stable surface.
Individual characteristics:
x Shape and size of the device.
x Suitable for left and/or right-handed use.
x Suitable for any physical limitation or condition.
Task characteristics:
x Amount of use of device.
x Speed and accuracy required.
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Using a Pointing Device

It is important to place the device towards the midline of the user’s body, to avoid the need to stretch the arm
out to the side. The upper arm should be relaxed and at the side of the body. The arm may be supported on
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the chair arm or work surface when using the device.
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Mouse mats should have a smooth surface and be large enough for the task. They should not have any
sharp or pronounced edges.
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The speed and sensitivity of the device should be set to suit the individual user.
Controlling
Periods of using a pointing device should be interspersed with other activities. Training users in alternative
methods can reduce intensive use of the device, e.g., use of keyboard shortcuts.
Users should be aware that it is better to remove their hand from the device when not actually using it to
avoid prolonged static postures.
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Pointing devices will need to be maintained and moving parts cleaned periodically. Users should be
provided with relevant training and instruction in the setting up and use of their pointing device.
Daily Work Routine of Users
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Employers should plan the activities of users at work so that their daily work on display screen equipment
is periodically interrupted by breaks or changes of activity.
Intensive work at a display screen can cause visual discomfort that may in turn lead to problems such as
headaches and even mental stress. Intensive keyboard use and static posture are contributory factors in
most incidences of work-related upper limb disorders.
Changes of Activity or Rest Breaks for Users

Breaking up long spells of display screen equipment work helps prevent fatigue and may prevent work
related upper limb problems. Where possible, employers should include spells of other work, e.g., telephone
calls, filing, photocopying, etc. in user’s work activities.
Otherwise, employers should plan for users to take breaks away from the screen if possible.
Those responsible for organising users work could consider some of the following ways of reducing health
risks to users:
x Vary the tasks to include other duties.
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x Educate users to stretch and change position periodically.
x Breaks should be taken before users are tired, rather than to recover.
x Short frequent breaks are better than longer, infrequent ones. NEBOSH
x
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Offering individual control over work patterns.
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x Users should be discouraged from working intensely for too long.

x Imposed rest breaks may sometimes be the only solution.
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Eyes and Eyesight

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Eye and eyesight tests are often undertaken to determine whether a user needs a corrective appliance
specifically for their display screen work.
Further tests may be carried out at appropriate regular intervals after the first test and in between if they are
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having visual difficulties which may reasonably be considered to be caused by their display screen
equipment work.
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Provision of Training
Employers should provide users with adequate health and safety training in the use of any workstation upon
which he or she may be required to work.
Training should address six inter-related aspects:

x The users’ role in the detection of hazards and risks.
x An explanation of the causes of risk and the mechanisms through which harm occurs.
x User initiated actions to bring identified risks under control.
x Arrangements for bringing concerns to management attention.
x Information on the workstation minimum requirements, eye tests and time management.
x The users’ contribution to the assessment process.
Further training for all users must be provided if the workstation is substantially modified. Furthermore, there
is an expectation that employers provide information on associated risks and control measures relating to the
use of display screen equipment.
Practical Control Measures - Manual Handling

For unavoidable manual handling operations, the employer must take appropriate steps to reduce the risk of
injury to employees, from manual handling operations to the lowest level reasonably practicable.
In deciding appropriate steps to reduce the risk of injury, it is usually convenient to again consider the task,
the load, the working environment and
individual capability. However, the extent to which any of these factors can be changed may differ between
different types of work.
Routine manual handling operations carried out in essentially unchanging circumstances (e.g., manufacturing
processes) may lend themselves particularly to improvement of the task and working environment.
Manual handling operations carried out in circumstances that change continually (e.g., construction sites) may
offer less scope for improvement of the task and working environment. In these situations, it may be more
appropriate to focus on the loads themselves such as making it easier to handle. Training of the workers will
be more important in these cases.
Mechanical Assistance

The use of mechanical aids usually involves some element of
manual handling but will reduce the forces required and allow more
efficient handling techniques. All handling aids must be well
maintained, and there should be a recognised procedure for
reporting faults and defects.
Organisation of the Work System,

Workstations, or Task
There are a variety of possible changes to the workstation or task that can reduce the risk of injury due to
manual handling:
x Changing the layout of a work area to reduce the need for carrying loads from one place to another.
x Placing large and awkward loads on shelves at or near to waist level.
x Avoiding the need to carry out handling tasks while seated.
x Positioning workbenches to avoid the need for twisting or stretching from one to the other.
x Flexible approaches to pauses and breaks from the task to prevent static postural stress and fatigue.
x Job rotation to reduce the risk to each individual of a task carried out frequently.
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x Establishing procedures whereby the task is carried out by two or more people working together as
a team. It should be noted however that team handling can introduce new hazards, and careful
planning and co-ordination between the team members is essential.
Additionally, changes to the overall organisation of the work may eliminate or reduce any
psychosocial risk factors identified such as reducing monotonous and repetitive tasks and setting
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reasonable work rates through realistic targets and deadlines.
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Changes to the Load
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The risk associated with manual handling can often be reduced by making relatively straight-forward changes
to the load itself. Examples include:
x Making the load lighter and / or smaller in size, e.g., by purchasing smaller units (although it should
be noted that this can increase the frequency of the task).
x
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Making the load easier to grasp, e.g., by placing the load in a rigid container or by the provision of
handholds and handles.
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x Ensuring that loads that are liable to move about during handling (e.g., liquids in containers, sacks
of powder) are placed tightly in containers or are handled with slings or similar to secure the load;
and
x Ensuring that wherever possible, loads are not hot, cold, sharp, etc., and where this is not possible,
that appropriate PPE is provided.
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Changes to the Working Environment
The working environment should be designed, constructed and maintained to maximise available space,
minimise unnecessary obstructions and hazards (e.g., closed doors, uneven floors) and where possible
ensure that operations can be conducted on the same level.
Lighting, temperature and ventilation must be suitable for the task and if the workplace is outside (e.g.,
construction site) procedures are required to stop manual handling activities under unsuitable weather
conditions.
Proper Design of Pushing and Pulling Tasks

Approximately two-thirds of push-pull accidents involve objects that were NOT supported on wheels, e.g.,
furniture.
Strategies to eliminate or reduce the risks associated with manually pushing or pulling loads should:
x Eliminate the need to push or pull by providing mechanical or other equipment. (E.g., conveyors
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(powered and non-powered); powered trucks; lift tables; or slides and chutes.
x Reduce the force required to push or pull by reducing the size of loads or providing equipment such
as wheeled trucks or dollies and conveyors and ensuring the maintenance of equipment and the NEBOSH
working environment.
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x Reduce the distance of the push or pull by relocating storage, and working areas, and improving
production process to eliminate unnecessary materials handling steps; and
x Optimise pulling and pushing techniques, e.g., replace pull with a push whenever possible; provide
variable-height handles with suitable hand grips.
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Proper Design of Lifting and Lowering Tasks

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The need to manually lift heavy or bulky objects, and reduce unnecessary bending, twisting and reaching
should be eliminated or reduced wherever possible by optimising material flow through the workplace;
providing mechanical equipment such as lift tables, vacuum systems, lift trucks and cranes; and reducing the
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weight of the load (or conversely increasing the weight so that it can only be lifted or lowered mechanically).
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Proper Design of Carrying Tasks

Carrying materials that are too heavy or too bulky are important factors associated with musculoskeletal strains
and sprains.
Wherever possible the need to carry should be eliminated, where this is not possible the weights to be carried
should be reduced by design or specification of the load itself or its container.
Reducing the bulk of materials to be carried and reducing travel distances are also effective means of reducing
risk.
Mechanical Handling
Mechanical aids vary from simple, manually operated tools to power assisted trucks and lifting devices.
All mechanical aids ‘lighten the load’ and make things more efficient - this can lead to fewer injuries and higher
productivity.
However, the use of handling aids can create different kinds of risks (vehicle and pedestrians coming into
contact with each other, exceeding the Safe Working Load (SWL) of lifting devices / accessories, traps, nips,
etc.).
Mechanical handling aids include:

x Simple tools to improve grip or increase leverage, such as lifting hooks, manhole cover lifters and
paving slab handlers.
x Trucks and trolleys, e.g., sack trucks, pallet trucks and roll cages.
x Lifting devices, such as a block and tackle improve mechanical advantage when lifting or lowering
loads manually. Powered hoists further reduce the amount of manual effort.
Information for Employees

Each employer should provide employees who are undertaking manual handling operations posing a risk of
injury with general indications and where it is reasonably practicable to do so, precise information on: the
weight of each load; and the heaviest side of any load whose centre of gravity is not positioned centrally.
Reviewing the Assessment

Assessments should be reviewed when they are no longer valid or there has been a significant change in the
manual handling operations to which they relate. It should also be reviewed if a reportable injury occurs.
Training, Clothing, and Individual Assessment NEBOSH International Diploma

In determining whether manual handling operations involve a
risk of injury, and in determining the appropriate steps to
reduce that risk, regard must be given to:
x The physical suitability of the employee to carry out

the operations.
x The clothing, footwear, or other personal effects he /
she is wearing.
x His / her knowledge and training.
x The results of any risk assessment.
x Whether the employee is within a group of employees
identified by the assessment as being especially at
risk.
x The results of any health surveillance.
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Physical Suitability of the Employee

An individual’s physical capability varies with age, typically declining after their early twenties. Older workers
may tire more easily and take longer to recover from injury. However, the range of individual capability is large,
and the benefits of experience and maturity should not be overlooked.
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Clothing, Footwear, or other Personal Effects
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Personal protective equipment (PPE) should not be compromised to make manual handling operations easier.
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All work clothing, including PPE should be well-fitting and restrict movement as little as possible. Footwear
should provide adequate support, a stable non-slip base and proper protection.
Knowledge and Training
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Workplace Health
Effective training has an important role to play and should be
considered as a key part of a safe system of work rather than as
a substitute for it. The provision of information and training alone
is unlikely to ensure safe manual handling.
Training should be appropriate to the particular type of work and
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the manual handling activities being carried out, and should
address:
x Recognition of hazards and how they may be

avoided.
x How to deal with unavoidable and unfamiliar handling
operations.
x The proper use of handling aids.
x The proper use of personal protective equipment.
x Environmental factors and their impact upon safety.
x The importance of appropriate housekeeping.
x Factors affecting individual capability; and
x Good handling technique.
Where workers have been given training, it is important to ensure

that their supervisors and managers are also aware of the good
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practices that have been recommended, and that they regularly
encourage the workforce to use the techniques they have been
taught.
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Employees Especially at Risk
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Particular consideration should be given to employees who are or have recently been pregnant, or who
are known to have a history of back, knee or hip trouble, hernia, etc., or have previously had a manual
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handling injury, and to young workers.
Careful assessment of the individual by an occupational health doctor or nurse is essential, as any
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additional measures aimed at reducing the risk of injury need to be specific to that individual.
Health Surveillance
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There are currently no known techniques to reliably detect early indications of ill-health caused by manual
handling, and therefore specific health surveillance does not need to be carried out for workers carrying out
manual handling tasks.
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Duty of Employees
All employees should make full and proper use of any system of work provided by the employer.
This relates to the employees’ general duties to co-operate with the employer and requires employees to
follow appropriate systems of work laid down by their employer to promote safety during the handling of loads.
Flowchart 6: Manual Handling chart

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Good Handling Techniques: Basic Principles

Introduction
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Training will inevitably support any efforts to reduce the risk of injury from manual handling. Training
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employees in the efficient use of the human body, together with ergonomic assessment and improvement
of tasks, and the introduction of mechanical assistance will collectively reduce the stresses upon the back
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and hence the risk of injury.
Controlling
Two-Handed Symmetrical Lifting
Plan the lift. Where is the load going to be placed? Use appropriate handling aids if possible. Do you need
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help with the load? Remove obstructions such as discarded wrapping materials.
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Think about the best way of lifting the load. For a long lift - such as floor to shoulder height – consider
resting the load mid-way on a table or bench to change grip.
Keep the Load Close to Your Waist
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Keep the load close to the trunk for as long as possible. The distance of the load from the spine at waist height
is an important factor in the overall load on your spine and back muscles. Keep the heaviest side of the load
next to your body. If a close approach to the load is not possible, try sliding it towards you before attempting
to lift it.
Adopt a Stable Position

Have the feet slightly apart with one leg slightly forward to help maintain balance (alongside the load if it is on
the ground). Be prepared to move your feet during the lift to maintain a stable posture.
To Ensure a Good Hold on the Load

Hug it close to the body if possible. This may be better than gripping it tightly only with your hands.
At the start of the lift, moderate flexion (slight bending) of the back, hips and knees is preferable to fully flexing
the back (stooping) or the hips and knees (squatting).
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Don’t Flex Your Back any Further as you Lift
This can happen if you begin to straighten your legs before starting to raise the load.
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Avoid Twisting the Trunk or Leaning Sideways especially while the Back
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is Bent.
Keep shoulders level and facing in the same direction as the hips. Turning (by moving the feet) after lifting
is better than twisting and lifting at the same time.
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Keep Your Head Up When Handling

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Look ahead, not down at the load once you have grasped it and secured it.
Move Smoothly
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Try not to jerk or snatch at the load as this can make it harder to keep control of the load and can increase
the risk of injury.
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Don’t Lift or Handle More than you Lifting from a Container

can Easily Manage Getting the load as close as possible to the body is
There is a difference between what you can lift more important than avoiding all but complete
and what you can safely lift. If in doubt, seek flexion (stooping) or bending the knees. If safe to
advice or get help. do so, leaning (bracing) against the side of the
container will be beneficial. Bending the knees and

twisting to the side is not to be advocated. Placing
Put Down, Then Adjust one foot in the container results in a period of
standing on one leg whilst holding the load and
If precise positioning of the load is necessary, put should therefore be avoided.
it down first then slide it into the desired position
Lifting in Limited Headroom

Other Forms of Lifting and Carrying Except in extremely limited headroom where
The principles for good (safe) manual handling complete flexion would be necessary, stoop lifting,
determined for two-handed symmetrical lifting are following the other principles as much as possible is
fundamental principles that are equally valid in other preferable to kneeling.
forms of lifting.
Lifting Whilst Seated
However, it is not always possible to follow all of
these principles. Because, when seated, movements such as
twisting, leaning forwards or lateral bending all
The key principles are ‘plan the task’, ‘minimise the primarily involve the spine (unlike standing where,
horizontal distance’ (keep the load close to the for example, some hip rotation is possible with
body) and ‘get a secure hold’. twisting) then adherence to the basic principles is
even more important. There is evidence that use of
The following sections give some guidance on a backrest can reduce the load on the spine when
priorities in different forms of handling. lifting. This would seem to be in addition to the
constraints imposed on undesirable movements by
using the backrest.
One-Handed Lifting
When lifting in front of the body, lifting with two Lifting Light Loads from Low Down
hands is preferred. However, if lifting to the side is
unavoidable then lifting with the hand on that side is Bending the knee to lift light loads, particularly in a
preferable to twisting to use both hands. repetitive manner, is believed to place
disproportionate loading on the knees in relation to
the extent of any risk. The basic principle of
Large Bulky Loads moderate flexion in back, hips and knees and the
Keeping the load close to the body is more exhortation to avoid extreme flexion of any joint are
important than bending the knees. However, the equally valid here and should enable a suitable
instruction to avoid extreme flexion is still valid. technique to be adopted.
Large, Flat Vertical Loads Carrying Loads

Lifting the load with two hands at the side of the Discomfort and fatigue present reasonable early
warnings of excessive local loading and possible
body involves twisting and lifting which should be
avoided, even though it may allow the knees to be injury risk. Techniques that minimise local muscle
bent. fatigue and other body part loading (e.g., straps on
shoulders) should be considered, as should
Such loads should be lifted in front of the body, systems of work that allow changes in carrying
stooping slightly if necessary. If the load is to be technique.
carried any distance, lifting in this manner and then
moving the load round to the side is preferable to
lifting at the side. Team Lifting
Planning the lift and having a good hold are vitally
important in team lifting. Where the characteristics
of the load and the lifting environment permit,
adherence to the principles for two-handed
symmetrical lifting will optimise the technique.
Where the nature of the load precludes the use of
this technique then the guidance appropriate to the
nature of the load should be applied.
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9.15 Workplace Temperature and Welfare

Arrangements
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Maintaining Body Heat Balance
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Ordinarily the body remains at a constant temperature of 37°C. It is very important that this body
Controlling
temperature be maintained and, since there is a continuous heat gain from internal body processes, there
must also be a continuous loss to maintain body heat in balance. Excess heat must be absorbed by the
surrounding air or lost by radiation. As the temperature and humidity of the environment vary, the human
body automatically regulates the amount of heat it gives off. However, the body’s ability to adjust to varying
environmental conditions is limited. Furthermore, although the body may adjust to a certain (limited) range
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of atmospheric conditions, it does so with a distinct feeling of discomfort. The following discussion will help
you understand how atmospheric conditions affect the body’s ability to maintain a heat balance.
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Body Heat Gains
The human body gains heat (1) by radiation, (2) by convection, (3) by conduction, and (4) as a byǦ
product
of the physiological processes that take place within the body (for example, the conversion of food into
Health Issues
energy). Heat gain from radiation comes from our surroundings. However, heat always travels from areas
of higher temperature to areas of lower temperature. Therefore, the human body receives heat from those
surroundings that have a temperature higher than body surface temperature. The greatest source of heat
radiation is the sun.
Some sources of indoor heat radiation are heating devices, operating machinery, and hot steam piping.
Heat gain from conviction comes only from currents of heated air. Such currents of air may come from a
galley stove or an operating diesel engine.
Heat gain from conduction comes from objects with which the body comes in contact. Most body heat
comes from within the body itself. Heat is produced continuously inside the body by the oxidation of food,
by other chemical processes, and by friction and tension within muscle tissues.
Body Heat Losses

There are two types of body heat losses: loss of sensible heat and loss of latent heat. Sensible heat is
given off by (1) radiation, (2) convection, and (3) conduction. Latent heat is given off by the breath and by
evaporation of perspiration.
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Heat Gain and Loss
Other factors that affect bodily heat gain and loss are:
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x The metabolic rate.

x The type of clothing worn.
x The duration of exposure.
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An individual’s metabolic rate of an individual is governed largely by his / her activity or work rate. Work
rates tend to be self-regulating as workers will voluntarily reduce their work rate when they feel overheated.
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For the human body, there are three different components which influence the rate of heat transfer, the
insulation factors of the skin tissues, clothing, and the air. An arbitrary unit of insulation, the Clo, is used for
assessing the insulation value of ‘clothing assemblies. Clothing assemblies have varying resistances to
heat flow.
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Table 28: Examples of Typical Clothing Insulation Values

Type of Clothing Id (Clo)

Nude 0
Shorts only 0.1
Summer clothing 0.5
Suit 1.5
Winter clothing (coat, gloves, etc) 2.0
Specialist thermal clothing 3 to 5
Heat Balance Equation M=K+/-C+/-R+/-E
To maintain a steady flow of heat from the human body's core at 37 C to the environment, the skin should
have a temperature of about 33 C. A rise in M means various physical processes have to come into play to
maintain the skin temperature, primarily the removal of clothing and sweating. If heat outputs are greater, the
core body temperature will fall – heating and warm clothing required.
The human heat balance equation involves the following processes
Heat generation in the body

Heat storage
Heat transfers
The heat balance equation is presented in several formats, one of which is as follows:
M = K + or – C + or – R + or – E or – S
M – rate of metabolic heat production

K – rate of heat exchange by conduction
C – rate of heat exchange by convection
R – rate of heat exchange by radiation
E – rate of heat exchange by evaporation
S – rate of heat storage
For E, R, C, K and S a positive value is heat loss and a negative value is heat gained. M is always a positive
value representing a heat creation.
If the body heat balance is at a constant temperature the rate of heat storage (S) is zero. If there is a net heat

gain, the storage (S) is positive, and the body temperature will rise. If the body temperature falls, storage (S)
will be negative.
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Health Effects of Working in Extreme Thermal

Environment
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Exposure to Hot Environment
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The body reacts to heat by increasing the blood flow to the skin’s surface, and by sweating. This results in
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cooling as sweat evaporates from the body’s surface and heat is carried to the surface of the body from within
by the increased blood flow. Heat can also be lost by radiation and convection from the body’s surface.
Controlling
Typical symptoms include:
• An inability to concentrate.
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• Muscle cramps.
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• Heat rash.
• Severe thirst - a late symptom of heat stress.
• Fainting.
• Heat exhaustion - fatigue, dizziness, nausea, headache, moist skin; and
• Heat stroke - hot dry skin, confusion, convulsions and eventual loss of consciousness. This is the
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most severe disorder and can result in death if not detected at an early stage.
Health Effects of Exposure to Hot and Humid Conditions

Someone wearing protective clothing and performing heavy work in hot and humid conditions could be at
risk of heat stress because:
• Sweat evaporation is restricted by the type of

clothing and the humidity of the environment.
• Heat will be produced within the body due to the
work rate and, if insufficient heat is lost, deep body
temperature will rise.
• As deep body temperature rises the body reacts
by increasing the amount of sweat produced,
which may lead to dehydration.
• Heart rate also increases which puts additional
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strain on the body.
• Should the body gain more heat than it can lose
the deep body temperature will continue to rise. NEBOSH

Eventually it reaches a point when the body’s
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control mechanism itself starts to fail. The

symptoms will worsen the longer they remain
working in the same conditions.
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Health Effects of Exposure to Cold

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The effect of exposure to low temperatures is to cause a nerve reaction causing vascular constriction of the
skins blood vessels. This restriction has the effect of increasing the body surface insulation. This also has
the effect of increasing the arterial blood pressure. Skin temperature gradually falls and the increased
insulation of the shell of the body maintains deep body temperature, but with more prolonged cold stress
internal heat production may then increase. This is brought about by an involuntary reflex increasing muscle
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tone that eventually results in shivering. During bursts of intense shivering total oxygen consumption can
increase by up to 5 times the basal level.
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Toes, fingers, ears, and nose are at greatest risk because these areas do not have major muscles to
produce heat. In addition, the body will preserve heat by favouring the internal organs and thus reducing
the flow of blood to the extremities under cold conditions. Hands and feet tend to get cold more quickly than
the torso because:
• They lose heat more rapidly since they have a higher surface area-to-volume ratio.
• They are more likely to be in contact with colder surfaces than other parts of the body.
If the eyes are not protected with goggles in high wind chill conditions, the corneas of the eyes may freeze.
The most severe cold injury is hypothermia which occurs from excessive loss of body heat and the
consequent lowering of the inner core temperature (internal temperature of the body). Hypothermia can be
fatal and is caused when body’s core temperature starts to fall.
The sensation of cold followed by pain in exposed parts of the body is one of the first signs of mild
hypothermia. As the temperature continues to drop or as the exposure time increases, the feeling of cold
and pain starts to diminish because of increasing numbness. If no pain can be felt, serious injury can occur
without the victim noticing it. Next, muscular weakness and drowsiness are experienced. This condition is
called hypothermia and usually occurs when body temperature falls below 33°C. Additional symptoms of
hypothermia include interruption of shivering, diminished consciousness and dilated pupils. When body
temperature reaches 27°C, coma (profound unconsciousness) sets in. Heart activity stops around 20°C
and the brain stops functioning around 17°C.
Other Effects of Exposure to Extremes of Cold
Chilblains
These are a mild cold injury caused by prolonged
and repeated exposure for several hours to cold
air temperatures. In the affected skin area there
will be redness, swelling, tingling, and pain.
Immersion foot
This occurs in individuals whose feet have been
wet, but not freezing cold, for days or weeks. It
can occur at temperatures up to 10°C. The
primary injury is to nerve and muscle tissue.
Symptoms include tingling and numbness; itching,
pain, swelling of the legs, feet, or hands; or blisters may develop. The skin may be red initially and turn to
blue or purple as the injury progresses. In severe cases, gangrene may develop.
Trench foot NEBOSH International Diploma

This is ‘wet cold disease’ resulting from prolonged exposure in a damp or wet environment from above the
freezing point to about 10°C. Depending on the temperature, an onset of symptoms may range from several
hours to many days, but the average is three days. Trench foot is more likely to occur at lower temperatures,
whereas an immersion foot is more likely to occur at higher temperatures and longer exposure times. A similar
condition of the hands can occur if a person wears wet gloves for a prolonged period under cold conditions
described above. Symptoms are similar to an immersion foot.
Frostnip
This is the mildest form of a freezing cold injury. It occurs when ear lobes, noses, cheeks, fingers, or toes are
exposed to the cold and the top layers of a skin freeze. The skin of the affected area turns white, and it may
feel numb. The top layer of skin feels hard, but the deeper tissue still feels normal (soft).
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Frostbite
This is a common injury caused by exposure to extreme cold
or by contact with extremely cold objects (especially those
made of metal). It may also occur in normal temperatures
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from contact with cooled or compressed gases. Frostbite
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occurs when tissue temperature falls below the freezing
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point, or when blood flow is obstructed. Blood vessels may
be severely and permanently damaged, and blood circulation
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may stop in the affected tissue. In mild cases, the symptoms
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include inflammation of the skin in patches accompanied by
slight pain. In severe cases, there could be tissue damage
without pain, or there could be burning or prickling
sensations resulting in blisters. Frostbitten skin is highly
susceptible to infection, and gangrene (local death of soft
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tissues due to loss of blood supply) may develop.
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Parameters affecting thermal comfort:
The most commonly used indicator of thermal comfort is air temperature – it is easy to use, and most people
can relate to it. However, air temperature alone is not a valid or accurate indicator of thermal comfort or thermal
stress. It should always be considered in relation to other environmental and personal factors.
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The six factors affecting thermal comfort are both environmental and personal. These factors may be
independent of each other, but together contribute to an employee's thermal comfort.
Environmental factors
Air temperature
This is the temperature of the air surrounding the body. It is usually given in degrees Celsius (°C).
Radiant temperature
Thermal radiation is the heat that radiates from a warm object. Radiant heat may be present if there are
heat sources in an environment.
Radiant temperature has a greater influence than air temperature on how we lose or gain heat to the
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environment.
Examples of radiant heat sources include: the sun; fire; electric fires; ovens; kiln walls; cookers; dryers; hot
surfaces and machinery, molten metals etc.
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Air velocity
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This describes the speed of air moving across the employee and may help cool them if the air is cooler than
the environment.
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Air velocity is an important factor in thermal comfort for example:

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• Still or stagnant air in indoor environments that are artificially heated may cause people to feel
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stuffy. It may also lead to a build-up in odour

• Moving air in warm or humid conditions can increase heat loss through convection without any
change in air temperature
• Physical activity also increases air movement, so air velocity may be corrected to account for a
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person's level of physical activity

• Small air movements in cool or cold environments may be perceived as a draught as people are
particularly sensitive to these movements
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Humidity
If water is heated and it evaporates to the surrounding environment, the resulting amount of water in the air
will provide humidity.
Relative humidity is the ratio between the actual amount of water vapour in the air and the maximum amount
of water vapour that the air can hold at that air temperature.
Relative humidity between 40% and 70% does not have a major impact on thermal comfort. In workplaces
which are not air conditioned, or where the weather conditions outdoors may influence the indoor thermal
environment, relative humidity may be higher than 70%. Humidity in indoor environments can vary greatly
and may be dependent on whether there are drying processes (paper mills, laundry etc) where steam is
given off.
High humidity environments have a lot of vapour in the air, which prevents the evaporation of sweat from
the skin. In hot environments, humidity is important because less sweat evaporates when humidity is high
(80%+). The evaporation of sweat is the main method of heat reduction.
When non-breathable vapour-impermeable personal protective equipment (PPE) is worn, the humidity
inside the garment increases as the wearer sweats because the sweat cannot evaporate. If an employee is
wearing this type of PPE (e.g., asbestos or chemical protection suits etc) the humidity within the PPE will
be high.
Personal factors
Clothing insulation
Thermal comfort is very much dependent on the insulating effect of clothing on the wearer.
Wearing too much clothing or PPE may be a primary cause of heat stress even if the environment is not
considered warm or hot.
If clothing does not provide enough insulation, the wearer may be at risk from cold injuries such as frostbite
or hypothermia in cold conditions.
Clothing is both a potential cause of thermal discomfort as well as a control for it as we adapt to the climate in
which we work. You may add layers of clothing if you feel cold or remove layers of clothing if you feel warm.
Many companies inhibit this ability for employees to make reasonable adaptations to their clothing as they
require them to wear a specific uniform or PPE.
It is important to identify how the clothing contributes to thermal comfort or discomfort. By periodically
evaluating the level of protection provided by existing PPE and evaluating newer types of PPE you may be
able to improve the level of thermal comfort.
Work rate/metabolic heat
The more physical work we do, the more heat we produce. The more heat we produce, the more heat needs
to be lost so we don't overheat. The impact of metabolic rate on thermal comfort is critical.
A person's physical characteristics should always be borne in mind when considering their thermal comfort,
as factors such as their size and weight, age, fitness level and sex can all have an impact on how they feel,
even if other factors such as air temperature, humidity and air velocity are all constant.
Sweat Production
High heat and sweat production during work periods, leading to increased sweat accumulation, will give higher
thermal discomfort ratings for rest periods as well as for work periods compared to intermittent work with lower
work intensities. The extremities are much more sensitive to thermal discomfort from wetness than the trunk
of the body.
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Duration of Exposure
Thermal discomfort increases with exposure time.
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Using Wet Bulb Globe Temperature (WBGT) Index
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There are a number of indices of increasing complexity. In principle, these are calculated from a
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combination of environmental / physiological parameters to give a single number. This number is then
compared with a table of limiting values which will indicate the maximum time that the person should work
under this heat stress.
Corrected Effective Temperature Index (CET) can be obtained from a chart and takes into account work
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rate and clothing.
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Wet Bulb Globe Temperature Index (WBGT) calculated as follows:
• INDOORS: WBGT = 0.7 x Wet Bulb Temp + 0.3 x Globe Temp.

• OUTDOORS: WBGT = 0.7 x Wet Bulb Temp + 0.2 x Globe Temp + 0.1 x Dry Bulb.
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The duration of exposure can be varied by work / rest regimes.
Table 29: WBGTs (°C) and Recommended Work / Rest Regimes
Workload (Total)
Light Moderate Heavy
Continuous 30.0 26.7 25.0

75% work, 25% rest each hour 30.6 28.0 25.0
Table 29 illustrates how the WBGT can be used to set work / rest regimes. For example, at a WBGT of
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30°C, an individual could undertake light work continuously, but if heavy work was involved, he / she could
only maintain it for 25% of the time in any hour.
Example of WBGT in Use NEBOSH

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If the following workplace parameters are measured in an indoor workplace:

x Air temperature = 26o C
x Globe Temperature = 27.50 C
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x Wet-bulb temperature = 190 C

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x Continuous heavy manual work

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The WBGT = 0.7 WB + 0.3 GT

= (0.7 x 19) + (0.3 x 27.5) = 13.3 + 8.25 = 21.550C
Looking in the table above, the WBGT reference value for Heavy continuous work is 25 and so it can be
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concluded that the heat stress is not a risk in this environment
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Practical Control Measures to Minimise the Risks when

Working in Extreme Thermal Environment
There is a range of factors to consider when developing appropriate controls for extremes of temperature.
The following control strategies are recommended:

x If possible, remove or reduce the sources of heat.
x Control the temperature using engineering solutions, e.g., building design the most effective way
of ensuring thermal comfort is to design the workplace appropriately.
A number of issues can be addressed as follows:

x Heating. Many types of heating are available such as hot air heated by gas or oil burners, central
heating by steam heat circulated through radiators, combined heating and ventilating systems
where the air-conditioning system is used to heat air, which is then circulated, electric heaters,
floor heating or overhead radiant heating from gas or electric.
x Air Movement. Small personal fans can provide a refreshing movement of air on the face and
larger oscillating fans can provide a swirling air movement, although some people find this
‘draughty’. Large diameter fans suspended from the ceiling can provide a swirling air movement
that is effective over wide areas. Exhaust fans mounted in the roofs and walls are useful for
removing heated air, however, whilst improving general air movement they may have little effect
on thermal comfort.
x Air-Conditioning. This can range from small units that lower the air temperature but do not control
humidity levels or air movement, to large units that can cope with extreme conditions, and also
control humidity and air movement.
x Evaporative Cooling. These produce a moderate reduction in air temperature and increase
humidity. They operate by passing hot air over water-saturated pads and the water evaporation
effect reduces the dry-bulb temperature.
x Regulate the length of exposure to hot environments by:
- Allowing workers to enter only when the temperature is below a set level or at cooler times of
the day.
- Issuing permits-to-work that specify how long your workers should work in situations where
there is a risk.
- Providing periodic rest breaks and rest facilities in cooler conditions.
x Prevent dehydration. Working in a hot environment causes sweating which helps keep people
cool but means losing vital water that must be replaced. Provide cool water in the workplace and
encourage workers to drink it frequently in small amounts before, during and after working.
x Provide personal protective equipment. Specialised personal protective clothing is available
which incorporates, for example, personal cooling systems or breathable fabrics. This may help
protect workers in certain hot environments. Protective clothing or respiratory protective

equipment is often required when there will be exposure to some other hazard at work, e.g.,

asbestos. This type of equipment, while protecting from the other hazard, may increase the risk
of heat stress.
x Thermal Insulation. There are many different types of thermal insulation materials such as loose
fills, foams, rock wool and boards. The material acts as a barrier that retards heat flow in the
summer and heat loss in the winter. It is only effective where there is a temperature difference
between the inside and the outside of the building or between two areas inside a building.
x Provide training, especially new and young employees, telling them about the risks of heat stress
associated with their work, what symptoms to look out for, safe working practices and emergency
procedures.
x Allow workers to acclimatise to their environment and identify which workers are acclimatised /
assessed as fit to work in hot conditions.
x Identify employees who are more susceptible to heat stress either because of an illness / condition
or medication that may encourage the early onset of heat stress, e.g., pregnant women or those
with heart conditions.
x Monitor the health of workers at risk. Where it is considered that a residual risk remains after
implementing as many control measures as practicable, the health of workers exposed to the risk
may need to be monitored.
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x Clothing. When working in hot environment, lightweight and loose clothing; furnace work uses
of metallic reflective overalls. Ensure that workers are not wearing more / or less clothing than
required.
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Welfare Facilities and Arrangements in Fixed and
Temporary Workplaces
The Need for Workplace Lighting

Lighting should be sufficient to enable people to work, use facilities and move from place to place safely
and without experiencing eye-strain. Stairs should be well lit in such a way that shadows are not cast over
the main part of the treads. Where necessary, local lighting should be provided at individual workstations
and at places of particular risk such as pedestrian crossing points on vehicular traffic routes.
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Increasingly, over the last decade or so, employers have come to appreciate that indifferent lighting is both
bad economics and bad ergonomics, not to mention potentially bad industrial relations. Conversely, good
lighting uses energy efficiently and contributes to general workforce morale and profitability – that is,
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operating costs fall whilst productivity and quality improve. Alternatively, poor and indifferent lighting reduce
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efficiency, thereby increasing the risk of stress, denting workforce morale, promoting absenteeism and
leading to accidents, injuries and even deaths at work.
Ideally, good lighting should guarantee:

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x Employee safety.
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x Acceptable job performance.

x
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Good workplace atmosphere, comfort and appearance.
This is not just a matter of maintaining of correct lighting levels. To accommodate these ‘requirements’, a
combination of general and localized lighting (not to be confused with ‘local’ lighting, e.g., desk light) is
necessary.
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Natural Lighting
Daylight is the natural, and cheapest, form of lighting, but it has only limited application to places of work
where production is required beyond the hours of daylight. However good the outside daylight, windows can
rarely provide adequate lighting alone for the interior of large floor areas. Single storey buildings can, of
course, make use of insulated opaque roofing materials, but the most common provision of daylight is by
side windows. There is also the fact that the larger the glazing area of the building, the more other factors
such as noise, heat loss in winter, and unsatisfactory thermal conditions in summer must be
considered.
Modern conditions, where the creation of pleasant building interior environment requires the balanced
integration of lighting, heating, air conditioning, acoustic treatment, etc. are such that lighting cannot be
considered in isolation. At the very least, natural lighting will have to be supplemented for most of the time
with artificial lighting, the most common source for which is electric lighting.
Artificial Lighting
Capital costs, running costs and replacement costs of various types of electric lighting have a direct bearing
on the selection of the sources of electric lighting for particular application. Such costs are as important
considerations as the size, heat and colour effects required of the lighting. The efficiency of any type of lamp
used for lighting is measured as light output, in lumens per watt of electricity.
In general, the common incandescent lamps (coiled filament lamps, the temperature of which is raised to
white heat by the passage of current, thus giving out light) are relatively cheap to install but have relatively
expensive running costs. A discharge or fluorescent lighting scheme (which works on the principle of electric
current passing through certain gases and thereby producing an emission of light) has higher capital costs
but higher running efficiency, lower running costs and longer lamp life. In larger places of work the choice
is often between discharge and fluorescent lamps.
Lighting Design
While the quantity of lighting afforded to a particular
location or task in terms of standard service
illuminance is an important feature of lighting
design, it is also necessary to consider the
qualitative aspects of lighting, which have both
direct and indirect effects on the way people
perceive their work activities and dangers that may
be present. The presence or absence of glare, the
distribution of the light, brightness, diffusion and
colour rendition affects the quality of lighting.
Health and Safety Aspects of Lighting

Flicker
Light modulation at lower frequencies (about 50 Hz or less) which is visible to most people, is called flicker.
Flicker is a source of both discomfort and distraction and may even cause epileptic seizures in some people.
Sensitivity to flicker varies widely between individuals.
The perceptibility of flicker is influenced by the frequency and amplitude of the modulation and the area of
vision over which it occurs. The eye is most sensitive to flicker at the edge of the field of view thus visibly
flickering overhead lights can be a source of great discomfort.
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Veiling Reflections
Veiling reflections are high-luminance reflections that overlay the detail of the task. Such reflections may be
sharp-edged or vague in outline, but regardless of form they may affect task performance and cause
discomfort. Task performance will be affected because veiling reflections usually reduce the contrast of a
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task, making task details difficult to see, and may give rise to discomfort, e.g., reflections on a DSE screen.
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Radiation
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All light sources radiate energy at shorter wavelengths in the ultra-violet as well as at longer wavelengths in
the infrared parts of the spectrum. This radiation can promote physiological effects that are either a benefit
or a hazard.
Occupational
Lasers
Workplace Health
The narrow beam of light produced by lasers can focus on the retina to cause severe burns. Since some
lasers operate at non-visible frequencies, the eye may not have the natural protection of the blink response.
Health Issues
The Impact of Lighting Levels on Safety Issues
The employer has a duty of care to provide suitable and sufficient lighting in the workplace. Lighting from
natural and/or artificial sources needs to be provided for employees to ensure working conditions that are
appropriate to the nature of the work, the location of the work and the times at which the work is performed.
People see differently at different light levels. Some common issues related to lighting levels include:
Incorrect Perception
Deterioration of visual acuity. For example, visual fatigue, glare, falls resulting from level changes which
are not apparent.
Failure to Perceive
Increased likelihood of accidents caused by incorrect perception. For example, slips, trips and falls, vehicle
collision, etc.
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Stroboscopic Effect
One aspect of lighting quality that formerly gave trouble was the stroboscopic effect of fluorescent tubes
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that gave the illusion of motion or even the illusion that a rotating part of machinery was stationary. With
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modern designs of fluorescent tubes, this effect has largely been eliminated.
Colour Rendition
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Colour rendition refers to the appearance of an object under a specific light source, compared to its colour
under a reference illuminant, e.g., natural light. Good standards of colour rendition allow the colour
appearance of an object to be properly perceived. Generally, the colour rendering properties of luminaires
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should not clash with those of natural light and should be just as effective at night when there is no daylight
contribution to the total illumination of the working area.
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The Effects of Brightness Contrast

Glare is a visual sensation caused by excessive brightness.
Disabling and Discomfort Glare

This is the effect of light that causes impaired vision or discomfort experienced when parts of the visual field
are excessively bright compared with the general surroundings. Older people are usually more sensitive to
glare due to the aging characteristics of the eye.
Glare can be experienced in three different forms:
x Disability glare: Disability glare is the reduction in visibility caused by intense light sources.
Example: The visually disabling effect caused by bright bare lamps directly in the line of vision at
night or from a car with its lights on full beam.
x Discomfort glare: This is where there is too much contrast of brightness between an object and its
background and is frequently associated with poor lighting design. It can cause discomfort without
necessarily impairing the ability to see detail. Over a period, it can cause visual fatigue, headaches
and general fatigue.
x Reflected glare – This is the reflection of bright light sources on shiny or wet work surfaces, such
as plated metal or glass, which can conceal the detail in or behind the object that is glinting.
Tissue Damage from Light Exposure

Excessive exposure to the lowest wavelengths of UV light can damage the eyes, affecting surface tissues
and internal structures, such as the cornea and lens. Blue light (380-480 nm) can cause damage to the
retina.
Snow Blindness (Photo keratitis): A temporary but painful burn to the cornea caused by reflections off of
snow, water, or concrete; or exposure to artificial light sources such as tanning beds. Sustained exposure
could result in cataracts.
Natural light (sunlight) can cause damage to the skin. Damage includes sunburn, skin cancers, wrinkling and
premature skin aging, and possibly allergic reactions and worsening of existing skin diseases.
Visual Fatigue
Visual fatigue adversely affects focusing resulting in blurred vision and a feeling of discomfort which could
lead to reduction in productivity and the ability of the person to concentrate. It is caused by spending extended
hours in close-range activities such as computer work, e-books, and even hand-held gaming.
Visual fatigues can be controlled by improving the working environment:

x Reduce screen glare, but only use anti-glare screen filters as a last resort (as these will reduce

contrast and hinder reading).
x Ensure the field of vision doesn’t include a window or any source of direct light, to minimise glare.
x Use blinds or curtains to prevent screen glare.
x Ceiling lights should have shades or grids to deflect the light.
x Take regular breaks and switch between different tasks to prevent eye strain.
The Technical Measurement of Illuminance

The standard of illuminance (i.e., the amount of light) required for a given location or activity depends on a
number of variables, including general comfort considerations and the visual efficiency required. The unit of
illuminance is the ‘lux’, which equals one lumen per square metre. This unit has replaced the ‘foot candle’
which was the number of lumens per square foot. The term ‘lumen’ is the unit of luminous flux, describing the
quantity of light received by a surface or emitted by a source of light.
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Light Measuring Instruments

Measurement at a particular working point requires a reliable instrument.
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Such an instrument, suitable for most measurements, is a pocket light meter that incorporates the principle of
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This current deflects a pointer on a graduated scale measured in lux.
Manufacturers’ instructions should, of course, be followed in the care and use
of such instruments.
Occupational
Workplace Health
Average Illuminance and Minimum Measured Illuminance
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Illuminance levels need to be related to the degree or extent of detail that needs to be seen in a particular task
or situation. Various guidance exists, identifying recommendations both for average illuminance for the work
area as a whole and for minimum measured illuminance at any position within it.
As the illuminance produced by any lighting installation is rarely uniform, the use of the average illuminance
figure alone could result in the presence of a few positions with much lower illuminance that pose a threat
to health and safety. The minimum measured illuminance is therefore the lowest illuminance permitted in
the work area taking health and safety requirements into account.
The planes on which the illuminances should be provided depend on the layout of the task. If predominantly
on one plane, e.g., horizontal, as with an office desk, or vertical, as in a warehouse, the recommended
illuminances should be provided for that plane. Where there is either no well-defined plane or more than
one, the recommended illuminances should be provided on the horizontal plane and care taken to ensure
that the reflectance of surfaces in working areas are high.
Assessing Lighting levels in the Workplace
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The following factors need to be considered when assessing if lighting is sufficient in the workplace.
Tasks to be done NEBOSH

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The amount of light a worker needs depends on the tasks to be done. For example: detailed work such as
making diamond polishing, requires lighter than less visually demanding tasks such as general office work.
Task performed during the day may have a different light requirement if performed at night.
Work that requires colour identification is more difficult and prone to errors if the wrong type of lighting is
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used.
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People Affected
Lighting should be suitable and sufficient to allow all employees to comfortably see what they’re doing,
without straining their eyes.
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Consideration for special lighting arrangement needs to be given to older workers and workers with visual
limitations.
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Size of Workplace
Consider the size and shape of the work area and how it is used and ensure that the right level of lighting
is installed. Lighting design needs to consider casting of shadows. Shadows can make work difficult and
dangerous as potential hazards may be hidden behind shadows.
Illuminance Standards
Table 30: Illuminance Standards (HSG 38 ‘Lighting at Work’)
Nature of Work Example Illumination (Lux)

Rough Tasks
300
Large detail: heavy machinery, stores, corridors
Ordinary Tasks
500
Medium detail: general assembly work, offices
Severe Tasks
750
Small details: clothing manufacture, drawing office, typing
Prolonged Tasks
Small detail 1,000
Minute detail 1,500 – 3,000
Illuminance Ratios
The relationship between the lighting of the work area and adjacent areas is significant.
Large differences in illuminance between these areas may cause visual discomfort or even affect safety
levels where there is frequent movement, e.g., fork-lift trucks. This problem arises most often where local or
localized lighting in an interior exposes a person to a range of illuminance for a long period, or where there
is movement between interior and exterior working areas exposing a person to a sudden change of
illuminance.
Maintenance of Light Fitments

The lighting output of a given lamp will reduce gradually in the course of its life but regular cleaning and
maintenance, not only of the lamp itself but also of the reflectors, diffusers and other parts of the luminaire,
can obtain an improvement. A sensible and economic lamp replacement policy is called for, e.g., it may be
more economical, in labour cost terms to change a batch of lamps than deal with them singly as they wear
out.

Distribution
Distribution is concerned with the way light is spread. The actual spacing of luminaires is also important when
considering good lighting distribution. To ensure evenness of illuminance at operating positions, the ratio
between the height of the luminaire and the spacing of it must be considered. The IES spacing height ratio
provides a basic guide to such arrangements.
Brightness
Brightness or ‘luminosity’ is very much a subjective sensation and, therefore, cannot be measured. However,
it is possible to consider a brightness ratio, which is the ratio of apparent luminosity between a task object and
its surroundings. To ensure the correct brightness ratio, the reflectance (i.e., the ability of a surface to reflect
light) of all surfaces in the working area should be well maintained and consideration given to reflectance
values in the design of interiors.
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Diffusion
This is the projection of light in all directions with no predominant direction. The directional flow of light can
often determine the density of shadows, which may prejudice safety standards or reduce lighting efficiency.
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Diffused lighting will reduce the amount of glare experienced from bare luminaires.
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Emergency Lighting
Workplace Health
There must be adequate lighting in the workplace during an emergency or power failure.
Emergency lighting provides visual conditions which make safe and timely evacuation possible. Safeguards
for emergency management are vital in areas to which either the public or workers have access. The lighting
could be between 5 & 100% of the illuminance produced by ambient lighting. The lights may be powered by
Health Issues
either batteries or generator, and the lighting should reach illuminance within 15 seconds.
Welfare Facilities
‘Welfare facilities’ is a wide term, embracing both sanitary and washing accommodation at workplaces,
provision of drinking water, clothing accommodation (including facilities for changing clothes) and facilities
for rest and eating meals. The International Labour Standard R102 Welfare Facilities Recommendation,
1956, is particularly relevant here and establishes requirements in relation to feeding, rest and recreational
facilities.
The need for sufficient suitable hygienic lavatory and washing facilities in all workplaces is obvious.
Sufficient facilities must be provided to enable everyone at work to use them without undue delay. They do
not have to be in the actual workplace but ideally should be situated in the building(s) containing them and
they should provide protection from the weather, be well-ventilated, well-lit and enjoy a reasonable
temperature.
Where disabled workers are employed, special provision should be made for their sanitary and washing
NEBOSH
requirements. Wash basins should allow washing of hands, face and forearms and, where work is
particularly strenuous, dirty, or results in skin contamination (e.g., molten metal work), showers or baths
should be provided. In the case of showers, they should be fed by hot and cold water and fitted with a
thermostatic mixer valve.
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Washing facilities must ensure privacy for the user and
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be separate from the water closet, with a door that can

be secured from the inside; nor should it be possible to
see urinals or the communal shower from outside the
facilities when the entrance / exit door opens.
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Entrance / exit doors should be fitted to both washing

and sanitary facilities (unless there are other means of
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ensuring privacy). Windows to sanitary

accommodation, showers / bathrooms should be
obscured either by being frosted, or by blinds or
curtains (unless it is impossible to see into them from
outside).
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Sanitary Conveniences
Sanitary conveniences should be provided at readily accessible places. In particular:
x The rooms containing them should be adequately ventilated and lit
x They (and the rooms in which they are situated) should be kept clean and in an orderly condition
x Separate rooms containing conveniences should be provided for men and women except where the
convenience is in a separate room which can be locked from the inside
Table 31: UK Minimum Requirements for Toilets and Washing Facilities
Number of people at
Number of toilets Number of wash basins
work
1–5 1 1
26 - 50 3 3
51 - 75 4 4
76 - 100 5 5
Washing Facilities
Washing facilities (including showers where necessary), should be provided at readily accessible places or
points. In particular, facilities should:
x Be provided in the immediate vicinity of every sanitary convenience (whether or not provided
elsewhere).
x Be provided in the vicinity of any changing rooms – whether or not provided elsewhere.
x Include a supply of clean hot and cold or warm water (if possible, running water).
x Include soap (or something similar).
x Include towels (or the equivalent).
x Be in rooms sufficiently well-ventilated and well-lit.
x Be kept clean and in an orderly condition (including rooms in which they are situated).
x Be separate for men and women, except where they are provided in a lockable room intended to
be used by one person at a time, or where they are provided for the purposes of washing hands,
forearms and face only, where separate provision is not necessary.

At temporary work sites, suitable and sufficient sanitary conveniences and washing facilities should also be
provided. If possible, these should incorporate flushing sanitary conveniences and washing facilities with
running water.
Drinking Water
An adequate supply of wholesome drinking water must be provided for all persons at work in the workplace.
It must be readily accessible at suitable places and conspicuously marked, unless non-drinkable cold water
supplies are clearly marked. In addition, there must be provided enough suitable cups (or other drinking
vessels), unless the water supply is in a jet.
Where water cannot be obtained from the mains supply, it should only be provided in refillable containers.
The containers should be enclosed to prevent contamination and refilled at least daily. Drinking water taps
should not be installed in sanitary accommodation, or in places where contamination is likely, for instance,
in a workshop containing lead processes. Stereotypes are based upon comparisons of average or typical
characteristics in one group against another.
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Clothing Accommodation
Accommodation must be provided for:
x Any person at work’s own clothing which is not worn during working hours.
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Special clothing which is worn by any person at work, but which is not taken home, for example
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Accommodation is not suitable unless it:
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x Provides suitable security for the person’s own clothing where changing facilities are required.
x Includes separate accommodation for clothing worn at work and for other clothing, where necessary
to avoid risks to health or damage to clothing.
x Allows or includes facilities for drying clothing.
Occupational
x Is in a suitable location.
Workplace Health
Work clothing is overalls, uniforms, thermal clothing and hats worn for hygiene purposes.
Workers’ own clothing should be able to hang in a clean, warm, dry, well-ventilated place.
If this is not possible in the workroom, then it should be put elsewhere. Accommodation should take the form
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of a separate hook or peg. Clothing which is dirty, damp or contaminated owing to work should be
accommodated separately from the worker’s own clothes.
Facilities for Changing Clothing

Facilities should be provided for any person at work in the workplace to change clothing where:
x The person must wear special clothing for work.
x The person cannot be expected to change in another room.
x The facilities are easily accessible, of sufficient capacity and provided with seating.
Facilities are not suitable unless they include:

x Separate facilities for men and women, or
x Separate use of facilities by men and women.
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Changing rooms (or room) should be provided for workers who change into special work clothing and where
they remove more than outer clothing; also, where it is necessary to prevent workers, own clothes being
contaminated by a harmful substance.
Changing facilities should be easily accessible from workrooms and eating places. They should contain NEBOSH
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adequate seating and clothing accommodation, and showers or baths if these are provided. Privacy of user
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should be ensured. The facilities should be large enough to cater for the maximum number of persons at
work expected to use them at any one time without overcrowding or delay.
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Rest and Eating Facilities

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Rest facilities should be provided at readily accessible places. A rest facility is:
x In the case of a new workplace, extension, or conversion – a rest room (or rooms).
x In other cases, a rest room (or rooms) or rest area including:
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x Appropriate facilities for eating meals where food eaten in the workplace would otherwise be likely
to become contaminated.
x Suitable arrangements for protecting non-smokers from discomfort caused by tobacco smoke.
x An adequate number of tables and adequate seating with backs for the number of persons at work
likely to use them at any one time.
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x Seating which is adequate for the number of disabled persons at work and suitable for them.
x Facility for a pregnant or nursing mother to rest in.
Canteens or restaurants may be used as rest rooms provided that there is no obligation to buy food there.
Where workers regularly eat meals at work, facilities must be provided for them to eat meals.
In offices and other workplaces where there is no risk of contamination, seats in the work area are sufficient,
although workers should not be interrupted excessively during breaks, for example, by the public. In other
cases, rest areas or rooms should be provided and in the case of new workplaces, this should be a separate
rest room.
Rest facilities should be large enough, and have enough seats with backrests and tables, for the number of
workers likely to use them at one time and seating which is adequate for the number of disabled persons at
work and suitable for them.
Where workers regularly eat meals at work, there should be suitable facilities. These should be provided
where food would otherwise be contaminated, by dust or water, for example. Seats in work areas can be
suitable for eating facilities, provided the work area is clean. There should be a means to prepare or obtain
a hot drink, and where persons work at places where hot food cannot be readily obtained, there should be
the means for heating their own food. Eating facilities should be kept clean. Prayer rooms may also need to
be established, or an area of the workplace designated for prayer, should religious beliefs require employees
to pray during working hours.
Special Circumstances
Pregnant and Nursing Mothers
Suitable rest facilities must be provided for pregnant women and nursing mothers. This would include
provision of a dedicated rest room that has a bed or couch where the pregnant worker can rest. Nursing
mothers will need a clean area where breast milk can be expressed and a dedicated fridge available to keep
the containers until she goes home.
First-Aid
Introduction
The correct response to an injured person once an accident has occurred is of vital importance. It can mean
the prevention of further injury, or even death.
First-aid has two functions:

x First, it provides treatment for the purpose of preserving

life and minimising the consequences of injury or illness
until medical (doctor or nurse) help can be obtained.
x Second, it provides treatment of minor injuries which
would otherwise receive no treatment, or which do not
need the help of a medical practitioner or nurse.
Every employer should provide equipment and facilities that are

adequate and appropriate in the circumstances for administering
first-aid to his employees.
Basis of Provision
Employers should assess first-aid needs. Consideration of the following is required.
x Workplace hazards and risks, e.g., if an electro-plating operation where cyanide salts are used there
will be a potential risk of cyanide poisoning, which requires very specific treatment.
x The size of the organisation.
x The organisation’s history of accidents.
x The nature and distribution of the workforce.
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x The remoteness of the site from emergency medical services.

x The needs of travelling, remote and lone workers.
x Employees working on shared or multi-occupied sites.
x Annual leave and other absences of first-aiders and appointed persons.
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Having made this assessment, the employer will then be able to work out the number and size of first-aid
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boxes required. At least one will always be required. Additional facilities such as a stretcher or first-aid room
may also be appropriate.
The employer must ensure that adequate numbers of suitable persons are provided to administer first-aid.
Suitable persons are those who have received training and acquired a qualification, and any additional training
Occupational
which might be appropriate under the circumstances, such as in relation to any special hazard. All relevant
factors must be taken into account when deciding how many suitable persons will be needed.
Workplace Health
These include:
x Situations where access to treatment is difficult. First-aiders would be required where work
activities are a long distance from accident and emergency facilities.
x Sharing first-aiders. Arrangements can be made to share the expertise of personnel. Usually, as
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on a multi-contractor site, one contractor supplies the personnel.
x Employees regularly working away from the employer’s premises.
x The numbers of the employees, including fluctuations caused by shift patterns. The more
employees there are, the higher the probability of injury; and absence of first aiders through illness
and annual leave.
Table 32: Suggested Numbers of First-Aid Personnel to be Available at all times
Numbers employed at any Suggested number of

Category of risk
location personnel first aiders
Fewer than 50 At least one appointed person.

50 – 100 At least one first aider.
Lower risk, e.g., shops,
offices, libraries.
One additional first aider for
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More than 100
every 100 employed.
At least one appointed person. NEBOSH

Medium risk, e.g., light At least one first-aider for
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Fewer than 20
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engineering and assembly every 50 employed (or part

20 -100
work, food processing, thereof).
More than 100
warehousing. One additional first-aider for
every 100 employed.
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At least one appointed person.

Higher risk, e.g., most Fewer than 5
At least one first-aider.
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construction, 5 – 50
One additional first-aider for
slaughterhouse, chemical More than 50
every 50 employed
manufacture, extensive work Where there are hazards
In addition, at least one first aider
with dangerous machinery for which additional first-aid
trained in the specific
or sharp instruments. skills are necessary
emergency action.
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In circumstances where the first-aider is absent in temporary and exceptional circumstances such as sudden
illness (but not through planned annual leave), an employer can appoint a person to take charge in an
emergency including the equipment and facilities provided. Also, in appropriate circumstances, an employer
can provide an ‘appointed person’ instead of a first-aider. He must first consider the nature of the work, the
number of employees and the location of the workplace. The ‘appointed person’ only will be adequate.
However, as a minimum an employer must provide an ‘appointed person’ at all times when employees are
at work.
Self-employed people must ensure that adequate and suitable provision is made for administering first-aid
while at work. Again, an assessment has to be made of the likely hazards and risks to determine the extent
and nature of what needs to be provided. It is also possible for the self-employed to make arrangements to
share facilities.
First-Aid Rooms
Employers should provide a suitable first-aid room (or rooms) where the assessment of first-aid needs identifies
this as necessary. The first-aid room(s) should contain essential first-aid facilities and equipment, be easily
accessible to stretchers, and be clearly signposted and identified. If possible, the room(s) should be reserved
exclusively for giving first-aid.
A first-aid room (or rooms) will usually be necessary in establishments with high risks, e.g., chemical industries,
large construction sites and in larger premises at a distance from medical services. A designated person should
be given responsibility for the room.
Information for Employees

Employers should inform employees about the first-aid arrangements, including the location of equipment,
facilities and identification of trained personnel. This is normally provided at induction training, or when
commencing work in a new area. This is normally done by describing the arrangements in the safety policy
statement, displaying at least one notice giving details of the location of facilities and trained personnel.
First-Aid Boxes
First-aid boxes, which are to form part of an establishment’s permanent first-aid provision, should contain only
those items that a first-aider has been trained to use.
Sufficient quantities of each item should always be available in every first-aid box or container. In most cases
these will be:
x One guidance card.
x Twenty individually wrapped sterile adhesive
dressings (assorted sizes) appropriate to the work
environment (which may be detectable for the

catering industry).

x Two sterile eye pads, with attachment.
x Six individually wrapped triangular bandages
x Surgical tape.
x Six medium sized individually wrapped sterile un-
medicated wound
dressings (approx. 10 cm x 8 cm).
x Two large sterile individually wrapped un-
mediated wound dressings.
x Three extra sterile individually wrapped un-
medicated wound
dressings (approx. 28 cm x 17.5 cm).
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Training of First Aiders

First aid training course covers a broad range of topics to enable participants to confidently manage
emergency situations, providing care for the ill or injured until medical aid arrives. Employers should conduct
a first aid assessment to decide on the number of first aiders required and their level of training.
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In the UK, the training of first-aiders is controlled by The Health and Safety Executive (UK HSE)
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The training focuses on two levels of competence
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Emergency first aid at work (EFAW): EFAW training enables a first-aider to give emergency first aid to
someone who is injured or becomes ill while at work. Minimum of 6 hours training over one day covering
competencies in sections (a) and (b) below.
FAW training includes EFAW and also equips the first-aider to apply first aid to a range of specific injuries and
Occupational
illnesses.
Workplace Health
First Aid at Work FAW: FAW includes EFAW. Participants will learn to apply first-aid to a range of specific
injuries and illness. A minimum of 18 hours training over 3 days covering competencies in sections (a) and
(b) below.
Participants should expect the following learning outcome from attending the FAW program:
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a) Understand the role of the first-aider including reference to:
x The importance of preventing cross-infection
x The need for recoding incidents and actions
x Use of available equipment.
b) Provide emergency first-aid at work as listed below:

x Assess the situation and circumstances I order to act safely, promptly and effectively in
an emergency
x Administer first-aid to a casualty who is unconscious (including seizure)
x Administer cardiopulmonary resuscitation (CPR)
x Administer first-aid to a casualty who is chocking
x Administer first-aid to a casualty who is wounded and bleeding
x Administer first-aid to a casualty who is suffering from shock
x Provide appropriate first aid for minor injuries
c) Administer first aid to a casualty with:
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x Injuries to bones, muscle and joints, including suspected spinal injuries
x Chest injuries
x Burns and scalds NEBOSH

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x
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Eye injuries
x Sudden poisoning
x Anaphylactic shock
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d) Recognise the presence of major illness and provide appropriate first aid.
Training should be provided by a suitable training provider. Certificate of qualification are for first
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aiders and are generally valid for three years. A refresher course, followed by examination, is
usually required before re-certification. To keep their basic skills up to date, it is strongly
recommended that fist-aiders undertake annual refresher training.
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References
International Labour Conference, Provisional Record 20A, Convention Concerning the Promotional Framework for
Occupational Safety and Health, International Labour Organisation, Geneva, 2006 Article 4: International system
Reasonable adjustments in workplace – NHS confederation
https://www.personneltoday.com/hr/organisational-culture-influences-employee-wellbeing/
How to promote wellbeing and tackle the causes of work-related mental health problems from mind.org.uk
Wellbeing at work – cipd.co.uk
Promoting employee well-being – SHRM
Working well – IOSH
HSE.gov.uk – INDG 69 – Violence at work-a guidance for employers
Safe Work Australia - Preventing workplace violence and aggression January 2021
International Labour Standards, Occupational Health Services Convention, C161, International Labour Organisation,
Geneva, 1985
Occupational Health Services at the Workplace, Dr V Forastieri, ILO
Chartered Institute of Personnel and Development: Absence Guidance:

http://www.cipd.co.uk/hr-resources/a-z/default.aspx
Chartered Institute of Personnel and Development: Absence management Tools 1-4:

http://www.cipd.co.uk/hr-resources/a-z/default.aspx
Institution of Occupational Safety and Health: A Healthy Return - A Good Practice Guide to Rehabilitating People at
Work
The Guides Newsletter, Chicago, American Medical Association, 2008; May/June: 1-13
International Labour Office, Radiation Protection of Workers (Ionising Radiations), an ILO Code of Practice,
International Labour Organisation, Geneva, 1987. ISBN: 9221059960
International Labour Office, Ambient Factors in the Workplace, an ILO Code of Practice, ILO, Geneva, 2001. ISBN
922111628X
Chapter 5: Ionising Radiation
Chapter 6: Electric and Magnetic Fields
Chapter 7: Optical
British Standards Institution, BS EN 60825-1 Safety of Laser Products. Equipment Classification,
Requirements and User's Guide, BSI,

ILO, safety in the use of radiofrequency dielectric heaters and sealers, an ILO Code of Practice, NEBOSH International Diploma
International Labour Organisation, Geneva, 1998. ISBN 9221103331
ILO, The use of Lasers in the workplace, an ILO Code of Practice, International Labour Organisation, Geneva, 1993.
ISBN 9221082601
ILO, Visual Display Units: Radiation Protection Guidance, an ILO Code of Practice, International
Labour Organisation, Geneva 1994. ISBN 9221082628
UK Royal College of General Practitioners, NHS Executive (2002) The Back Book (Second edition). The Stationery
Office
Mckeown, C. & Twiss, M. (2004) Workplace ergonomics: a practical guide (Second edition) Wigston: Institution of
Occupational Safety and Health Services Ltd.
UK HSE MAC tool: http://www.hse.gov.uk/msd/mac/
Assessment of Repetitive Tasks of the upper limbs (the ART tool). Guidance for health and safety practitioners,
consultants, ergonomists and large organisations. UK HSE INDG 438: http://www.hse.gov.uk/pubns/indg438.pdf
and http://www.hse.gov.uk/msd/uld/art/index.htm
323
National Center for Chronic Disease Prevention and Health Promotion

healthandsafetyhandbook.com.au/bulletin/10-tips-to-manage-the-risks-of-shift-work/
ID2
IB11
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Controlling
Occupational
Workplace Health
Health Issues
NEBOSH
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NEBOSH

On completion of this Element, candidates should be able to (cont’d.):

9.6 Understand the role of epidemiology and toxicological testing.

NEBOSH International Diploma

9.1 Principles and Benefits of Vocational Rehabilitation 8

Ventilation 113 NEBOSH

Local Exhaust Ventilation (LEV) Systems 114

9.9 Hazardous Substance Monitoring 152

Concept of Exposure Limits 152

The Role of Other Health Related Professionals 161

Additional Control measures for Exposure to Biological Agents 195

Health Effects of Working in Extreme Thermal Environment 303

Flowchart 2: Design of a Case – Control Study 101

Flowchart 5: Approach for Assessing Hazards to Health by Inhalation 164

Chart 4: Measuring Pulling Force 290

Illustration 22: Venturi Scrubber 121

NEBOSH International Diploma

Illustration 37: IOM Inhalable Sampler 172

Graph 1: Time Varying Concentrations 153

Graph 3: Audiogram for Normal Hearing 223

Graph 4: Audiogram Showing Noise Induced Hearing Loss (NIHL) 224

Graph 5: Comparison Between Attenuation of Typical Earplugs / Muffs 225

9.1 Principles and Benefits of Vocational

The Basic Principles of the Bio-Psychosocial Model and

Biological refers to physical or mental health condition.

NEBOSH International Diploma

Why Is It Important to Make ‘Reasonable Adjustments’ for

x Redistributing duties that a person with disability finds difficult to do.

x Provide training, mentoring, supervision and support.

x Provide height-adjustable work stations

Workplace adjustments allow people with disability to:

x Perform their job safely with higher level of productivity

x Have equal opportunity in their career development

x Enjoy equitable terms and conditions of employment

Pre-placement Health Assessments

assessment can consist of any or all of the following: NEBOSH

The pre-placement health assessment is there to:

Managing Long-term or Recurring Short or Long-term Sickness

This guidance is for:

x Employers' representatives including managers, human resource professionals and occupational

1.4 Making workplace adjustments

1.5 Keeping in touch with people on sickness absence

1.6 Early intervention

1.7 Sustainable return to work and reducing recurrence of absence NEBOSH

Chan et al., (1997) defined vocational rehabilitation as:

The Rehabilitation Process

Benefits of Vocational Rehabilitation within the Context of the Worker

experience and abilities

NEBOSH International Diploma

Possible Rehabilitation Barriers

• Provide modified jobs in the workplace to accommodate workers

Who should carry out the assessment? NEBOSH

Why is an assessment needed?

An assessment is needed because the line manager may have to:

What information will the assessor need?

• The job description and/or person specification

Carrying out the assessment:

Liaison with other Disciplines in the Assessment and

Existing Health Problems

Drugs and Alcohol Policy

• All new applicants will be screened.

Role of Agencies to Support Rehabilitation