Enforcement Management Model (EMM): Application to Health Risks

Formerley OC 130/5 - Enforcement Management Model (EMM)


This guidance explains how to apply the principles of the Enforcement Management Model (EMM) to health risks and includes occupational health descriptors for the "consequence" element of risk gap analysis.


This guidance has been produced to help inspectors reach a proportionate enforcement decision. It contains advice on use of the EMM, determining the Risk Gap, risk-based decisions and compliance issues. It also refers to issues concerning personal protective equipment, training and supervision.

Enforcement action should either be risk based (EMM, Step 1, Table 5.1) or compliance based (EMM, Step 1, Table 5.2) In some cases, a combined approach may be required. For example, situations where risks may be controlled in the short term by PPE but full compliance with the law also requires consideration of a hierarchy of measures including elimination/substitution through to control by engineering means. Further guidance is given below in the section titled Personal protective equipment.

A valid enforcement decision could be PN and IN action taken in parallel - the former to reduce the risk in the short term and the latter to secure compliance in the longer term.


This section gives guidance on;

  • Applying the risk gap table descriptors to health risks
  • Determining the most credible health outcome
  • Making risk-based decisions in respect of health issues
  • Making compliance and administrative-based decisions in respect of health issues
  • Personal protective equipment considerations
  • Training and supervision considerations

Risk Gap Table

Table 1 - 'Consequence' (Appendix 1) has been developed to give descriptors with supporting characteristics for health risks comparable to those used for safety risks.  For example, 'serious health effect' is the equivalent of 'serious personal injury'. They should be employed when determining the risk gap for health issues.

In relation to "Likelihood", the EMM states that inspectors should use their professional judgement and any supporting guidance to determine whether the likelihood of the priority for action, in this case the occurrence of ill health. Due to the varied nature of occupational health hazards, it is not possible to give more precise definitions of these descriptors. Guidance on individual hazards generally provide assistance on determining the likelihood of ill health by means of reference to exposure levels.

Determining the most credible health outcomes

Consideration has been given to the most likely typical end health effects from a range of occupational exposures. There will be circumstances where lesser health effects might well be the outcome. Conversely, worse outcomes may be possible but the approach taken here does not reflect the 'worst case scenario'. In general, no account has been taken of specific individuals' susceptibility since this will not be known - the working population has been taken as a whole. For each of the topics, the approach has been to determine the most credible health outcome.

The resultant enforcement outcome should be preventive, aimed at dealing with the particular situation confronting the inspector, who may not know the details of previous exposures or likely future changes to exposure patterns. In weighing up the quality of evidence available, inspectors will use their judgement about the nature of the exposure to risk. Where necessary they should seek advice and support from Specialists, HSL and relevant Directorate Units in accordance with Directorate/Divisional procedures.

Risk based decisions - EMM table 2.1

Inspectors should refer to specific topic guidance  when determining the risk gap for relevant health issues. Current examples include: Hand Arm Vibration and Noise at work.

When applying the EMM to risks from manual handling, inspectors should refer to the Manual Handling Assessment charts, MAC. When applying the EMM to manual handling risks not covered by this guidance and for upper limb disorder risks, Inspectors should seek further advice from specialists, on a case by case basis, concerning the actual risk and the benchmark.

Topic guidance gives information on risk with supporting explanatory notes. This should be used in conjunction with the EMM Table 2.1 to determine the risk gap. Where possible, the position of the benchmark has been indicated. For some topics, further industry/sector or specialist inspector advice may be needed, for example to advise on the reasonable practicability of control measures.

Since much occupational health legislation uses numerical limits for minimum standards of performance, inspectors should refer to specific topic guidance that uses a corresponding approach to reflect the seriousness of a breach, and the extent of the actual risk, in terms of how far minimum limits are exceeded. For example, a range of exposure levels will indicate a particular likelihood of an ill-health effect. The boundaries to the ranges have been determined through debate within HSE involving specialist and medical inspectors and policy units. Discussions and agreements both inside and outside HSE (for example concerning occupational exposure limits) have informed these discussions.

The approach proposed is not intended to be prescriptive, but aims to give inspectors a broad indication of the relative seriousness of a particular set of circumstances to help determine a proportionate enforcement response. The inspector is not expected to carry out a surrogate assessment in place of one often required of the employer by legislation. Rather, the inspector is expected to make a best estimate of the situation based on the evidence to hand. As a result, enforcement of the assessment duty itself might be a high priority. Where issues are complex, inspectors should involve relevant specialists in determining the actual level of risk, and any corresponding benchmark.

Single/multiple casualties

In general, inspectors should use the single casualty table even if more than one person is at risk. Both the breach and the extent of the risk should be the same for single or multiple casualties. Inspectors will still need to take into account numbers exposed to the risk as part of a 'proportionate' enforcement response. Strategic Factors may be important even for single casualties, eg where circumstances could serve as an example to other duty holders.

Use of the multiple casualty table should usually be restricted to scenarios such as major hazards with off site risks, or where a number of members of the public may be at risk, for example where inspectors are considering risk of exposure to Legionella from cooling towers.
However, single events affecting large numbers of employees may also be considered. An example would be large scale poorly controlled  use of metal working fluids. There have been instances of multiple instances of asthma where large numbers of persons have been exposed to MWF aerosol.

Compliance and administrative issues - EMM table 5.2

Many Regulations covering health risks require a package of measures, some of these are risk control measures, whilst others may be 'administrative'. Inspectors will be used to applying judgement in deciding whether, for example, the absence of a certificate of examination from a third party, is a matter that is risk related or administrative. Generally, the outcome of such considerations will depend on the performance of the dutyholder and the confidence the Inspector has in the way the dutyholder is controlling the relevant risk. However, since the risks from hazards to health are not always evident, the absence of such a certificate may mean that the dutyholder does not have the information necessary to ensure that the required control measures are working adequately.

In making such judgements, Inspectors will need to consider the nature of the hazard. The more aggressive the hazard or the more likely exposure will result in a serious health risk, the more likely it is that defects in systems or the absence of documentation is risk related.

Equally, the same deficiencies with a less aggressive hazard may be administrative issues that should be dealt with by reference to Table 5.2 of the EMM.

Personal protective equipment

Inspectors will need to make judgements about the entire hierarchy of risk controls when identifying breaches of the law including any reliance on PPE/RPE as a control measure. In some circumstances elimination, substitution or control at source may be reasonably practicable and PPE would not be considered to constitute adequate compliance. In others, PPE might be the only reasonably practicable option for controlling risk. Industry/sector guidance will be an important consideration.

Training and supervision

Where training and supervision, necessary to ensure that control measures are properly used or applied, is lacking but control is good, Inspectors may experience difficulty in applying the "risk gap" route of the EMM. In such circumstances, the matter should be dealt with via the "compliance and administrative issues route", employing EMM Table 5.2.

However, where training is a primary precautionary measure, for example, where there is reliance on PPE for protection and absence/inadequacies lead to employees being at risk, the "risk gap" route should be followed and EMM Table 2.1 should be used.


This guidance supplements that contained in http://intranet/legal/emm/index.htm, and the EMM itself.


There are no specific organisational requirements associated with this guidance.


FOD HQ Legal & Enforcement Account

Appendix 1: Occupational Health Descriptors and Supporting Characteristics

Modified Consequence table from EMM applying to health risks only

Table 1 – Consequence (What are the potential consequences of the event?
Descriptor Definition - Possible characteristic(one or more may be relevant)

Serious Health Effect

Any disease or condition causing or likely to cause;

  • death;
  • a permanent, progressive or irreversible condition;
  • permanently disabling, ie
    • i) lifelong restriction of work capability or,
    • ii) major reduction in quality of life

Examples of conditions, infections and diseases that can meet these criteria are listed in Appendix 2.

Significant Health Effect

Any disease or condition causing or likely to cause;

  • A non-permanent, reversible, non-progressive condition;
  • Temporary disability eg restriction of work capability or quality of life lasting more than seven days.

Examples of conditions, infections and diseases that can meet these criteria are listed in Appendix 3.

Minor Health Effect

Any other disease or condition causing or likely to cause;

  • Transient, temporary symptoms lasting seven days or less.

Examples include:

  • Temporary symptoms like irritation, nausea, headache,
  • Minor skin irritations,
  • Some infections caused by biological agents in Hazard Group 2, such as Staphylococcus aureus.

Appendix 2: Serious health effects

The following may be considered as having a serious health effect:

1. Conditions due to physical agents and the physical demands of work:

  • inflammation, ulceration or malignant disease of the skin due to ionising radiation;
  • cataract due to electromagnetic radiation;
  • malignant disease of the bones due to ionising radiation;
  • blood dyscrasia due to ionising radiation;
  • decompression illness;
  • barotrauma resulting in lung or other organ damage;
  • dysbaric osteonecrosis;
  • hand-arm vibration syndrome;
  • noise-induced hearing loss.

2. Infections due to biological agents in Hazard Groups 3 & 4 and some agents in Group 2,

  • Legionella pneumophila,
  • Neisseria meningitis.

3. Conditions due to substances:

  • cancer of a bronchus or lung;
  • primary carcinoma of the lung where there is accompanying evidence of silicosis;
  • Cancer of the urinary tract or the bladder;
  • angiosarcoma of the liver;
  • skin cancer;
  • mesothelioma;
  • cancer of the nasal cavity or associated air sinuses;
  • peripheral neuropathy;
  • chrome ulceration of the nose or throat;
  • pneumoconiosis;
  • byssinosis;
  • asbestosis;
  • occupational asthma;
  • allergic contact dermatitis, (eg where MSDS contains risk phrase R43; May cause sensitisation by skin contact)
  • extrinsic alveolitis (including farmer's lung) Repeated attacks of alveolitis may lead to disabling scarring of the lungs.

Appendix 3: Significant health effects

The following may be considered as having a significant health effect:

1. Conditions due to physical agents and the physical demands of work:

  • cramp of the hand or forearm due to repetitive movements;
  • subcutaneous cellulitis of the hand (beat hand);
  • bursitis or subcutaneous cellulitis arising at or about the knee, due to severe or prolonged external friction or pressure at or about the knee (beat knee);
  • bursitis or subcutaneous cellulitis arising at or about the elbow, due to severe or prolonged external friction or pressure at or about the elbow (beat elbow);
  • traumatic inflammation of the tendons of the hand or forearm or of the associated tendon sheaths;
  • carpal tunnel syndrome.

2. Infections due to biological agents:

  • most agents in Hazard Group 2, eg Salmonella spp(food poisoning) and Campylobacter spp.

3. Conditions due to substances:

  • chrome ulceration of the skin of the hands or forearm;
  • folliculitis;
  • acne;
  • irritant contact dermatitis (eg where MSDS contains risk phrase R38; Irritating to skin);

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Updated 2023-10-30