Report of Hazards

in the Emergency Unit of

Klinik Kesihatan Juasseh

By

Index No: NDE0982

IC No: 900112055123

Occupational Health Doctor Examination

Paper II: Workplace Assignment

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EXECUTIVE SUMMARY

The purpose of this report is to identify all health hazards associated with the work activities

in the Emergency unit of Klinik Kesihatan Juasseh which provides blood taking services, wound

dressing and emergency care for the community of its operation area, and review the adequacy of its

existing risk control measures including its health surveillance programmes. This work unit consists

of a total number of 5 medical assistant with a registered medical officer for consultation and

management of patients.

The main activities consist of providing blood taking services, wound dressing services,

intravenous medicine administration, oxygen therapy, emergency care and triaging patient.

Findings: The health hazards identified can be divided systematically to physical, chemical,

biological, ergonomic and psychosocial factors. The physical hazards include needle prick injury

from blood taking, electric shock from equipments. Chemical hazards are exposure to illicit drug

such as opiods, or latex allergic, . Exposure to airborne pathogens such as tuberculosis, covid-10 and

influenza are potential biological hazards. Ergonomic hazards are associated with awkward posture,

sustained postures, and repetitive movements. The workers are also susceptible to psychological

hazards like work related stress and violence or harassment from patients and their relatives.

Conclusion: It can be concluded that the workers of the emergency unit are exposed to

various health and safety hazards. It is recommended that the employer improves the existing risk

control and health surveillance programmes for his workers.

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2. INTRODUCTION

2.1 Purpose and objectives of the report.

This report is written fundamentally as a requirement in conducting Workplace Assignment

(WPA) of Paper 2 of Malaysia National Institute of Occupational Safety and Health (NIOSH) for

Occupational Health Doctor (OHD) Examination. Passing Paper 1 and Paper 2 is compulsory for an

OHD candidate to be certified as Occupational Health Doctor and hence, registered under

Department of Occupational Safety and Health (DOSH) to practice. In conformance with the

Regulation on the Use and Standards of Exposure of Chemicals Hazardous to Health (USECHH)

2000, health surveillance has to be conducted by OHDs registered with the DOSH and having valid

certificates. In compliance with this regulation, medical surveillance is conducted by the OHDs to

protect workers exposed to, or likely to be exposed to, chemicals hazardous to health. The main

purpose of this study is to assess the general well being and health status of the employees who are

working in the emergency unit at Klinik Kesihatan Juaseeh and at the same time, to assess and

improve the management of identified risks in the clinic. As stated in Section 15 of Occupational

Safety and Health Act 1994, it shall be the duty of every employer and every self-employed person

to ensure, so far as is practicable, the safety, health and welfare at work of all his employees.

Therefore, this report specifically aims to identify any hazards existing at the described

workplace, to assess the safety, health or environmental risks associated with each of the hazards and

to evaluate the adequacy of the existing risk control and its monitoring.

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2.1.2 General Objective

Workplace assessment is an effort as part of promoting a positive safety and health culture

among workers at any workplace in accordance to the objects of Occupational Safety and Health Act

1994;

(a) to secure the safety, health and welfare of persons at work against risks to safety or health

arising out of the activities of persons at work;

(b) to protect persons at a place of work other than persons at work against risks to safety or

health arising out of the activities of persons at work;

(c) to promote an occupational environment for persons at work which is adapted to their

physiological and psychological needs;

(d) to provide the means whereby the associated occupational safety and health legislation

may be progressively replaced by a system of regulations and approved industry codes of practice

operating in combination with the provisions of this Act designed to maintain or improve the

standards of safety and health.

The key elements of this positive culture includes safe working practices and rules for

effectively controlling hazards, a positive attitude towards risk management and compliance with the

control processes and the capacity to learn from accidents, near misses and safety performance

indicators and bring about continual improvement.

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2.1.3 Specific Objectives

The specific objectives of this report are as outlined below :

(a) To identify any existing or potential hazards in the work unit;

(b) To determine the degree of hazard exposure and the risks it poses to the safety, health and

environment of the work unit;

(c) To study the existing working environment, work processes, materials, equipment and the

facilities available at the work unit;

(d) To identify, evaluate and assess the adequacy of control measures in place;

(e) To propose appropriate control measures to prevent or reduce the risks produced by the

hazard;

(f) To give recommendations regarding workplace safety and health at the work unit

2.2 Company description

Klinik Kesihatan Juasseh is a primary care level government clinic under the Ministry of

Health Malaysia. It is a two storey high building, which involves medical services on the ground

floor, dental services and administration office over the second floor. It was recently rebuilt from the

old clinic in the year of 2000. Currently, this clinic is having ten (10) in-house medical officers, five

(5) medical assistants, three (3) pharmacists, two (2) assistant pharmacist, eight (8) health nurses,

four (4) community nurses, three (3) medical laboratory technologist, two (2) health attendant, and

three (3) general workers. It received around 150 patients from Monday to Friday. A new x-ray

rooms is recently established this year to further accommodate and improve services to the patients.

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 All of the employees of Klinik Kesihatan Juasseh are government sector workforce under the

Ministry of Health Malaysia.

The clinic involve in providing various medical services such as consulting and diagnosis of

illness, vaccination, obstetric services, pharmacy, wound dressing, emergency services and medical

check up. Thus, these services are divided into 6 units which are;

(a) Outpatient and non-communicable disease unit

(b) Women and child health unit

(c) Pharmacy unit

(d) Medical Laboratory unit

(e) Administrative unit

(f) Emergency unit

This clinic is one of eight (8) primary level government clinics of the Kuala Pilah District in

Negeri Sembilan state. It is under the direct supervision of Kuala Pilah Health District Office, headed

by a Public Health Specialist. Specifically Klinik Kesihatan Juasseh covers a wide operation area

mainly in the county of Juasseh. .At the state level, it is under the supervision of Negeri Sembilan

State Health Department, specifically under the Public Health Division. At the national level, it is

under the directive of the Ministry of Health Malaysia.

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Organisation Chart of Klinik Kesihatan Juasseh (as below);

Emergency
unit

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Organisation Chart of Kuala Pilah District Health

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Organisation Chart of Negeri Sembilan State Health Department (as below);

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Organisation Chart of Ministry of Health Malaysia (as below);

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2.3 Description of Work Unit

2.3.1 Introduction

The emergency unit is a unit providing variety of services such as attending emergency case,

transporting case to hospital, wound dressing services, blood taking services and oxygen therapy,

which averaging about 50-60 clients per day. The unit also involve in triaging patient that came to

the klinik for consulation services which averaging around 60 clients per day. It also responsible in

managing emergency medication such as opiod medication for pain management, and taking care of

emergency trolley which contains defibrillators, intravenous fluid, oxygen mask among other things

for use of emergency situation. The unit also responsible in responding to emergency call outside of

clinic areas. This emergency unit comprises of 2 emergency rooms which contains 3 bed, asthma bay,

an emergency trolley, an registration counter, 2 blood taking area, and a storeroom as shown in the

picture.

Image 1 : Emergency bed and trolley

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 Image 2 Registration counter

Image 3 Procedure bed

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 Image 4 Oxygen tank storage

There are 5 medical assistants working in the unit with 1 medical assistant trainee. This

emergency unit is supervised by senior medical assistant and the chief medical officer of the clinic.

2.3.2 Operating hours

Generally, the emergency unit operates during office hours from 0800H till 1700H daily

Monday till Friday. However, emergency services available 24 hours everyday for responding

emergency cases.

2.3.3 Job Title

There are 5 employee working in this unit which comprises of 5 medical assistant with an on

call medical officer.

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2.3.4 Job Scope

The job scope of the employees of emergency unit are as below;

I. Medical Assistant.

A. Attending emergency cases

B. Triaging patients

C. Providing wound dressing services

D. Blood taking services

E. Managing asthma bay and oxygen therapy

F. Administering intravenous medication

G. Transporting patients to hospital

H. Keeping record of emergency trolley equipment and medications

2.3.5 Work activities

The main activities of this work unit is attending emergency cases which may include a few

of job scope of the emergency unit. When emergency cases came, the medical assistant require to

triage the patient by taking vital signs of the patient and chief complain. Triaging a patient can

expose worker to biological hazards such as tuberculosis or covid-19 as patient status is still

unknown at this points. It also involve of awkward posturing when transporting patient or taking

blood pressure as patient most likely lying on the bed. Medical assistant also may require to do blood

taking or intravenous cannulation upon medical doctor’s orders. This also bring risk of needle stick

injury to the medical assistants or biological hazards such as HIV and Hep B or C to the workers.

Depends on the vital sign of the patients, patient may require oxygen therapy or intravenous

medication based on medical officer’s orders. While giving oxygen to the patient, there also risk of

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fire hazards when dealing with oxygen tank if no proper standard of operation not done. Medical

assistant also responsible in administrating intravenous medical and they may risk of needle stick

injury or expose to illicit drug such as opiod medication (fentayl or morphine) if such drug is ordered

by medical officers. While attending the patients, worker may risk of slipping or fall if the floor are

wet or there are blood at the floor especially dealing with trauma patients.

Medical assistant also may feeling stress or get psychological/physical abuse from family

members when given emergency care as the situations are usually stressful as it involve life and

death. Lastly, the patient may be refer to hospital for further care thus medical assistance need to

transfer patient to the ambulance and accompany the patient to the hospital. Transferring patients

from the bed to the ambulance can involve use of force and awkward posture which are ergonomic

hazard to the worker. Medical assistant also experience whole body vibration while escorting patient

in an ambulance which may worsen any existing conditions.

2.4 Review of existing health surveillance programme

In this clinic, there is an assigned Occupational Health person-in-charge (PIC) which is

appointed by the Chief Medical Officer. The Occupational Health PIC is an Assistant Medical

Officer, which liaise with the Occupational Safety and Health (OSH) Unit of the District Health

Office. The OSH Unit is responsible to ensure the health and safety programmes for the health clinic

employees are conducted based on the standard or national guidelines and abiding to Occupational

Safety and Health Act 1994 regulations. Monitoring, notification and investigation of occupational

related diseases, poisoning or injuries among the hospital employees, as well as ensuring

preventative measures are taken pertaining to such cases falls under the responsibility of OSH Unit.

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 OSH Unit is responsible to oversee and monitor the continuity of staff wellness programmes

run by the health clinic, i.e walk-in outpatient clinic for clinic employees, health screening

programme and medical surveillance programme.

Current health surveillance programme is as below;

1) Medical surveillance

I. Annual General and Physical Examination

A. Anthropometry, including Body Mass Index (BMI)

1. For overweight and obese, to refer to dietitian and physiotherapy for

weight loss programme.

B. Blood Pressure and Pulse Rate

1. To detect hypertension, to refer Medical Officer if needed for

pharmacotherapy

C. Echocardiogram (ECG) for staff above 40 years of age

1. To screen for any cardiac abnormalities

II. Serial Chest Radiograph and Mantoux Test

A. For Tuberculosis screening, done 2 yearly

B. To carried out earlier if symptomatic

III. Annual Blood Investigations

A. Full blood count

1. To detect anaemia

B. Renal Profile

1. To detect any kidney diseases or electrolyte imbalances

C. Liver Function Test

1. To detect any possibility of fatty liver or liver diseases

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 D. Fasting Serum Lipid

1. To detect hypercholesterolemia

2. To start pharmacotherapy if indicated

E. Fasting Blood Glucose

1. To rule out diabetes mellitus

2. To proceed for Modified Oral Glucose Tolerance Test (MOGTT) if

fasting blood glucose deranged

F. Hepatitis B Surface Antigen Level

1. To detect adequacy of hepatitis antibody, which is prophylaxis for

Hepatitis infection if needle prick injury took place

2. To retake hepatitis vaccine if antibody level below 10,000 mIU/L

IV. Smoking and alcohol intake history

A. To refer staff to Stop Smoking Clinic if smoking or vaping

B. For alcohol withdrawal programme if alcoholic

V. Mental health screening

A. Set of questionnaire to detect Anxiety, Depression, or Stress

B. To refer to counsellor or Family Medicine Specialist if abnormal result

All health screening results should be seen by Medical Officer in-house, and to carry out any

relevant additional investigations if deemed necessary. Annual reports of health surveillance

programmes are documented by staff in-charge of Occupational Safety and Health, and record

keeping to the OSH Unit. Clinic also are provided with personal protection equipment such as

surgical gloves, mask, face shield and aprons when dealing with patients.

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3. ASSESSMENT METHODS

3.1 Explain how you identify all hazards in the workplace.

Three main imperative aspects need to be taken into consideration when identifying existing

hazards in any workplace includes the individual health factors of the personnel, work organization

or environment as well as the work process. Employees with co-morbid illness and pre-existing

health conditions might increase their risk of exposure to any hazards. Therefore, they are more

susceptible to be exposed to any infectious diseases while engaging with the patients during

dispensing medications and during counselling of medications.

The average number of patients with acute illnesses who engage with emergency unit per day

is about 60-70 patients from all other unit, while on average about 20 emergency case per day. Those

patients with acute illnesses are possibly patients with actively infectious respiratory diseases such as

pneumonia, covid-19, tuberculosis, conjunctivitis, viral upper respiratory tract infections, which are

airborne diseases. Superficial skin diseases such as impetigo, scabies, and furunculosis are also

potential hazards if there is any skin-to-skin contact.

Fatigue with their workload of emergency duties, long working hours of doing repetitive

movements as well as awkward body posture may contribute to various ergonomic problems in the

workplace. Thus, this may lead to musculoskeletal problems which will later may cause work

absenteeism and hence the drop in productivity.

Exposure to certain chemicals also may result in this group of workers to have some bad

complications to their health. Some of them may develop short term complications such as skin and

eye irritation, respiratory tract irritation, but long term effects in prolonged exposure can develop for

example chronic lung involvement, subfertility and malignancy (carcinogenic).

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 Occupational stress and psychosocial hazards may also worsen the hazard exposure on top of

the available hazards amongst the employees. Mental and psychological impairment may later

reduce work productivity, and increase the risk of work absenteeism among them.

3.2 Describe the technique used to assess and evaluate the risk of the hazards identified.

3.2.1 Assessment Technique

In order to assess and evaluate the risk and outcome of hazard exposure, the severity of the

hazards plays an important role. Secondly, the likelihood of the worker exposed to such hazards also

is crucial to evaluate the hazards. Any kind of handling process of these hazardous materials or its

source would make these people at risk.

As per definition, risk is determined by the hazard (severity) and the exposure (likelihood).

The more frequent the hazard is exposed to the staff, the higher risk will be imposed on the worker.

Duration of exposure of each hazard to the workers may also impose higher risk to them.

Therefore, from this study, it provides an organized approach to identify or assess the hazards

and their associated risks, which then would evaluate the risk of each hazard as well as to render

various measures to control the risk. This is as stated as one of the objectives of the Occupational

Safety and Health Act (OSHA) 1994, every employer should provide a safe workplace to their

employees and other related persons which is adapted to their physiological and psychological needs.

By definition, likelihood is an event likely to occur within a specific period of time or in

specified condition, whilst severity is the outcome from an incident to people’s health and well being,

property, environment as well as the combination of those caused by the incident.

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Process of Hazards Identification, Risk Assessment, and Risk Control (HIRARC)

There are 4 steps of HIRARC :

(1) to classify work activities;

(2) to identify hazard;

(3) to conduct a risk assessment (analyze and estimate risk), by calculating or estimating -

a) severity of hazard; and

b) likelihood of occurrence

(4) to decide if risk is tolerable and apply control measures if necessary.

(1) Establishment of the context:

First and foremost, we need to establish the context. In this selected organization, it is vital to

emphasize on the risk management of occupational safety and health risks to all exposed workers in

this hospital. After the context has been established and the work activities are classified, we proceed

with risk identification, risk assessment which consists of risk analysis and risk evaluation and

finally, we identify risk control and apply the control measures as necessary.

(2)Hazard identification:

The aim of hazard identification is to highlight the work tasks which potentially could cause

any significant risks to the employee’s health and safety. The hazards related to certain equipment

due to energy sources, working conditions or activities performed also can be highlighted. There are

three groups of hazards/risks that can be identified; safety risk, health risk and environmental risk.

(3) Risk assessment : risk analysis/evaluation:

Risk is the result of likelihood and severity of any incident or accident occurrence. A risk

analysis may denote a number of risks with similar severity. When there are too many risks clustered

at or about the same level, a rational risk prioritization method is required to prioritize risk responses

and maximize the use of available resources. Risk can be analyzed and estimated by three methods

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which are qualitative, quantitative or semi-quantitative methods in order to determine magnitude and

to prioritize the identified hazards.

(a) Severity of hazard:

Severity is the outcome from an incident to people’s health and well being, property,

environment as well as the combination of those. Severity of hazard (refer Table 1) which are based

upon an increasing level of severity to an individual’s health, the environment, or to property.

Severity (S) Example Rating

Catastrophic Numerous fatalities, irrecoverable property damage and 5

productivity

Fatal Approximately one single fatality, major property damage if 4

hazard is realized

Serious Non-fatal injury, permanent disability 3

Minor Disabling but not permanent disability 2

Negligible Minor abrasions, bruises, cuts, first aid type injury 1

Table 1: Severity of the Hazard

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 (b) Likelihood of hazard:

Likelihood is an event likely to occur within a specific period of time or in specified

condition. Likelihood refers to the possibility of risk potential occurring measured in qualitative

values. The likelihood of an occurrence can be categorized as Table 2 below:

Likelihood (L) Example Rating

Most likely The most likely result of the hazard/event being realized 5

Possible Has a good chance of occuring and it is not unusual 4

Conceivable Might occur at sometime in the future 3

Remote Has not been known to occur after many years 2

Inconceivable Is practically impossible and has never occured 1

Table 2: Likelihood of An Occurrence

In qualitative method, the risk analysis uses likelihood of an occurrence and severity of the hazard

which would be displayed in a risk matrix (refer Table 3). It is a very effective way to exhibit the

distribution of the risk on an area in a workplace.

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Risk can be calculated using the following formula:

Relative Risk= L x S

L = Likelihood

S = Severity

A risk matrix is an important tool used during risk assessment to delineate mechanisms to increase

clarity of risks. Thus, this will aid the decision making of risk management to any workplace.

Table 3: Risk Matrix Assessment

In order to prioritize the necessary actions to effectively manage workplace hazards, the relative risk

value can be used. Table 4 determines priority of the action based on the following range:

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 Table 4: Risk Rating and Risk Level

(4) Risk control

Risk treatment is also known as risk control. Control measure is the removal or dismissal of a

risk in such a way that the hazard does not cause any risk to the workers who have to be in an area or

to work on equipment during the course of stipulated work. Risks are best controlled at their source.

However, if unable to do so, the hierarchy of control can be applied to control the risks. At the source

of hazard, the elimination and substitution methods can be used. If the hazard cannot be removed or

be replaced, it can be isolated. Then, the engineering control such as redesign, automation, barriers

can be implemented. In most workplaces, another control measure routinely used is administrative

control. This includes safe work practices, job rotation, supervision and training, housekeeping and

repair and maintenance program. Finally, personal protective equipment (PPE) can be used when

other control measures are not practicable and where additional protection is needed.

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(5) Monitoring and review

Monitoring and reviewing the risk is also essential. It is pointless if one risk is identified,

analyzed and controlled but none or poor monitoring/reviewing of the risk is done. Some risks need

to be monitored and reviewed regularly . The presence and functionality of an organization risk

management components and the quality of their performance over time need to be assessed by

ongoing activities and separate evaluations.

3.3 You are required to provide data or related documents to support your explanation.

This is the guideline produced by Department of Occupational Safety and Health, Ministry of

Human Resources, which this assignment is referred to regarding the explanation given above;

Guidelines for Hazard Identification, Risk Assessment, and Risk Control 2008, by the

Department of Occupational Safety and Health, Ministry of Human Resources

MalaysiaOccupational Safety and Health Act, 1994

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4. RESULT

Work Hazard Identification Current Risk Risk Control

Activities Risk Assesment

Control

Hazard Effect L S R

Triaging Biological Covid-19 Facemask, 4 4 16 Engineering

emergency Hazard: /tuberculosis glove , hand Control : Proper

patients exposure to infection hygiene, ventilation over the

Airborne Worker Vaccination emergency unit

Task infection as exposure may Administrative

exposure: unknown require self- control : Infectious

duration >6 patient status quarantine that disease training,

hours, result in lower work rotation

frequency : productivity PPE:

daily Proper use of Face

mask/N95, face

shield, apron when

dealing with

emergency cases

Ergonomic : Musculoskeletal 4 2 8 Engineering

awkward disorder control : ergonomic

posture while Back pain chair while taking

transporting patient vital sign,

and taking use of adjustable

vital signs bed heights

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 Administrative

control : work

rotation.

Psychological Emotional 4 2 8 Administrative

trauma: instability, work control :

verbal/physica absenteeism Soft skills training

l abuse by Counselling and

family support group

members. Reinforce violence

prevention policy

Blood Biological Liver cirrhosis, Surgical 3 3 9 Engineering

taking and hazard : HIV, Aids glove control : use of

intravenous Hep B or c Stress Annual hiv needlestick-

cannulation Infection and Hep B prevention devices

Task through neede antibody which are needle-

exposure : 4 stick injury test retracting syringe

hours/day, Administrative

frequency control : proper

daily SOP while taking

blood, regular

training of iv

cannulation/blood

taking

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 Ergonomic : Musculoskeletal 4 2 8 Engineering

awkward disorder, back control : adjustable

posturing pain bed heights with use

while taking of appropriate work

blood desk.

Administraive

control : work

rotation.

Oxygen Fire hazards Burns injury Oxygen 3 5 15 Isolation : store

therapy via from towards the tank oxygen tank at well

nasal/facem exploding worker Pressure ventilated storage

ask with oxygen tank regulators, rooms far from

oxygen tank Property proper other ignition

damage maintenanc sources.

Frequency : e and Engineering

daily regular Control: use of

1 hours check up trolley when

for leaking transporting oxygen

tanks, oxygen tanks

with regulators and

pressure valve.

Administration

control :

Fire hazards

training, proper

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 hazards labelling

over the worksite,

ensure appropriate

fire extinguisher are

kept nearby

Biological Covid 19 Facemask 3 4 12 Administrative

hazards, infection or N95 control :

airbone resulting in mas Proper SOP, work

infection quarantine, rotation and training

Tuberculosis PPE : Use of N95

infection and face shield

when dealing with

emergency cases

Administrati Physical Blood borne Surgical 4 2 8 Engineering

ng hazards : infection such Glove control : use of self

intravenous needle stick as hepatitis b or Proper retracted needle

medication injury C and HIV standards of Administrative :

administrati injection technique

Frequency ng IV drug training, work

daily rotation, Proper

Hours : 2 standard of

operation.

PPE : use of

surgical gloves,

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 Chemical Respiratory Facemask, 3 3 9 Administrative

hazards : depression, Surgical control : Training

exposure to drowsiness glove of illicit drugs

illicit opiods (symptoms, method

such as fentayl of exposure,

management),

employ specific

person in charge of

illicit drugs for

monitoring.

PPE : use of proper

PPE such as aprons,

face mask, face

shield and glove to

prevent exposure

Transporting Physical Fracture of the Keeping the 4 2 8 Administrative

patient from hazards: slips bones, sprain or floor clean control : Regular

patient’s car and floor may muscle injury with the maintenance of the

or to be possible if maintenanc floor

ambulance the floor is e staff PPE : Wearing anti-

Frequency wet or blood Avoiding slip shoes when

daily covered equipment working

Hours: 1 blocking

Routine the way

works

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 Ergonomics Musculoskeltal Using 4 2 8 Administrative

hazard : disorder, back buddy control : work

Awkward pain system rotation, employ

posture, using buddy system,

a great deal of maintenance of

force for emergency beds.

lifting patients

Accompany Whole body Musculoskeletal Shift 4 3 12 Engineering

patient to vibration disorder system Control :

the Hospital Eye pain, Low vibration seats

Via Cardiovascular Administrative

Ambulance diseases control :

Task Fatigue Jobs rotations,

exposure: regular maintenance

Duration >4 of the ambulance.

hours/day PPE : anti vibration

Frequency 5 gloves.

days /weeks

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 Prioritize of the hazards and explanation steps

Priortizing the hazards as most dangerous are important as it show which one that need to be

control immediately and reduce the health effects to the workers. The hazards are identified and

classify in the activities and adjust according to the mostly likehood to happen. Then, each of the

hazards are determined what are the health effects and how severe it is to the workers. The hazards

that can cause multiple death or single death and cause property damage will rank higher compare to

others. Then, the relative risk is calculated based on the likehood and the severity of the hazards. . As

conclusion the the most risks hazards are as below:

1. Airbone infection such as covid 19 and tuberculosis

2. Fire hazard from the oxygen tanks

3. Whole body vibration

4. Blood borne infection, such as HIV, Hep B and C, as the disease can be controlled by

medication

5. Exposure to illicit drug such as opiods

6. Ergonomics hazards involving awkward posture using great deal of force for lifting

patients

7. Physical hazards due to slips and fall

8. Psychological hazads

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5. DISCUSSION & RECOMMENDATION

Based on the above results, most of the activities of the workers have multiple hazards

involve and there are also so many factors that can contribute to the accidents at the workplace.

Thus, it is much better for us to try identify all the hazards that may happen and take precaution to

minimize or control the hazards, The most important factor that may contribute to the accidents to

occur is knowledge about the hazards presents with the worker’s activities. Thus, it is imperative for

administration to do training and keeping worker well informed regarding the hazards and the effect

they faced everyday, so that the worker themself can protect themself from the hazards and prevent

“shortcut” when doing their works. For example in above results, the biggest risk of the hazards is

thorough simple activity of triaging patient where the workers exposure themself to airborne diseases.

This can be minimize through wearing facemask/N95, surgical gloves and faceshield when dealing

with patients and knowledge regarding covid-19 or tuberculosis infection. Thus, it is important that

the worker take this matter seriously for their health and taking “shortcut” and ignore the protective

equipments.

One of the factor that may contribute to the significant health risk is the current worker’s

health condition and appropriate job assignment to the specific jobs. Worker with history of back

pain or with spinal cord disorder may not suitable to do transporting, taking blood that involve

awkward posture. Administrative must have a thorough medical check up for each worker so that

they can assign appropriate worker that did not add significant health risk to worker current

conditions. Appropriate work shifts also can help worker to rest and relieve the stress they having

when doing their works. Infrastucture of the workplace also play significant contribution towards the

significant health risk shown above. A well ventilated and spacious workplace can help reducing the

risk of hazards such as airborne infection or slips or fall. Appropriate storage rooms to store

flammable chemical or other dangerous chemical can help reducing the risk towards the worker’s

health as it minimize the exposure of the chemical.

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Recommendations to the employer on the necessity for a health surveillance programe

Health surveillance programme is a program to protect the health of employee by early

detection ill-health effects at an early stage and providing data to help employer evaluate health risk.

This can help reducing the compensation cost and increase productivity. It is also required by laws

for employees that exposure to noise or vibration, radiation, biological agents and other substances

hazardous to health. It can also help protecting visitor from the workplace hazards. Health

surveillance programs also help management in evaluating existing control measures and show

places that needed more control measures to further protect the skilled workers. This can help reduce

cost to trained skilled workers and reduce cost of operations.

Health surveillance processes require four simple steps; classify the work activities, identify

the hazards, conduct risk assessment and apply control measures based on the relative risks that have

been identified and calculated. The first three steps have been completed and the result has been

tabulated in the table above (under result). So, the next step is control measures. Control is the

elimination or inactivation of a hazard in a manner such that the hazard does not pose a risk to

workers who have to enter into an area or work on equipment in the course of scheduled work.

Hazards should be controlled at their source (where the problem is created). The closer a

control the source of the hazard is the better. Selecting a suitable control often involves; evaluating

and selecting short and long term controls, implementing short-term measures to protect workers

until permanent controls can be put in place and implementing long-term controls when reasonable

practicable.

Type of control;

1. At the source of the hazard:

a. elimination – getting rid of the source of hazard is perhaps the best way of protecting workers.

However, it can be not applicable to the jobs settings or situations.

b. substitution – replace the source of hazards.

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c. Isolation – if the hazard cannot be replaced, it sometimes can be isolated, contained or otherwise

kept away from workers. For example storing the oxygen tanks away from flammable chemicals.

2. Engineering control

Using better equipment such as self retracting needle can significantly reduce the risk of needle stick

injury. Also provide better insulation from the hazard and the workers to reduce the exposure.

3. Administrative controls

a. safe work procedure – the workers required to use standardize safety practices. Work procedures

must be periodically reviewed with workers updated.

b. supervision and training – initial training on safe work procedures and refresher training should be

offered. Appropriate supervision is needed to assist workers in identifying potential hazards and

evaluating work procedures.

c. job rotation – reduced the time that workers are exposed to the hazard. .

d. housekeeping, repairs and maintenance programs – including cleaning, waste disposal and spill

cleanup. Tools, equipment and machinery less cause injury if proper maintained.

e. Record keeping - all the hazards must be fully documented\

4. personal protective equipment (PPE)

PPE and clothing are used when other controls measures are not feasible and where additional

protection needed. The workers must be trained to use and maintain equipment properly. Both owner

and workers must know or understand the limitation of the PPE. The owner is expected to require

workers to use their equipment whenever needed. Care must be taken to ensure that equipment is

working properly. Otherwise, PPE may endanger a workers health by providing an illusion of

protection.

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6. CONCLUSION (10 marks)

From the concise workplace assessment, various types of hazards are identified. Some of the

control measures are already in place, however the enforcement of the existing measures including

health surveillance programme and the introduction of new measures is necessary to improve the

safety and health of the employees in the emergency unit of Klink Kesihatan Juasseh

The clinic administrator plays a very important role in ensuring safety and health practices

are carried out by all employees in terms of the administrative control and provision of safety

training for all employees. However, the support, cooperation and active participation of all the

employees also are necessary to create a safe working environment for all.

HIRARC has proven to be a beneficial tool in identifying hazards, performing risk

assessment and subsequently formulate the appropriate risk control based on the relative risk.

Moreover, following the risk control, regular monitoring and review must be done to evaluate the

effectiveness of control measures and intervene at any point if necessary. The HIRARC should be

kept in the record and need to be reviewed every three years or whenever there are changes in the

work process or activities.Systematic record keeping should be done by the clinic administrator for

all the healthcare workers as to provide a continuous optimum care of safety and health.

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 In accordance to the Section 4 of Occupational Safety and Health Act 1994;

The objects of this Act are—

(a) to secure the safety, health and welfare of persons at work against risks to safety or health

arising out of the activities of persons at work;

(b) to protect persons at a place of work other than persons at work against risks to safety or

health arising out of the activities of persons at work;

(c) to promote an occupational environment for persons at work which is adapted to their

physiological and psychological needs;

(d) to provide the means whereby the associated occupational safety and health legislations

may be progressively replaced by a system of regulations and approved industry codes of

practice operating in combination with the provisions of this Act designed to maintain or

improve the standards of safety and health.

With proper health surveillance programme, those 4 objectives of the Act can be achieved,

and workplace accidents or diseases can be prevented for the benefit of both employer and

employees.

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7. APPENDICES

8.

All necessary information used to support the report must be included in the appendices.

7.1 References

Below are the guidelines which this assignment is followed upon;

1. Guidelines on Ergonomics Risk Assessment at Workplace 2017, by the Department of

Occupational Safety and Health, Ministry of Human Resources Malaysia

2. Guidelines on Occupational Safety and Health in The Office 1996, by the Department

of Occupational Safety and Health, Ministry of Human Resources Malaysia

3. Guidelines for Hazard Identification, Risk Assessment, and Risk Control 2008, by the

Department of Occupational Safety and Health, Ministry of Human Resources

Malaysia

4. Occupational Safety and Health Act, 1994

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Appendix 1

The differences between 3 ply face-mask with N95 respirator

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Appendix 2

Hierarchy of control, with the topmost is the most effective, with decreasing effectiveness going

lower down the hierarchy.

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Poster of good hand washing technique.

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