03
Health Surveillance
and Screening
HEALTH POLICIES
01. Proactive Health Policy
02. Internal Health Relationships
03. Health Surveillance and Screening
04. Mental Health and Stress
05. Getting People Back to Productive Work
06. Employee Wellness and Engagement
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Health Screening and Surveillance
Contents
Why carry out health surveillance? . . . . . . 3
Why go back and re-evaluate
your programme? . . . . . . . . . . . . . . . 5
Key elements of a successful
health surveillance programme . . . . . . . . 7
Health surveillance can start with
simple health check questionnaires . . . . . . 9
Off-the-shelf surveillance programmes
are available . . . . . . . . . . . . . . . . . 11
Further information . . . . . . . . . . . . . . 13
Notes . . . . . . . . . . . . . . . . . . . . . 13
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About the Proactive
Health Policies booklet
series
Management of employee health and
wellbeing is an important challenge
for all organisations. Becoming
proactive in health management can
assist corporate responsibility, reduce
company costs, increase productivity
and, most importantly, improve
people’s lives.
involved engage with a similar set of
ideas. These ideas will enable a flow
of information and understanding that
can push the health agenda forward.
They highlight:
This nest of six health policy booklets
is designed to support organisations
in becoming proactive in health
management. They are a starting
point to help the different disciplines
• Good practice
• Key focus areas
• Important concepts
• Useful tools and links
Booklet 3 Health Surveillance
and Screening
The management of ill health through
co-ordinated and consistent health
surveillance and screening processes
can provide considerable benefits to
the employer in ensuring compliance,
financial savings and reputation.
This document aims to present the
case and provide sources of useful
information for promoting employee
wellness through health surveillance.
It outlines a management approach,
which organisations can use to
provide benefit to both employer and
employee.
3 |
Health Screening and Surveillance
Why carry out health
surveillance?
If the meaning and purpose of health surveillance is not
clearly understood, organisations may tend to focus on health
assessment and monitoring programmes.
The Health and Safety Executive (HSE)
defines health surveillance as ‘putting in
place systematic, regular and appropriate
procedures to detect early signs of
work-related ill health among employees
exposed to certain health risks and acting
on the results’ (From the HSE health
surveillance webpages http://www.hse.
gov.uk/health-surveillance/).
Health surveillance is about managing
the effects of work on someone’s health.
For example, health surveillance would
identify a potential risk of white finger for
an employee whose work involved the
use of vibrating tools. Health surveillance
may be required by law for employees
who are exposed to noise or vibration,
ionising radiation, solvents, fumes, dusts,
biological agents and other substances
hazardous to health.
Health surveillance is not the same as
health assessment and monitoring which
might include:
• Pre-employment health checks
• Monitoring sickness absence
• Lifestyle health promotion
and education
• Annual health checks/health MOTs
While these types of assessment may
highlight potential risks to employees,
they should not be regarded as health
surveillance. Under the Railways and
Other Guided Transport Systems
(Safety) Regulations there are health
assessments that railway companies do
need to undertake in order to fulfil legal
requirements associated with safety
critical workers. A health assessment can
identify the potential effects of someone’s
health on their work. For example, an
assessment must identify a driver who is
colour blind and unable to perceive a red
signal. However, only health surveillance
fulfils the legal obligation to protect an
employee from the effects of work on an
individual’s health.
To achieve effective health surveillance
within an organisation, a number
of support functions need to work
together. For instance, health and safety
managers need to understand the legal
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requirements within the workplace,
manage the risks, set up surveillance
schemes and communicate their actions
and needs to others. HR managers
need to manage employee take up of
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the schemes, relay information and data
about health issues, make changes to
roles and notify others of their actions and
needs.
Health and Safety
Managers
Line Manager
Identify those
requiring assessment
Human Resource
Managers
Occupational Health
Specialists
Report findings to update
employment practices
Health surveillance requires cooperation across a number of roles
– are you doing enough to support your colleagues?
5 |
Health Screening and Surveillance
Why go back and
re-evaluate your
programme?
A lack of adequate health surveillance and its on-going
management can fool an organisation into thinking there is no
problem.
Health surveillance is a tool to protect
employees from illness caused by
exposure to health risks at work. It
provides information that helps to ensure
that any control measures are working
and helps identify where further controls
are needed. Under Section 2 of the
Health and Safety at Work Act 1974 there
is a legal duty on employers to reduce,
so far as reasonably practicable, the risks
to the health and safety of employees
and others who may be affected by work
activity.
for health surveillance. In a recent court
case involving a railway company, the
lack of a health risk assessment was
cited in a ruling against the company.
Without adequate health risk assessment
health surveillance cannot be in place.
Equally, downplaying a health issue in the
workplace, for example ‘Our employees
don’t suffer from stress, hence no need
for risk assessment’ is not a defence in
the court of law.
Health surveillance should be considered
following a risk assessment where
there is a significant residual health risk
to employees even after reasonably
practicable control measures are in
place. Employee’s attendance for health
surveillance is mandatory where a risk
assessment has established that a
genuine need for health surveillance
exists.
A pilot study was carried out by
Constructing Better Health (CBH) to
look at work-related health needs in the
construction industry and the case for
a national scheme. It found employers
were unsure how to provide occupational
health surveillance, there was a lack of
consistency and co-ordinated feedback
to management on occupational health
matters, and a lack of consistency in the
collection, reporting and communication
of individual and group health information.
Health surveillance is the result of
an adequate health risk assessment,
so it follows that an inadequate risk
assessment may not identify the need
Within our own industry, the ORR
overview of work-related ill-health in the
GB rail industry in 2010 identified, ‘Many
of the occupational diseases reportable
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under RIDDOR Schedule 3 are relevant
to the rail sector, including Hand Arm
Vibration Syndrome (HAVS), other upper
limb disorders, occupational asthma,
dermatitis, asbestos related disease,
tetanus, legionella and leptospirosis, but
we see few reported cases.’
Although the negative effects of HAVS
are permanent, the damage can be
limited if identified early by health
surveillance. In 2002, as a result of
Stress
in partnership with
• Top cause of long-term absence
• 40% of employers reported an increase
in stress-related absence
• 10% reported a decrease
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targeted health surveillance, a single train
depot diagnosed 24 new cases of HAVS
and reported them under RIDDOR1. In
this case, 24 lives were positively affected
by a good health surveillance programme.
In cases such as this, simple things
like playing catch with a young family
member would not have been possible if
the condition had not been identified in
time. This is a thought that should not be
dismissed as cliché because they are the
very real effects on people’s lives.
The 2012 Chartered
Institute of Personnel
and Development (CiPD)
report into absenteeism
identifies stress as the
leading cause of long
term health absence –
how does your health
surveillance programme
pick up this issue?
Does your organisation adequately support your health surveillance programme?
7 |
Health Screening and Surveillance
Key elements of a
successful health
surveillance programme
There are some useful documents available to help an
organisation re-evaluate its programme.
The main resource for information is
the HSE’s Health Surveillance web
pages (http://www.hse.gov.uk/healthsurveillance/) which provide guidance
for organisations on how to meet their
legal duty regarding health surveillance.
It states that a health surveillance
programme may not be costly and
can start with simple self-checks by
employees, to look for and report any
signs of work-related ill health.
The website provides guidance on:
• How to ensure a health surveillance
programme is successful
• Being sure about its purpose
• Involving employees and their
representatives and building trust
• Getting the programme right for your
needs
• Being clear about roles and
responsibilities
• Recording and acting on the results
• Dealing with special cases
• Monitoring, and evaluating the
programme
• Keeping health records
When managing a health surveillance
scheme, it is important that the
roles involved understand when the
complexity of the situation exceeds their
competency. For example, Health and
Safety Managers should know when
Ergonomists and Occupational Hygienists
should be used to understand complex
health risks.
The CBH has developed industry
standards for the construction industry.
These standards provide guidelines for
the employer on legal compliance, best
practice and what makes good business
sense in workplace health management.
The industry standards:
• Define safety critical work (SCW)
• Define fitness for work and task
requirements
• Outline the competencies required of
occupational health service providers
(OHSPs) delivering services
• Outline the legal requirements for
health checks
• Outline the health checks required on
different types of workers
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Health surveillance is needed to ensure
that the controls of health hazards are
working. Some common health hazards
that may need surveillance include:
• Chemical hazards, arising from
liquids, solids, dusts, fumes, vapours,
gases.
• Physical hazards, such as noise,
vibration, unsatisfactory lighting,
radiation, extreme temperatures (hot
or cold).
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• Biological hazards, from bacteria,
viruses, infectious waste.
• Psychological hazards, resulting from
stress and strain.
• Non-application of ergonomic
principles, resulting in poorly designed
machinery/tools or poorly designed
work practices.
Alstom Transport – implementation of a health surveillance
programme
Alstom Transport carried out a gap analysis within their workplace,
which highlighted where they were failing to identify potential ill
health effects from hazardous exposures.
A Health Surveillance programme was set up including risk
assessments to identify any potential hazards and residual risks to
health after reasonably practicable control measures were applied. A
hazard matrix was developed, to identify exposure against roles, to
enable Occupational Health (OH) specialist advice on level and type
of health surveillance required.
An OH provider was then engaged to provide a three-year
scheduled assessment programme. This was supported by a
communication programme via employee factsheets and toolbox
talks with key stakeholders. A Health Surveillance report for each
site was produced using a red flag system to highlight any significant
issues. The OH specialist will report back to the appropriate
business representatives to ensure control measures are effective
as far as reasonably practical.
ORR website: http://www.rail-reg.gov.uk/server/show/nav.2565
9 |
Health Screening and Surveillance
Health surveillance can
start with simple health
check questionnaires
Based on solid risk assessment techniques, the starting point
to a good health surveillance programme can be a simple
checking process.
The purpose of a basic health check
questionnaire is to act as a starting point
to evaluate the adequacy of controls.
This can help to protect employee health
by early detection of any adverse health
effects. The questionnaire could be
completed by any employee identified
(by risk assessment) as requiring health
surveillance. However, such a health
check is not likely to be adequate for
those with pre-existing conditions. In
some cases, the health check may be
enough to monitor a health issue but
they should not be used to replace a well
thought out surveillance regime.
HAND-ARM VIBRATION SYNDROME (HAVS)
Since your last review or in the last 12 months
Do you have any numbness or
tingling of the fingers which
lasts for more than 20 minutes
after using vibrating tools?
Have any of your fingers gone
white* on exposure to cold?
*whiteness is a clear discolouration of the
fingers with a sharp edge, usually followed
by a red flush.
Do you have numbness or
tingling of the fingers at any
other time?
Do you wake at night with pain,
tingling, or numbness in your
hands or wrists?
Have you noticed any change in
your response to your tolerance
of working outdoors in the cold?
Are you experiencing any other
problems in your hands or arms?
Do you have difficulty picking up
very small objects, for example
screws or buttons or opening tight
jars?
Has anything changed about your
health since the last assessment?
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SKIN
Since your last review or in the last 12 months have you had any of
the following symptoms:
Redness or irritation of fingers or
hands?
Have you seen your GP for a
skin problem?
Flaking or scaling of the skin on
fingers or hands?
Have you been diagnosed with a
skin problem?
• Are moisturisers/barrier creams
Cracking of the skin on fingers or
hands?
• Are gloves worn when
Blisters on fingers or hands?
• Visible skin problems today?
used?
required?
• If pre-existing skin problem, has there
Itching of fingers or hands?
been any change?
• Further action required?
Have you lost time from work
with a skin problem?
• Refer to Occupational Health?
RESPIRATORY
Since your last review or in the last 12 months have you had any of the
following: (do not include isolated illnesses such as colds or flu.)
Wheezing?
Have you taken any treatment for
your chest?
Chest tightness?
Breathlessness?
Have you ever been told by
a doctor that you suffer from
asthma?
Cough?
Do you smoke?
Blocked or runny nose?
• Is Respiratory Protective Equipment
(RPE) required?
Soreness and/or watering of
eyes?
• If so, is Respiratory Protective
Equipment (RPE) used?
• Further action required?
Have you seen your GP for chest
problems?
• Refer to Occupational Health?
11 |
Health Screening and Surveillance
Off-the-shelf surveillance
programmes are available
Constructing Better Health (CBH) offers a framework to help
fulfil health surveillance requirements.
Constructing Better Health (CBH) defines
health surveillance as a legal requirement
and a systematic check on health and
maintaining records on an individual
engaged in certain work activities where:
• There is a valid way to detect a
disease or condition
• It is reasonably likely that damage to
health will occur under the particular
conditions at work
• Health surveillance is likely to benefit
the employee
• Steps can be taken to eliminate
or reduce the probability of further
damage
CBH has produced a health assessment
matrix which employers and OH
providers can use to identify the health
assessment requirements (subject to the
risk assessment process) for a particular
job role. The matrix sets out the health
checks and fitness levels required for
each job role found within construction
and rail track side environments.
A traffic light system is used within the
matrix that identifies which health checks
are:
• RED Legally required, so there is a
legal requirement to undertake health
surveillance/statutory medicals
• AMBER Evidence-based or best
practice (strongly recommended) and
fitness for task assessments
• GREEN Discretionary, so should be
chosen as an enhancement to the two
categories above and decided on a
cost/benefit analysis basis
The Hazards table section in the matrix
below can be used to identify additional
risks which may be relevant if an
individual is to carry out a task that is not
normally part of their role. For example,
further risk assessment would be needed
for a plumber who works as a lone
worker. Each health assessment in the
matrix has an allocated Fitness Standard
code (A-R). The fitness standards set out
the health requirements of each health
check and provide evidence-based or
best practice guidance to follow. The
standard sets out the recommended
frequency for carrying out each health
check.
The CBH website can be found at:
http://www.cbhscheme.com/
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K
L
M
N
O
P
Q
R
General Health/Lifestyle
J
Workplace Stress /
Mental Health Assessment
I
Drug and Alcohol Screening
(Company Policy)
H
Colour Vision
G
Biological Monitoring
F
Mid Range Acuity (DSE users)
E
Urinalysis
D1 D2 D3 D4
Visual Acuity
C
Vibration Health Check
B
Audiometry Health Check
A
Skin Health Check
HEALTH ASSESSMENT MATRIX
Respiratory Health Check
Health Assessment Matrix
Blood Pressure
Compressed Air
Musculoskeletal
Questionnaire/Assessment
Lead
Ionising Radiation
Asbestos
Pre-Placement Health
Assessment/Medical
Safety Critical Workers - Fitness
For Task Assessments
Pre-Placement Questionnaire
Statutory Medicals (Appointed Doctor)
SECTION 1: JOB ROLE/TASK
ADMINISTRATOR (site)
ASBESTOS LICENSED WORKER
C
BRICKLAYER
CARPENTER/JOINER/SHOP FITTER
CONCRETE SPRAYER
CONSTRUCTION SITE OPERATIVE - GENERAL
CONSTRUCTION SITE OPERATIVE - SPECIALIST (risk assessment)
DIVER (refer to standards)
C
DEMOLITION OPERATIVE
ELECTRICIAN - FITTER/ENGINEER
FORM WORKER
GEOTECHNICAL
C
GLAZIER/GLASS FITTER/WINDOW INSTALLER
INDUSTRIAL CLEANER
LGV/HGV DRIVER
C
MARITIME OPERATIVE GENERAL (refer to standards)
MARITIME OPERATIVE SPECIALIST (refer to standards)
C
PAINTER/DECORATOR
PILING OPERATIVE
PIPE FITTER
PLANT OPERATOR - GENERAL
C
PLANT OPERATOR - CRANE DRIVER
C
PLANT OPERATOR - MOBILE MACHINE DRIVER
C
PLASTERER/DRY LINER
PLUMBER/GAS/HEATING/VENTILATION ENGINEER
PROFESSIONAL
ROAD CONSTRUCTION - ASPHALTER/PAVER
ROOFER - SLATER/THATCHER/TILER
C
SCAFFOLDER/RIGGER
SITE FOREMAN/SUPERVISOR
SITE MANAGER
SLINGER/SIGNALLER/BANKSMAN/TRAFFIC MARSHALL
C
STEEL ERECTOR STRUCTURAL/FABRICATOR
C
STEEPLEJACK
C
STONEMASON
TUNNEL BORING GANG
C
WALL TILER/FLOOR TILER
WELDER
SECTION 2: HAZARDS TABLE
ASBESTOS (short duration)
BIOLOGICAL
CEMENT/CONCRETE
CHEMICAL - RESPIRATORY (sensitisers)
CHEMICAL - SKIN (sensitisers)
COMPRESSED AIR
CONFINED SPACE
C
IONISING RADIATION
LEAD
LONE WORKING
MANUAL HANDLING
NOISE
NIGHT WORK (and annual assessment)
RAIL TRACKSIDE (refer to standards, PTS or equivalent)
ROADSIDE (high speed)
C
SILICA
TUNNELLING (Hyperbaric and/or confined space only)
C
VIBRATION
C
SECTION 3: SAFETY CRITICAL WORKERS - All workers must be assessed for safety critical worker status
HEALTH CHECKS INCLUDED IN ASSESSMENT
KEY TO CODING:
HEALTH SURVEILLANCE/MANDATORY HEALTH CHECK (Dependant on worker risk exposure - risk assessment required)
C
SAFETY CRITICAL - CBH classes this as an ESSENTIAL health check requirement in construction
ASSESSMENT OF HEALTH (BEST PRACTICE) (Strongly recommended - risk assessment required)
NOT LEGALLY REQUIRED - GOOD BUSINESS SENSE
Prevention is better than cure.
NATIONAL INDUSTRY SCHEME
FOR WORKPLACE
HEALTH MANAGEMENT
Helpline: 0845 873 7726
www.cbhscheme.com
This Matrix is not to be used in isolation, refer to the
CBH Industry Standards for Workplace Health in UK Construction
Matrix2/1152/1111/©CBH
WORKING AT HEIGHT (control measures not practicable)
13 |
Health Screening and Surveillance
Further Information
HSE provides information and guidance on health surveillance on their website
http://www.hse.gov.uk/construction/healthrisks/surveillance.htm
Health Surveillance at Work HSG61, HSE, 1999
Occupational health standards in the construction industry, RR584 Research Report,
Health and Safety Laboratory prepared for HSE, 2007
The Railways and Other Guided Transport Systems (Safety) Regulations 2006
Guidance on Regulations Office of Rail Regulation April 2006:
http://www.rail-eg.gov.uk/upload/pdf/283.pdf
Notes
1
ORR overview of work related ill health in the GB rail industry in 2010, ORR, 2011
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