Health surveillance

Health surveillance is about systematic, regular checks on workers to identify early signs of ill health, and then acting on the results.

• Health surveillance by trade

Health surveillance is needed to:

• protect workers who are at an increased risk;
• identify work-related ill health at an early stage so that steps can be taken to treat the condition and prevent further damage; and
• give early warning that protective control measures are no longer effective.

Health surveillance does not reduce the need to eliminate or manage health risks.

You may conduct other health checks, including fitness-for-work checks for safety-critical workers, and general health checks for all workers.

Formal health surveillance is only necessary if work damages health in a particular way and the following three factors all apply:

• there is a valid way to detect a disease or condition; and
• it is reasonably likely that damage to health will occur under the particular conditions at work; and
• health surveillance is likely to benefit the employee.

Health surveillance might be appropriate for workers who are exposed to:

• hazardous substances, eg:
  • skin or respiratory sensitisers;
  • asbestos;
  • lead;
• noise;
• hand-arm vibration; or
• radiation (eg industrial radiography).

You may need help from an occupational health nurse or doctor to set up a suitable health surveillance system, and to agree a ‘referral' system.

Three important points to remember are that:

• you must keep records of health surveillance that is carried out;
• people must be competent to do health surveillance;
• health surveillance will only work if you act on the results - it should be clear how and when people will be referred for further examination and how the results will be used to improve the way that you manage health risks.

Health and safety law only requires employers to provide health surveillance for employees, and only then if formal surveillance is appropriate. However, workers who you treat as self-employed for tax and national insurance purposes may be seen as employees in the context of health and safety.

Analysing the results of your health surveillance and monitoring gives an insight into how well your control measures protect workers. Use the results to help target your efforts effectively. Share this information with your employees and their safety representatives.

Some larger contractors use a common occupational health provider for their business units and subsidiaries. This can help to improve the quality and continuity of health surveillance and monitoring if tradesmen move between different parts of the business. Alternatively, you may be interested to know more about the Constructing Better Health scheme.

• Health and safety benchmarking. Improving together: Guidance for those interested in applying benchmarking to health and safety INDG301

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Involve your workers

Consult your trade union safety representative, or employee health and safety representative before introducing health surveillance.

Tell workers why health surveillance is important, and describe the preventative and protective measures that are in place.

It is important that workers understand that the aim of health surveillance is to prevent them developing ill health. You will need their understanding and co-operation if health surveillance is to be effective.

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Statutory medicals

Health and safety law requires pre-employment and periodic medicals for workers who are exposed to certain defined hazards, such as asbestos, lead and radiation. These ‘statutory medicals' have to be carried out by an appointed doctor who is designated by HSE. The nature and frequency of the medical is described in the relevant legislation and supporting guidance.

• Guidance for appointed doctors on the Control of Asbestos Regulations 2012
• Lead and you: A guide to working safely with lead

Table 1 Types of procedure

Procedure	Who can do it?
Self-checks	Those exposed to hazards who have been properly trained in how to look for easily recognisable signs and symptoms of disease. They should know who to go to if they find anything that causes them concern (eg where employees notice sore, red and itching skin and work with substances that cause skin damage). Note that self-checks on their own are not enough to comply with the regulations and can only be done as part of an overall health surveillance programme, eg where they complement checks by a responsible person.
A responsible person making basic checks for signs of disease	Anyone trained to identify straightforward signs and symptoms caused by working with certain substances or processes (eg skin inspections where people work with wet cement, or self-reported symptoms of using vibrating tools. Managers, supervisors or first aiders could carry out these checks. An occupational health doctor or nurse should train these people to recognise signs or symptoms that need further assessment and to know when and how to refer employees. A responsible person must not be expected to diagnose the possible cause of symptoms.
Enquiries about symptoms, inspection and examination by a qualified person	Usually an occupational health nurse (eg for signs of asthma) or someone with technical knowledge (eg an audiologist carrying out hearing tests or someone trained to do lung function tests).
Clinical examinations	Should be carried out by or be supervised by a doctor. In some cases this is a legal duty (eg for employees exposed to lead); in others the nature of the tests will need the expertise of a doctor to interpret the results and advise on their significance. Examination by a doctor is also likely to be necessary where health surveillance by a responsible person or an occupational health nurse has identified possible work-related ill health issue that needs further investigation, diagnosis and treatment.
Biological monitoring and biological effect monitoring	In general, these should be carried out by or supervised by a doctor. Examples are tests for lead and mercury in blood, and cadmium in urine. However, in some circumstances, the actual taking of samples can be straightforward and be carried out by a suitably trained person.

Source: Health surveillance

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Specific requirements for health surveillance

• Dermatitis
• Noise-induced hearing loss
• Respiratory problems

MSDs and stress

There are health risks (eg stress; musculoskeletal disorders) for which the law doesn't require employers to provide formal health surveillance. This is because valid techniques don't yet exist to detect the symptoms of these diseases. However, it is still be good practice to monitor health using other arrangements, such as symptom reporting and sickness absence records.

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Occupational health referral

The purpose of a referral to an occupational health doctor or nurse is to provide support and work-related advice to the worker and their managers.

Before making a referral, it is important to meet with the employee to discuss all aspects, including the sickness absence record. An employee is entitled to attend an occupational health appointment within paid working time. Refusing to attend a referral will need to be discussed with a HR professional and/or the occupational health provider.

To get the best advice from occupational health service providers, the referral will need to include enough detail for an appropriate assessment to be made. The information package should include reasons for the referral, specific questions to be answered and a complete attendance record for the employee. It is also recommended that details of the current job and relevant risk assessments are provided to help the clinician understand the nature of the employee's work and advise whether any aspects might be affecting their health.

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