RM1647210802RRC
RRC Study Text
NEBOSH
International Diploma for Occupational
Health and Safety Management Professionals
Unit ID2 - PART 1
Do - Controlling Workplace Health Issues (INT)
June 2021
RM1648210802RRC
RM1649210802RRC
NEBOSH INTERNATIONAL DIPLOMA FOR
OCCUPATIONAL HEALTH AND SAFETY
MANAGEMENT PROFESSIONALS
UNIT ID2 - PART 1
ID2 Learning Outcome 9.1
ID2 Learning Outcome 9.2
ID2 Learning Outcome 9.3
ID2 Learning Outcome 9.4
ID2 Learning Outcome 9.5
ID2 Learning Outcome 9.6
ID2 Learning Outcome 9.7
ID2 Learning Outcome 9.8
RM1650210802RRC
CONTRIBUTORS
Kevin Coley, MSc, BA, CMIOSH
© RRC International
ACKNOWLEDGMENTS
All rights reserved. RRC International is the trading name of The Rapid
Results College Limited, Tuition House, 27-37 St George’s Road,
London, SW19 4DS, UK.
RRC International would like to thank the National Examination Board
in Occupational Safety and Health (NEBOSH) for their co-operation in
allowing us to reproduce extracts from their syllabus guides.
These materials are provided under licence from The Rapid Results
College Limited. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted in any form, or by any means,
electronic, electrostatic, mechanical, photocopied or otherwise,
without the express permission in writing from RRC Publishing.
This publication contains public sector information published by the
Health and Safety Executive and licensed under the Open Government
Licence v.3 (www.nationalarchives.gov.uk/doc/open-governmentlicence/version/3).
For information on all RRC publications and training courses, visit:
www.rrc.co.uk
RRC: ID2 - Part 1
ISBN for this volume: 978-1-912652-43-3
First edition June 2021
Every effort has been made to trace copyright material and obtain
permission to reproduce it. If there are any errors or omissions, RRC
would welcome notification so that corrections may be incorporated in
future reprints or editions of this material.
Whilst the information in this book is believed to be true and accurate
at the date of going to press, neither the author nor the publisher can
accept any legal responsibility or liability for any errors or omissions
that may be made.
RM1651210802RRC
Contents
Introduction
ID2 Learning Outcome 9.1
Principles and Benefits of Vocational Rehabilitation
9-5
Basic Principles of the Bio-Psychosocial Model
The Importance of Making ‘Reasonable Adjustments’ for Workers With Physical and Mental Ill Health
Pre-Placement Health Assessments
Managing Long-Term and Short-Term Frequent Sickness Absence and Capability
Vocational Rehabilitation
Risk Assessment
9-5
9-6
9-8
9-9
9-14
9-16
Occupational Health Services
9-19
Make-Up of a Typical Occupational Health Service
Typical Activities Offered by an Occupational Health Service
Calling on Specialist Help
9-19
9-22
9-25
Summary
9-26
2-3
RM1652210802RRC
Contents
ID2 Learning Outcome 9.2
Mental Ill Health at Work
9-29
Circumstances Leading to Mental Ill Health
Anxiety and Depression
Work-Related Stress
Causes of Work-Related Mental Ill Health
Work-Related and Non-Work-Related Factors
9-29
9-33
9-35
9-36
9-38
Mental Health Controls
9-39
Why We Need to Manage Mental Ill Health
Facilitating Work
Identification and Assessment of Risk of Stress and Mental Ill Health
The Management Standards Approach
Practical Control Measures
Types of Intervention for Mental Ill Health
Managing Mental Ill Health in the Workplace
Benefits from Good Nutrition, Exercise and Sleep on Mental Ill-Health Conditions
9-39
9-40
9-40
9-41
9-43
9-45
9-46
9-48
Well-Being
9-51
Relationship between Well-being and Health
9-51
Work-Related Violence
9-58
Definitions
Physical and Psychological Effects
Risk Factors
Assessment of Risk of Violence
Control Measures
9-58
9-60
9-61
9-62
9-64
Lone Working
9-67
Introduction to Lone Working
The Hazards and Risks of Lone Working
Controlling the Risks of Lone Working
9-67
9-68
9-68
Summary
9-73
RM1653210802RRC
Contents
ID2 Learning Outcome 9.3
Health Surveillance: Health Monitoring and Biological Monitoring
9-77
Health Assessment and Health Surveillance
The Health Surveillance Cycle
Health Surveillance for Noise
Health Surveillance for Vibration
Keeping Health Records and Medical Records Confidential
Biological Monitoring
Health Assessments for Night Workers
Forms of Health Surveillance
9-77
9-79
9-79
9-85
9-85
9-86
9-89
9-91
Alcohol/Drugs Policy and its Legal Implications
9-94
Establishing and Maintaining an Alcohol/Drugs Policy
Disadvantages of Alcohol and Drug Testing
9-94
9-96
Summary
9-97
ID2 Learning Outcome 9.4
The Human Anatomical System
9-101
Introduction to the Human Anatomical System
Respiratory System
Digestive System
Circulatory System
Skin
The Eye
The Nose
Main Routes and Methods of Entry
Local and Systemic Effects and Target Organs
Defence Responses
Inhalable and Respirable Dust
9-101
9-101
9-102
9-104
9-108
9-109
9-109
9-109
9-111
9-112
9-116
Summary
9-117
2-5
RM1654210802RRC
Contents
ID2 Learning Outcome 9.5
Prevention and Control of Exposure to Hazardous Substances
9-121
Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH)
Purpose of Classification of Hazardous Substances, the Globally Harmonised System (GHS) and the
Classification, Labelling and Packaging Regulation (CLP)
Health Hazard Classes
Labelling and Safety Data Sheets
Factors to Consider when Assessing Health Risk
Review of the Assessment
The Prevention and Control of Exposure
The Hierarchy of Controls
9-122
Summary
9-145
9-122
9-124
9-130
9-133
9-140
9-140
9-141
ID2 Learning Outcome 9.6
Epidemiology and Toxicological Testing
9-149
Use of Epidemiology and Toxicological Testing in Classification
Human Epidemiology
Alternatives to Animal Testing
Dose/Response Relationship
9-149
9-150
9-154
9-155
Summary
9-158
ID2 Learning Outcome 9.7
Specific Requirements for Working with Asbestos
9-161
Asbestos Health Risks
Control of Asbestos
General Preventive Measures
Personal Protection
Cleaning of Plant and Premises
Packing, Transport and Storage
Waste Disposal and Collection
Use of Specialist Contractors
Supervision of the Health of Workers
Information, Labelling, Education and Training
Lead
Health Surveillance for Workers
9-161
9-162
9-163
9-164
9-165
9-165
9-165
9-166
9-166
9-166
9-167
9-168
Summary
9-169
RM1655210802RRC
Contents
ID2 Learning Outcome 9.8
Ventilation
9-173
Introduction to Ventilation
Local Exhaust Ventilation (LEV)
Stages to Carrying out Examination and Testing
Interpretation of Reports
9-173
9-176
9-184
9-190
Personal Protective Equipment and Respiratory Protective Equipment
9-192
Introduction to Personal Protective Equipment
Respiratory Protective Equipment (RPE)
Types of Respirator
Types of Breathing Apparatus (BA)
Selection of RPE
Skin and Eye Protection
Selection of Skin and Eye Protection
Storage and Maintenance of PPE
Training Requirements
Duty to Ensure PPE is Worn Correctly
9-193
9-194
9-195
9-198
9-200
9-207
9-210
9-212
9-212
9-213
Summary
9-214
Suggested Answers to Study Questions - Part 1
2-7
RM1656210802RRC
RM1657210802RRC
Introduction
Course Structure
This study text has been designed to provide the learner with the core knowledge needed to successfully complete the
NEBOSH International Diploma for Occupational Health and Safety Management Professionals, as well as providing
a useful overview of health and safety management. It follows the structure and content of the NEBOSH syllabus and
includes extra “Prior Learning” material to support your understanding of diploma-level content.
The NEBOSH International Diploma consists of three units of study. Learners must achieve a ‘Pass’ in all three units to
achieve the qualification, and you need to pass the three units within a five-year period. For more detailed information
about how the syllabus is structured, visit the NEBOSH website (www.nebosh.org.uk).
Assessment Background
There are no in-person examinations for the International Diploma for Occupational Health and Safety Management
Professionals. Instead, assessment will be via assignments and scenario-based case studies. Details of these together
with sample assessments and assessment dates can be found on the NEBOSH website:
www.nebosh.org.uk/qualifications/international-diploma-for-health-and-safety-managementprofessionals/#assessments
Please note that at the time of publication, a sample assessment for ID1 is available only.
NEBOSH state that the assessments are a substantial undertaking and should take around 60 hours for ID1, and 40
hours each for ID2 and ID3. It is important that you prepare well for the assessments and remember that whilst these
may not be traditional exams, they are still intended to be challenging assessments of your capabilities and skills. You
are therefore allowed a significant period of time to complete the assessment, so it is vital that you understand this and
do not leave the assessment until the last minute.
Unit
Estimated time required to
complete assessment
Time period given by NEBOSH to
complete assessment
ID1
60 hours
6 weeks (30 working days)
ID2
40 hours
4 weeks (20 working days)
ID3
40 hours
4 weeks (20 working days)
During the assessments you will have access to books and the internet, however this must be your own work and there
are stringent protocols in place to prevent plagiarism. All assessments will be checked via plagiarism software and each
assessment also includes a closing interview. Guidance on digital assessments can be found on the NEBOSH website at:
www.nebosh.org.uk/digital-assessments/diploma/
Unit ID2 Assessment
The Unit ID2 assessment consists of a scenario-based case study.
At the time of publication, full information on the ID2 assessment is unavailable. Updated information will be issued
as soon as it is published by NEBOSH.
Results
Results will be issued 50 working days after the submission date for the assessment. After successful completion of
each unit a ‘unit certificate’ will be awarded. After you have completed all 3 units the combined percentage mark will
be used to determine your final grade:
• 226 or more: Distinction
• 196-225: Credit
• 150-195: Pass
© RRC International
© RRC International
9-1
2-1
RM1658210802RRC
Introduction
More Information
As you work your way through this book, always remember to relate your own experiences in the workplace to
the topics you study. An appreciation of the practical application and significance of health and safety will help you
understand the topics.
Keeping Yourself Up-to-Date
The field of health and safety is constantly evolving and, as such, it will be necessary for you to keep up to date with
changing legislation and best practice.
RRC International publishes updates to all its course materials via a quarterly e-newsletter (issued in February, May,
August and November), which alerts students to key changes in legislation, best practice and other information
pertinent to current courses.
Please visit https://www.rrc.co.uk/news-resources/newsletters.aspx to access these updates.
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
Unit ID1
Know – Workplace Health and Safety Principles (International)
Unit ID2
Do – Controlling Workplace Health Issues (International)
Unit ID3
Do – Controlling Workplace Safety Issues (International)
9-2
© RRC International
RM1659210802RRC
Learning Outcome 9.1
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Understand how to treat disability and sickness fairly in the workplace and the role of an
occupational health service.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Outline the principles and benefits of the management of return to work including the
role of outside support agencies.
• Outline the management of occupational health (including the practical and legal
aspects).
© RRC International
ID2 Learning Outcome 9.1
9-3
RM1660210802RRC
Contents
Principles and Benefits of Vocational Rehabilitation
9-5
Basic Principles of the Bio-Psychosocial Model
The Importance of Making ‘Reasonable Adjustments’ for Workers With Physical and Mental Ill Health
Pre-Placement Health Assessments
Managing Long-Term and Short-Term Frequent Sickness Absence and Capability
Vocational Rehabilitation
Risk Assessment
9-5
9-6
9-8
9-9
9-14
9-16
Occupational Health Services
9-19
Make-Up of a Typical Occupational Health Service
Typical Activities Offered by an Occupational Health Service
Calling on Specialist Help
9-19
9-22
9-25
Summary
9-26
9-4
ID2 Learning Outcome 9.1
© RRC International
RM1661210802RRC
Principles and Benefits of Vocational Rehabilitation
Principles and Benefits of Vocational Rehabilitation
THIS SECTION...
•
The bio-psychosocial model is a way of considering human ill health as being more than simply a case of medical
disease, but a combination of biological condition and psychological response by the individual within a social
context.
•
The importance of making ‘reasonable adjustments for workers with physical and mental ill-health.
•
A pre-placement health assessment is undertaken as part of the risk assessment process (only after a job offer has
been made) to determine the health and fitness of the worker in respect of the job that they will be carrying out.
•
Employers must establish policies and procedures to actively manage employees’ return to work from long-term
and short-term frequent sickness absence. This is best done through appropriate liaison between managers,
occupational health and other health care providers as outlined in the UK’s National Institute for Health Care
Excellence ( NICE) guidance note NG146.
•
Vocational rehabilitation is concerned with helping someone with a health problem to stay at, return to, and
remain in work. There are benefits to rehabilitating workers back into the workplace, both for the employer and
the employee, and the bio-psychosocial model can be used to identify barriers to the rehabilitation of ill workers
and has been used in the rehabilitation of workers with musculoskeletal disorders (MSD) and other common
work-related conditions.
•
Risk assessment plays an important role in the return to work of an employee following ill health or incapacity.
•
Liaison with other disciplines in assessing and managing fitness for work is likely to achieve good employment
outcomes for individuals.
•
The role of various external agencies such as Occupational Therapists (OTs) exists to provide support to the
employer and employee during the return-to-work and rehabilitation process.
Basic Principles of the Bio-Psychosocial Model
The bio-psychosocial model was first developed by George Engel in 1977.
He was concerned that the medical or biological models of healthcare
in use at the time exclusively treated the person’s ill health by medical
means. Research in psychology and the social sciences challenged the
narrow framework approach of the medical models and Engel proposed
that behaviours, thoughts and feelings could influence a person's physical
well-being. The model, therefore, suggests that to treat a person’s medical
condition involves consideration of three factors:
•
Biological refers to the physical or mental health condition.
•
Psychological recognises that personal/psychological factors also
influence functioning and the individual must take some measure of
personal responsibility for his or her behaviour.
•
Social
Psychological
Health
Biological
The bio-psychosocial model
Social recognises the importance of the social context, pressures and constraints on behaviour and functioning.
The bio-psychosocial model is a holistic model of health, acknowledging that the health condition of the individual is
not the only factor that needs to be managed.
© RRC International
ID2 Learning Outcome 9.1
9-5
9.1
RM1662210802RRC
9.1
Principles and Benefits of Vocational Rehabilitation
DEFINITIONS
BIOLOGICAL ASPECTS
The physical and/or mental condition of the individual.
PSYCHOLOGICAL ASPECTS
The personal or psychological factors that influence function, behaviour, beliefs, coping strategies, emotions and
distress. (This term does not relate to mental illness.)
SOCIAL ASPECTS
The culture of the individual, the workplace and society and social interactions and relationships.
Individuals are affected by external factors, such as home responsibilities, financial pressures, relationships and social
interaction with colleagues and friends. These factors can be positive and supportive, but can also be destructive.
Additionally, personality type and psychological resilience also play a role in how the individual copes with external
pressure; the optimist may be able to cope with pressures that would cause the pessimist to struggle. Another factor
in long-term health conditions is whether the individual understands their condition and can normally manage it, e.g.
asthmatics are usually good at knowing when and how much medication to use but may struggle if the condition is
exacerbated by chest infections or ‘flu.
The World Health Organization’s (WHO’s) International Classification of Functioning, Disability and Health (ICF) is
based on the bio-psychosocial model, and is now widely accepted as the framework for disability and rehabilitation.
In the context of occupational health and vocational rehabilitation, the bio-psychosocial model has been successfully
used as a model for rehabilitation of those with ill health or a disability back into work. In particular, it is being used as
a treatment model for musculoskeletal disorders, such as upper-limb disorders and back pain.
The Importance of Making ‘Reasonable Adjustments’ for
Workers With Physical and Mental Ill Health
An organisation will typically seek to gain a competitive advantage over other organisations by offering consumers
greater value, either by having the lowest price for their product (either goods or services) or by providing greater
benefits and services that account for higher prices. Many organisations will have the objective of becoming the
lowest cost producer in a particular industry, by achieving high levels of productivity, high utilisation of productive
capacity, the effective use of technology, or by accessing the most effective distribution channels.
It is impossible to achieve high standards of customer service from workers who are unhappy in their roles, or who do
not feel valued by the organisation. Successful businesses recognise the importance of retaining valuable workers and
avoiding the costs of recruitment and sickness absence.
Efficiently managing the physical and mental health of workers to maximise their efficiency is as important to a
business as managing its clients. A physical or mental impairment that has a substantial and long-term effect on a
worker’s ability to carry out normal day-to-day tasks can be regarded as a disability.
Workers with progressive conditions can be classed as disabled. For example, a worker diagnosed with a HIV infection,
cancer or multiple sclerosis. Workers with fluctuating conditions, such as arthritis may also find they are restricted in
the activities they can perform.
In the context of managing occupational health and return to work following absence, it is important to recognise
that workers will need support to achieve their full potential for the organisation (and to maximise life benefits
themselves).
9-6
ID2 Learning Outcome 9.1
© RRC International
RM1663210802RRC
Principles and Benefits of Vocational Rehabilitation
Ill-health conditions and physical impairments can be:
•
Sensory, such as those affecting sight or hearing.
•
Impairments with fluctuating or recurring effects, such as Myalgic Encephalitis (ME) and epilepsy.
•
Progressive, such as motor neurone disease.
•
Auto-immune conditions, such as Systemic Lupus Erythematosus (SLE).
•
Organ-specific, including respiratory conditions, such as asthma.
•
Developmental, such as Autistic Spectrum Disorder (ASD).
•
Learning disabilities.
•
Mental health conditions, such as Post-Traumatic Stress Disorder (PTSD).
•
Mental illnesses, such as depression and schizophrenia.
•
Impairments produced by injury to the body, including to the brain, such as significant facial scarring.
An individual’s impairment may affect their capacity for work in terms of their:
•
Mobility.
•
Manual dexterity.
•
Physical co-ordination.
•
Continence/incontinence.
•
Ability to lift, carry or move everyday objects.
•
Speech, hearing or eyesight.
•
Memory or ability to concentrate, learn or understand.
•
Perception of the risk of physical danger.
Where workers have an impairment that affects their capacity for work making reasonable adjustments could be to:
•
Physical features of the workplace.
•
Auxiliary aids.
•
Practices or criteria applied by the employer.
Adjustments are measures that can be taken that are specific to a particular worker, so that the worker can continue
doing their job. Reasonable adjustments in the workplace are ones that are effective for the worker that do not incur
excessive costs or other disruption to the organisation.
Examples of adjustments may include:
•
Purchasing specialist equipment, such as an ergonomic chair.
•
Discounting disability-related sickness leave for the purposes of
absence management.
•
Providing additional supervisory guidance/support.
•
Including a disabled parking space in the car park.
•
Allowing different start and end times to the working day.
•
Moving furniture to create space for wheelchair access.
•
Allowing a guide or hearing dog into the workplace.
•
Providing recruitment information in large print.
© RRC International
ID2 Learning Outcome 9.1
9-7
9.1
RM1664210802RRC
9.1
Principles and Benefits of Vocational Rehabilitation
The question of what is a ‘reasonable adjustment’ is an objective one. It does not mean the employer must comply
with every requirement asked of them by the worker with a physical or mental health condition. The issue will be
what the employer can reasonably do to avoid making the work harder or less accessible to the worker. For example,
a disabled worker might request that their employer builds a special ramp for wheelchair access to their offices.
Having considered this, the employer might decide it to be unfeasible in cost and practical terms to make structural
alterations to the building, but they might decide that a temporary ramp can be made available with someone ready
to assist with entry and exit to the building. In doing so, the employer would have made a ‘reasonable adjustment’ by
providing a workable solution that is reasonable in the circumstances.
The organisation that wants to maximise its workforce efficiency and contribution to the business will consider
reasonable adjustments before work is impacted. The employer should not wait until the worker asks for an
adjustment but should anticipate the requirement of the individual. Not every situation can be reasonably anticipated
but the employer is required to think about the moral, legal (national laws may make the requirement a legal duty,
such as the Equality Act 2010 in the UK) and financial implications of maximising the wellbeing of its workers. This
can be achieved by taking reasonable and proportionate steps to overcome barriers that may impede a worker with
physical or mental health conditions.
Pre-Placement Health Assessments
A pre-placement health assessment is undertaken by a health professional
as part of the risk assessment process and (usually) only after a job offer has
been made. The pre-placement assessment can consist of one or both of
the following:
•
Questionnaires - usually used as a method of pre-screening to establish
whether a more detailed medical examination is required.
•
Medical examination - used where:
–– The questionnaire has indicated a problem which requires further
investigation.
–– It is a statutory requirement or if specific medical standards have to
be met.
Questionnaires can indicate problems
that need further investigation
–– A baseline examination is required since those involved will be exposed to high-noise levels, respirator
sensitisers, radiation, etc.
The reasons for undertaking pre-placement health assessments are to:
•
Ensure that all new employees are medically fit to fulfil the duties and responsibilities that are intrinsic to their
role.
•
Consider reasonable adjustments that could be made to assist the person in their role.
•
Assess whether the job may adversely affect the new employee’s health and whether any extra precautions are
therefore needed.
•
Provide a record of health information as a baseline for comparison before work begins (such as a hearing test on
a worker before they begin work in a high-noise environment).
9-8
ID2 Learning Outcome 9.1
© RRC International
RM1665210802RRC
Principles and Benefits of Vocational Rehabilitation
The Benefits of Pre-Placement Assessment
Making pre-placement health assessment part of the organisation’s recruitment process demonstrates an early
commitment to the health of the workers. The benefits to new workers and the employer include:
•
A medical assessment of the worker is made prior to placement with a view to gauging their fitness to work. The
worker may not need to be ‘100%’ fit, but they will need to be fit to perform their role in the business.
•
It provides a way of identifying health problems that may affect the prospective workers ability to be effective.
•
Understanding workers health conditions can be used to reduce sickness absence levels.
•
The workers’ health condition is known when they join the business, a ‘base line’ health status can be used as
supporting evidence during and after employment.
•
The assessment supports the identification of any reasonable adjustments that can be made.
Managing Long-Term and Short-Term Frequent Sickness
Absence and Capability
Managing Short-Term Frequent Absence
In the UK, short-term absence is defined in the National Institute for Health and Care Excellence (NICE) guidance
note NG146 as an absence period lasting no more than 4 weeks and recurring short-term absence as more than
1 episode of absence, each lasting less than 4 weeks. Absences such as this can have an effect on the person’s
performance and be disruptive to others and the organisation as a whole (particularly small and medium-sized
enterprises).
Employers should take a systematic approach to managing such absences:
•
Proactive Application of the Policy
The organisation’s policy will outline the procedure to follow for the management of short-term absences.
Line managers should know the steps to take and should follow the procedures, supporting the employee and
ensuring that all relevant information on sick pay and return to work is given. Managers should stay in contact
with the employee without appearing to be harassing them. A good manager will appear supportive and it has
been shown that regular contact reduces short-term absences and the length of long-term sickness absence.
•
Return-to-Work Interviews to Establish Real Reasons for Absence
Research has shown that the single most effective action to reduce absence is to consistently conduct return-towork interviews for all staff who have been absent, however long or short the absence period. The purpose of the
return-to-work interview is to:
–– Determine the reason for absence.
–– Assess whether the reason is consistent with other reliable evidence.
–– Discuss any doubts/issues with the employee and give them the opportunity to explain the reason for
absence.
The employee may have been genuinely sick and it is always best to start with that assumption unless patterns
start to emerge. However, there may be underlying issues at work, such as workload, relationships with colleagues,
training issues or environmental factors, or external factors, such as caring or parenting issues, financial pressures,
relationship breakdown or bereavement. Good managers will know their staff well enough to identify that there
may be a problem and will have the skills to deal with it. If the absence is of a genuine nature (medical) then
procedures should be put in place to support the employee; if it is due to a temporary domestic issue then the
employer may need to decide on the appropriate action to take, but in all cases the employee will be expected to
improve their attendance rate.
© RRC International
ID2 Learning Outcome 9.1
9-9
9.1
RM1666210802RRC
9.1
Principles and Benefits of Vocational Rehabilitation
•
Procedures to Deal with Unacceptable Absence Levels and/or Breach of the Policy
MORE...
More on the management of sickness absence and return to work can be found at:
www.hse.gov.uk/sicknessabsence
Persistent absence must be dealt with promptly, firmly and consistently in order to show both the employee
concerned and other employees that absence is regarded as a serious matter and may lead to disciplinary
procedures being followed.
Staff need to be aware of the consequences of repeated short-term absence, whether disciplinary action or loss
of earnings. Employers should ensure they can demonstrate that they have:
–– Carried out a fair review of the employee’s attendance record and reasons for the absences.
–– Provided an opportunity for the employee to make representations.
–– Given appropriate warnings of dismissal if the employee’s attendance does not improve.
In the case of sickness absence, the potentially fair reason will usually be on the grounds of the worker’s capability
to perform the kind of work they were employed to do. ‘Capability’ in this instance refers to the skill, aptitude,
health or any other physical or mental quality, and ‘the kind of work’ the worker could be required to do under
the contract of employment, not just the kind of work actually being performed before the sickness absence.
•
Use of Trigger Mechanisms to Review Attendance
Trigger points are a common method used to identify repeated short-term absences in individuals and should
be part of the overall monitoring system which analyses short-term absences in teams or departments to try
and identify hot spots which can then be investigated. In the UK, the ‘Bradford Factor’ score is an example of a
calculation method commonly used for this purpose.
Common trigger points are:
–– Length of period of sick leave (duration) - over 10 days may trigger a review.
–– Number of absences (frequency) - the number of times a person is off in a given period (e.g. three periods
of absence in a rolling six-month period or six days lost in three months).
–– Patterns of absence - based around days of the week (commonly Fridays or Mondays), or school holidays.
•
Early Involvement of Occupational Health Professionals
Occupational health staff can react very quickly to intervene if a problem is spotted. They can advise whether
a given pattern of absence is likely to be consistent with a stated medical condition, or whether the available
evidence suggests some additional underlying factor that has not yet been identified. They should be able to
provide advice as to appropriate interventions and other sources of specialist advice. Possible interventions
include:
–– Counselling.
–– Continuing health monitoring.
–– Risk assessments.
–– A workstation assessment (in the case of repeated musculoskeletal problems).
9-10
ID2 Learning Outcome 9.1
© RRC International
RM1667210802RRC
Principles and Benefits of Vocational Rehabilitation
Managing Long-Term Absence
Long-term sickness absence is defined in the UK’s NICE document NG146 as an absence lasting four or more weeks.
Recurring long-term sickness absence is defined as more than one episode of long-term sickness with each absence
period being four or more weeks. In many ways, long-term absence is easier for an organisation to manage than
short-term absence. If an employer is aware of long-term health problems then they can arrange cover more easily
and plan return-to-work strategies.
Sometimes, repeated short-term sickness is indicative of a long-term condition and the two can be managed in the
same way through proactive application of the policy, return-to-work interviews and involvement of the occupational
health professionals.
•
Identification of Someone to Undertake Initial Enquiries
DEFINITION
BUDDY
Usually a colleague working at the same level who gives support and helps with any practical day-to-day issues
or problems that arise.
Sometimes, it is not appropriate for line managers to carry out initial enquiries into causes of long-term
absence or the possibility of a return to work. A suitably trained, impartial person may be able to gain a better
understanding of the problem. This is typically someone from Human Resources (HR), but they may also be from
occupational health, a trade union representative or a mediator or ‘buddy’. Some local authorities train staff as
‘Listening Officers’.
Such enquiries are best initiated between two to six weeks after the beginning of the absence.
•
Keeping in Contact with the Individual
Regular contact is vital to prevent the employee from feeling isolated,
to keep them up to date with developments in the workplace and to
prepare them for return to work. Sometimes (usually with permission
from the occupational health department or the medical doctor)
the worker will be allowed to come in and carry out some training
or they might meet up socially with their colleagues. It is part of a
process of ‘normalising’ them back into the workplace. Such contact
is usually undertaken by the manager.
However, there may be occasions where managers may find it hard
to keep their own feelings hidden and remain impartial. This may
Contact with employees helps to
be due to a previous conflict or dislike for the worker, or to lack of
prepare them for return to work
knowledge about the medical condition. In particular, mental health
problems can elicit feelings of ‘Why can’t they just pull themselves together?’ or ‘They can’t be as stressed as I am
right now.’
Some conditions, such as bipolar disorder, HIV or cancer can create feelings of unease or even fear in colleagues.
This is where occupational health professionals or the HR department can be useful in finding out more about
the condition and showing that people suffering from the condition can live a normal life and return to work with
any necessary support.
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If an absent worker is having difficulties communicating with their manager, they may request to liaise with
another manager or colleague. As long as this is not a problem (e.g. in a very small team), the request should
be accommodated, though it will highlight a problem that needs to be dealt with preferably before the worker
returns to work.
•
Flexibility and Restricting Sick Pay
In some organisations, there are flexible working arrangements and workers on long-term sick leave may be
able to use holiday entitlement and flexi-time to prevent them slipping into restrictive pay (e.g. someone who
has been off following major surgery and is due back after they have dropped to half pay may be allowed to use
holiday entitlement (at full pay) for the last few weeks of their absence).
•
Detailed Assessment by Relevant Specialists
The organisation may feel that the worker needs more detailed medical assessment than is available in the
workplace and may pay, for example, for a spinal assessment, hearing screening or respiratory function tests.
Arrangements for any such special assessments could be co-ordinated by a suitably trained case worker, usually
from the occupational health department.
•
Health, Occupational or Rehabilitation Interventions
It is vital that the manager, health specialists, HR and the worker work together to bring about the most positive
outcome - usually a return to work and an ongoing reduction in sickness absence. Early investment (financial,
training or time) is more likely to lead to a complete recovery and positive return to work.
•
Changes to Work Patterns or the Environment
Temporary or permanent changes to work patterns or to the working environment are often an effective way of
managing a return to the workplace after long-term sickness absence:
–– Temporary changes can include:
–– Phased return to previous job and hours.
–– No night shifts.
–– No lone working.
–– No driving (e.g. cars or forklift trucks).
–– Not operating specific pieces of equipment.
–– Not working in specific areas (e.g. outdoors, hot rooms, confined spaces, heights).
–– Buddying with a colleague.
–– Shadowing for training purposes if the job has changed, or to refresh skills.
–– Permanent changes can include:
–– Change of job or job level/responsibility.
–– Change of hours.
–– Change of team.
–– Change of base.
–– Permanent workstation or environmental adaptations (reasonable adjustments).
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TOPIC FOCUS
Key elements of managing sickness absence are:
•
Recording sickness absence.
•
Maintaining contact.
•
Return-to-work interviews.
•
Making use of professional advice.
•
Planning and undertaking workplace adjustments.
•
Agreeing and reviewing a return-to-work plan (rehabilitation programme).
•
Co-ordinating the return-to-work process.
The UK’s National Institute for Health and Care Excellence (NICE)
Guidance NG146
NG146 contains guidance on the management of sickness absences. The guidance is wide-ranging, but the
recommendations are aimed specifically at employers and those assessing and certifying fitness for work.
•
Workplace Culture and Policies
The employer should make health and well-being a core priority and ensure managers are committed to the
priority. A proactive and visible commitment can be reflected by the organisation, including well-being in its
training development programmes and worker inductions.
Health and well-being should be incorporated into all relevant corporate policies and communications, e.g. by
ensuring workers work reasonable hours and have regular breaks.
The organisational culture should recognise that a worker returning to work following sickness does not
necessarily mean their well-being has improved.
Trends in sickness absence should be regularly reviewed to establish areas of intervention and the adequacy of
policies.
•
Assessing and Certifying Fitness for Work
Workers assessed as ‘not fit’ for work should be encouraged to maintain regular contact with the workplace.
Absence of more than four weeks should trigger referral to health rehabilitation services (e.g. counselling or
physiotherapy).
The worker should be encouraged to reflect on lifestyle choices (diet and exercise) that may have contributed to
their current absence.
The assessment should consider the person’s functional capacity to carry out tasks at work and any reasonable
adjustments that may be required because of disability. Barriers to return to work should be identified, including
psychological and social barriers. A range of interventions and support services might be identified that will
facilitate the employee’s recovery and return to work. A return-to-work plan might be developed that enables
monitoring of any workplace adjustments to ensure they are meeting the needs of both the worker and
employer.
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Principles and Benefits of Vocational Rehabilitation
•
Keeping in Touch
The organisation must maintain regular contact with the worker. Contact should be made as early as possible. This
contact may require sensitivity with an awareness of the style of communication as well as the suitability of the
content of the communication. The employer should ensure the need for sensitivity and discretion. The manager
making contact should also have a full understanding of the organisation absence management procedures.
•
Early Intervention
All workers must be made aware of the organisations Employee Assistance Programmes (EAPs) and the access to
rehabilitation services, such as counselling. Where sickness absence is likely to exceed four weeks, the possibility of
referral to occupational health services should be considered. At this stage, an assessment of fitness for work or a
discussion on other support services to establish if referral is appropriate, can be undertaken.
For workers resuming work after an absence of four or more weeks with a mental health problem, the employer
should consider a three-month structured support programme of interventions to reduce the likelihood
of recurring absence. Some of these interventions may be physical and others psychological (e.g. Cognitive
Behaviour Therapy).
MORE...
Further information on sickness absence and incapacity to work can be found at:
www.nice.org.uk/guidance/ng146
Vocational Rehabilitation
Meaning of Vocational Rehabilitation
The concept of vocational rehabilitation has grown out of efforts to rehabilitate people with disabilities. Today it
encompasses the provision of assistance to a much broader group, including people with physical health conditions
and mental health problems.
Vocational rehabilitation can be defined in a number of ways. One short and useful definition is:
“Vocational rehabilitation is whatever helps someone with a health problem to stay at, return to and remain in work.”
(Waddell, G, Burton AK, Kendall NAS eds. Vocational rehabilitation. What works, for whom, and when?, 2008)
The focus is to help people retain or regain the ability to participate in work, rather than to treat any illness or injury
itself. It is now well recognised that, as well as providing economic benefits, engagement in work has health benefits
for the individual, and can aid recovery from physical or mental health problems.
There is growing evidence that health, work and well-being are closely connected.
Work is known to be the best route out of poverty and the UK’s 2006 Department for Work and Pensions (DWP)
report Is work good for your health and well-being? found that work is also usually good for health.
For all age groups, work generally:
•
Makes people healthier.
•
Helps people with a health condition get better.
•
Improves the health of people returning to work from unemployment.
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Far more people gain health benefits from work than suffer negative effects:
•
The long-term unemployed or those who have never worked are two to three times more likely to have poor
health than those in work.
•
People are twice as likely to become psychologically distressed after going from work to unemployment.
Absence has further health implications too - the longer someone is out of work due to ill-health, the lower their
chance of getting back into work:
•
Someone absent from work due to sickness for six months has an 80% chance of being off for five years.
•
In the UK, 90% of people making a claim for incapacity benefits expect to return to work, but if they claim for
two years or more, they are more likely to retire or die than return to work.
Benefits of Vocational Rehabilitation
Vocational rehabilitation has significant benefits both for the employer
and the employee.
Employer Benefits
Rehabilitation of workers back into work, with the consequent
improvements to their health and well-being, can bring a range of
business benefits:
•
Simple measures to prevent and manage ill health can lead to
a decrease in employee absence, which in turn can improve
productivity and competitive edge.
•
Healthy working environments can contribute to reduced employee absence through sickness and stress.
•
Employees who feel cared for are often more satisfied and perform better, which can have the effect of reducing
staff turnover and increasing productivity.
•
Getting employees back into work after illness reduces the loss of experienced staff and the cost of recruiting
new staff.
•
Being known as an organisation that cares about employees can enhance business reputation and helps attract
staff and customers.
Vocational rehabilitation benefits both
employer and employees
Worker Benefits
The benefits to individuals of returning and remaining at work are:
•
Better physical health.
•
Better mental health.
•
Increased financial security.
Improvements in the physical health of employees who have rehabilitated back into the workplace are derived
from the physical and mental demands of the job that they are performing. If carefully managed so as to match the
capabilities of the employee, these demands have been shown to have a positive effect. This is counter to some
historic preconceptions that the best place for an ill worker to recover is at home.
Improvements to the mental health of workers are linked to the fact that many people define themselves by the work
that they do and society at large defines individuals in the same way. Work is therefore often a vital component to an
individual’s self-esteem. There is also a strong social component to most people’s work. For many individuals, work
provides social contact, with the mental health benefits that such interactions bring.
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The financial benefits to a worker of returning and remaining at work are both direct and indirect, such as wage or
salary, pension contributions and the opportunity for advancement and pay increases that may result from work.
Overcoming Barriers
MORE...
Useful sources of information include:
www.healthyworkinglives.com
www.hse.gov.uk/sicknessabsence
www.gov.uk/browse/disabilities/work
fitforwork.org
Using the bio-psychosocial model, it is possible to identify barriers to the rehabilitation of a worker back into work.
These might be:
•
Biological barriers - the physical disease, ill-health condition, disability or mental health condition that the
worker might be suffering from. For example, they may have a form of musculoskeletal disorder, such as back pain
or carpal tunnel syndrome. They may be suffering from anxiety or depression. They may have impaired mobility
or a sensory impairment. They may be recovering from major heart surgery. Each of these conditions presents
restrictions on the types of work that the individual can safely perform.
•
Psychological barriers - which the individual may have to overcome in order to feel comfortable returning back
to work. These psychological barriers do not arise from mental health conditions (since these are aspects of
biology and so fall under that heading). Rather, these barriers are the inevitable psychological ones that will arise
following any long-term absence from work. The worker may be fearful that returning to work may worsen their
ill-health condition. They may worry that work colleagues will think less of them if they are unable to work to the
full extent due to restriction on working hours or types of work. They may be understandably anxious about their
future prospects should their rehabilitation back into work not go as smoothly as was hoped.
•
Social barriers - that may be imposed by the work and the working environment. These barriers may be physical
in nature, such as access to and from the workplace, appropriate sanitary conveniences and workstation design
and layout. In other instances, these barriers may be more to do with workplace arrangements and the way that
work is organised.
Effective rehabilitation will require that the employer recognises these barriers and takes steps to eliminate or reduce
their impact. This often requires the involvement of internal occupational health services and external agencies.
Risk Assessment
Prior to return to work, it may be necessary to undertake or review the risk assessment that relates to the worker’s
job. Risk assessment should not focus on the person’s ill health or disability, but should look more broadly at the
overall demands of the job and how any risks can be appropriately managed.
The standard risk assessment should be conducted by a suitably qualified person to avoid accusation of direct
discrimination. It is advisable to involve the worker themselves as they are often the best person to identify what is
needed and to ensure that it refers to the individual circumstances of the worker. The assessment will need to identify
the hazards and risks associated with the nature of the task and whether reasonable adjustments need to be made to
remove or reduce such risks to the individual.
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The risk assessment should cover the:
•
Specific needs of the individual with respect to their ill health or disability.
•
Design of the job and the working environment, such as access to the workstation and layout of the premises,
heating, lighting, etc.
•
Work equipment and workstations to be adjusted to individual needs and use of assistive technologies.
•
Health hazards that may affect the individual - chemicals, respiratory sensitisers, etc.
•
Work organisation, specific training needs and methods of communication.
•
Psycho-social aspects, such as stress, bullying, etc.
In addition to the standard risk assessment, fire safety legislation may place a requirement on employers to make
evacuation plans for disabled people, which will include workers, visitors or service users.
This involves the development of a Personal Emergency Evacuation Plan (PEEP) which is tailored to meet the
individual needs of a disabled employee, visitor or service user. It outlines the safe means of escape and identifies the
support which may be needed in the event of an emergency evacuation.
Liaison with Other Disciplines
Vocational rehabilitation is likely to require liaison between primary care health professionals (e.g. doctors, dentists,
physiotherapists, etc.) and the organisation's management of human resources. Liaison may also require the
involvement of the health and safety professional together with managers, occupational health teams, trainers or
mental health teams, who may be involved in the process of transitional arrangements. Transitional arrangements may
also require building maintenance teams where reasonable adjustments have been identified to the infrastructure
of the workplace. Getting all these functions/people on side is crucial to a positive outcome. Close liaison is likely
to achieve good employment outcomes for the individual. Early implementation of this principle will mean fewer
individuals will require more structured, and therefore more expensive, interventions.
Role of Other Disciplines and External Agencies
Many external agencies offer help and support both for employers and employees during the vocational
rehabilitation process. Some examples of external agencies that offer such help and support in the UK are:
•
Primary Care
The NHS provides advice and support to individuals suffering from various health conditions to facilitate the
management of those conditions. This includes supporting individuals to return and remain in work.
•
DWP Jobcentre Plus
Jobcentre Plus advises employers on ways to adopt good employment policies and practices in the recruitment,
retention, training and career development of disabled people. Jobcentre Plus also operates a range of schemes
and services designed to assist both employers and disabled people looking to work. Disability Employment
Advisers (DEA) are based at local Jobcentre Plus offices and offer advice on employing disabled people.
•
Access to Work (AtW)
Access to Work helps disabled people to get or keep jobs by contributing towards their extra employment costs.
It provides advice and practical support to disabled people and their employers to help overcome work-related
obstacles.
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Principles and Benefits of Vocational Rehabilitation
•
Occupational Therapists (OTs)
Occupational Therapists (OTs) have a central role in resolving issues following a period of illness and medical
treatment, and also in advising employers about the needs of sick or disabled workers when they return to work.
OTs can assist employees who are still at work but having difficulties due to illness or disability.
An OT will carry out a detailed assessment of the needs of the workplace and the abilities of the individual, and
identify problems and potential solutions. Where appropriate, the OT will provide an action plan and oversee its
implementation.
•
Fit for Work
The ‘fit-for-work’ service is a government-funded initiative to assist GPs, employers and employees where there
are health issues associated with the employee’s work or absence caused by health issues. The service includes
support and advice for both GPs, employers and employees provided by occupational health professionals.
MORE...
The UK’s Access to Work programme offers technical and financial support for employers taking on disabled
recruits or accommodating workers who develop a disability. More information is available at:
www.gov.uk/access-to-work
STUDY QUESTIONS
1. Give three examples of occupations where there are defined fitness-to-work standards.
2. What is the bio-psychosocial model?
3. Outline the meaning of ‘vocational rehabilitation’.
(Suggested Answers are at the end.)
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Occupational Health Services
Occupational Health Services
IN THIS SECTION...
•
The roles of typical occupational health specialists in the management and treatment of sickness and disability is
covered. Roles include: occupational health physicians, nurse, adviser, technician and hygienist.
•
The typical activities provided by occupational health specialists include health promotion, health assessment,
advice to management, treatment, other specialist support, e.g. ergonomist, and medical and health surveillance.
Make-Up of a Typical Occupational Health Service
Types of Occupational Health Service
Occupational health services aim to provide a safe and healthy working environment.
The ILO Occupational Health Services Convention C161 defines occupational health services as:
“services entrusted with essentially preventive functions and responsible for advising the employer, the workers and their
representatives in the undertaking on:
i.
the requirements for establishing and maintaining a safe and healthy working environment which will facilitate optimal
physical and mental health in relation to work;
ii. the adaptation of work to the capabilities of workers in the light of their state of physical and mental health;”
(Copyright © International Labour Organization, 1985)
The provision of an occupational health service to the workforce requires the involvement of a range of professionals,
including physicians, nurses, occupational hygienists, ergonomists, and safety engineers. We will be considering this
aspect later when we look at the role of the occupational health specialist.
A hypothetical example of the combined approach working in practice could be:
•
The recognition of a particular health effect by a worker, safety representative, nurse, or doctor.
•
Diagnosis of the illness and treatment by a nurse or doctor.
•
Discovery of the environmental cause by a hygienist.
•
Implementation of controls by a safety engineer, hygienist or ergonomist.
Occupational health services can fall into a range of categories, such as:
•
A full occupational health service, staffed by a full-time doctor, with a supporting nurse(s) (perhaps working on a
shift basis). Specialist treatment might also be available in a work’s health centre, such as dental, optical, chiropody
and physiotherapy. This type of service might be found in a large organisation, where the risk profile of the
organisation requires a full provision, or where the organisation can afford to offer such a provision as a benefit of
employment.
•
An occupational health service staffed by an occupational health nurse(s) (perhaps on a shift basis) with regular
visits by a doctor and clinics (perhaps weekly). The doctor combines their duties with other work (such as a
general medical practitioner or other occupational health work). This type of service might be found in a smaller
organisation or a large organisation that does not have a risk profile that demands the full provision above.
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Occupational Health Services
•
An outsourced occupational health service provided by a private occupational health-service provider. This might
comprise weekly visits by an occupational health nurse and/or doctor or the provision of on-request advice and
services as required. This type of service might be retained by a small- to medium-sized employer with a low-risk
profile.
The type of service provided, the make-up of personnel providing the service and its functions have to be determined
by the employer. Some of the specialist roles involved in the provision of an occupational health service are outlined
below.
Occupational Health Physician
Occupational medicine is a professional discipline concerned with the diagnosis and assessment of health hazards and
stressors at work. Since it is a specialist branch of the medical profession, we need a medical practitioner with suitable
training and/or experience in the field. This type of doctor is referred to as an occupational health physician.
The exact role of an occupational health physician can be determined (to a degree) by the organisation retaining their
services. There are certain types of work that can only be performed by the physician. Other types of work might
equally well be carried out by an occupational health nurse. It is important to note that occupational health physicians
are bound by the legal and ethical rules of their profession.
An occupational health physician may carry out:
•
Statutory medicals.
•
Health surveillance required by relevant legislation (e.g. in the UK the Control of Substances Hazardous to
Health Regulations 2002 (COSHH).
•
Pre-employment/post-sickness/rehabilitation/ill health/retirement health assessments.
Occupational Health Nurse
Occupational health nursing is a specialist branch of the nursing profession. Similar to the occupational health
physician, the occupational health nurse must be a qualified nurse with appropriate training and/or experience. The
exact role of an occupational health nurse can be determined by the organisation, though there are certain functions
that they are not able to perform since they can only be conducted by a physician.
It is important to note that the designation ‘nurse’ is often misleading in the context of the role of an occupational
health nurse. Use of the word ‘nurse’ brings to mind a traditional image of someone in a hospital or healthcare setting
carrying out practical care duties under the supervision of a medical practitioner. An occupational health nurse will
rarely be involved in the direct treatment of injury or ill health (such as minor-injury first-aid treatment).
Instead, they will be very involved in the proactive prevention of disease and ill health and the management of
treatment and care programmes.
An occupational health nurse may be concerned with:
•
Assisting the employer in complying with health and safety legal responsibilities.
•
Monitoring the health of employees.
•
Promoting good health activities in the workplace.
•
Working with line managers to minimise hazards, ensure compliance with health and safety legislation and
implement the organisation’s occupational health policies.
•
Dealing with cases of substance misuse.
•
Advising on placement at work through pre-employment health assessments.
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Conducting a health assessment after a return to work from accident or ill health.
•
Managing health-centre facilities, offering basic health checks and co-ordinating first-aid services.
•
Advising on ergonomic issues.
•
Promoting good health education and activities in the workplace, geared to encouraging employees to take
personal responsibility for their health.
•
Providing advice and counselling.
Occupational Health Adviser
The job title Occupational Health Adviser is often used to indicate an occupational health nurse concerned with the
provision of occupational health services.
Occupational Health Technician
Occupational health technician is a developing role. With supervision from occupational health nurses and doctors
and the correct training, they may be able to carry out some aspects of health surveillance. This frees up doctors and
nurses for other tasks.
Occupational Hygienist
Hygiene is generally considered to be the maintenance of health and the
prevention of disease. Occupational hygiene applies this definition to the
place of employment and the principal aim is to prevent occupational ill
health.
The work of the occupational hygienist generally follows these steps:
•
Identification of the hazard.
•
Assessment of the risk.
•
Measurement of the risk and interpretation of the result.
•
Application of control measures and their maintenance.
•
Information, instruction and training.
A key speciality of the occupational hygienist is the measurement of risk
and interpretation of results. As inhalation is the most important method
of entry of a toxic substance into the body, the work of the occupational
hygienist often involves measurement of airborne contaminants,
using personal or static samplers and comparing the results with those
published in relevant standards. The correct sampling instruments,
methods and analytical procedures must be identified.
Occupational hygienists work to prevent
occupational ill health
As well as airborne dust, gas and vapour, the occupational hygienist is
concerned with measurement of heat, noise and other pollutants.
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Typical Activities Offered by an Occupational Health Service
Pre-Employment/Pre-Placement Screening
This is done to ensure as far as possible that the person is fit, both mentally and physically, to do the duties required
of them in the job they have successfully interviewed for.
In some instances, the employer will be under a statutory duty to perform this type of pre-employment screening
to ensure that the worker is medically fit for the type of work they are being employed for. For example, in the UK, a
Classified Person under the Ionising Radiations Regulations must be certified as fit to work with ionising radiation
before they can be designated as a Classified Person. This assessment can only be made by an Employment Medical
Advisory Service (EMAS) Adviser or an Appointed Doctor (a medical practitioner appointed by the HSE).
In other instances, there is no statutory duty on the employer, they are simply screening employees to ensure that
workers are not put into positions for which they may prove unsuitable. For example, workers required to undertake
work at height might be assessed to ensure that they do not have any obvious medical condition that might make
them unsuitable for working at height.
Return-to-Work Rehabilitation Programmes
Occupational health services are usually heavily involved in providing advice and support to get workers back to work
after a long-term absence for whatever reason. This is usually done by formulating a return-to-work programme in
collaboration with the workers and line managers to enable the worker to return according to their capabilities. There
are often physical and psychological barriers to the rehabilitation of workers following long-term absence which the
occupational health service is well-placed to recognise and address.
External specialists (such as occupational therapists) and agencies (such as Access to Work) may be pulled in to assist
as required.
Sickness Absence Management
Occupational health services may be directly involved in ill-health absence management or they may simply offer
advice, support and education for anyone who requires assistance in this area. Depending on the nature of their
involvement, this might include:
•
The collection of self-certifying notifications from employees absent for less than seven days.
•
The collection of medical fitness-to-work declarations from employees absent for over seven days.
•
Initial and follow-up contact with employees following the notification of absence.
•
Medical assessment of workers who have phoned in sick or submitted a medical fitness to work declaration.
•
Treatment or referral of absent workers who have phoned in sick or submitted a medical fitness-to-work
declaration to aid their recovery (e.g. a worker phoning in sick with a bad back might be referred on to private
physiotherapy treatment which may speed their recovery and return to work).
•
Collation of statistics on ill-health absence.
Counselling
Occupational health services usually offer a ‘Listening Ear’ support service for any situation which may be affecting
workers, whether it is work-related or personal. The service may include trained counselling staff, or they may refer
on to specialist in-house counsellors or external providers. This service is often central to the role of an occupational
health service and is significant in the management of stress and traumatic stress.
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Risk Assessments
A proactive occupational health service may be fully involved in many of
the health risk assessments being conducted within the workplace. This
might include:
•
Display Screen Equipment (DSE) workstation assessments.
•
Hazardous substance exposure risk assessments.
•
Manual handling assessments.
•
Ergonomics assessment, such as those for musculoskeletal disorders
and upper-limb disorders.
•
Personal protective equipment assessments.
DSE needs to be risk assessed
Involvement might be on a routine basis or ad-hoc. This type of involvement can be important to fully integrate
occupational health into the health and safety management of the organisation, so that occupational health
personnel gain an understanding of the workplace environment and practices and are not simply reactively advising
once illness has been caused.
Specific Risk Assessments
The occupational health service will be involved in the risk assessment and management of new and expectant
mothers within the workplace. The service may be involved in all such assessment as a matter of policy, or may be
involved in certain assessments as required. The service may be involved in other individual assessments where health
conditions may complicate risk (such as lone worker risk assessments).
Health Education and Promotion
Though some occupational health personnel view their role as strictly advising workers and the employer on specific
work-related health issues, most take the view that health and well-being cannot be conveniently divided up into
work and home partitions. Occupational health services will usually take part in national health promotion campaigns,
e.g. Stop Smoking Day, Sun Awareness, Drink Awareness, etc. They can often advise and support people on a oneto-one basis for weight loss, stopping smoking, etc. They will also be involved in the formulation, and perhaps
implementation, of policy on some of these areas. For example, an occupational health service might be involved in:
•
Formulating an organisational policy where smoking is permitted (the law may prevent people from smoking in
enclosed places, but the employer may also decide to restrict smoking in outside parts of their premises or may
decide whether or not to provide facilities for smokers, such as shelters).
•
Providing factual advice on the health risk associated with smoking to encourage workers to quit.
•
Providing an in-house support service to assist workers to quit.
•
Signposting external services that a worker can use if they want to quit.
Providing Advice
The service will usually provide advice to both line managers and employees on work-related issues. This might be
done via telephone or on a ‘drop-in’ basis. This might be done informally for minor queries, but will normally be
formalised in writing where a specific health issue has been raised with regards to workplace standards. For example,
an employee complaining of a wrist ache might be diagnosed with upper-limb disorder and recommendations made
to them and their line manager to prevent the condition worsening.
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ID2 Learning Outcome 9.1
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9.1
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9.1
Occupational Health Services
Treatment Services and First Aid
An occupational health service will usually provide treatment in the event
of injury or ill health that occurs at work. This is often restricted to firstaid treatment of casualties only (e.g. first-aid treatment of a heart attack
victim or casualty with a broken leg). In some cases, the service may be
equipped to deal with the injury in the longer term because of the lack of
an immediate emergency service response (e.g. remote locations).
In many instances, the service will be involved in the assessment and
management of the first-aid provision in the workplace. That is to say,
the occupational physician decides what kind of facilities, equipment
and personnel are provided by the organisation. They then manage this
provision and oversee the training of the first aiders.
First-aid treatment may be
provided in the event of an occurrence
at work
The service may provide specialist treatments, such as chiropody and physiotherapy. In other instances, these
treatment services will not be provided in-house but by referral to external providers.
Management of Infectious Diseases
The service will offer advice on whether workers suffering from contagious diseases can work or if they need time
off, and if so, when they can return to work in order to minimise the risk of cross-infection in the workplace. In many
workplaces, this is an important but relatively minor part of the services role, but in some instances (such as in a
healthcare setting or on an oil platform) it is more significant.
Immunity Assessment and Vaccination
In some workplaces, where contagious diseases are a health hazard requiring management, the occupational health
service may be involved in assessing workers’ immune status and vaccinating as appropriate. Immunisation must
always be done with informed consent.
Health Surveillance
This is performed according to identified measurable risks in the job, e.g. airborne substances, noise, etc.
Preliminary health checks are carried out to ensure that a worker is fit to work with a specific hazard (often referred
to as ‘baseline screening’) and follow-up checks are then conducted routinely to ensure that the work is not making
the worker ill. Health surveillance is conducted as a statutory requirement and there are recognised methods and
standards for the evaluation of results.
For example, a worker in a bakery will undergo health surveillance because of the risks presented by flour dust
exposure. Lung function tests can indicate whether the worker is asthmatic (in which case they will not be considered
fit to work with flour dust in the first instance) or showing signs of becoming asthmatic.
Medical Surveillance
Under specific Regulations, the British HSE requires medical assessments for workers, involved with hazardous
substances, including asbestos and lead, or ionising radiation, to be assessed by a HSE-approved doctor. The type and
frequency of the medical is specific to the defined hazard.
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ID2 Learning Outcome 9.1
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Occupational Health Services
Health Assessment
An occupational health assessment is a medical examination performed by an occupational health physician or nurse.
An assessment of general health and fitness is often undertaken when a worker is returning to work from sickness
absence. The information is shared with the employer so that the return to work can be facilitated and the worker is
enabled to do their job.
The health assessment is more focussed on how the worker does their job and how the job may affect the workers
health. The assessment may result in phased returns to work, referrals to additional therapies or adjustments in the
workplace.
An occupational health assessment should also enable the worker to take greater control of their own well-being.
Calling on Specialist Help
It is highly unlikely that the occupational health services team will be able to provide all the competencies required
across the full spectrum of health needs. Where the in-house team does not have the required competency then
specialist support needs to be identified.
Examples of specialists available to deal with issues outside of the available team’s competency include:
•
Ergonomists
Can provide professional support on the suitability of work equipment, workspace layout, guarding, task
management, manual handling, and repetitive tasks.
•
Microbiologists
Can provide support on the assessment of biological agents and offer advice on risk control measures. The
microbiologist would also be able to sample for micro-organisms.
•
Physiotherapists
Can provide treatment and rehabilitation advice including advice on preventing musculoskeletal disorder.
•
Radiation Protection Advisers
Can provide advice on complying with legislation where ionising radiation is used in the workplace, they can also
conduct environmental monitoring.
STUDY QUESTIONS
4. Outline the typical functions of an occupational health service.
5. What are the possible benefits from undertaking a health assessment?
(Suggested Answers are at the end.)
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Summary
Summary
Principles and Benefits of Vocational Rehabilitation
We have:
•
Outlined the bio-psychosocial model as a way of considering human ill health as being more than simply a case of
medical condition, but a combination of biological disease and psychological response by the individual within a
social context.
•
Explained that a pre-placement health assessment is undertaken as part of the risk assessment process (usually
only after a job offer has been made) to determine the health and fitness of the worker in respect of the job that
they will be carrying out.
•
Described how employers must establish policies and procedures to actively manage the return to work of
employees from long-term and short-term frequent sickness absence through appropriate liaison between
managers, occupational health and other healthcare providers, as outlined in the British NICE guidance note
NG146.
•
Defined vocational rehabilitation as helping someone with a health problem to stay at, return to, and remain in
work and outlined the benefits to rehabilitating workers back into the workplace, both for the employer, and the
employee and how the bio-psychosocial model can be used to identify barriers to the rehabilitation of ill workers,
as has been used in the rehabilitation of workers with musculoskeletal disorders (MSDs) and other common
work-related conditions.
•
Identified how risk assessment plays an important role in the return to work of an employee following ill health or
incapacity.
•
Identified the various external agencies, such as Occupational Therapists (OTs), that exist to provide support to
the employer and employee during the return-to-work and rehabilitation process.
Occupational Health Services
We have:
•
Defined occupational health as “the promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations by preventing departures from health, controlling risks, and adapting work to people and
people to their jobs”.
•
Explained that an occupational health service will involve the services of occupational health doctors, nurses and
technicians, as well as specialists in particular fields and outlined the minimum standards of qualification and
registration for occupational health doctors and nurses, as well as specialists.
•
Described the typical services provided by occupational health include pre-employment screening, health
surveillance, return-to-work rehabilitation programmes, sickness absence management, counselling, risk
assessment (both general and personal), health education and promotion campaigns, treatment services,
management of first-aid and immunisation programmes.
•
Highlighted the difference between general health assessment (an assessment of an individual’s general health
and fitness) and health surveillance (the monitoring of an individual’s health to ensure that they are suitable for
work involving exposure to a specific health hazard) and tracking of their health over time as they work with that
hazard.
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Workplace Welfare Requirements and Specific Workplace Issues
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Learning Outcome 9.2
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• 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 and the problems associated with lone working.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Explain the effects and causes of common types of mental ill health within the workplace.
• Explain the identification and control of workplace mental ill health.
• Explain the impacts of well-being strategies on mental health.
• Explain the scope, effects and causes of work-related violence/aggression.
• Explain the identification and control of work-related violence/aggression.
• Explain the hazards, risks and controls for lone working.
© RRC International
ID2 Learning Outcome 9.2
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Contents
Mental Ill Health at Work
9-29
Circumstances Leading to Mental Ill Health
Anxiety and Depression
Work-Related Stress
Causes of Work-Related Mental Ill Health
Work-Related and Non-Work-Related Factors
9-29
9-33
9-35
9-36
9-38
Mental Health Controls
9-39
Why We Need to Manage Mental Ill Health
Facilitating Work
Identification and Assessment of Risk of Stress and Mental Ill Health
The Management Standards Approach
Practical Control Measures
Types of Intervention for Mental Ill Health
Managing Mental Ill Health in the Workplace
Benefits from Good Nutrition, Exercise and Sleep on Mental Ill-Health Conditions
9-39
9-40
9-40
9-41
9-43
9-45
9-46
9-48
Well-Being
9-51
Relationship between Well-being and Health
9-51
Work-Related Violence
9-58
Definitions
Physical and Psychological Effects
Risk Factors
Assessment of Risk of Violence
Control Measures
9-58
9-60
9-61
9-62
9-64
Lone Working
9-67
Introduction to Lone Working
The Hazards and Risks of Lone Working
Controlling the Risks of Lone Working
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9-68
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Summary
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ID2 Learning Outcome 9.2
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Mental Ill Health at Work
Mental Ill Health at Work
IN THIS SECTION...
•
There are occupational circumstances that could lead to workplace mental ill-health issues.
•
The impact of chronic pain, especially pain from injuries resulting from a workplace accident or health condition,
can have an impact on a worker’s mental health.
•
Stress, anxiety and depression are the single biggest causes of lost time in the UK.
•
Fatigue can have an effect on mental health.
•
Work-related stress can be defined as the adverse reaction that people have to excessive pressure or other
demands placed on them at work.
•
The causes of work-related stress can be characterised as organisational factors (such as how work is organised
and the workplace culture), job factors (such as role, content and control) and individual factors (such as working
relationships and work-life balance).
•
Common mental health problems are rarely due entirely to work related factors but are a combination of a
number of factors.
Circumstances Leading to Mental Ill Health
The structure of an organisation is essentially concerned with the way
in which work activities are divided between different functions and
different individuals. Organisations have sub-systems and associated
procedures that co-ordinate these activities. Mechanisms exist in
organisations to allow the work of individuals to be co-ordinated, such as
a supervisory or management structure.
The operation of the organisation is linked to its environment, e.g. the
legislative framework or the economic circumstances it operates in.
The work activities and organisation structure may lead to operational
circumstances where mental ill-health issues become significant.
Lone working can lead to long-term
effects on mental health
Lone Working
Lone workers are people who work by themselves usually without close supervision. They may be in contact with
other human beings, but their role means they are in a separate location to the rest of the team. Occupational
circumstances may include factors such as:
•
Working outside standard working hours (cleaners, security guards, hotel staff).
•
Working away from a fixed location (vehicle recovery, lift maintenance, plant installations, transport and logistics).
•
Working in the service industry (estate agents, postal staff, community nurses).
•
Working in facilities designed for one person (petrol stations, kiosks).
•
Home working (ad-hoc working or permanently working from home.
Research by CV-Library published in a HR magazine in 2018 exploring 1,200 UK workers found that 42% said their
job played a significant role in their mental health and of these people, 17.8% said working alone was the reason for
their mental health condition.
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9.2
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9.2
Mental Ill Health at Work
Agile Working
Organisations may have implemented a ‘hot desking’ approach, where workers use any desk available instead of
having a workstation assigned to them. For the organisation, hot desking provides flexibility for a mobile workforce;
studies have shown employees spend less than half their working day at their desk. Hot desking can provide
opportunities for improved collaboration and communication between workers. Better desk utilisation can also lead
to reduced office space and savings on rental agreements and hot desking also reduces the amount of stationary left
on the desktop, supporting ‘clean desk’ policies.
For others though, hot desking has a negative impact on their mental health, with workers finding they wasted
large amounts of time finding an available desk or setting up display screen equipment. Some workers will find hot
desking makes collaboration with co-workers harder to do, leading to loneliness and feelings of isolation. There is
also an impact on the individual’s identification with their team. The loosening of team bonds can lead to a sense of
solidarity. Hot desking has also been associated with an increase in distractions, unco-operative behaviours, distrust
and negative relationships.
In 2020, because of a global pandemic, a large proportion of the working population conducted some of their work
at home. The British Office for National Statistics (ONS) identified that in April 2020, in the UK, 46% of people in
employment conducted that activity at home.
Working at home can blur the dividing line between home (an environment to relax in) and work (an environment
for work). The temptation to ‘log on’ and answer emails may lead to an increase in working during the evening and
weekends and difficulties disengaging from work activities.
Many people who live alone may find the combination of restrictions on hospitality and social interaction with work
colleagues leads to a deterioration in their mental health.
Shift Working
The term ‘shift work’ refers to work schedules that fall outside 07:00hrs
to 18:00hrs and can include working during the evenings, early mornings
or during the night. The British Office for National Statistics (ONS)
estimates that almost 5 million workers are on a shift system which
represents over 18% of the UK workforce. The same survey shows that
over 3 million workers will have some form of ‘night-shift working’ as
part of their shift pattern.
Shift working is associated with a disturbance on biological rhythms
(circadian rhythms) and this disturbance is reflected in acute effects
on mood and longer-term effects on mental health. A study sponsored by the Institute of Occupational Safety and
Health (IOSH) on shift working found that those working shifts for 10 years or more displayed a clear relationship
with decreased cognitive performance. The decline in cognitive performance reduced the coping strategies used
by the individuals which in turn can lead to chronic mental health conditions. Concerns with shift working and the
impact on mental health must also consider the type of work being undertaken while shift working. Some job roles
involving shift working may also lead to fatigue, which may, in turn, lead to depression. Depression is a mental health
condition.
Zero-Hour Contracts
A zero-hour contract is usually regarded as one where the employer does not guarantee the individual any hours of
work. Work is offered when the requirement for that work arises and the individual accepts, or declines, the offer of
that work. Zero-hour contracts is a non-legal term.
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Examples of zero-hour work may include:
•
Care work.
•
Delivery driving.
•
Hospitality work (restaurants/hotels).
Those on zero-hour contracts, especially younger workers, are at greater risk of reporting psychological distress. This
is particularly true if the zero-hour contract involves shift working. It is likely that a combination of financial stress, low
job status and irregular work will cause physical or mental health conditions.
In many countries (for example, Denmark, Spain, Poland, China and the United Arab Emirates) national employment
laws do not allow zero hours contracts.
Violence, Aggression, Bullying and Harassment
Violence at work is recognised by many organisations (such as employers,
health and safety authorities and various charities) as a significant
workplace hazard.
The UK’s HSE defines violence as “any incident in which a person is
abused, threatened or assaulted in circumstances related to their work”.
Verbal abuse and threats are the most common forms of violence. This is
closely associated with aggression, which is an intention to dominate by a
forceful action, such as a verbal threat. Harassment is an aggressive form
of intimidation that may range from unpleasant comments to physical
violence; bullying is also a form of intimidation to someone perceived to
be vulnerable.
Occupational circumstances that may lead to violence include:
•
Working in the care industry.
•
Working in education.
•
Delivery and collection services.
•
Representing authority.
The British Crime Survey also links these occupations with harassment. Significantly, a large proportion of workers feel
that contact with members of the public is likely to lead to threats (which is a definition of violence). The individual
experiencing violence, aggression, bullying and harassment is likely to have an increase in anxiety levels and panic
attacks. Anxiety itself can be expressed in terms of mild or severe and have a significant impact on mental health.
Organisational Change
Organisation change is a reference to how the organisation responds to:
•
Market growth opportunities both in existing and new markets.
•
Economic downturns where trading circumstances are challenging.
•
Changes to strategic objectives, such as divestment or investment.
•
Technological change.
•
Competitive pressures caused by mergers/acquisitions or new market entrants.
•
Legislation changes.
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9.2
Mental Ill Health at Work
The organisation needs to change to ensure it achieves organisational objectives and to ensure the business continues.
Organisational change must have a coherent plan, e.g. legislative changes may require a new organisational structure,
but is also likely to require new systems and processes within the organisation to facilitate the new structure. Lack of
effective change management in the organisation can lead to greater employee resistance.
Organisational change is often associated with:
•
Increased workloads.
•
Changing workloads.
•
Time pressures.
•
Reduction in support networks.
•
Role ambiguity.
•
A general increase in uncertainty for the employee, including job insecurity.
All these factors can be associated with detrimental effects on the individual’s mental health.
Impact of Multiple Job Holding on Mental Health
There is a considerable body of research that shows the many facets of work can have positive or negative effects on
the individual’s mental health. Negative effects of work are often associated with non-standard working schedules,
low pay, and low job quality. One emerging factor in the study of the effects of work on mental health is Multiple
Job Holding (MJH). MJH arises when individuals work in more than one job at the same time. For some individuals,
MJH is a technique to minimise the impact of economic downturns and some studies suggest the practice is more
common among females than males.
The advantage of holding more than one job is that a supplementary income is provided which can be used to
manage personal debt. Work is diverse, especially where one role requires the performance of repetitive tasks, and
increased independence is achieved. MJH is associated with a higher probability of depression due, in part, to multiple
job holders working more hours on average than single job holders, and working more non-standard hours.
Impact of Chronic Pain on Mental Health
Pain can be expressed as a physical condition or an emotional condition. Pain can be caused by an injury or an
upsetting event. Most people will experience pain, and though we would prefer to avoid it, pain does serve a purpose.
When you experience pain, your nervous system is activated to stop you doing whatever is causing the pain. Pain
can be acute or occur over an extended time period exceeding three months when it is termed ‘chronic’. Chronic
pain can affect your ability to function both at home and work. The pain may also inhibit your ability to enjoy a social
activity or hobby.
Examples of common chronic pain conditions are:
•
Osteoarthritis.
•
Rheumatoid arthritis.
•
Fibromyalgia.
•
Multiple sclerosis.
In osteoarthritis, protective cartilage breaks down allowing bones to come into contact with other bones causing pain.
Workers with osteoarthritis are likely to experience pain when making movements.
Some chronic health conditions can be caused by a specific work events (a prolapsed spinal disc caused by poor
manual handling technique), overuse (repetitive movement injuries, such as carpal tunnel syndrome or use of
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vibrating tools causing hand-arm vibration syndrome) or a gradual onset (such as poor posture when using display
screen equipment or inhaling dust leading to Chronic Obstructive Pulmonary Disorders (COPD)).
Chronic pain is associated with other health conditions, such as low self-esteem, sleep disturbance, fatigue, anxiety
and depression which will result in a lower quality of life for the person suffering these conditions.
Anxiety and Depression
DEFINITION
ANXIETY
“A feeling of unease, such as worry or fear, that can be mild or severe.”
(The UK’s National Health Service (NHS))
Anxiety can have both psychological and physical symptoms.
Psychological symptoms can include:
•
Feeling worried or uneasy a lot of the time.
•
Having difficulty sleeping.
•
Inability to concentrate.
•
Irritability.
•
Being extra alert (hypervigilance).
•
Feeling on edge or not being able to relax.
Physical symptoms can include:
•
Pounding heartbeat.
•
Breathing faster.
•
Palpitations (irregular heartbeat).
•
Nausea.
•
Chest pain.
•
Headaches.
•
Loss of appetite.
Long-term anxiety can lead to serious ill health conditions, such as hypertension (chronic high blood pressure).
Anxiety is sometimes linked to panic disorder (having panic attacks) and Post-Traumatic Stress Disorder (PTSD),
caused by exposure to a traumatic event. It is also frequently linked to depression.
DEFINITION
DEPRESSION
“Feelings of extreme sadness, despair or inadequacy that last for a long time.”
(The UK’s NHS)
The severity of the symptoms of depression can vary. At its mildest, depression involves being persistently low in spirit
(low mood) while, at its most severe, depression makes sufferers feel suicidal and that life is no longer worth living.
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Mental Ill Health at Work
Symptoms of depression can include the following:
•
Continuous low mood.
•
Feelings of hopelessness and helplessness.
•
Low self-esteem.
•
Guilt.
•
Irritability and intolerance.
•
Lacking motivation or interest.
•
Difficulty with decision-making.
•
Suicidal thoughts.
•
Thoughts of self-harm.
At the more severe end of the scale, depression may lead to a diagnosis of clinical depression that can be categorised
as mild, moderate or severe. At the severe end of the scale, clinical depression can involve psychosis characterised by
hallucinations, delusions and disturbed thoughts.
Effects of Fatigue on Mental Health
Fatigue and mental ill-health conditions frequently occur simultaneously. Fatigue can be regarded as a subjective
condition, but most people would recognise extreme fatigue as a persistent mental and physical tiredness or
exhaustion. It is important to separate physical exhaustion from mental exhaustion. Physical exhaustion may arise
from poor sleeping patterns, over exertion or aches and pains. Causes of mental exhaustion are associated with:
•
Working too hard without rest breaks, especially when the job is emotionally demanding (e.g. physicians).
•
Chronic stress, feelings of flight or fight responses for extended time periods.
•
Mental health conditions, such as depression and anxiety
•
Physical injury or physical tiredness may cause a person to feel mentally exhausted.
The emotional effects of being fatigue associated with mental exhaustion are:
•
Low emotional resilience.
•
Feelings of anxiety.
•
Irritability with others.
•
Feelings of helplessness.
•
Low motivation.
•
Depression.
Fatigue is associated with impaired cognitive abilities which result in poor decision-making, poor psychomotor skills
(clumsiness), rigid thinking and risk-taking. These cognitive dysfunctions will themselves lead to increased stress levels,
anxiety and depression.
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ID2 Learning Outcome 9.2
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Work-Related Stress
DEFINITION
WORK-RELATED STRESS
“The adverse reaction that people have to excessive pressure or other demands placed on them at work.”
(The UK’s HSE)
The European Agency for Safety and Health at Work expands upon this by stating that “people experience
stress when they perceive that there is an imbalance between the demands made of them and the resources
they have available to cope with those demands”.
Stress is not a disease, but a natural reaction to pressure. Unrelieved
stress can cause disease. It certainly contributes to poor work
performance and absence.
Pressure is an inherent part of work, whether it is a deadline that must
not be missed, a rate of output that must be maintained, multiple
demands that must all be met simultaneously or simply the risk of
financial loss if work does not go well.
Pressure does not necessarily lead to stress. In many circumstances,
people are able to cope with the pressure they are under. In fact, in many situations, pressure is a good thing. It results
in a positive performance, maintains motivation and interest and improves health.
However, in some instances, a person finds themselves unable to cope with the pressure that they are under. This
leads to a negative reaction, rather than a positive one. This reaction is psychological in origin, i.e. the negative
reaction is in the mind.
If the pressure is short term, then the person may show some of the signs and symptoms of stress, but it is unlikely
that there will be any significant health consequences. It is a common experience to suffer a few sleepless nights
worrying about an exam or an interview, you prepare yourself as best you are able, then afterwards the pressure is
relieved and the worry goes away. But if the pressure continues or increases, then the relatively minor symptoms of
stress can escalate into physical and/or mental ill health.
Work-related stress should not be confused with anxiety or depression. These are common mental health problems
that can and do exist entirely independently of work-related stress. It is estimated that a quarter of the population
will suffer some form of mental illness at some stage in their lives. The two most common forms of mental illness are
anxiety and depression. Many of the signs and symptoms of anxiety and depression are the same as those for stress.
It is possible to suffer from these mental health problems without being stressed or under any pressure (work-related
or not). However, it must be recognised that there is a strong relationship between these mental health problems and
work-related stress. The one can trigger or contribute to the other, and vice-versa.
Physical and Psychological Effects of Stress
The physical effects of stress in the workplace can involve a range of symptoms, which include:
•
Raised heart rate.
•
Increased sweating.
•
Headaches.
•
Dizziness.
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Mental Ill Health at Work
•
Blurred vision.
•
Aching neck and shoulders.
•
Skin rashes.
•
Lowered resistance to infection.
These symptoms are usually short-lived, depending on the nature of the stressful condition.
As well as physical effects, stress can also cause psychological and behavioural changes, such as:
•
Increased worrying and irritability.
•
Increased alcohol consumption.
•
Increased smoking.
•
Difficulty sleeping.
•
Poor concentration.
•
Loss of appetite or overeating.
•
Inability to cope with everyday tasks and situations.
Again, these symptoms may be short term, in response to an isolated, finite period of excessive pressure.
If excessive pressure remains and the individual cannot cope in the long term, then chronic symptoms and disease
may occur. Examples of these are:
•
Anxiety and depression.
•
High blood pressure (hypertension).
•
Heart disease.
•
Eczema and psoriasis.
•
Irritable bowel syndrome.
•
Susceptibility to ulcers.
•
Loss of libido, erectile dysfunction (in men) and irregular menstrual cycle (in women).
We can see, therefore, that chronic stress may lead to a range of serious ill-health conditions and diseases, and should
be treated seriously as a workplace hazard.
Causes of Work-Related Mental Ill Health
One of the problems with dealing with stress, anxiety and depression as an
occupational health matter is that different people have different abilities
to cope with pressure at work. These abilities vary massively between
people and are influenced by many factors, such as personality, cultural
background, experience, education, motivation, etc.
Also, the coping abilities of an individual are not set, but vary over time.
Indeed, many people find that the trigger that sets off an inability to cope
with work-related stress does not come from within work at all; it comes
from outside. Personal bereavement, separation, divorce, familial ill health
and other stressors outside of work render the individual unable to deal
with work pressures that they would ordinarily cope with.
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ID2 Learning Outcome 9.2
People cope with pressures
at work in different ways
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Therefore, it is not easy to identify one, or even several different causes responsible for stress - there is a range.
With regards to the range of work-related factors that cause stress, the UK’s HSE has developed a framework that
can be adopted by organisations. This framework is called the ‘management standards approach’. The management
standards approach examines the causes of work-related stress under six headings:
•
Demands - excessive demands of the job in terms of workload (too much or too little), targets (e.g. unachievable
sales targets for sales staff), speed of work and deadlines, as well as working hours (e.g. excessively long) and work
patterns (e.g. changing shift patterns). Also, the nature of the job itself: some jobs are inherently difficult (e.g. airtraffic control) and some expose workers to highly emotional situations (e.g. dealing with child-protection issues
for a social worker).
•
Control - lack of control over work, especially where the work is demanding. Control means personal control by
the worker over what work is to be done, how it is to be done, the priorities involved (e.g. realistic deadlines) and
even simple things like control over the working environment (e.g. light levels, temperature, background noise,
etc.).
•
Support - lack of support in terms of information, instruction and training to do the work and having no-one to
turn to when pressure increases (e.g. no advice/counselling service).
•
Relationships - poor workplace relationships and, in particular, bullying and harassment whether by managers,
peers or subordinates (e.g. social isolation and exclusion of a worker by their peer group as a result of prejudice).
•
Role - lack of clarity about an individual’s role, what responsibilities and authority they have, and how they fit into
the larger organisational structure (e.g. lack of any form of job description, or role clarity for a worker used to
working in a highly bureaucratic organisation). Conflicting demands can also create stress under this heading (e.g.
having to increase productivity while at the same time decreasing headcount).
•
Change - the threat of change and the change process itself, whether it is a change that affects just one worker
(e.g. demotion, re-assignment), or the whole organisation (e.g. redundancies, management take-over). This can
create huge anxiety and insecurity.
(More on the management standards approach later in this Learning Outcome.)
It is important to recognise that, though this framework provides a range of factors that can be used to identify and
assess the potential causes of stress (these can be considered as the stress risk factors), the specific risk factors that
are actually present in the workplace will vary depending on the nature of the work being undertaken and the actual
circumstances relating to that work. For example, staff working in a call centre may not be undergoing any kind of
organisational change, so this risk factor will be irrelevant. But they may be subject to demanding call targets on a
daily basis and they may work in a call centre where high staff turnover means that workplace relationships cannot
form, or be maintained.
The home-work interface is a broad concept referring to the many ways families and workplaces intersect. Home life
and work life influence one another in mutual and bi-directional ways. The influence can be positive or negative. The
home-work interface is often expressed using six mechanisms:
•
Spillover. Positive or negative spillover is the energy derived from one domain that affects the other, e.g.
achieving/failing a production target positively impacts on mood.
•
Compensation. Individuals unhappy at home compensate by enhancing the effort put in to succeed at work.
Compensation is also bidirectional.
•
Segmentation. This is the opposite of ‘spillover’; the person actively compartmentalises each domain, e.g. not
prepared to talk about work at home and not prepared to talk about home at work.
•
Resource drain. This interface refers to the energy level being absorbed by home or work. Commonly when the
worker gets home, they are too exhausted to have an interactive family life.
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•
Congruence. While there is a relationship between home and work, the relationship is more dependent on other
factors such as personality.
•
Work-family conflict. This is an ‘inter-role’ conflict where involvement in one role interferes with involvement in
another, e.g. working irregular hours or taking time off work to look after a sick family member.
The home-work interface also involves commuting. Commuting is recurring travel between the place of work and
the home community. ‘Commuting’ is also a term used when it is unrelated to work. Many modes of travel can be
used. A report by the British Royal Society for Public Health found that the average commute in England and Wales
is 56 minutes travelling time. Lengthy non-active commutes negatively impact on the person’s health and well-being.
Over half of those polled in the survey found the commute stressful.
Parenting has many challenges (managing child development) and for the working parent managing the home-work
interface. Being a working parent can involve the additional problems of finding childcare provision while the parent is
at work and the impact on family finance that this childcare provision may have.
Relocation can be a major life decision that impacts on housing choice and commuting. The cost of relocation
may impose significant financial concerns. The new location may be an unfamiliar area that may pose the difficulty
of selecting schools, new commuting routes, impact on other family members and involve a new type of culture
(moving from the city to the countryside or even a new country). Integration in the community may be problematic
and, if the relocation is the consequence of a new job, relationships at work will need to be formed.
Work-Related and Non-Work-Related Factors
Most cases of stress and mental ill health found within the workplace are rarely caused by work-related factors alone.
As was previously highlighted, the coping abilities of an individual are not set, but vary over time. Stressors from the
individual’s personal (non-work-related) life may act as a significant cause or contribution to the pressure that they
are under. Personal bereavement, separation, divorce, family ill health and other stressors outside of work render
the individual unable to deal with work pressures that they would ordinarily cope with. Or these non-work-related
stressors may act as triggers for mental ill health.
Just as there is an interaction between a person’s physical fitness and their ability to deal with the physical demands of
their work, so there is an interaction between their mental fitness and the mental demands of their job. Physical injury
or illness acquired outside of work can have consequences within work. And so it is for mental health.
STUDY QUESTIONS
1. What are the short-term symptoms that might arise in staff who are suffering high levels of stress?
2. Which organisational factors could be responsible for creating avoidable workplace stress?
3. Define anxiety and depression.
(Suggested Answers are at the end.)
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IN THIS SECTION...
•
Factors that have a positive impact on a worker’s mental health include strong leadership, systems for monitoring
worker health and consultation and engagement with workers representatives.
•
Employers must adopt policies and procedures to facilitate work for those with mental ill health to remain in
work.
•
The management of work-related stress and mental ill health can be achieved by applying a standard risk
assessment methodology (five-step approach).
•
The UK’s HSE management standards approach to risk assessment establishes six standards to be achieved by the
organisation under the headings: demands, control, support, relationships, role and change.
•
Organisations can benchmark their performance against these six standards in a variety of ways, e.g. by using the
HSE staff survey.
•
Risk-reduction measures have to be tailored to meet the specific needs of the organisation.
•
The World Health Organization (WHO) world health report classifies types of interventions for the management
of mental health in three major categories: prevention, treatment, and rehabilitation.
•
Good nutrition, exercise and sleep are associated with improvements on mental ill-health conditions.
Why We Need to Manage Mental Ill Health
Mental health problems can have a wide range of symptoms. We may notice these symptoms more at work because
we are more tired than usual due to the physical and mental activity of our job; we may procrastinate more because
of difficult decision-making; we may experience physical injury because of the hazardous nature of our work.
Whatever the size of the organisation:
•
strong leadership,
•
accountable managers with good people management skills,
•
systems for monitoring worker health, such as sickness absence records,
•
empowering employees to care for their own health,
•
consultation and engagement with workers representatives who can give advice and support, and
•
job design that recognises ‘good work’,
will all have a positive impact on the mental health of the workforce. Supportive organisations, therefore, co-ordinate
the activities of safety professionals, occupational health services, Human Resource (HR) departments and others, to
achieve a holistic response to the management of mental ill-health conditions.
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Facilitating Work
Most people who experience stress or mental health problems recover fully
or are able to live with and manage them, and continue to work effectively.
“If more people knew about the nature of mental illness, they would understand
that it doesn’t mean people are unable to contribute to society. The mentally
ill are the most keen to work out of all those with disabilities, and yet it is a
common experience for people to be discriminated against at work after being
diagnosed, to be passed over for promotion, to lose their job or not even be
considered when applying for one.”
(www.rethink.org)
For many years, mental ill health has been stigmatised and those suffering
from it have been discriminated against. Consequently, those suffering from
stress and mental ill health are often excluded from work.
Employers should have policies
and procedures in place to help
employees get back into work
At the same time, it must be recognised that a prolonged absence from work can have a negative impact on a
person’s physical and mental health. Studies have shown that individuals off work for long periods of time can
become less active, which may result in their being unable to maintain social contacts, possibly leading to feelings of
social exclusion. They may subsequently suffer from feelings of isolation, lose their confidence and have low selfesteem. All these effects could lead to poor mental health and the person suffering from anxiety and depression.
So, here we have an example of a vicious cycle; people who suffer from stress and mental ill health are excluded from
work and long-term absence from work can cause mental ill health.
The solution: the employer must adopt policies and procedures that enable those suffering from stress and mental ill
health to remain in work.
It is important to remember that disability and equality legislation makes it unlawful to discriminate against people
with mental health problems.
Identification and Assessment of Risk of Stress and Mental Ill
Health
There is unlikely to be specific national legislation relating to the management
of work-related stress or mental ill-health. Employers may have implied duties
under general health and safety legislation, e.g. the requirement to carry out
suitable and sufficient risk assessment. Aside from any legal duties, employers
will often want to effectively manage stress, anxiety and depression as a
matter of good practice and to reduce the impact of worker absence on the
organisation. Though management practices will vary by region, the UK’s
HSE’s approach will be used as a good example.
A standard five-step approach to risk assessment can be adapted for both
work-related stress and mental ill health:
•
Identify the risk factors.
•
Identify the people who might be harmed.
•
Evaluate the risks: explore problems and identify solutions.
•
Record findings and implement them.
•
Monitor and review to assess effectiveness.
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A five-step risk assessment can be
adapted for work-related stress and
mental ill health
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In practice, many different tools are used as part of the risk assessment to identify and evaluate risk at either the
individual and/or organisational level and also to develop workable solutions, for example:
•
Discussions and focus groups.
•
The use of sickness absence data.
•
Interviews.
•
Surveys/questionnaires.
As work-related stress, anxiety and depression are a widespread problem, some regulators (such as the UK’s HSE)
have developed a framework that can be adopted by organisations for this risk assessment. This framework is called
the ‘management standards approach’ and will be explained in more detail next (as an example of one approach).
It is important to point out that prevention is better than cure; the risk assessment-based approach for both workrelated stress and mental ill health is designed to minimise the incidence of these in the workplace. This can only
be done by taking a strategic organisational view and adopting organisation-wide control measures. In this way, the
various factors that lead to stress are removed or moderated across the whole organisation and the varying personal
susceptibilities to their influence become of secondary importance.
Some organisations have taken a different approach to stress risk assessment in that they have applied an individual
approach (rather than an overall organisational approach), focusing on the specific factors that might lead to stress
for individual workers, taking into account personal factors, etc. However, this approach may prove ineffective in
operation.
The strategic risk-assessment-based approach designed to prevent stress (discussed next) does not discharge an
employer of their duty of care, should individual cases of work-related stress or mental ill health occur. When
individual cases come to light (and even with management arrangements in place they can and do still happen), the
employer will have to respond appropriately. In both cases, the immediate and long-term response of the employer
is critical in ensuring the minimisation of harm. In many cases, the employer’s response when at-risk individuals are
identified can ‘make or break’ the individual concerned.
The Management Standards Approach
The UK’s HSE’s management standards define the culture of an organisation where the risks from work-related stress
are being effectively managed and controlled. In other words, they represent goals or targets to be achieved by the
organisation.
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TOPIC FOCUS
There are six management standards to aim for, which effectively cover the primary sources of stress at work:
•
Demands - this includes issues, such as workload, work patterns and the work environment.
•
Control - how much say the person has in the way they do their work.
•
Support - this includes the encouragement, sponsorship and resources provided by the organisation, line
management and colleagues.
•
Relationships - this includes promoting positive working to avoid conflict and dealing with unacceptable
behaviour.
•
Role - whether people understand their role within the organisation and whether the organisation ensures
they do not have conflicting roles.
•
Change - how organisational change (large or small) is managed and communicated in the organisation.
These six management standards represent a framework against which an organisation can benchmark its
performance through the risk assessment process. For each standard, the UK’s HSE has set out a description of
the standard to be met, along with a description of some of the actions that would be observable within the
organisation if the standard were being achieved (indicators that the standard is being met).
For example, under the management standard entitled ‘demands’, the standard is that:
•
employees indicate that they are able to cope with the demands of their jobs, and
•
systems are in place locally to respond to any individual concerns.
What should be happening/states to be achieved:
•
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.
•
Jobs are designed to be within the capabilities of employees.
•
Employees’ concerns about their work environment are addressed.
Organisations can, therefore, use various methods to benchmark their performance against each of these
management standards and then use the result of that benchmarking exercise to prioritise which standards
are being achieved already, which are being approached and which are being missed. This then allows for the
correct identification of priorities and action planning to address those priorities.
Benchmarking might be done by analysing data that already exists within the organisation, such as:
•
Sickness and absence data.
•
Productivity data.
•
Staff turnover.
•
Performance appraisals.
•
Exit interviews.
•
Team meetings.
•
Informal talks to staff.
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Alternatively, the UK’s HSE has designed a survey questionnaire and survey analysis software that can be used
to analyse the results from that survey. This is a sensible approach as it takes the benchmarking exercise out of
management hands (where management perceptions may bias the results) and relies on direct feedback from
employees on their perception of the cultural standards. Since it is the personal opinions of employees that matter
in the context of stress management, this is a very useful way of gathering data on perceived standards.
The questionnaire management standards indicator tool contains 35 questions and is two pages long. The
intention is that it will be completed anonymously by all, or a very significant sample of staff, and used to give an
indication of the level of compliance with each of the six management standards. It is not intended as a personal
stress indicator tool and does not necessarily give any indication of the ability of any one individual to cope with their
work pressures.
The indicator tool does not have to be used. Organisations are free to adapt the survey questionnaire to suit their
own purposes or use other questionnaires instead.
Analysis of the indicator tool allows the organisation to identify their current level of performance against each of
the six management standards and highlight areas for improvement. The organisation then has to act on these results
and has to design a series of actions to address each. The HSE has indicated that larger organisations might take six
months to carry out their risk assessment, involving use of the survey tool and analysis and evaluation for results,
followed by a further 12 months to put action plans into effect and monitor results. Consequently, the risk assessment
might be reviewed after a period of 18 months by completion of a second staff survey to view areas of improvement
and areas of future concern.
MORE...
The HSE’s management standards indicator tool is available at:
www.hse.gov.uk/stress/standards/downloads.htm
In the UK, the Trade Union Congress (TUC) and the HSE have produced Tackling workplace stress using the HSE
Stress Management Standards - TUC and HSE guidance for health and safety representatives. It describes the
HSE’s Management Standards approach to work-related stress - see:
www.tuc.org.uk/resource/tackling-workplace-stress-using-hse-stress-management-standards
Practical Control Measures
The practical control measures needed to effectively manage stress must be
targeted to the needs of the organisation. Implementing control measures
when the matter that those control measures address is not a stress risk
factor in the workplace is a waste of time, money and effort. Consequently,
any control measure introduced has to address a real need. One advantage
of the management standards approach described above is that the survey
tool allows for identification of the gap between current performance and
the target standard. Tailored actions can then be developed within the
organisation to address that gap.
Informal training to staff
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Using the management standards as a framework, the UK’s HSE gives various examples of possible control measures,
such as:
•
Demands
–– Involve staff in the review of working hours and shift systems.
–– Consider flexible working and changes to start and finish times.
–– Develop a system to notify employees of unplanned tight deadlines and the need to work long hours.
–– Hold team meetings and individual meetings to discuss anticipated workload and challenges.
–– Agree fair work patterns to cope with peaks and staff absences.
–– Ensure sufficient resources are available for staff to be able to do their jobs (time, equipment, etc.).
–– Provide training (formal or informal) to help staff prioritise, and information on how they can seek help if
they have conflicting priorities.
–– Include training and personal development plans in the appraisal process to allow staff to achieve
development.
–– Deal with risk of violence in consultation with employees.
•
Control
–– Allow staff to have a say over the way their work is organised and done.
–– Consult staff during the planning stage of projects to talk about the anticipated output and methods of
working.
–– Allocate responsibility to teams, rather than individuals, to take work forwards.
–– Talk about the way decisions are made and possible scope for staff involvement.
–– Talk about the skills people have and how they would like to use their skills.
•
Support
–– Hold regular one-to-one meetings to talk about any emerging issues or pressures.
–– Include ‘work-related stress/emerging pressures’ as a standing item for staff meetings and/or performance
reviews.
–– Seek examples of best practice where people received good support from managers or colleagues.
–– Adopt ‘open door’ policies or agreed times when managers are available.
–– Support staff experiencing problems outside work.
–– Disseminate information on other areas of support (HR department, occupational health, trained counsellors,
charities).
–– Offer access to counselling, either internally or externally.
Support staff seeking to return to work following long-term absence caused by, or made worse by, stress. This
should be done in line with organisational return to work policies as detailed in Learning Outcome 9.1.
•
Relationships
–– Develop a written policy for dealing with unacceptable behaviour at work and communicate this to staff.
–– Implement procedures to resolve conflict at work.
–– Introduce a confidential reporting system for unacceptable behaviour.
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–– Establish grievance and disciplinary procedures.
–– Select or build teams that have the right blend of expertise and experience for new projects.
–– Provide training to help staff deal with difficult situations.
–– Celebrate success.
•
Role
–– Enable staff to clarify their role and to discuss any possible role conflict.
–– Display team/department targets and objectives to help clarify unit’s and individual’s roles.
–– Agree specific standards of performance for jobs and individual tasks and review periodically.
–– Introduce personal work plans that are aligned to the outputs of the unit.
–– Introduce or revise job descriptions to help ensure the core functions and priorities of the post are clear.
–– Hold regular one-to-one meetings to ensure individuals are clear about their role and know what is planned
for the coming months.
•
Change
–– Ensure all staff are aware of why the change is happening.
–– Define and explain the key steps of the change.
–– Ensure employee consultation and support is a key element of the programme.
–– Establish a system to communicate new developments quickly.
–– Ensure staff are aware of the impact of the change on their jobs.
–– Provide a system to enable staff to comment and ask questions before, during and after the change.
In order to identify the various controls through the risk assessment process, there will have to be some form of
consultation with staff about the results of the survey analysis and the priorities that it has raised. This is best
achieved by some form of working group made up of appropriate managers and staff.
As might be expected, the starting point for this approach will be establishing an organisational policy on stress
management setting out the aims and objectives of the organisation and responsibilities for implementation.
Significant guidance on stress risk assessment and the practical implementation of the management standard
approach is available from the HSE.
MORE...
PAS 1010:2011, Guidance on the Management of Psychosocial Risks in the Workplace, BSI, 2011, provides a practical
tool to help managers, specialists and employee representatives to successfully implement and maintain a
psychosocial risk management framework and is useful further reading to supplement the identification and
control of stress.
Types of Intervention for Mental Ill Health
Over the last 200 years people in all countries in the world have an increased life expectancy. In the last 100 years the
global average life expectancy has more than doubled. While there exists considerable inequality in life expectancy,
ranging from 53 to 80+ years, people are living longer.
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Consequently, the population is living with long-term physical health conditions and one in three people with a
long-term health condition also has a mental health condition. Many mental health conditions are undiagnosed,
but it is estimated that depression is significantly more common in people who have two or more long-term health
conditions. A holistic approach is needed to achieve good outcomes.
Mental health conditions may be influenced by multiple determinants, such as genetics and biology, but also by social
and environmental factors (e.g. income, education, stigma).
The World Health Organization (WHO) world health report classifies types of interventions for the management of
mental health in three major categories: prevention, treatment, and rehabilitation.
Prevention (Primary Prevention)
Primary prevention is stopping mental ill-health conditions before they occur by making changes to the task or
environment the employee operates in, e.g. legislative changes, job enrichment, ergonomic improvements, reduction
of noise, reduced workload, improving role clarity and social relationships (e.g. communication, conflict resolution). In
this stage, the goal is to avoid the occurrence of the condition.
Treatment (Secondary Prevention)
In this category, the mental health condition has begun, and the goal is for early identification so that actions
that prevent the condition deteriorating or being made worse by work, can be made. The organisation can offer
support with screening, questionnaires, well-being initiatives targeted at preventing deterioration. The mental health
condition may cause other health conditions (referred to as ‘sequelae’) such as anxiety leading to negative coping
strategies (e.g. smoking cigarettes) leading to further ill-health conditions.
Rehabilitation (Tertiary Prevention)
Rehabilitation involves minimising the impact of the health condition or adopting measures aimed at restoring the
person to their previous situation or to maximise capability. The organisation can support the employee in regaining
skills and increased confidence to enable living in the community (both at work and socially). Rehabilitation is likely to
require working in partnership with carers and collaborating with health care workers to maximise the outcomes for
those with mental health conditions.
Managing Mental Ill Health in the Workplace
There are compelling reasons to manage mental health. It will not only reduce illness, save lives and save money, but it
will also promote resilience and good mental health in the workforce.
Workers with mental ill-health conditions can be managed in the workplace by:
•
Speaking to workers as soon as it is recognised that there may be an issue:
You may see behaviours or performance signs that suggest a worker has a mental health issue. There is a
responsibility on the employer to the individual worker and the organisation to act. In most cases the initial
approach should be a private one where the concerns are discussed. The employer representative should be
familiar with the organisation's policies and procedures and have at least a basic understanding of mental health
before any conversation takes place.
–– Raise the concern as a work-related performance issue.
–– Provide access to Employee Assistance Programmes (EAP).
–– Assure the worker meeting with the EAP are confidential.
–– Set a time to review and meet again.
–– Document the meeting.
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•
Using routine management tools to identify and tackle issues:
Managers should create a culture in the workplace that supports workers to be open and honest about their
mental health. This can be supported by a clear mental health strategy and specific policies and procedures to
support that strategy. Managers must be approachable and confident in their ability to normalise conversations
on mental health. Temporary adjustments can be made to change workloads, flexible hours, change work
environment (provide a laptop computer to enable home working), change rest times, return-to-work policies
and relaxing absence rules. Adjustments can also be made to provide additional on the job support where
required.
•
Supporting workers who become emotionally distressed:
Mental health disorders can cause symptoms of emotional distress that may persist for extended time periods.
Distress is associated with times when we are not coping. Warning signs of emotional distress may include:
–– Excessive smoking or drinking alcohol.
–– Eating too much or too little.
–– Thinking of self-harm.
–– Becoming withdrawn.
Support for workers who become distressed is to respond to the feelings they may be experiencing of being
overwhelmed with worries and fears by listening and not being judgmental. Help the worker cope by encouraging
positive coping strategies, such as exercise (routine walks), and discourage negative coping strategies (smoking).
Make it clear to the worker that declining help now will still mean they can access that help in the future.
•
Supporting workers with on-going mental health conditions:
Support for a worker with a mental health problem is about helping them find ways to recover, helping them stay
well and ensuring the workplace is safe and free from discrimination. Actively listen to the worker with the mental
health conditions and provide support that they believe will be helpful. Treating the mental health condition as
equally important to someone's physical health. Regular team meetings and confidential supervision meetings can
be used to offer support.
•
Encouraging workers to develop coping strategies to help manage their condition:
Workers can be encouraged to develop coping strategies by setting boundaries on what work they take on. The
work can be physically or mentally challenging or the work may be undemanding and boring. Workers should
be supported to take on work they can cope with. The organisation could offer a ‘mental health day off’ to
spend time assessing how to feel better, or divide the day into small tasks so that it is easier to gain a sense of
achievement.
•
Use of ‘advance statement’:
An ‘advance statement’ is a document that can be completed by the worker to say how you (the worker) would
like to be treated if you are unable to make that decision yourself. The statement is not legally binding but the
information it contains can reflect your views, beliefs and values. Advance statements are made when you have
the mental capacity to make them.
•
Ensuring that the worker knows where to get help and support for their mental health condition
outside the workplace:
Managers should be aware of what additional support the organisation is able to offer. This will include the
Employee Assistance Programme and access to it. This may lead to counselling service advice where other
external services are identified for the worker.
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In the UK, possible support services include:
–– Access to work – which provides advice for disabilities or long-term health conditions, for those in work or
about to start work.
–– Mind - is a leading mental health charity in England and Wales. It provides information and support on how
to improve mental health.
–– NHS website - offers information and practical advice for anyone experiencing mental ill health.
–– Remploy - offers a free and confidential Workplace Mental Health Support Service for anyone absent from
work or finding work difficult because of a mental health condition. It aims to help people remain in, or
return to, their role.
–– Rethink Mental Illness - is a voluntary sector provider of mental health services offering support groups,
advice and information on mental health and problems.
MORE...
For more details on these support services, please visit:
Access to Work:
https://www.gov.uk/access-to-work
Mind:
https://www.mind.org.uk
NHS:
https://www.nhs.uk
Remploy:
https://www.remploy.co.uk
Rethink Mental Illness:
https://www.rethink.org
Benefits from Good Nutrition, Exercise and Sleep on Mental
Ill-Health Conditions
Poor nutrition is a significant contributor to poor physical health. Poor nutrition is associated with obesity, heart
disease, diabetes, high blood pressure and cancer. It should also be recognised that the brain is an organ that benefits
from a diet of carbohydrates, amino acids, and water to remain healthy. What we eat and drink influences how we
feel, think, and behave. Eating a balanced diet ensures the brain is not exposed to oxidants that have been shown to
negatively affect mood and mental health. There is also a clear, causal relationship between poor physical health being
a contributor to poor mental health.
The relationship between poor nutrition and mental health is complex, demographic factors such as socio-economic
status, education, gender, and age can all have a causative role. However, the relationship between obesity causing
depression and depression causing obesity is more established.
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Mental Health Controls
Eating well (a well-balanced diet) is associated with feelings of well-being. Consumption of fruit, vegetables,
fish and unsaturated fats such as olive oil, are associated with sustainable reduction in depression. Deficiencies
in micronutrients, e.g. omega 3 and omega 6, are associated with poor concentration, depression and memory
problems. Increased consumption is associated with reductions in bipolar depressive symptoms.
DEFINITIONS
DIET
Usually refers to what we eat or what we choose to stop eating (to lose weight).
NUTRITION
Usually used in the context of the quality of food we eat, the kind of food we eat, how we choose to eat and
how the food has been produced.
Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, are associated with
improvements in mental health by reducing anxiety, depression, and negative mood and by improving self-esteem
and cognitive function. Exercise is especially important in patients with schizophrenia since these patients are already
vulnerable to obesity and because of the additional risk of weight gain associated with treatment.
Exercise can also:
•
Improve sleep.
•
Improve libido.
•
Lower stress levels.
•
Improve mood.
•
Increase energy and stamina.
•
Reduce tiredness that can increase mental alertness.
•
Contribute to weight reduction.
•
Reduce cholesterol and improve cardiovascular fitness.
Many of these benefits will have corresponding benefits for mental health. Improved sleep helps us recover from
mental as well as physical exertion. Whereas, lack of sleep can lead to difficulty coping with daily life that leads to
reduced self-esteem and elevated stress levels - which in turn impair sleep.
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Mental Health Controls
Feelings of worry
and/or stress
Lack of
sleep
Low self
esteem
Tiredness
Difficulty coping
with daily life
Image based on sleep/mental health cycle, source: https://www.mind.org.uk/
information-support/types-of-mental-health-problems/sleep-problems/about-sleepand-mental-health/
STUDY QUESTIONS
4. Outline the employer’s statutory obligations to control the risks of occupational ill health arising from
stress.
5. Discuss examples of good management practice that can serve to reduce stress levels in an organisation that
is undergoing change.
6. List measures that can be taken to reduce individual stress by improving work relationships.
(Suggested Answers are at the end.)
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Well-Being
Well-Being
IN THIS SECTION…
•
The relationship between health and well-being is not one-way, they influence each other.
•
Well-being strategies, with support from top management, boost worker commitment to the organisation.
•
There is a link between well-being and safety culture: ill health can lead to loss of confidence, social exclusion and
feelings of isolation at work.
Relationship between Well-being and Health
The World Health Organization (WHO) states that, “well-being exists in
two dimensions, subjective and objective. It comprises an individual’s experience
of their life as well as a comparison of life circumstances with social norms and
values”.
The life circumstances referenced in the statement are the socioeconomic influences of:
•
Education,
•
Work,
•
Social relationships,
•
Housing, and
•
Work-life balance.
Health influences well-being and wellbeing itself influences health
Subjective experiences are a person’s sense of well-being, the individual feelings, and how effectively the individual
feels they are functioning psychologically. Physical and mental health influence well-being.
The relationship between health and well-being is not just one-way – health influences well-being and well-being
itself influences health. Someone eating a nutritious diet has higher energy levels, so can exercise more, which reduces
the likelihood of cardiovascular conditions, which makes the individual healthier, which enhances the individual’s
sense of well-being.
Mental illness and well-being are independent dimensions; mental health is not the opposite of mental illness. It is
possible for someone to have a mental disorder and high levels of well-being. It is also possible for someone to have
low levels of well-being without having a mental disorder. Mental health is strongly linked to personal feelings of wellbeing. Depression and anxiety are associated with low levels of well-being.
How Health and Well-Being Workplace Strategy can Help to Improve
Employees’ Mental Health
In the 2017 REBA Employee Well-Being Survey undertaken in the UK found that 55.8% of respondents considered the
most effective well-being initiative for the business was mental health support. Around a third of respondents provide
training to managers which tended to focus on stress and resilience, absence management and having difficult
conversations.
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Benefits to the Organisation from Well-Being Strategies
In a 2017 UK report produced by ‘The Centre for Mental Health’, it was highlighted that aggregate costs associated
with sickness absence, presenteeism and labour turnover to the UK economy was:
•
£10.6 billion in sickness absence.
•
£21.2 billion in reduced productivity at work, or ‘presenteeism’.
•
£3.1 billion in replacing staff who leave their jobs because of their mental health.
The same report states that this can be broken down per employee as:
•
£395 per employee absence.
•
£790 per employee ‘presenteeism’.
•
£115 per employee labour turnover.
The 2017 REBA Employee Well-Being research report states that the median annual spend on supporting well-being
strategies was between £51 and £75 per employee.
It should be noted that the costs of absence may need to be adjusted when the impact of lost sales (due to workers
not making the goods/services to sell), lost customers, inability to take on new contracts, inability to fulfil existing
contracts, are taken into consideration.
Healthy workers who demonstrate physical and psychological well-being have been shown to demonstrate higher
levels of commitment to the organisation than those workers who are less well. Committed workers are more likely to
value their organisation and tend to be more willing to ‘discretionary effort’.
Support from Top Management
Leadership is more effective if board members can re-inforce the well-being message by setting the direction for
effective well-being management and making well-being an integral part of the organisation’s culture, of its values
and performance standard. The chief executive can give the clearest visibility of leadership, but some boards find
it useful to name one of their numbers as the well-being champion. The senior leadership team is responsible for
ensuring policies and procedures are in place that are fully integrated with the organisation's goals and well-being
strategy.
Lack of senior management commitment to well-being can be a significant barrier due to the lack of role models.
Workers are more likely to engage with well-being initiatives if they see active participation from the leadership team.
Line managers (middle managers) are unlikely to prioritise well-being initiatives if there is a lack of commitment from
the leadership team.
Types of Well-Being Initiatives
There are a number of well-being initiatives that can support mental
health:
•
Subsidised Gym Membership
Exercise-induced increases in blood circulation influences the
reaction to stress. Physical exercise can also improve self-efficacy,
feeling good about yourself.
•
Free Fruit
Fresh fruit, as part of a nutritious diet providing vitamins C and E.
Medical trials have established that these vitamins, when present, reduce depression.
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•
Employee Assistance Programmes
Can support the reduction of mental ill health by helping manage relationships with co-workers, support
individual workers with counselling, referrals to primary care and follow up support.
•
Mindfulness/Meditation Sessions
Mindfulness is a methodology of paying attention to the present moment, using a range of techniques to
combine the mind and body. The individual becomes aware of thoughts, feelings and body sensations so that
instead of being overwhelmed by these thoughts/feelings/sensations they are better able to manage them.
•
Free Access to Medical Support
The individual may find it comforting to be able to talk to someone about their experiences and feelings. Debt
and mental health can affect each other. Therefore, if this service is provided free, it is more likely to be used.
There are many misunderstandings and stigma surrounding mental ill health, one of which is the level and
effectiveness of available treatment. However, there are effective treatments within the health system and free
access will improve the uptake of these services.
•
Physiotherapy
Physiotherapists are professional persons in aspects of physical health
care. They are able to support a non-pharmacological management
of pain, can devise exercise programmes, they have expertise in
motivation and can provide advice and interventions to address
impaired body awareness (disassociation from thoughts/feelings),
particularly associated with mental ill health.
•
Medical Screening
Medical screening is effectively an examination of a person’s
emotional health. Primary care services may conduct an evaluation of the individual’s mental health by asking
questions about feelings/behaviours/thoughts. This is often undertaken by a series of standardised tests or
questionnaires carried out by a professionally qualified person. In addition, screening will establish:
–– Physical health.
–– Financial circumstances.
–– Social circumstances.
–– Use of drugs/alcohol.
–– Dependants (such as children).
–– Strengths and skills.
–– Hopes and aspirations.
•
Financial Education
There are a wide range of studies that demonstrate a cyclical link between financial worries and mental health
problems. Financial concerns impact adversely on mental health and poor mental health can make earning and
managing money harder. Financial education can support individuals to maximise their income through:
–– Signposting benefit and debt services.
–– Compiling household budgets.
–– Advice on food shopping within a budget.
–– Advice on the best deals for utility services.
–– Providing information on charities for people on low incomes.
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Well-Being
Role of Education and Support Programmes
Education promotes the development of thinking, increases knowledge, develops personality and changes attitudes.
The associated effects of education filter into everyday life and social interactions. The role of education in well-being
is to ensure workers are aware of the purpose of interventions and what will happen consequently. For example,
describing to someone who smokes cigarettes that smoking can lead to arteries becoming restricted with plaque
and blood becoming thicker, thereby restricting blood flow; these conditions will have a synergistic impact when
using vibrating tools, given that the health effects from excessive exposure to vibration are vascular and neurological.
Education and support, through smoking cessation projects, can encourage the worker to stop or reduce cigarette
use.
Many of the secondary interventions aimed at the management of psycho-social risks require the provision of
education and training. Through the provision of education and training, workers become more aware of workrelated stressors - bullying and harassment factors, for example - and are, therefore, better able to self-manage
the situations that arise. Issues covered in education and training could include interpersonal relationships, time
management and conflict resolution.
Well-Being Initiatives
Organisational change is a recurring theme in many organisations, driven by a range of socio-economic reasons.
However, research shows that change initiatives fail to achieve their intended outcomes, and some will limit an
organisation’s potential and its workers. Among the many drivers for change is the need to manage sickness absence,
retain workers and provide good work. There is also the increased societal awareness of the organisation’s moral and
legal role in not harming their workers’ health.
Resistance to change can be expressed as a resistance to the content of the change or resistance to the process of
change. The change the organisation is targeting is to improve worker well-being to reduce sickness absence, reduce
job turnover and increase output. To avoid resistance, the content of the well-being programme needs to be targeted
at the workplace demographic. For example, the UK is an ‘ageing population’; older workers, statistically, will have
more than one chronic health condition. Age equality does not necessarily mean identical treatment across a range of
ages. Providing gym membership may, therefore, be an initiative that is irrelevant and the take up of the initiative will
be low.
The collection and analysis of quantitative and qualitative data on worker health and well-being will enable strategies
and interventions relevant to the workforce to ensure the planned benefits from the initiative are realised.
Working with Partners
Partnership working brings together separate organisations so that the partner organisation can benefit from the
pooled level of expertise provided. The partner organisations used in the process of well-being must have the same
common goals and the same beliefs in the beginnings of well-being. Each partner organisation must value the benefit
of the other’s contribution to the wellbeing framework. Partnership working can follow various models:
•
Networking - partner organisations regularly meet to share best practice.
•
Referral - partner organisations agree to a process of referrals which will save time on information gathering
(patients’ details, etc.).
•
Consortium working - organisations work together by formal agreements with the purpose of acting together.
•
Multi-agency working - two or more organisations share resources, such as consulting rooms.
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Occupational health services can be provided internally (the service is owned by the organisation) or externally (the
service is contracted to the organisation). The role of an occupational health service, however it is provided, is to
ensure that workers are supported when they are at work or when they return to work following injury or ill health.
Services provided by occupational health are confidential and have the dual role of supporting management and
the worker. Occupational health is a specialised clinical service that provides clear benefits to workers, as well as
contributing to an organisation’s productivity as an investment in the well-being of the workforce.
Involving and Empowering All Employees
Health champions can have a positive impact on a business and will play an important part in the implementation of
the workplace health and well-being strategy. The main function of a health champion is to:
•
Champion health initiatives within the workplace.
•
Act as a point of contact for workers who want information on health issues.
•
Encourage workers to become involved in health promotion activities.
•
Empower workers to become involved in well-being activities.
•
Work in consultation with management, workers, occupational health professionals and HR departments in the
development and implementation of the health and well-being strategy.
Small- to medium-sized organisations may appoint a health champion from their existing workforce, but it is essential
that they are given the time, resource, and training to carry out the role.
Larger organisations may appoint a team of health champions, depending on the size of the organisation or a specific
role and appoint one health champion.
Health needs assessments identify key issues affecting worker health. Once a health needs assessment has been
completed, the organisation can identify areas of concern with workers’ health, prioritise those concerns, and identify
effective interventions. Demonstrating to workers that the organisation is concerned about their health is a good first
step to empowerment.
Empowering workers requires the organisation to delegate responsibility, giving autonomy to the workers at the same
time as provide the necessary resources, underpinned by clear well-being expectations.
Monitoring, Reviewing and Communicating the Health and Well-Being
Strategy
The report published by the Reward and Employee Benefit Association in 2017 shows that in the UK, 28.8% of
respondents to the research measure the performance of their well-being initiatives - which means that organisation
resource is being allocated in 71.2% without having to demonstrate a return on the investment.
Monitoring workplace practices that can be detrimental to a worker’s health and safety is a core component of
health and safety management. Monitoring work-related practices that can be detrimental to health and well-being,
including long-term health hazards that are cumulative (e.g. work-related stress, musculoskeletal disorders) is equally
important. For the effective management of absence, monitoring absence levels, so that the organisation can have a
co-ordinated response, is a key function of HR professionals.
Well-being strategies should be based on primary, secondary, and tertiary interventions. Suitable interventions will
create ‘good work’. Communicating these interventions will show workers that the organisation cares for them. The
response of the worker is predicted to be increased loyalty, more discretionary effort, and less sickness absence. The
effectiveness of the strategy needs to be monitored to ensure the expected benefits for workers and the organisation
are being realised. The strategy needs to be reviewed if the interventions are not being targeted correctly and
communicated to the workforce so that they can continue to be involved.
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Well-Being
Link between Health and Well-Being and Safety Culture
DEFINITIONS
HEALTH
“A state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity.”
Source: WHO
WELL-BEING
“The creation of an environment that promotes a state of contentment which allows employees to flourish and achieve their
full potential for the benefit of them and the organisation.”
Source: Chartered Institute of Personnel and Development (CIPD).
Health and safety professionals are engaged in developing working environments that are free from physical harm
(e.g. entanglement in a machine) and free from health-related hazards (e.g. excessive demands placed on the worker
causing mental health problems).
There is, therefore, a clear correspondence between the definition of health and well-being provided by the WHO
and the Chartered Institute of Personnel and Development (CIPD) with the role of the health and safety professional.
Workers operating machinery, working at height, working in construction, etc. all need good physical and mental
health to perform their roles. Ill health, especially long-term ill health, can lead to loss of confidence, social exclusion,
and feelings of isolation from work colleagues. In turn, these conditions may lead to increased errors, more risktaking, not reporting health conditions and an increase in accidents.
It should be noted that being 100% fit (either mentally or physically) may not be a requirement to fulfil a particular
role safely.
Why Line Managers Must be Trained on Well-Being Strategies and
Initiatives
The involvement of line managers is pivotal to determining whether a worker has a good or bad day at work.
Managers must adopt the approach that supports their teams to achieve a state of well-being. A line manager’s
behaviour is a significant influence on organisational culture and on the worker’s work experience.
Many organisations are actively involved in changing the HR-line manager interface. Many formerly HR exclusive
activities, such as recruitment and advancement through pay grades, have been moved away from traditional HR
functions. Outsourcing of HR transactional activity (record maintenance) is also resulting in increased responsibility
for the line manager.
Line managers have busy and demanding roles with a range of different targets to meet and pressures to manage. It
is probable that line managers will have received no training on the people management side of their role. Positive
manager-worker interactions will prevent disruptive issues (such as mental ill health and absence) occurring.
Managers who have been trained on the well-being strategies and initiatives will be in a better position to deal with
these issues at an early stage that will prevent deterioration.
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STUDY QUESTIONS
7. What is the role of education and support programmes in well-being initiatives?
8. What are four of the main functions of a health champion?
9. Give reasons why line managers should be trained on well-being initiatives.
(Suggested Answers are at the end.)
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Work-Related Violence
Work-Related Violence
IN THIS SECTION...
•
Work-related violence is defined as any incident in which a person is abused, threatened or assaulted in
circumstances relating to their work.
•
Violent incidents cause physical and psychological harm and are significant contributor to work-related stress.
•
Various factors contribute to the risk of work-related violence. These all relate to the job that the worker is
carrying out, such as: dealing with members of the public, handling cash, lone working and conducting home
visits.
•
The assessment of risk of work-related violence can be based around a four-stage approach:
–– Find out if there is a problem.
–– Decide what action to take.
–– Take action.
–– Check what you have done.
•
Identifying the extent of the problem usually involves use of incident reporting systems and/or formal or
informal staff surveys.
•
The control measures for minimising risk of violence can be categorised as organisational (such as zero-tolerance
policies, cashless systems and customer vetting), physical controls (such as security screens, alarms and CCTV
cameras) and behavioural controls (such as recognising and defusing potential violent incidents prior to
escalation).
•
Training for staff is essential.
Definitions
Violence at work is recognised by many organisations (such as employers,
the UK’s HSE and various charities) as a significant workplace hazard.
The UK’s HSE’s definition of work-related violence is:
“Any incident in which a person is abused, threatened or assaulted in
circumstances relating to their work”.
The ILO Code of Practice - Workplace Violence in Services Sectors and Measures
to Combat this Phenomenon (CoP) defines workplace violence as:
“Any action, incident or behaviour that departs from reasonable conduct in
which a person is assaulted, threatened, harmed, injured in the course of, or as a
direct result of, his or her work.”
Copyright © International Labour Organization 2003
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Work-Related Violence
The CoP goes on to further clarify the definition by stating that:
“Internal workplace violence is that which takes place between workers (including managers and supervisors).
External workplace violence is that which takes place between workers (and managers and supervisors) and any other person
present at the workplace.”
Copyright © International Labour Organization 2003
In the ILO Framework Guidelines for Addressing Workplace Violence in the Health Sector - The Training Manual the following
definition is given:
“Violence can be defined as a form of negative behaviour or action in the relations between two or more people. It is
characterised by aggressiveness which is sometimes repeated and sometimes unexpected.
It includes incidents where employees are abused, threatened, assaulted or subject to other offensive acts or behaviours in
circumstances related to their work.
Violence manifests itself both in the form of physical and psychological violence. It ranges from physical attacks to verbal
insults, bullying, mobbing, and harassment, including sexual and racial harassment.”
Copyright © International Labour Organization 2005
It is important to recognise that this definition goes well beyond the immediate and obvious association of violence
with physical assault (being punched, kicked, stabbed or shot, etc.). Inclusion of the words “abused” and “threatened”
significantly broadens the range of events that fall within the scope of the definition. Verbal threats, gestures and
personal abuse are clearly brought within the meaning of the term. It is also important, however, to recognise that
this definition has no basis in statute law (it does not come from a set of Regulations) and that an organisation is
therefore free to use a definition of violence as they see fit. This would be particularly important when creating and
implementing an organisational policy on work-related violence.
Using the ILO definition of work-related violence, the following incidents might fall within its scope:
•
A member of the public hits a shop assistant during a customer query.
•
A security guard is threatened with a gun during a robbery.
•
A social services worker is verbally threatened with assault during a home visit.
•
A train driver is spat at by a customer on a station platform.
•
A call centre operative is verbally abused during a credit control call.
Harassment
Any form of harassment is unacceptable.
A European social partner agreement on harassment reached an independent consensus on preventing harassment
and violence at work. This was published in the UK by the HSE in a document titled ‘Preventing workplace harassment
and violence’. The definition of ‘harassment’ in that agreement is:
“Harassment occurs when someone is repeatedly and deliberately abused, threatened and/or humiliated in circumstances
relating to work”.
The aim of the agreement is to raise awareness and increase understanding of harassment, and provide a framework
of responses to identify, prevent and manage harassment.
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Work-Related Violence
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 between workers or third parties such as clients, customers, patients, pupils, etc.
•
Range from minor cases of disrespect to more serious acts, including criminal offences.
Physical and Psychological Effects
Clearly, a very wide range of physical injuries can result from physical assault, from a fatal wound to bruising and
grazing (the most common reported injury). Most incidents, however, do not involve physical assault and so never
result in physical injury. This can belie the fact that perhaps the most serious effect of many violent incidents is not
the physical injury; it is the psychological effect of the incident. Violent incidents of any type, whether physical or
verbal, can be traumatic, may leave the victim suffering from traumatic stress and can result in PTSD.
The effect that an incident has will depend on many factors, such as the nature of the incident itself and, very
significantly, the personal characteristics of the victim. For example, some individuals may be ‘thick skinned’ enough
to shrug off verbal abuse as simply ‘part of the job’ (see note below). Other individuals would find a single incident of
verbal abuse very distressing and would show the typical symptoms of traumatic stress (tearfulness, anxiety, etc.). This
can lead to PTSD. It may also be a trigger for any mental health condition (such as anxiety and depression) that an
individual may be susceptible to.
(Note: it is worth pointing out that whilst individual workers are fully entitled to their opinion that abuse is simply
‘part of the job’, it should never be the policy of their employer that this is the case. Workers are entitled to enjoy
safe working conditions and that includes freedom from violence.)
Victims of violence can often suffer psychological harm in this way. Typical reactions include:
•
Withdrawal.
•
Hypervigilance.
•
Loss of confidence.
•
Loss of self-esteem.
•
Mood swings.
•
Breakdown of working and personal relationships.
•
Anxiety and depression.
•
Suicide attempts.
The other way that violent incidents may cause harm is by contributing to work-related stress. This is less to do with
the fact that being spat at was traumatic and has left you with PTSD. It is more to do with the fact that when you
know that your job exposes you to the risk of being spat at by complete strangers, it makes you more anxious and
vigilant than you might otherwise be. It increases stress. It is the feeling of being at risk (feeling vulnerable) that is
important here, rather than an incident that has already happened.
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Risk Factors
Workers at Risk
The single biggest risk factor for work-related violence is the nature of the job being carried out by the worker.
Workers whose jobs require them to deal with the public are most at risk from violence. In fact, working with the
public might be identified as the single biggest risk factor for work-related violence.
There are certain workplaces, however, where this is not the case; workers are not dealing with the general public but
are still at risk of violence, e.g. prison service and psychiatric hospital staff.
Particularly at risk are those who are engaged in:
•
Giving a service - such as social services, infrastructure maintenance engineers, retail staff, etc.
•
Caring - such as nurses, doctors, care assistants, etc.
•
Education - teachers and support staff.
•
Cash transactions - bus drivers, taxi drivers, bank staff, post office staff, etc.
•
Delivery/collection - postal workers, lorry drivers, security van drivers, etc.
•
Controlling - stewards, security staff, etc.
•
Representing authority - police, traffic wardens, bailiffs, various enforcement officers and inspectors, etc.
Another very significant risk factor is lone working. Staff working alone are more at risk of violence than they might
otherwise be if they were accompanied by a colleague. For example, social workers conducting home visits, service
engineers working in a local community, and night-shift security.
One final risk factor worth drawing attention to is conducting home visits. Workers making home visits, such as
care workers, social workers, doctors, engineers and enforcement officers (e.g. environmental health officers) are at
greater risk. The reason for the home visit is significant here; an enforcement officer following up a noise complaint is
more at risk of violence during a home visit than a satellite TV installation engineer.
Though there is some relationship between the sex of victim and risk of violence and the age of victim and risk of
violence, these effects are relatively minor and probably result from the age and sex correlation for particular jobs and
sectors (e.g. there are more female nurses than male ones).
It can be misleading to make general assumptions about at-risk workers. For example, the assumption that women are
more at risk than men (which seems to be based on the view that men are more muscular and therefore better able
to defend themselves). This assumption is often erroneous as, in many sectors, men are more frequently the victim of
violence than women.
MORE...
The Suzy Lamplugh trust is a useful source of information on the risks of work-related violence and lone
working:
www.suzylamplugh.org
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Work-Related Violence
Assailants
The majority of incidents involve assailants who were strangers to the victim. Where the assailant was already known
to the victim, it was almost always work that has made them known to the victim.
Whilst it might be easy to stereotype assailants as white, male with low IQ, it is the case that the typical assailant (if
there is such a thing) will depend largely on the nature of the job and sector under scrutiny. For example, whilst it
is true that nurses are assaulted by drunk males in hospital emergency departments, it is also the case that they are
assaulted by sober elderly female patients in Care of the Elderly wards. Most at-risk sectors and organisations have
access to statistics that allow for some definition of the typical assailant. It will, however, always be the case that some
assailants will not fit this typical mould.
What is the case, however, is that the circumstances of violent incidents often involve risk factors such as when the
assailant:
•
Is under the influence of drink or drugs.
•
Is in pain or distress.
•
Is under significant stress.
•
Is being forced or coerced.
•
Is committing theft.
•
Is committing sexual assault.
•
Has a mental health condition.
In many instances, violent incidents do not occur without warning or without some build-up of tensions. There are
often tell-tale signs that reveal the build-up of tension, anger and aggression in the assailant. In the minority of cases,
there will be no warning, e.g. theft and sexual assault are usually premeditated and therefore the tell-tale signs are
concealed by the assailant.
Assessment of Risk of Violence
The UK’s HSE, in their guidance publication Violence at Work - A Guide
for Employers (INDG69(rev)), sets out a structured action plan for the
assessment and control of risk of violence. The key elements of the action
plan are:
•
Find out if there is a problem.
•
Decide what action to take.
•
Take action.
•
Check what you have done.
Find Out if there is a Problem
HSE sets out an action plan for
the assessment and control
of risk of violence
The first stage must be to identify whether a problem actually exists.
In some workplaces there may be a perceived threat of violence at work, but no supporting evidence. In other
workplaces there will be real evidence of violent incidents taking place.
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Work-Related Violence
There are two common ways of investigating this question:
•
Staff surveys - informal or formal surveys of the workforce. This might
be done for all workers or it might be targeted at groups of workers
who are at risk, such as those who deal with the public (rather than
backroom staff). This type of survey might involve managers or worker
representatives and enables the collection of a wide range of workbased experiences described by employees themselves to give their
personal views.
•
Incident reporting - through the introduction of a formal reporting
system. Existing accident reporting systems may already provide
adequate information. In some instances, existing reporting systems can
be adapted to suit; in other instances, a separate reporting system has to
be designed and implemented.
It is important that data collection provides adequate information to enable
proper evaluation of the risks so that the correct preventive measures can
be formulated. The following basic information will need to be reported:
•
Type of incident (physical, verbal abuse, etc.).
•
Details of the incident (before and during).
•
Information about the assailant.
•
Information about the victim.
•
Details of the outcome (injury, emotional shock, stress).
Incident reporting
Decide What Action to Take
The action above is the first step of the risk assessment process. The remaining five steps of risk assessment can then
be applied:
•
Identify who might be harmed, and how.
•
Are the existing arrangements adequate or does more need to be done?
•
Develop any necessary preventive measures. (Examples of preventive measures are considered later in this
Learning Outcome.)
•
Record the significant findings of the risk assessment.
•
Review it regularly.
Take Action
Involvement of workers in introducing measures to combat violence, and inclusion of the measures in the safety
policy, will ensure that staff are aware of what is going on. It is important to seek the co-operation of workers, and
ensure that they follow procedures properly and report any further incidents.
Check What You Have Done
As with any programme designed to manage an occupational health and safety risk, it is important to check that
control measures are working. Reviews on the effectiveness of implemented controls can be done by management,
or by the health and safety committee.
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Work-Related Violence
Control Measures
Control measures will be considered under three headings: organisational, physical and behavioural.
Organisational Controls
Some of the control measures designed to eliminate or reduce risk of
violence have to be designed and implemented at an organisational level.
For example:
•
Clear organisational policy on work-related violence.
•
A zero-tolerance policy towards violence by customers, clients,
members of the public and staff. This is agreed at senior level and then
broadcast through signs and notices.
•
Prosecution of offenders who commit criminal assault.
•
Changes to give staff less face-to-face contact with the public, e.g. by
means of automatic ticket dispensers/collectors and cash machines.
•
Use of cash-free systems, such as cheques, credit cards or tokens to
make robbery less likely.
•
Use of work activity risk assessment protocols to identify and address potential problem activities.
•
Vetting of clients and customers and identification of potentially violent individuals, where the organisation has
records relating to the individual prior to any face-to-face meetings.
•
Use of work/visit scheduling where workers working in the community follow a known schedule and periodically
report in to base, so that their route and last known contact point are known.
•
Development of emergency procedures, including methods for raising an alarm and the subsequent emergency
response. Some organisations use code words to raise the alarm (e.g. used in a mobile phone conversation with
base during a home visit where a worker feels anxious but no assault has actually taken place).
•
Prohibition of lone working for certain high-risk jobs or when visiting high-risk areas.
•
Policies and procedures to ensure minimum worker numbers are maintained.
•
Post-incident handling and the support and counselling services made available to workers after an event.
Less contact with the public can
reduce risk of violence to bank staff
Physical Controls
Physical controls can be used to both reduce the risk of violent incidents occurring and also to reduce the severity of
such incidents, should they occur. Examples include:
•
Changing the layout of public waiting areas. Better seating, lighting, décor and more regular information about
delays can stop tension building up in hospital waiting rooms, housing departments and benefit offices.
•
Re-designing counters to increase width or height to give staff protection from physical contact.
•
Securing loose objects, such as display stands and chairs, so that they cannot be used as weapons in the event of
an incident.
•
Using panic buttons, personal alarms, mobile phones, etc. to enable rapid contact for assistance. Technology has
developed rapidly in this area and low-profile devices exist that can send an alarm, give GPS co-ordinates and
transmit real-time audio in the event of activation.
•
Using security measures, such as cameras, protective screens and security-coded doors to monitor staff and
prevent unauthorised access.
•
Employing security staff to act as a deterrent and to control assailants in the event of an incident.
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Behavioural Controls
It is, of course, essential that workers make use of all of the organisational and physical control measures that exist
within a workplace. For example, if security doors exist between public and staff areas, then those doors must be kept
securely closed at all times except when in use. Similarly, if staff conduct lone-working home visits in areas where
such visits are prohibited, or without making use of client vetting procedures, or without informing control staff of
their whereabouts, then obviously control breaks down. Individual staff behaviour is, therefore, essential in ensuring
effective use of available control measures.
It is also the case though, that in many instances, despite attempts to engineer risk reduction, there will be some
element of staff/public or staff/client interaction. In some instances, virtually none of the controls mentioned above
can be applied. Heavy reliance then falls on behavioural controls in ensuring that staff show the right behaviours in an
attempt to reduce the risk of incidents occurring and the severity of outcome should they occur.
Typical behavioural controls include:
•
Quick and courteous handling of complaints and queries.
•
Demonstrating assertive authority without becoming aggressive.
•
Reading verbal and body language clues that indicate a person is becoming tense and that an incident may
escalate.
•
Using appropriate verbal and body language to diffuse a potentially escalating situation.
•
Using appropriate self-defence or restraint techniques in the event of an incident.
Even simple and specific behaviours can make a difference in this context. Things such as:
•
Wearing non-grabable clothing (such as a clip-on tie and trousers rather than a long skirt).
•
Not wearing flamboyant or expensive clothing that attracts attention.
•
Not conducting home visits during hours of darkness.
•
Not carrying obvious valuables (such as laptop or mobile phone).
•
Not displaying obvious ID when out in the community (it must be carried but can be concealed except when in
use).
•
Parking to allow a quick getaway.
•
Not accepting food or drink during a home visit.
Of course, these behaviours have to be tailored to suit individual circumstances.
Organisations should consider documenting these behavioural controls in the form of guidelines for staff.
© RRC International
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Work-Related Violence
TOPIC FOCUS
Staff Training
Various types and levels of training should be provided to staff, depending on circumstances. Typical training
would include:
•
Awareness training to enable staff to understand the causes of violence relevant to their workplace and the
general measures in place to reduce risks, such as incident reporting procedures and security controls.
•
Specific training on safe systems of work that minimise the risk of violence, such as lone-worker procedures
and client/customer vetting.
•
Personal behaviour training that focuses on the verbal and body language associated with aggression and
violence, early recognition of such signs in others and appropriate responses to diffuse escalating incidents
(often referred to as ‘diffusion training’).
•
Self-defence training, including restraint techniques and the use of reasonable force.
STUDY QUESTIONS
10. Explain what is meant by ‘violence at work’.
11. Outline the principal activities, and examples of associated staff, where it is possible that there might be a
risk from workplace violence.
12. What are the employer’s legal duties to protect employees from violence?
13. Outline the principal elements of a strategy for management of violence at work.
14. State the range of measures commonly used to combat violence at work.
(Suggested Answers are at the end.)
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Lone Working
Lone Working
IN THIS SECTION...
•
Lone workers are those who work by themselves (i.e. in isolation from other workers) without close or direct
supervision. They may be found in a wide range of situations, both in fixed establishments and working away from
their fixed bases.
•
Employers need to investigate the potential hazards faced by lone workers and assess the risks involved. The
precautions and safe working procedures for lone working will depend on the work activity.
•
Particular problems facing lone workers include:
–– Increased risk of violence.
–– Dealing with injury or ill health.
–– Safe access and egress.
–– The risks associated with the task.
–– Operating machinery.
–– Vulnerabilities such as medical conditions.
•
Employers should ensure that measures are in place either to avoid the risks or to control them. These control
measures must include the development of emergency procedures, supervision of the worker and training in lone
working procedures.
Introduction to Lone Working
The UK’s HSE document - Protecting lone workers, INDG 73 refers to
lone workers are those who work by themselves (i.e. in isolation from
other workers) without close or direct supervision. Working alone is not
necessarily hazardous in its own right and the hazards of lone working
depend very much on the nature of the activity.
Lone workers may be found in a wide range of situations, both in fixed
establishments and work away from their fixed bases:
•
Fixed establishments, for example:
Lone worker taking soil samples
–– Small workshops, petrol stations, kiosks or shops.
–– Working from home.
–– Separately from others in factories, warehouses, leisure centres, research and training establishments.
–– Outside normal hours, such as cleaners and security, production, maintenance or repair staff.
•
Work away from their fixed base, for example:
–– Construction, plant installation, maintenance, electrical repairs, vehicle recovery.
–– Agricultural and forestry work.
–– Service work, such as rent collectors, postal staff, social workers, doctors, drivers, sales representatives and
other professionals visiting domestic and commercial premises.
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9.2
Lone Working
It is important to recognise that in some of the examples given above the lone worker may be truly alone, i.e. there
are no other people anywhere nearby (e.g. a lone-working farmer in a field). However, in other instances the lone
worker is close to other people, but those other people are not fellow workers (e.g. a postal worker walking through a
housing estate).
The Hazards and Risks of Lone Working
The specific hazards and risks associated with lone working will vary hugely depending on the actual work activity
being undertaken and the nature of the work environment. There are, however, some general problems associated
with lone working that either present a specific hazard to the worker or increase their risk:
•
Violence - lone workers may be at increased risk of violence for the simple fact that they are on their own and are
therefore perceived as more vulnerable by a potential assailant.
•
Accident or ill health - in the event of an accident, a lone worker may not have any immediately available person
to help them, render first aid or alert the emergency services. Simple accidents and injuries, such as falling and
breaking an ankle, can therefore become life threatening if the person is in a remote location exposed to the
elements. Similarly, a worker taken ill can be put at far greater risk, e.g. a worker who has a heart attack.
•
Access and egress - many lone working activities take place in workplaces outside of ‘normal’ work hours (e.g.
office cleaning). Consequently, premises will often be locked and secure, so getting into, and most importantly
out of, the premises may be more complicated.
•
The hazards of the task - the work itself may involve or create significant hazards and/or involve greater risk. For
example, hot works, maintenance of machinery (e.g. a passenger lift), entry into confined spaces, working with
harmful or hazardous substances, working at height and vehicle movements. Even relatively simple tasks, such as
manual handling of equipment or loads, may increase the risk associated with lone working.
•
Operating machinery - some machinery can be operated by one person but safety requires a second person to
be present to give direction (e.g. a lifting operations signaller) or to assist in the event of a problem (e.g. someone
to lower a stranded MEWP).
•
Vulnerabilities - risk may be increased because of the characteristics of the worker themselves, for example, they
may be pregnant, young (under 18 years old), or have a medical condition (such as epilepsy). These characteristics
may not prevent the worker undertaking any lone working, but they must be factored into the risk assessment.
•
Mental health problems - chronic loneliness occurs when feelings of isolation go on for extended time periods,
e.g. the whole working shift and then continued at home by living alone. If not properly managed by the
employer and worker, chronic loneliness can lead to a greater risk of depression, sleep disorders, heart disease
and negative coping strategies. Awareness of the risks associated with the task could cause a lone worker to feel
distressed while at work (e.g. security guards). If this is not managed, depression and anxiety may result which in
turn impact confidence and self-esteem.
Controlling the Risks of Lone Working
The first step in the control of lone working is, of course, risk assessment. Employers need to investigate the potential
hazards faced by lone workers and assess the risks involved both to the lone worker and to any person who may be
affected by their work.
The employer must establish a policy on lone working that can be applied across the organisation. They should
define what is meant by lone working before setting out their general policy and the specific arrangements for the
management of lone working.
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Lone Working
Certain types of lone working might be outright prohibited. In other words, certain types of work activity can never
be done by a lone worker without being in direct breach of company policy. Good examples of work activities that
should never be carried out alone include:
•
Working in a confined space.
•
Working at or near exposed live electricity conductors.
•
Other electrical work where at least two people are sometimes required.
In other instances, lone working might not be prohibited as a matter of company policy, but the risk assessment might
prohibit lone working on a more case-by-case basis due to circumstances. For example, the risk assessment of a home
visit might allow for one home visit to be done by a lone-working social worker because of the nature of the visit and
the known history of the client; whereas another home visit might be done by two or more social workers because of
the more difficult nature of the visit and the known violent history of the client.
The best option, of course, would be to avoid the risk by not lone working, e.g. by using a buddy system, where
people work in pairs at difficult or out-of-the-way sites, including home and community visits. However, this may not
be possible/reasonably practicable in many circumstances and therefore the employer must control the risks. This is
done by:
•
Developing a Safe System of Work (SSW).
•
Ensuring an appropriate level of supervision.
•
Ensuring workers are competent.
•
Providing appropriate instruction and information.
•
Developing emergency procedures.
Safe System of Work for Lone Working
The precautions and safe working procedures will depend on the work activity, since lone working may occur in a
wide range of different work environments.
The general principle is that lone workers should not be put at more risk than other employees and to achieve this,
extra risk control measures may be necessary. The risk faced by lone working should be assessed; while there is no
specific legal requirement to assess lone working, there is a duty to assess risks. The risk assessment must be reviewed
if there is a significant change.
Precautions should take account of normal work and foreseeable emergencies such as fire, equipment failure, illness
and accidents. Precautions should also take into account the possibility of violence to the lone worker. Lone working
does not automatically infer a greater risk of violence on the worker, but it does make the worker more vulnerable.
The absence of support from colleagues and others who may be able to assist may result in the lone worker being less
able to prevent an incident happening. Factors that increase the risk of violence include:
•
High-crime areas.
•
Late evening, early morning working time - when fewer people are around.
•
When the worker holds a position of authority (security officers).
•
Where alcohol and drugs may be consumed by people the lone worker has to come into contact with.
•
Transporting money or other valuables.
Being subject to violence can lead to work-related stress and cause significant psychological problems in the long
term.
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ID2 Learning Outcome 9.2
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9.2
Lone Working
When lone working takes place in another employee's workplace, consultation should take place with the employer
to identify any risks that may need to be controlled.
When developing the SSW, employers should involve workers in the development process in order to ensure a good
level of worker engagement and ownership. This might be done through union or staff representatives if such bodies
exist in the workplace:
•
Supervision
The extent of supervision required depends on the risks involved
and the ability of the lone worker to identify and handle health and
safety issues. The style of supervision must also take into account
the workers' understanding of the language being used, especially
where the communication is in a language that is not the worker’s
first language. The lone worker must be able to understand the safety
critical information the supervisor is trying to impart.
The higher the risk, the greater the level of supervision required.
This may involve:
The higher the risk, the greater the level
of supervision required
–– Supervisors periodically visiting and observing people working alone.
–– Regular contact between the lone worker and supervisor, using mobile phones, telephones, radios or e-mail.
–– Electronic and visual monitors.
–– Automatic warning devices which operate if specific signals are not received periodically from the lone
worker.
–– Other devices/alarms designed to raise the alarm in an emergency, operated manually or automatically by
the absence of activity.
–– Checks to ensure a lone worker has returned to their base or home once their task is completed. The
implementation of a robust system to ensure the lone worker has returned home safely imposes responsibility
on the worker and the supervisor to ensure the process is followed.
•
Competence
Training may be critical to avoid people panicking in unusual situations where there is limited supervision.
–– Lone workers need to be sufficiently experienced and fully understand the risks and precautions.
–– Training in personal safety and conflict resolution can support workers to recognise when they are at risk.
–– Employers should set the limits to what can and cannot be done while working alone and ensure employees
are competent to deal with circumstances that are new, unusual or beyond the scope of training, for example:
–– When to stop work and seek advice from a supervisor.
–– How to handle aggression.
•
Information and Instruction
Employers need to pass on appropriate information to lone workers so that the worker can fully appreciate the
hazards and risks associated with a specific work activity or specific location. For example:
–– A maintenance engineer carrying out plant-servicing work must be informed of the specific hazards and risks
associated with the work site where he/she will be working.
–– A worker conducting a home visit must be informed of the known history of the client they are visiting, such
as previous violent incidents or a mental health condition that may make the client’s behaviour unpredictable.
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Lone Working
This information may be provided on file for the worker to read or it may be provided in a specific work
instruction issued by the work supervisor prior to the activity taking place.
•
Medical Conditions
Certain medical conditions may make a worker unsuitable for lone-working activities. For example, a worker who
experiences blackouts is unsuitable to be left working alone in a remote outdoor location. Therefore employers
need to:
–– Check that lone workers have no medical conditions that may make them unsuitable for working alone.
–– Consider both routine work and foreseeable emergencies that may impose additional physical and mental
burdens on an individual.
This will require the employer to establish the fitness criteria required by the lone-working activity so that they
can then screen workers against these fitness criteria. Safety-critical lone-working activities must be given special
attention.
The employer should involve their workplace health service in this process as the fitness criteria and the screening
process itself will require professional medical opinion.
Working at home may lead to ill health through feelings of isolation. Minimal contact with work colleagues can
add to feelings of social exclusion in our domestic life. Home working may not be suitable for those personality
profiles where social interaction is needed to avoid feelings of depression and anxiety. The employer may have to
set limits on what can and cannot be done by home working. If workers have specific concerns related to home
working they should inform their supervisor or health and safety representative.
•
Emergency Procedures
The risk assessment should identify foreseeable emergencies that might affect lone workers. These will vary
hugely depending on the nature of the lone working activity and its location. For example, a forestry worker
might suffer an injury and be unable to move and may be in a remote location where there is no mobile phone
signal; a lift engineer may become stranded on top of the lift car they are testing; a social worker may be violently
assaulted during a home visit.
Procedures must be established to deal with these emergencies and relevant information and training provided.
These procedures must be carefully pre-planned and set out so that they can be rapidly put into effect. Issues to
consider include:
–– How an emergency call will be initiated (including the use of covert alarm signals, such as ‘code’ words).
–– Who the first responders will be and the procedure they will adopt.
–– The kit and equipment those first responders may need.
–– There may be a requirement to liaise with other emergency responders, such as the police or a private health
care provider, for speedy medical evaluation.
Lone workers should also have access to adequate first-aid facilities; they may even need first-aid training
themselves and mobile workers may need a first-aid kit.
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ID2 Learning Outcome 9.2
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9.2
Lone Working
MORE...
More information on working alone can be found in the HSE guidance document INDG73 (rev4), Protecting lone
workers which can be found at:
www.hse.gov.uk/pubns/indg73.pdf
BS 8484:2016 Provision of lone worker services - Code of practice provides recommendations aimed at reducing
and/or eliminating the risk to staff operating away from colleagues who might provide direct assistance. It’s
applicable to lone worker devices and lone worker applications and acknowledges that these are part of an
overall lone worker protection strategy.
IOSH has issued a guidance document, Home office, Mobile office – Managing remote working, which explains
how to manage the risks of remote working and includes some assessment checklists.
STUDY QUESTIONS
15. Explain:
(a) the hazards; and
(b) the risks
of lone working.
16. Outline controls employers can put in place to deal with the risks involved in lone working.
(Suggested Answers are at the end.)
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Summary
Summary
Mental Ill Health at Work
We have:
•
Outlined the range of work activities where mental ill health issues are more significant, including lone working,
agile working, shift working, zero-hour contract working, occupations more likely to be exposed to violence and
harassment, and multiple job holding.
•
Defined anxiety and depression.
•
Defined work-related stress as the adverse reaction that people have to excessive pressure or other demands
placed on them at work.
•
Outlined the range of physical and behavioural symptoms caused by stress, which can go on to become serious ill
health.
•
Outlined the range of physical and psychological effects caused by stress, which can go on to become serious ill
health.
•
Described the causes of work-related stress as organisational factors, job factors and individual factors.
Mental Health Controls
We have:
•
Explained how employers can facilitate work for workers with mental ill health.
•
Explained the UK’s HSE management standards approach to stress risk assessment that establishes six standards
to be achieved by the organisation, under the headings, ‘demands’, ‘control’, ‘support’, ‘relationships’, ‘role’ and
‘change’ and how organisations can benchmark their performance against these standards using the HSE staff
survey tool.
•
Outlined the types of intervention for management of mental health: prevention, treatment, and rehabilitation.
•
Described the benefits of good nutrition, exercise and sleep on mental ill-health conditions.
Well-Being
We have:
•
Outlined the relationship between well-being and health and how workplace well-being strategies can help
improve workers’ mental health, along with:
–– Support from top management.
–– Different types of well-being initiatives.
–– Education and support programmes.
–– Working with partners.
–– Involving and empowering employees.
–– Monitoring, reviewing and communicating the well-being strategy.
•
Outlined the link between health and well-being, and safety culture.
© RRC International
ID2 Learning Outcome 9.2
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Summary
Work-Related Violence
We have:
•
Defined work-related violence as any incident in which a person is abused, threatened or assaulted in
circumstances relating to their work.
•
Outlined the physical and psychological harm caused by violence.
•
Considered the risk factors, such as dealing with members of the public, handling cash, lone working and
conducting home visits.
•
Outlined a four-stage approach to risk assessment for violence that usually involves identifying the extent of the
problem, using incident reporting systems, and/or formal or informal staff surveys.
•
Categorised control measures for minimising risk of violence as organisational, physical and behavioural, and
emphasised the need for staff training.
Lone Working
We have:
•
Described lone working - which can mean either working at a fixed establishment or working away from their
base.
•
Identified the hazards and risks of lone working and the precautions which should be taken for safe working.
•
Described the common problems faced by lone workers and the procedures which should be followed to avoid
these.
•
Outlined the control measures for lone working, including risk assessment and SSW.
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Learning Outcome 9.3
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Understand the legal requirements for and when health surveillance or biological
monitoring must be carried out.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Explain how workplace exposure limits are used in the workplace.
• Outline the methods for the sampling of airborne contaminants.
• Outline the principles of biological monitoring.
• Explain the effects of noise on the individual and the use of audiometry.
• Explain how to establish and maintain drugs and alcohol policies and the legal
implications.
© RRC International
ID2 Learning Outcome 9.3
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RM1732210802RRC
Contents
Health Surveillance: Health Monitoring and Biological Monitoring
9-77
Health Assessment and Health Surveillance
The Health Surveillance Cycle
Health Surveillance for Noise
Health Surveillance for Vibration
Keeping Health Records and Medical Records Confidential
Biological Monitoring
Health Assessments for Night Workers
Forms of Health Surveillance
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9-86
9-89
9-91
Alcohol/Drugs Policy and its Legal Implications
9-94
Establishing and Maintaining an Alcohol/Drugs Policy
Disadvantages of Alcohol and Drug Testing
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9-96
Summary
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Health Surveillance: Health Monitoring and Biological Monitoring
Health Surveillance: Health Monitoring and Biological
Monitoring
IN THIS SECTION...
•
General health assessment is an assessment of an individual’s fitness to carry out the general duties or specific
tasks associated with work.
•
Health surveillance is the monitoring of an individual’s health to ensure that they are suitable for work involving
exposure to a specific type of health hazard and to track their health over time as they work with that hazard.
•
Health records must be kept following health surveillance; these records contain personal details of the individual
and their work and may contain the conclusions of a clinician following any test or assessment. These records
must be kept for a defined period, often 40 years.
•
Health records are subject to data protection legislation and must be kept secure and confidential.
•
Since health records do not contain clinical information, they may be viewed by the employer. Medical records
containing clinical information are confidential between the clinician and individual. The content can only be
shared with the employer with the individual’s authority.
•
Biological monitoring involves taking a blood, urine or breath sample and then measuring the concentration of a
substance or the products produced from its metabolic breakdown within that sample.
•
Biological monitoring is useful where inhalation is not the only significant route of entry for a substance, and it
has both advantages and disadvantages.
•
For most substances where biological monitoring is carried out, the results are evaluated by comparison with nonstatutory Biological Monitoring Guidance Values (BMGVs).
•
Employers should offer night shift workers free health assessment, usually made up of a questionnaire and
a medical examination. Night shift work and worker fatigue should be managed through clear policies and
procedures.
•
Health surveillance identifies the likelihood of disease or medical conditions while work is being carried out and
comes in different forms, e.g. survey, questionnaire, screening, etc.
Health Assessment and Health Surveillance
It is important to distinguish between general health assessment and
health surveillance.
General health assessment is any form of medical assessment that
determines the general state of health or fitness of an individual. This
assessment will normally be carried out by an occupational health
doctor or nurse. However, it is quite possible that it is carried out by the
individual themselves through some form of self-assessment. It may also
be carried out by a specialist focusing on one specific aspect of health,
e.g. eye test carried out by an optician.
© RRC International
Health assessments will determine the
health of an individual
ID2 Learning Outcome 9.3
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RM1734210802RRC
9.3
Health Surveillance: Health Monitoring and Biological Monitoring
General health assessments are often carried out by organisations as a form of pre-placement screening. These may
take the form of self-assessment health questionnaires with follow up by an occupational health doctor or nurse
where specific issues are raised by the answers given. These health assessments may then be repeated periodically.
In some instances, there is no specific health and safety aspect to this assessment and it is provided as a benefit of
employment.
Alternatively, specific health assessments are carried out by an organisation to ensure that a worker is fit for a specific
role or task. For example, the Display Screen Equipment (DSE) user’s eye and eyesight test, a forklift truck driver’s
medical and a crane operator’s medical are all forms of health assessment that ensure that an individual is medically
fit for work. These health assessments may be provided:
•
to comply with a clear statutory duty; or
•
as a matter of good practice (e.g. a health assessment for a company car driver; though the driver has to be
medically fit to drive there is no statutory duty on their employer to carry out an assessment of fitness to drive).
Health surveillance is a more specific assessment of a worker’s medical fitness that focuses on one specific aspect
of health in relation to a particular hazard or hazard group. The intention of health surveillance is to determine a
worker’s state of health with regards to the hazard and then to track that aspect of their health forward in time
through repeat assessments.
Health surveillance is a requirement of good practice where the following criteria are met:
•
There is an identifiable disease or adverse health condition related to the work concerned.
•
Valid techniques are available to detect indications of the disease or condition.
•
There is a reasonable likelihood that the disease or condition may occur under the particular conditions of work.
•
Surveillance is likely to further the protection of the health and safety of the employees to be covered.
Health surveillance is normally provided where there is a clear statutory duty under specific health and safety
legislation.
The way that health surveillance is carried out will vary depending on the form of health surveillance and the relevant
standards. Health surveillance might be carried out by:
•
Examination and assessment by a specialist or an occupational health doctor or nurse with a specific qualification
in that particular form of health surveillance.
•
Examination and assessment by an occupational health doctor or nurse using appropriate guidance to determine
the method and standards.
•
Examination and assessment by a responsible person under the supervision of an occupational health doctor or
nurse.
•
Self-examination and/or self-assessment by the worker under the supervision of a responsible person.
Most forms of health surveillance should be carried out by the first group. A notable exception to this is the skin
check that is often carried out when workers are potentially exposed to primary cutaneous irritants or skin sensitisers.
These substances are capable of causing primary contact dermatitis or secondary allergic dermatitis, respectively.
Since skin checks usually involve visual examination of exposed skin (on the hands and forearms), self-assessment or
assessment by a responsible person are normally adequate to ensure freedom from symptoms.
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The Health Surveillance Cycle
The UK’s HSE has provided an effective method of enabling employers to manage health surveillance. The method is
demonstrated as a health surveillance cycle.
The diagram below provides an overview of the health surveillance cycle. It shows how the employer is responsible
for identifying the need for health surveillance through the risk assessment process and how the specific type of
health surveillance must be sourced and implemented. Results from health surveillance then inform and feed back
into the risk assessment process.
Risk assessment
and controls
Manage performance,
interpret the results and act
on the results
Implement health
surveillance for those
who need it
Do I need health
surveillance?
What sort of health
surveillance do I need?
Employer
Identify who will do the
health surveillance
Set up and design health
surveillance according to
need. Seek help in doing so,
if required
The health surveillance cycle
The diagram also clearly shows how the employer has a central role in every aspect (with involvement from
employees) to ensure effective implementation.
MORE...
More on health surveillance and the health surveillance cycle is available at:
www.hse.gov.uk/health-surveillance
And
https://www.hse.gov.uk/health-surveillance/assets/documents/health-surveillance-cycle.pdf
Health Surveillance for Noise
The ILO Code of Practice - Ambient Factors in the Workplace (CoP) (Section 9.4) specifies the conditions under which
health surveillance may be required. The CoP states that health surveillance (audiometry) may be required when a
worker’s noise exposure reaches levels prescribed in national law or in international standards. The records of health
surveillance should be retained in a confidential medical file and shared with the worker.
Health surveillance may include:
•
Pre-employment or pre-assignment examinations, in order to:
–– Determine whether the worker should not be exposed to noise.
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–– Determine any existing sensitivity to noise.
–– Establish a baseline record for use in further medicals.
•
Medical examinations, which should be carried out:
–– Periodically, to detect early signs of occupational disease or any sensitivity to occupational noise or stress due
to noise exposure.
–– Upon return to work after prolonged absence.
–– At the end of employment, in order to establish a picture of the effects of noise during employment.
–– When abnormalities are detected.
Health surveillance for noise will involve a system of audiometric testing. Audiometry can also be carried out
following the results of workplace noise assessments or following complaints, to satisfy both the employer and
employees that workers’ hearing is being adequately protected.
Use of Audiometry
Audiometry is the process of scientifically quantifying hearing performance in order to detect problems with
hearing, such as noise-induced hearing loss. The most commonly used form of audiometry is pure tone audiometry
where the threshold of audibility (i.e. the level of sound required to be just audible) at predetermined frequencies
allows the plotting of a graph (audiogram) to visualise hearing acuity.
The following figure shows an audiogram for a person with normal hearing.
Normal hearing
The graph above shows the normal hearing, an almost horizontal line indicating that the worker being tested has a
good range of hearing across a range of different sound frequencies. The audiogram shows the person has normal
hearing acuity in both their right and left ears.
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Presbycusis
The figure above shows typical audiograms for individuals of various ages. This clearly shows the effects of presbycusis
(age-related hearing loss), with a small amount of hearing loss at low frequencies but very marked hearing loss at high
frequencies (demonstrated by the results line sloping downward), as a consequence of ageing.
Noise-induced hearing loss
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The audiogram above is typical for an individual suffering from noise-induced hearing loss. The graph shows little
or no reduction in hearing levels at low frequencies (0.25-1kHz), but then marked reduction in hearing levels from
2-8kHz with the most significant dip at 4kHz - the low point on the graphed data. This 4kHz dip is very indicative
of noise-induced hearing loss, rather than presbycusis (where the reduction in hearing level continues as frequency
increases). Note that both ears are affected to a similar degree.
Audiometry Technique
Audiometry should only be carried out by a suitably qualified person using a standard method and calibrated
equipment. Various international standards exist that govern the method and equipment used. This is important to
ensure scientific accuracy and repeatability of results.
Audiometry is usually carried out in a soundproof booth to remove unwanted background noise. It is important
that the test subject is protected from any significant noise exposure before the test takes place, as this might cause
temporary threshold shift that will lead to an invalid test. Ideally, individuals who might suffer significant noise
exposure at work would be tested before they start work, but this is often not possible in a large workplace where
lots of workers require testing. In these circumstances, individuals should wear hearing protection prior to testing to
ensure no significant noise exposure occurs.
Before carrying out a hearing test, information is obtained about the person’s past medical history, not only
concerning the ears but also other conditions that may have a bearing on possible hearing loss. The ears should then
be examined to ensure that there is not an excessive build-up of wax and to determine if the eardrum has suffered
any damage which may have an impact on hearing.
The audiometric test can be carried out using automatic or manual audiometers, but the essential test procedure is
the same:
•
The subject is asked to remove anything that might upset the test results, e.g. spectacles, earrings, hearing aids
and chewing gum.
•
Instructions are given about the test procedure and the subject is required to indicate whether they can just hear
or cannot hear a certain sound (usually by pressing or releasing a button).
•
Earphones are fitted carefully over the ears and the test is then carried out on each ear.
•
Firstly, a threshold test is undertaken in which each ear is subjected to sound at a frequency of 1kHz at varying
levels of intensity, ranging from low to high and high to low.
•
Following this pre-check, both of the subject’s ears are tested through a range of frequencies (usually 0.5, 1, 2, 3,
4, 6 and 8kHz) and the hearing level is recorded for each frequency.
•
When the test is completed, a second threshold check should be carried out to see that no errors have crept in
during the test.
The results of the test are normally displayed as an audiogram that is then explained to the individual. The individual
is often given a copy of their audiogram. A letter is then sent to the individual confirming the results of the test and
any further action required.
The accuracy of audiometry can be affected by several factors:
•
Technical limitations - how accurately can the hearing level be determined?
•
Learning effect - the first ear tested sometimes appears worse than the second one since the individual becomes
more proficient at detecting the threshold.
•
Headphone fit - some of the variation in threshold measurement has been attributed to differences in the
location of the headphones.
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A further complication of audiometric testing is that it is subjective and relies on the co-operation of the subject. If
the subject is unable or unwilling to co-operate with the test then unrepresentative results will be obtained.
Use of Results
As seen in the previous audiograms, noise-induced hearing loss gives a fairly distinctive pattern of hearing loss, with a
characteristic dip at 4KHz. This dip is not temporary (so a repeat test several days after the first test would reveal the
same pattern).
The results of audiometry should only be interpreted by a suitably qualified person, such as an occupational health
physician, occupational health nurse or audiologist, as there are many reasons why hearing level may be affected, of
which over-exposure to noise is only one.
It is not usually necessary to remove a worker from a noisy environment, even if they are classified as suffering from
noise-induced hearing loss, provided it is possible for them to wear adequate hearing protection.
Records of the results of hearing tests and any letters sent to the individual form part of that person’s medical
records. As such, they must be kept secure and separate from other personnel records. Medical ethics dictate that
records and results of hearing tests are medically confidential and should not be shared with anyone without the
consent of the individual concerned. Group results of hearing tests can be shared with the employer, provided they
have been anonymised so that the employer cannot identify the individuals’ results.
A common use of audiometric testing is at the pre-employment stage. This serves two purposes:
•
It enables an initial assessment of hearing ability to be made in order to establish a baseline, which can be used as
a standard against which any deterioration due to poor noise control arrangements can be measured by future
audiometric tests.
•
The other use is to detect any signs of noise-induced hearing loss arising from previous employment. If this is
detected and documented, it can serve to safeguard the employer against any false accusations (and civil law
liability) that hearing loss might have been due to this employment rather than previous ones.
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TOPIC FOCUS
Advantages and Disadvantages of Audiometry
The advantages of audiometry are:
•
Early detection of individuals with hearing loss that will allow those individuals to be further protected to
prevent deterioration.
•
Early detection of poorly controlled noise exposure in the workplace that will allow other workers to be
further protected before hearing loss occurs.
•
Negative test results (i.e. no hearing loss) will confirm that the hearing conservation programme in place in
the workplace is working effectively.
•
Establishment of a pre-employment baseline that will protect the employer in the event of a claim for
compensation.
•
Compliance with legal requirements.
Some disadvantages of audiometry are:
•
As a form of health surveillance, it is inherently reactive in that it simply confirms hearing loss after it has
occurred (rather than preventing that hearing loss).
•
It can be inaccurate for technical reasons or due to an unco-operative test subject.
•
It can be difficult to operate in practice when large numbers of workers have to be tested.
•
Classification of a worker into Category 2, 3 or 4 may act as the trigger for a claim for compensation.
Audiometry and Legal Implications
In many legal systems, noise-induced hearing loss can form the basis
of a claim for compensation. The results of audiometry can be used
both by the claimant to substantiate their claim and by the employer to
defend such a claim. Pre-employment testing establishes a baseline which
may allow the employer to show that hearing loss was a pre-existing
condition, rather than the result of exposure during employment.
MORE...
Useful information, including a demonstration can be found at:
www.hse.gov.uk/noise
The ACoP and Guidance on the CNAW Regulations - L108 - Controlling Noise at Work can be downloaded
from:
www.hse.gov.uk/pubns
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Health Surveillance for Vibration
The ILO Code of Practice - Ambient Factors in the Workplace (Section 10.4) recommends that health surveillance is
carried out for all workers potentially exposed to vibration in the workplace. This could take the form of the following
checks:
•
A pre-employment medical to identify symptoms of HAVS and other non-occupational diseases, such as
Raynaud’s phenomenon.
•
Periodic medical examinations for those workers exposed to hand-arm vibration, including the identification of
possible symptoms of HAVS, such as numbness and loss of sensation.
In the event that symptoms are detected, the employer should be informed that there may be a weakness in the
controls.
In the UK, the Control of Vibration at Work Regulations 2005 require the employer to provide health surveillance
to:
•
Employees who are exposed to Hand-Arm Vibration (HAV) at or above the exposure action value.
•
Employees who are likely to be occasionally exposed to HAV above the Exposure Action Value (EAV) where there
is risk to their health.
•
Employees diagnosed with HAVS.
There is no legal requirement for health surveillance for Whole-Body Vibration (WBV) as back pain cannot be solely
attributed to WBV exposure. However, a health surveillance programme might still be used to monitor WBV and back
pain.
Records must be kept and made available as required.
A simple approach to health surveillance for hand-arm vibration exposure involves working through a number of tiers:
•
Tier 1 is a short questionnaire used as a first check for people moving into jobs involving exposure to vibration.
The replies to the questionnaire will indicate whether they need to be referred to Tier 3 for a HAVS health
assessment.
•
Tier 2 is a short questionnaire that can be issued once a year to employees exposed to vibration risks to check
whether they need to be referred to Tier 3 for a HAVS health assessment.
•
Tier 3 involves a HAVS health assessment by a qualified person (e.g. occupational health nurse). If the assessment
shows that the employee has HAVS, Tier 4 will apply.
•
Tier 4 involves a formal diagnosis and is carried out by a doctor qualified in occupational health. The doctor will
advise you on the employee’s fitness for work.
•
Tier 5 is optional and involves referral to a specialist for tests.
Where employees have been found to have HAVS, they should be assigned to alternative work where there is no
further risk of vibration exposure, if recommended by their doctor.
Keeping Health Records and Medical Records Confidential
Health records created by the employer contain personal data about individuals. As such, they are likely to be subject
to data protection legislation and must be kept secure and confidential. They must not be accessed by anyone who
does not have a legitimate right of access.
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Local statute law may allow employees a right to see and comment on their health records. This includes any health
records kept by their employer. Employees also usually have a right of access to their health records granted under the
specific health and safety legislation that required the health surveillance in the first place. It is good practice to offer
individual employees a copy of their health records when they leave employment.
Local labour law enforcement inspectors normally have a right of access to health records granted by specific
legislation.
Trade Union safety representatives may also have a legitimate interest in health records. Legal guidance may indicate
that they should be given access where the employee, to whom the record relates, has given authorisation.
Medical records contain clinical information that is legally and ethically confidential between the individual
concerned and their clinician (medical practitioner, occupational health doctor, nurse, etc.). As such, this information
can only be disclosed to the employer or any other party with the authorisation of the individual concerned. The
storage and security of medical records is the responsibility of the clinician.
As an example of data protection legislation, we will look at the EU General Data Protection Regulation 2016/679,
which seeks to control the way that personal data (data that relates to an identifiable person) is stored and used. Key
principles of the Regulation are:
•
Data can only be used for the purposes for which it was collected.
•
Data must not be disclosed to others without the consent of the individual, unless there is a legitimate reason.
•
Individuals have a right of access to data held about them.
•
Data must not be kept for longer than is necessary.
•
Data must be kept secure.
The individual has the right to have factually incorrect information corrected.
In the context of health records, the Regulation places requirements on
employers to tell employees on whom records are held:
•
That a record is being kept.
•
The purpose for which it is being held.
•
That they have the right of access to the information and the right to
correct it.
Biological Monitoring
The data protection legislation seeks to
control the way personal data is stored
The ILO Code of Practice - Occupational Exposure to Airborne Substances Harmful to Health (CoP) (Section 4) states that
biological monitoring “should be used to complement monitoring of the working environment in order to increase protection of
workers’ health.” The CoP also states that, where necessary and practicable, biological monitoring should be based on
several parameters for each hazardous substance.
DEFINITION
BIOLOGICAL MONITORING
Is defined by the UK’s Control of Substances Hazardous to Health Approved Code of Practice as “the
measurement of a substance or its metabolite (substance formed when the body converts the chemical) in a biological fluid
(breath, urine or blood), e.g. monitoring for isocyanates in urine”.
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Biological monitoring is a technique that complements air monitoring as a method of measuring and evaluating the
risk to health of exposure to chemical agents. Its purpose is to assess the extent of exposure, uptake and metabolism
of chemicals in the workplace. It involves the analysis of biological samples (blood, urine or breath) to provide an
index of exposure, thereby giving an indication of the possible risks to health.
For example, the detection of significant levels of lead in blood indicates the presence of potentially harmful levels
of absorbed lead. The concentration of bromide in blood is an indicator of methyl bromide exposure, and the
concentration of mandelic acid in urine is an indicator of styrene exposure.
Biological monitoring is used to indicate how much of a chemical has entered a worker’s system (rather than how
much was in the air that the worker might have inhaled).
Biological monitoring is especially useful when:
•
Absorption is likely to be through skin and ingestion rather than inhalation, therefore air monitoring is not a
complete indicator of uptake.
•
There are valid laboratory methods available for the detection of the chemical or its metabolites in the body.
•
There are reference values available for the interpretation of the results obtained.
•
PPE is used as a significant control; failure to wear PPE correctly would not be shown up by air monitoring, but it
would be indicated by biological monitoring.
Advantages and Disadvantages
The advantages of biological monitoring include the following:
•
It can help to demonstrate whether PPE (e.g. gloves and masks) and engineering controls (e.g. extraction systems)
are effective in controlling exposure.
•
It measures individual exposure to a chemical by all routes of entry.
•
It identifies what has been absorbed by the body (unlike airborne monitoring).
•
It shows how effective improvements in control measures have been in reducing exposure.
•
It gives reassurance to workers that their individual exposure is being monitored.
The disadvantages of biological monitoring include the following:
•
Sampling may require blood to be taken, which would require a physician or nurse.
•
Measurements relate to individuals, so confidentiality and data protection issues need to be addressed.
•
As with all standards, biological monitoring standards aim to protect the majority of the exposed population. An
individual may suffer adverse changes at concentrations below the published standard.
The Role of Biological Limits
The ILO CoP states that:
•
Evaluation of the overall hazard presented by the working environment should be based on the results from a
group of workers exposed to a given level of the harmful substance, in order to offset the effect of individual
biological variability.
•
Any worker for whom the findings exceed the biological limits should undergo further and repeated biological
and medical investigations.
Thus, the Biological Limit is the standard against which measurements taken from workers can be compared, to see
whether the workers have been over-exposed to the hazardous agent.
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Biological Monitoring Guidance Values (BMGVs)
The UK’s HSE has derived Biological Monitoring Guidance Values (BMGVs) for interpreting biological monitoring
measurements. These are published in EH40 Workplace exposure limits.
MORE...
BMGVs are explained in EH40: Workplace exposure limits and L132: ACoP and guidance on the control of lead at work,
both available from:
www.hse.gov.uk/pubns
BMGVs in EH40 do not have the same status as OELs. They are not approved and, consequently, are not statutory.
Given that BMGVs are non-statutory, any biological monitoring undertaken must be conducted on a voluntary basis
(i.e. with fully informed consent of workers). BMGVs are intended to be used as tools in meeting the employer’s
primary duty to ensure adequate control under relevant legislation. Where a BMGV is exceeded it does not
necessarily mean that any corresponding airborne standard has been exceeded nor that ill health will occur. The
intention is that where they are exceeded, this will indicate that investigation into current controls and work practices
is needed. Similarly, it must not be assumed that because biological monitoring results are below a particular guidance
value, no further action is needed to reduce exposure. BMGVs are not an alternative to or a replacement for OELs
and airborne monitoring; instead they are a useful addition.
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Extract from Table 2 of EH40 showing BMGVs
Source: EH40/2005 Workplace exposure limits (Fourth Edition 2020), (www.hse.gov.uk/pubns/
priced/eh40.pdf)
Health Assessments for Night Workers
In the UK, the Working Time Regulations 1998 (WTR) implement the EU Working Time Directive which covers
the basic rights of European workers with regard to working time, rest breaks, annual leave, night work and young
workers.
Working time is defined in the Regulations as time when someone is “...working, at the employer's disposal and carrying
out activities or duties”.
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‘Night time’ may be defined by collective agreement, but the default position is that this is the period between 23:00
and 06:00. Even where varied, the hours between midnight and 05:00 must be included and the period in question
must be at least seven hours long.
Under the WTR, employers must offer night workers a free health assessment before they start working nights and
on a regular basis whilst doing so. This assessment can be made up of two parts:
•
a questionnaire, and
•
a medical examination,
from a suitably qualified health professional. The assessment should take into account the nature of the work and any
restrictions on the working time under the WTR.
Shift working, especially night shift working, is associated with a range of health concerns that may cause or
compound health conditions in the worker. Undertaking health assessments is a good idea to establish any preexisting
health conditions and to monitor the workers health while undertaking shift work.
Managing Shift Work
There is no specific definition of shift work in legislation. It is, however,
a common requirement for working activities to be scheduled outside
standard daytime hours (considered as 07:00 to 19:00) where there is
also likely to be a handover of a task from one individual or group to
another. The UK’s HSE have produced a guidance document HSG256
Managing Shift Work that provides a useful framework for managing the
risks associated with shift working:
•
Consider the risks of shift work and the benefits of effective
management.
•
Establish systems to manage the risks of shift work.
•
Assess the risks associated with shift work in your workplace.
•
Take action to reduce these risks.
•
Check and review your shift-work arrangements.
Shift work should be managed to
reduce the risk of worker fatigue,
sleeping problems and other related
issues
Shift working has been associated with:
•
Fatigue.
•
Sleeping problems.
•
Disturbed appetite.
•
Disturbed digestion.
•
Disruption of internal body clock.
•
Social and domestic issues.
These consequences will impact on health and safety (e.g. increased accidents), increased error and lower
productivity. Effective management of these consequences requires clear policies and procedures and the allocation
of sufficient resources to reduce their impact. Employers should carry out risk assessments that would enable
the organisation to fully consider hazards associated with fatigue, etc. and to take action to reduce those risks. The
shift system implemented should include systems for reporting concerns associated and monitoring actions taken
(especially if that action is to change the shift pattern). The risk assessment would also be periodically reviewed to
ensure it remains suitable and sufficient.
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What is Fatigue and How Should it be Managed?
‘Fatigue’ is a term used to describe an overall feeling of tiredness and low energy levels. Being fatigued is not the
same as being tired. Fatigue is associated with a decline in mental and/or physical performance that has resulted
from prolonged exertion, sleep loss and/or disruption of the internal clock. The work being carried out is a factor in
becoming fatigued. Work that is monotonous or slow paced, complex, or requiring high concentration can contribute
to fatigue. The fatigued worker may have:
•
Slower reaction time.
•
Reduced ability to process information.
•
Memory lapses.
•
Absent mindedness.
•
Increased errors and accidents.
•
Reduced productivity.
Fatigue should be managed as any hazard in the workplace is managed. The UK’s HSE have produced a ‘fatigue risk
index’ designed primarily for comparing different shift schedules, which may be used to help assess the risk from
fatigue. Fatigue index scores can be reduced by ensuring an optimal balance between work (mental and physical
loading) and rest. Regular shift working can allow a worker to adjust to that shift system (rather than frequent
changes to the shift pattern), regular night-shift working should be avoided. Fatigue is more likely towards the end
of a shift, allowing workers some choice about length and timing of breaks may reduce fatigue. This may mean high
levels of discipline to prevent workers working excessive hours.
The organisation must have policies and procedures that are robustly implemented and managed to ensure working
time constraints are followed. The policy and procedures should also ensure rest breaks are taken by workers.
The organisation can also provide suitable facilities for shift workers. Poor diet is associated with shift working so
the provision of dietary information and ability to store and prepare (which may mean ‘heat up’) food should be
provided. Workers should be encouraged to seek medical support if they are experiencing ill health, e.g. gastrointestinal problems, cardiovascular disease, etc.
MORE...
For more information on fatigue, visit:
www.hse.gov.uk/humanfactors/topics/fatigue.htm
Forms of Health Surveillance
Health surveillance is the monitoring carried out on individuals to check for an identifiable disease or health condition
related to the work being carried out. It can be used where there is a likelihood that the disease or condition may
occur and where there is a valid technique to detect the early signs of the disease or health condition. The method
used in the health surveillance should not in itself pose a risk, e.g. using X-rays to identify chest infections.
Mental Health Conditions
For workers who may be experiencing mental health conditions arising from work-related stress, health surveillance
may take the form of a survey to determine the effectiveness of solutions that have been trialled (such as workload
management). It may be clear that the solutions implemented are not working to reduce worker stress levels and,
rather than waiting for worker absence levels to rise, the employer can take alternative actions.
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Working at Height
Working at height is a significant risk to the health and safety of workers involved. A range of activities involving
telecom engineering, construction work and building maintenance all have the potential to place a worker at risk due
to being at height.
Workers’ health can be monitored through medical history questionnaires. A person’s medical and mental health
can and does change, therefore monitoring for these changes is a good idea. Conditions such as dizziness, epilepsy,
diabetes, psychiatric conditions (e.g. phobias on working at height) and musculoskeletal conditions, can all increase
the risk of working at height if undetected.
Workers’ Body Mass Index (BMI), pulse rates, weight, tests for glucose and cholesterol can all be monitored by simple
tests - some of which the worker can carry out themselves.
Driving Occupations
It is a good idea to screen the health of workers required to drive as an occupation, e.g. forklift truck driving. While
there are formal medical assessments that must be carried out for heavy goods vehicle drivers, there is no statutory
duty associated with the medical health of forklift truck drivers. It is recommended that an agreement should be
made between the worker and employer as part of a contract of employment, to have routine medicals. As part of
the medical, a questionnaire could establish changing levels of agility (to get on/off the vehicles), changes to blood
pressure and BMI (through self-testing), heart conditions and the use of prescriptive medicines (especially ‘painkillers’
in the opiate based family of drugs).
Drugs and Alcohol Abuse
The ILO Code or Practice - The Management of alcohol and drugs related issues in the workplace requires national
policy and legislation with respect to the prevention, reduction and management of alcohol and drugs problems in
the workplace. National legislation may make it a criminal offence for certain workers to be unfit through drink or
drugs whilst working, for example, on railways, tramways and other guided transport systems. Additional legislation
may require that drivers of vehicles should not be under the influence of drink or drugs, whilst driving, attempting to
drive or being in charge of a vehicle.
Workers, in occupations covered by national legislation or workers undertaking safety critical roles, must perform
their tasks without hindrance to their mental or physical capacity caused by alcohol or substance abuse.
Surveillance can take the form of observing warning signs, such as frequent absences from the workplace, changes in
behaviours, dips in productivity, an increase in accidents or near misses and performance or conduct issues.
Employers who care about their workforce will want a healthy and engaged workforce. Effective policies and
procedures, together with the enforcement and management of those procedures, can ensure that support is
provided for individuals with an increasing dependence on alcohol and substances.
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Health Surveillance: Health Monitoring and Biological Monitoring
STUDY QUESTIONS
1. What forms of health surveillance are recommended in the ILO CoP Ambient factors in the workplace?
2. Who can conduct medical surveillance as opposed to health surveillance?
3. What is the minimum requirement for health surveillance and the keeping of a health record?
4. What is the difference between a health record and a medical record?
5. What types of surveillance are recommended in The ILO Code or Practice - The Management of alcohol and
drugs related issues in the workplace?
6. What does the term ‘biological monitoring’ mean?
(Suggested Answers are at the end.)
© RRC International
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9.3
Alcohol/Drugs Policy and its Legal Implications
Alcohol/Drugs Policy and its Legal Implications
IN THIS SECTION...
•
Employers should establish and maintain a drugs/alcohol policy; there are advantages and disadvantages of
testing.
•
There are benefits of pre-employment testing for drugs/alcohol and employers should establish when testing
should be carried out.
Establishing and Maintaining an Alcohol/Drugs Policy
Effective alcohol and drug misuse policies and disciplinary procedures
in the workplace are key to reducing the cost of absenteeism, impaired
productivity and accidents caused by the misuse of drugs and alcohol in
the workplace. Such policies and procedures will improve the morale of
the workforce as well as raise the reputation of the company in the view
of the public and other businesses by demonstrating commitment to
the safety and welfare of the workers as well as the environment. These
policies and procedures allow the organisation to meet its statutory
duties in relation to substance misuse.
The person (or team) responsible for introducing a policy, HR specialist supported by an occupational health specialist
and safety professional, must present a business case to the senior leadership team, the ultimate success of the policy
will be dependent on strong and active support for it, from the leadership team.
A recommended next step would be to use a working party, made up of key areas of the workforce (safety
representatives, trade unions, occupational health, safety professionals) who are likely to have some responsibility for
implementing the policy.
Drug and alcohol misuse is likely to be hidden in the workplace; it’s unlikely to be carried out openly. Conducting a
workplace audit may, therefore, be a prudent next step. The audit could examine:
•
Documentation on absenteeism.
•
Accidents.
•
Early retirements.
•
Disciplinary records to look for links between possible drug/alcohol misuse associated with the workplace.
Process audits could be carried out to review workloads and concentration factors that may lead to fatigue (and
therefore, negative coping strategies). The organisational culture could be audited to establish the organisation's
attitude to alcohol (is it served on the premises, is it consumed during lunch breaks, etc.).
The process of introducing a policy would then turn to consultation. The more the workers are involved, the more
ownership of the policy is likely to be achieved. This phase of the policy introduction should also enhance trust and
support the credibility of the organisation in developing a meaningful policy.
The policy should then be drafted and linked to other policies such as sickness absence, and disciplinary procedures
established. The draft policy should clearly explain:
•
Why the organisation is concerned about drugs/alcohol misuse.
•
How to establish clear boundaries on what the organisation will and will not allow in relation to alcohol and drug
use.
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•
Clear rules and procedures for managing alcohol/drug misuse issues.
•
Who is responsible for administering and maintaining the policy.
When the initial draft of the policy has been agreed, the leadership team, together with trade union representatives
or representatives of employees’ safety, should undertake a review to resolve any final observations.
At this stage, it is important to ensure that training on the policy is considered and the interrelationship of other
policies to the alcohol/drug misuse policy is established. The policy should then be proactively launched together
with associated training programmes for managers and workers.
The final phase of monitoring the policy to ensure its rules and intentions are clear and complied with, and that
infringements are dealt with.
Benefits of Pre-Employment Screening for Alcohol and Drugs
In some high-risk industries, such as transport, an employer may require a prospective employee to take an alcohol/
drugs test before the employee starts work (though after an offer of employment has been made). Any tests are
justified if they are necessary and proportionate for the role.
Before starting work, some companies require candidates to undertake a pre-employment health assessment. The
most common form of pre-employment screening is a health questionnaire that is usually self-completed and
provides information on the person's fitness to undertake all tasks within a role. The purpose of the questionnaire is
to establish the ability of the candidate to undertake the tasks without risks to themselves or to others, and to avoid
them suffering sudden incapacity. The benefits from pre-employment screening are:
•
The identification of physical or psychological problems that may affect the person's ability to undertake the
duties of the role.
•
Allows the employer to meet any statutory health surveillance requirements which can be used as a baseline
measure to detect changes during employment.
•
Discover if a person is at risk of combining medications with alcohol (antidepressant medication combined with
alcohol may have a synergistic effect).
•
Identify any reasonable adjustments that may be required.
•
Advise candidates of why certain job roles may not be suitable for them.
•
Use the baseline data for future assessment.
High-risk occupations such as airline pilots, oil rig workers and train drivers are all likely to require some form of preemployment screening.
When to Test for Alcohol/Drugs
Because alcohol and drug abuse can significantly impact a person’s
ability to perform their standard day-to-day activities, the employer
may introduce drug and alcohol testing. The UK government (including
the HSE) believe that there is no need for widespread drug and alcohol
testing in the workplace. However, there are several industries where
it is deemed essential: safety critical areas, such as the armed forces,
police, some construction activities such as working at height, and public
transport. The employer must obtain your written consent for an alcohol
or a drugs test. When giving consent for an alcohol test, this will only
apply to tests related specifically to alcohol and to no other substances.
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Alcohol/Drugs Policy and its Legal Implications
If testing for alcohol and drugs is required, it must be incorporated in each worker’s contract of employment. Testing
should be administered fairly and be justified by the nature of the work being undertaken. Employers may target
individuals if they have reasons to believe that a decline in performance or behaviour is due to the misuse of alcohol
or drugs.
Disadvantages of Alcohol and Drug Testing
The disadvantages of alcohol and drugs testing are:
•
A positive alcohol or drug test reveals only a potential past condition, not necessarily a present one. This is
unhelpful if the purpose of the test is to dissuade drug and alcohol use while at work.
•
Timing is important when testing for certain drugs. Alcohol is water soluble and its presence in blood more
accurately reflects current intoxication. The chemical compounds in some drugs can be present in body fluids
long after they have been metabolised and long after the psychoactive effects have worn off.
•
Urine or blood sampling for drug use are ineffective in revealing intoxication, preventing accidents and
dissuading drug use while at work. Real-time sampling of behavioural and cognitive measures is a more accurate
reflection of current use.
•
Drug and alcohol testing measures consumption within a wide time-frame, and thus may have no implications on
workers’ actual level of impairment while at work.
•
Testing before work starts does not detect drug use while at work.
•
Testing does not dissuade drug or alcohol use after the test is complete. Therefore, there is a limited impact on
safety.
•
Applicants may take a break from consumption, so they are clean for the pre-employment drug screen.
•
False positives on random drug tests are common because certain medications and foods can replicate the
signatures of banned substances.
•
Drug testing may be perceived as politically expedient to demonstrate that ‘something’ is being done; however,
testing may be ineffective, costly, and potentially prone to ‘false positives’.
•
There may be negative repercussions for workers whilst giving the false impression of safety.
•
Some countries have legalised the use of some drugs, especially for medical purposes, which may cause conflict
at work.
•
Random drug and alcohol testing may make it harder to recruit suitable employees.
STUDY QUESTIONS
7. What actions should be undertaken to establish an effective alcohol and drugs policy?
8. What are four benefits resulting from pre-employment screening?
9. Give six disadvantages associated with alcohol and drug testing in the workplace.
(Suggested Answers are at the end.)
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Summary
Summary
Health Surveillance: Health Monitoring and Biological Monitoring
We have described how:
•
General health assessment is an assessment of an individual’s fitness to carry out the general duties or specific
tasks associated with work.
•
Health surveillance is the monitoring of an individual’s health to ensure that they are suitable for work involving
exposure to a specific type of health hazard and to track their health over time as they work with that hazard.
•
Health records must be kept following health surveillance; these records contain personal details of the individual
and their work and may contain the conclusions of a clinician following any test or assessment. These records
must be kept for a defined period, often 40 years.
•
Health records are subject to data protection legislation and must be kept secure and confidential.
•
Since they do not contain clinical information, they may be viewed by the employer. Medical records containing
clinical information are confidential between the clinician and individual. The content can only be shared with the
employer with the individual’s authority.
•
Biological monitoring involves taking a blood, urine or breath sample and then measuring the concentration of a
substance or its metabolic breakdown products in that sample.
•
Biological monitoring is useful where inhalation is not the only significant route of entry for a substance, and it
has advantages and disadvantages.
•
For most substances where biological monitoring is carried out, the results are evaluated by comparison with nonstatutory Biological Monitoring Guidance Values (BMGVs).
•
Night workers must be offered a free and regular health assessment before they start working nights. Night shift
work should be managed via clear policies and procedures to reduce the impact on health and safety.
•
Fatigue should be managed like any other risk - the UK’s HSE have produced a ‘fatigue risk index’ to assist with
assessing risk from fatigue and finding the optimal balance between work and rest.
•
Health surveillance comes in various forms.
Alcohol/Drugs Policy and its Legal Implications
We have described how:
•
Effective alcohol and drug misuse policies and procedures allow organisations to meet their statutory duties in
relation to substance misuse, and reduce the cost of absenteeism, impaired productivity and accidents caused by
the misuse of drugs and alcohol in the workplace.
•
Pre-employment health assessment provides information on the person's fitness to undertake all tasks within a
certain role.
•
For some industries, alcohol and drugs testing is essential and incorporated in workers’ contracts of employment.
•
There are some disadvantages to alcohol and drugs testing, such as:
–– Positive tests reveal only a potential past condition, not necessarily a present one.
–– Testing before work starts does not detect drug use while at work.
–– False positives on random drug tests are common.
–– There may be negative repercussions for workers whilst giving the false impression of safety.
–– Random drug and alcohol testing may make it harder to recruit suitable employees.
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Learning Outcome 9.4
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Understand how hazardous substances can affect the human body.
LEARNING OBJECTIVE
Once you've studied this Learning Outcome, you should be able to:
• Explain the main routes of entry and the human body’s defensive responses to hazardous
substances.
© RRC International

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Contents
The Human Anatomical System
9-101
Introduction to the Human Anatomical System
Respiratory System
Digestive System
Circulatory System
Skin
The Eye
The Nose
Main Routes and Methods of Entry
Local and Systemic Effects and Target Organs
Defence Responses
Inhalable and Respirable Dust
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Summary
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The Human Anatomical System
The Human Anatomical System
IN THIS SECTION...
•
The respiratory system consists of the upper respiratory tract and lungs, and its prime function is the delivery of
oxygen into the bloodstream.
•
The digestive system consists of a continuous tract through the body where ingestion, digestion, absorption and
excretion of foodstuffs take place.
•
The circulatory system consists of the heart, blood vessels and blood and is responsible for the continuous
transportation of all of the chemicals essential for life.
•
The nervous system is made up of the central nervous system (brain and spinal cord) and the peripheral nervous
system (which detects and transmits sensory information and controls motor function).
•
The skin is an organ made up of the epidermis and dermis and is the primary barrier between the body and the
environment.
•
The eye is a delicate sense organ used to detect light; similarly, the nose provides a sense of smell.
•
Chemicals gain entry to the body by four principal routes and methods of entry; inhalation, absorption through
the skin (pervasion), injection through the skin and ingestion. Aspiration and entry at the eye or ear are other
possible routes.
•
The health effects of chemicals can be described as local or systemic and often involve specific target organs and
target systems.
•
The body has innate and adaptive defence mechanisms to protect it from attack and damage.
•
Inhalable dust is all dust that can be breathed into the nose and mouth. Respirable dust is dust that can be inhaled
deep into the lungs.
Introduction to the Human Anatomical System
This section looks at several anatomical systems and sense organs that are important in the context of exposure to
hazardous substances.
Respiratory System
Air enters the nose and passes through the nasal cavity. There, it is
warmed and moistened by water vapour from the mucous membranes.
It passes out of the nasal cavity, through the pharynx (back of the throat)
and then down the trachea (the windpipe).
The trachea carries air down into the thoracic cavity (chest) and then
divides into two bronchi, one into the left lung and the other into the
right lung. In each lung, the bronchus branches into bronchioles, which
repeatedly branch into progressively smaller and smaller tubes. Air is
carried to the terminal bronchioles, which lead to an infundibulum
of alveoli (similar in appearance to a bunch of grapes). All of these
conducting airways are lined with mucous membrane to keep the
inhaled air moist.
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Oxygen passes into the bloodstream
when inhaled
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The Human Anatomical System
The alveoli (or air sacs) is where gas exchange takes place:
•
Oxygen (O2) leaves the inhaled air and passes, by diffusion, into the bloodstream, and
•
Carbon dioxide (CO2) leaves the bloodstream and is then exhaled. The walls of the alveoli are very thin (one cell
thick), moist and delicate.
The basic structure of the airway is shown in the following figure. The upper respiratory system is formed by the nasal
cavities, pharynx, larynx (voice box) and trachea. The lungs contain the bronchi, bronchioles, terminal bronchioles and
the alveoli.
The respiratory system showing detail of the alveoli in the inset box
During respiration, oxygen diffuses across the thin membranes of the alveoli into the
bloodstream. This bloodstream is carried in capillaries, very thin blood vessels that
form a network over the outer surface of the alveoli. As the blood collects oxygen so
it becomes oxygen rich (saturated) and fresh, deoxygenated blood is moved through
the capillaries to take its place. This gas exchange is illustrated in the diagram.
Digestive System
The function of the digestive system is the digestion and absorption of foodstuffs,
which is dealt with in four stages:
•
Ingestion through the mouth with mastication (chewing) and swallowing.
•
Digestion - the breakdown of food by enzymes secreted into it in the mouth,
stomach and duodenum (first part of the small intestine).
•
Absorption of the breakdown products of digestion. This occurs in the small
and large intestines.
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This shows the diffusion of
oxygen from air in the alveoli
across the thin membranes
of the lung and blood vessel
and into the bloodstream. At
the same time, CO2 diffuses
out of the bloodstream and
into the air in the alveoli.
This air is then exhaled.
Note the red blood cells (or
erythrocytes) in the blood
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•
Excretion of undigested food and waste through the rectum and anus.
The tube that food passes along as this process takes place is the gastrointestinal tract. This is made up of the
following parts:
•
Mouth - food is chewed, saliva containing enzymes is secreted. Some digestion starts.
•
Oesophagus - swallowed food is squeezed by muscular contractions down this tube.
•
Stomach - acidic gastric juices are secreted from the stomach wall into the food. Digestion is in full swing. Food
remains in the stomach for some time.
•
Small intestine - food from the stomach passes through the first part of the small intestines, the duodenum,
where further enzymes and bile are added. Further digestion takes place. The food then passes to another part
of the small intestine, the ileum, where the breakdown products of digestion (sugars, amino acids and fatty acids)
are absorbed into the bloodstream.
•
Large intestine - water is absorbed from the remaining material which is then collected in the rectum prior to
excretion.
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The following diagram shows the various parts of the gastrointestinal tract:
The digestive system
Circulatory System
Every cell in the body relies on a supply of oxygen and the removal of waste. The circulatory system provides this
service. The system comprises the blood (fluid), heart (pump) and blood vessels (pipework).
The Blood
Blood is a viscous fluid made up of blood cells (45%) suspended in a straw coloured liquid (plasma; 55%). The plasma
is high in various salts.
The blood cells include:
•
Erythrocytes (red blood cells) - contain haemoglobin which provides a chemical system that enables oxygen to
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be transported throughout the body. When oxygen obtained from the lungs is attached to the haemoglobin, it is
called oxyhaemoglobin.
•
Leucocytes (white blood cells) - there are three main types of leucocyte which together form the main defence
system in combating disease and the effects of toxic actions.
–– Granulocytes - move in and out of blood vessels and through tissues ingesting harmful microorganisms, such
as bacteria, and debris by a process called phagocytosis.
–– Lymphocytes - are associated with the production of antibodies which neutralise the effect of recognised
foreign matter (referred to as antigens).
–– Monocytes - change into macrophages when leaving the blood and have a similar ingesting role to
granulocytes, but also mediate in some of the jobs of the lymphocytes.
•
Thrombocytes (platelets) - their main function is in the clotting of blood.
The ratio of the cells in blood is 500 red cells: 1 white cell: 30 platelets.
The Heart
The heart is a muscular sac situated in the chest cavity. It is divided by a septum into right and left sides which, in
effect, makes it two pumps in one.
Each side is divided into an upper and lower chamber: the atrium which receives blood, and the ventricle which
distributes blood. Thus, when the heart contracts or beats, it squeezes blood from both atria down into the respective
ventricles and then from those ventricles out into the attached blood vessels. The beating of the heart is controlled
by nerve impulses.
Key to the diagram:
RA: right atrium
LA: left atrium
RV: right ventricle
LV: left ventricle
Longitudinal section of the heart (anterior view)
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The Blood Vessels
The blood vessels form the pipework down which blood flows as the heart pumps. The system is represented in the
following diagram.
The circulatory system
Note that deoxygenated blood from the body is returned to the heart and is then pumped to the lungs. At the lungs,
the blood becomes oxygenated. It is then piped back to the heart where it is then re-pumped out of the aorta and
around the body.
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The blood vessels that the blood flows through are tubes of varying wall-thickness and structure:
•
Arteries and arterioles carry blood away from the heart (usually oxygenated blood, with the exception of the
pulmonary artery).
•
Capillaries form the very fine tubes that carry blood into very close proximity to the cells and tissues that require
oxygen.
•
Veins and venules carry blood from the capillaries back to the heart (usually deoxygenated blood with the
exception of the pulmonary vein).
It typically takes 20 seconds for blood to flow around the entire system (e.g. heart to lungs; back to heart; out to big
toe; back to heart again).
Lymphatic System
The lymphatic system links with the circulatory system, and is almost as extensive.
A key function of the lymphatic system is to manufacture new lymphocytes in the lymph nodes. (Lymphocytes are a
type of white blood cell (leucocyte) that play a large role in defending the body against disease and are responsible for
immune responses. They can produce antibodies that attack bacteria and toxins or can attack body cells themselves
and are often present at sites of chronic inflammation.)
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 unit of the nervous system is the nerve cell or neuron. Nerve impulses generated at one end of the neuron
travel along the nerve fibre to release neurotransmitter chemicals at the other end. Nerve cells, unlike most other
cells in the body, do not repair well and so damage to nerve tissue tends to be irreversible.
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The Human Anatomical System
Skin
The skin is a complex assembly of connective tissues that forms the outer covering of the body and is continuous
with the membrane lining which covers the cavities within the body.
The skin has a distinctly layered structure:
•
The epidermis forms the outermost layer of skin and is composed of the:
–– Horny zone - layers of dead cells that protect the outer surface. These are continually being shed and
replaced.
–– Germinal (or living) zone - the living cells that reproduce to form the horny zone.
•
The dermis, a much thicker layer of living tissues that contains most of the interesting structures of the skin:
–– Blood vessels - that supply oxygen and lose heat to the skin.
–– Sweat glands - that excrete sweat (water and salts) from the blood up onto the surface of the epidermis.
–– Nerve endings - for pain receptors, heat receptors, pressure receptors, etc.
–– Hair follicles - where skin hair grows up through the epidermis, with an erectile muscle to the side of the hair
follicle capable of contracting to make the hair stand erect (for thermal insulation).
–– Sebaceous glands - that secrete sebum (oily liquid) onto the skin surface where it suppresses bacterial growth.
Cross-section of the skin
The skin is impermeable to water but can be permeated by other liquids, such as organic solvents (e.g. phenol).
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The Eye
The eyeball contains a transparent liquid through which light is focused by a lens onto a sensitive layer (the retina).
The outer coating of the eyeball (sclerotic coat) is very tough and is also transparent at the front (the cornea).
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.
The cornea and lens are delicate and therefore vulnerable to damage from chemicals or radiation. The eyeball sits in a
socket lined with delicate mucous membranes which have a rich blood supply.
Cross-section of the eyeball
The Nose
The nose performs a range of functions, one of which we have already outlined; the humidification and warming
of air as it is inhaled into the respiratory system. Another important function associated with the nose is the sense
of smell. This is provided by nerve cells that are embedded in the mucous membranes at the top of the nasal cavity.
When air is inhaled through the nostrils, odour molecules attach to these nerve cells. The nerve cells are then
stimulated to send nerve impulses to the olfactory bulbs - these are the parts of the brain responsible for the sense
of smell - that are positioned just above the nasal cavity. The sense of smell is useful to give early warning of the
presence of certain hazardous substances. However, many hazardous substances do not have an odour (e.g. carbon
monoxide gas, CO). And some hazardous substances can destroy the nerve cells responsible for generating the odour
signals (e.g. hydrogen sulphide, H2S).
Main Routes and Methods of Entry
Some hazardous chemicals do not need to enter the body in order to have a health effect. For example, a corrosive,
such as concentrated hydrochloric acid will cause damage to the skin on contact.
Many hazardous substances, however, have to gain entry into the body before they can have a health effect. The
routes and methods by which chemicals gain entry to the body are, therefore, important.
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The main methods of entry are:
•
Inhalation
Inhalation into the lungs is the most frequent and significant method of entry for the majority of hazardous
substances. There are several reasons why the lungs are so vulnerable:
–– The epithelium of the lungs has a massive surface area - the lungs have a highly convoluted structure to create
a very large surface area so that sufficient oxygen can be absorbed from inhaled air to supply the body.
–– The epithelium in the alveoli is very thin and in very close proximity to the blood supply - it has to be to allow
efficient diffusion of oxygen into the bloodstream. Unfortunately, this means that every other molecule that
is soluble in the mucous lining the epithelium can also diffuse across into the bloodstream.
–– You have to breathe - it is not optional (unlike eating or drinking); respiration demands that you inhale air
almost constantly. Therefore, if a chemical is in the air, it is going to be inhaled.
Any inhaled substance capable of dissolving in water or capable of passing through membranes will pass into the
bloodstream. And, of course, the lungs have a very rich blood supply. Once in the blood, the toxic substance will
be efficiently transported to all parts of the body. Typically within 30 to 60 seconds of inhaling a toxic substance,
it will be present in the blood in most parts of the body.
Consequently, for the majority of toxic chemicals, inhalation is the primary route of entry that has to be tackled to
eliminate or control exposure.
•
Skin Contact
The skin is the second most vulnerable area after the lungs, as it can
come into contact with solid, liquid or gaseous toxic substances,
possibly in high concentrations. Fortunately, the epidermis has many
layers of protection and does not allow solid or gaseous substances
to be absorbed in general.
The skin is also waterproof, so water-soluble chemicals are unlikely
to gain entry unless they remain in contact with the skin for long
periods of time.
Hazardous substances can be forced
The greatest risk comes from chemicals that can pass through the
through the skin
epidermis. This is sometimes called pervasion. Organic solvents,
such as benzene and toluene, are notorious for this property.
They achieve this absorption by dissolving the lipid membranes that the cells of the epidermis are made of. If
a chemical can pass through the skin in this manner then contact with the liquid, gas or vapour will result in
absorption.
The alternative process through the skin is, of course, injection. This occurs either where the substance is:
–– physically forced through the skin; e.g. needlestick injury, compressed air injection, cut with contaminated
sharp object; or
–– introduced through the epidermis where it is damaged; e.g. cuts, grazes, dermatitis chaps.
•
Ingestion
In terms of occupational hazards from toxins, the gastrointestinal tract is the least vulnerable part of the body.
The possibility of solid or liquid toxicants being ingested is limited. People are not in the habit of putting toxic
substances knowingly into their mouths in most workplaces. It can, and does, happen by accident of course;
either through cross-contamination of food with toxic chemicals (due to poor hygiene practices) or because the
individual concerned is not aware of their actions (young children or dementia patients).
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When ingestion does occur, the substance must be water soluble or able to pass through membranes to be
absorbed and it must reach a part of the gastrointestinal tract where this absorption can occur. The stomach has
a thick mucus lining (to prevent attack of the stomach wall by the very acidic gastric juices) so little absorption is
likely to take place there. Absorption is most likely to occur in the small intestine, where food is absorbed. Thus, if
you swallow a small lead pellet, you are unlikely to absorb very much lead into your bloodstream.
•
Other Routes
There are other methods of entry, but these tend to be less significant in most circumstances. For example:
–– Aspiration - the direct entry of liquid (or solid) into the lungs. This typically happens in two ways:
–– When substances that have been ingested are expelled in vomit and run down into the respiratory tract.
–– When substances are sucked directly into the lungs during pipetting or siphoning.
This can be very serious - swallowing a hydrocarbon solvent is unpleasant but survivable; inhaling it can be lethal.
–– Mucous membrane of the eye - substances may dissolve in the moist covering of the eye and undergo
absorption into the bloodstream of the eyelids and eye socket.
–– Ear - though the ear canal is coated with ear wax and is a relatively poor route of entry, it is possible that
substances can pass through the skin of the canal or the eardrum, especially organic solvents.
Local and Systemic Effects and Target Organs
When hazardous substances gain entry to the body, they may have a local or a systemic effect. They may also affect
target organs or target systems. To explain:
•
Local effects - are confined to the specific area of the body where contact with the toxic material occurs, such as
the skin, eyes, respiratory tract, etc. For example:
–– An irritant may cause local irritation to the eyes or skin after contact at those sites.
–– A sensitising agent may cause a specific allergic reaction on contact with the skin or respiratory tract.
•
Systemic effects - occur in organs or parts of the body distant from the site where initial contact with the toxic
substance was made. It may be that the entire body system is affected by the substance or several different parts
of the body and systems are affected only. For example:
–– Lead inhaled into the lungs as a fume will affect the central nervous system and blood-forming organs, and
may be incorporated into the bones.
–– Carbon monoxide inhaled into the lungs will combine with the haemoglobin of the blood to inhibit oxygen
transfer throughout the entire circulatory system.
•
Target organs and target systems - an organ is a group of structurally distinct tissues which perform some
specific function, or set of functions, e.g. heart, liver, lungs, etc. Organs are linked to one or more body systems,
such as the respiratory or circulatory systems.
Toxic substances do not often present the same degree of toxicity to all organs; their toxicity may be concentrated in
a few organs or systems, referred to as the target organs or systems for that toxin. For example:
•
Carbon tetrachloride affects the liver (organ), causing jaundice and scarring.
•
Mercury affects the central nervous system, causing narcosis and brain damage.
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The Human Anatomical System
Defence Responses
The body’s defences against ‘foreign’ agents are collectively called the ‘immune system’. The immune system is
comprised of two complementary and interacting systems:
•
Innate (or ‘Non-Specific’) Immune Response
This is the response with which we are born. It provides a rapid response, but is non-specific. There are various
mechanisms that are innate, such as:
–– Specialised white blood cells, e.g. macrophages.
–– Inflammation.
•
Adaptive (‘Acquired’) Immune Response
This response is targeted at a specific invader and takes time to develop.
Once developed, a memory of the invader is formed and subsequent defence response will be triggered very
quickly and is likely to be very effective. The mechanism involves various types of specialised white blood cell.
One of the most important sets of defence mechanisms of interest is the respiratory system. This is largely innate,
though an acquired response can also be shown.
The Respiratory System Defences
We can summarise the deposition of dust particles in the respiratory system as follows:
Particle Size
Deposition Site
Above 10µm
Nasal cavity.
7-10µm
Conducting airways trachea, bronchi and bronchioles.
0.5-7µm
Respiratory bronchioles and alveoli.
Below 0.5µm
Most remain airborne and are exhaled.
Some diffuse and come into contact with the airway or alveolar membrane.
(Note on units: 1µm is 1/1,000 of a millimetre or 1/1,000,000 of a metre. For comparison purposes, a typical human
hair has a diameter of 50-100µm.)
The defence mechanisms at work in the respiratory system (starting from the top) are:
•
Nasal hairs, which filter out the larger particles (>10µm).
•
Coughing and sneezing, which result in the forceful ejection of inhaled substances.
•
The mucociliary escalator - particles are trapped by mucus secreted by goblet cells lining the conducting airways
(particles between 7-10µm); the mucus, with the trapped particles, is moved up to the top of the throat by tiny
moving hairs, or cilia, so forming the mucociliary escalator. Sputum reaching the top of the throat is either
swallowed or spat out (expectorated).
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Mucociliary escalator
•
Macrophages - specialised attacking white blood cells in the alveoli. Smaller particles and aerosols between 0.5
and 7µm pass into the respiratory units where they are deposited. They may then be ingested by macrophages.
Macrophages are one form of white blood cell (leucocytes) that are present in body tissues. Macrophages destroy
foreign particles by phagocytosis; the cell ingests the foreign particle, secretes enzymes onto it and then absorbs
the digested remains. Phagocytosis is illustrated in the following figure.
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The Human Anatomical System
Phagocytosis
In some instances, the filtration mechanism outlined earlier is not effective at removing the substance. This may
either be because the substance is not in a particle form (it is a vapour or gas) or because the substance is inert
and so cannot be digested by macrophages (e.g. silica dust). In this case, the inflammatory response may be
triggered.
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•
Inflammatory Response
Inflammation is the means by which white blood cells (leucocytes) are called to the site of infection or injury.
Typically, the response is:
–– Blood vessels dilate and the capillary walls become more permeable.
–– Protein-rich fluid (plasma) exudes from the capillaries into the surrounding tissue, causing swelling
(oedema).
–– Leucocytes migrate through the capillary walls towards the harmful input, where they ingest it together with
any damaged tissue.
–– Tissue-dwelling macrophages join with other phagocytes and scavenge the affected area, which is sometimes
additionally bonded by fibrinogen (a protein associated with blood clotting).
–– Fibroblasts appear and secrete collagen. This fibrous protein forms a meshwork of scar tissue which steadily
builds up to repair the affected area.
Although inflammation is a defence process of great importance, if called upon to act for too long it can result
in disease. In some types of chronic inflammation, the repair process becomes disordered. The overgrowth
of scar tissue, brought about by an over-production of collagen, shrinks and contracts, tearing and distorting
the surrounding tissues. In the lungs, this results in the condition known as emphysema and some types of
pneumoconiosis result in extensive scarring and fibrosis. An example of a specific disease caused by chronic
inflammation in the lungs is asbestosis.
•
Respiratory Inflammation
The respiratory pathway is vulnerable to attack by many irritants and corrosives or any other substances which
attack the skin. The terminology of the inflammatory processes follows the pathway of air into the lungs, for
example:
–– Rhinitis (nose).
–– Laryngitis (larynx).
–– Tracheitis (windpipe).
–– Bronchitis (upper lung).
•
Acquired Immunity
The acquired immune system is a primary defence against viral and bacterial attack. When a biological agent
causing disease (pathogen) is detected, parts of the immune system produce antibodies in response to chemical
markers (antigens) on the pathogen. These antibodies are used to attack the pathogen and destroy it, often by
labelling the pathogen so that other white blood cells recognise it as a target for destruction.
Whilst this system is critical in keeping the respiratory system free of viral and bacterial infection, it can sometimes
become triggered by large molecules that in their own right do not represent a threat to the body.
Certain substances (e.g. flour dust) are able to sensitise the respiratory system in this way and evoke an immune
response.
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Inhalable and Respirable Dust
Inhalable dust is the fraction of airborne dust that enters the nose and
mouth during breathing, and is therefore available for deposition in the
respiratory tract.
Any dust that will stay suspended in the air can be inhaled into the nose
and mouth. One of the defining characteristics of dust is the diameter
of the particles, usually given in microns, µm (1 micron = 1/1000 of a
millimetre or 10-3 mm). Inhalable dust particles can be as large as 100µm
or more.
Respirable dust is the fraction of airborne dust that penetrates to the
gas exchange region of the lung.
Dust can be inhalable or respirable
Because the upper respiratory tract (nose, throat and windpipe) have
a filtering effect on inhaled dust, larger dust particles are not inhaled deep into the lungs. Typically, all dust particles
larger than 7µm in diameter will have been removed by the body’s filtration mechanism, so only dust particles of less
than 7µm diameter will enter the region of gas exchange.
The distinction between inhalable and respirable dust is important because different OESs may be given for inhalable
dust and respirable dust and the dust monitoring methods used to determine dust exposure are different depending
on whether the inhalable or respirable fraction is being measured.
We will consider the monitoring and measuring of airborne contaminants in Learning Outcome 9.9.
STUDY QUESTIONS
1. Describe how oxygen enters the bloodstream.
2. Identify the main purpose of the circulatory system.
3. What are the three essential components of the circulatory system?
4. What is the function of the retina?
5. Outline what is meant by the terms ‘local effects’ and ‘systemic effects’.
6. What are the body’s natural defences in the respiratory system?
7. What is the difference between the inhalable and respirable fractions of an airborne dust?
(Suggested Answers are at the end.)
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Summary
The Human Anatomical System
We have described how:
•
The respiratory system consists of the upper respiratory tract and lungs and its prime function is the delivery of
oxygen into the bloodstream.
•
The digestive system consists of a continuous tract through the body where ingestion, digestion, absorption and
excretion of foodstuffs take place.
•
The circulatory system consists of the heart, blood vessels and blood and is responsible for the continuous
transportation of all of the chemicals essential for life.
•
The nervous system is made up of the central nervous system (brain and spinal cord) and the peripheral nervous
system (which controls motor functions).
•
The skin is an organ made up of the epidermis and dermis and is the primary barrier between the body and the
environment.
•
The eye is a delicate sense organ used to detect light; similarly, the nose provides a sense of smell.
•
Chemicals gain entry to the body by four principal routes and methods of entry: inhalation, absorption through
the skin (pervasion), injection through the skin and ingestion. Aspiration and entry at the eye or ear are other
possible routes.
•
The health effects of chemicals can be described as local or systemic and often involve specific target organs and
target systems.
•
The body has innate and adaptive defence mechanisms to protect it from attack and damage.
•
Inhalable dust is all dust that can be breathed into the nose and mouth. Respirable dust is dust that can be inhaled
deep into the lungs.
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Learning Outcome 9.5
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• 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 with
reference to relevant legislation.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Explain the identification, classification and health effects of hazardous substances used
in the workplace.
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Contents
Prevention and Control of Exposure to Hazardous Substances
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Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH)
Purpose of Classification of Hazardous Substances, the Globally Harmonised System (GHS) and the
Classification, Labelling and Packaging Regulation (CLP)
Health Hazard Classes
Labelling and Safety Data Sheets
Factors to Consider when Assessing Health Risk
Review of the Assessment
The Prevention and Control of Exposure
The Hierarchy of Controls
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Prevention and Control of Exposure to Hazardous
Substances
IN THIS SECTION...
•
The aims of Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) are to protect
people and life from the use of chemicals.
•
The purpose of classification and the role played by hazard and precautionary statements for hazardous
substances with reference to the Globally Harmonised System of Classification and Labelling of Chemicals
(GHS), and the EC Regulation no. 1272/2008 Classification, Labelling and Packaging of Substances and
Mixtures Regulation (CLP) in line with GHS.
•
Health hazards classes (with reference to Chapter 3 of GHS) include acute toxicity, skin corrosion, eye damage,
etc.
•
Information on substances or preparations/mixtures which have the potential to cause harm to be
communicated to users should be included on labels and Safety Data Sheets; and Chemical Safety Assessments/
Reports.
•
A risk assessment is carried out where work is liable to expose employees to substances hazardous to health; the
ILO CoP Ambient factors in the workplace provides information on how an employer can carry out this assessment.
•
Review of risk assessment should take place when there is reason to suspect it is no longer valid, or where
significant change to the work to which the assessment relates has occurred.
•
Evaluation of existing, and consideration of additional, control measures should consider the prevention and
adequate control of exposure to hazardous substances.
•
Control of exposure to most hazardous substances can only be considered adequate when the OEL is not
exceeded, and the ILO CoP have been used. However, for carcinogens, mutagens and asthmagens, an additional
requirement is that exposure must be to the lowest level reasonably practicable.
•
A simple hierarchy of controls approximating to the CoP is;
–– Eliminating exposure.
–– Substitution of the substance.
–– Good design and installation of the process.
–– Total enclosure.
–– Engineering controls.
–– Work systems - minimise the numbers exposed.
–– PPE.
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Prevention and Control of Exposure to Hazardous Substances
Registration, Evaluation, Authorisation and Restriction of
Chemicals (REACH)
REACH is a Regulation of the European Union and the UK, developed to
improve the protection of human health and the environment from the
risks that can be posed by chemicals without reducing competitiveness
in the chemicals industry. REACH promotes alternative methods for the
hazard assessment of substances, in order to reduce the number of tests
on animals.
The aims of UK REACH are to:
•
Provide a high level of protection for people and the environment
from the use of chemicals.
•
Ensure people who place chemicals on the market are responsible for
understanding and managing the risks associated with their product.
•
Promote the use of alternative methods for assessment of the
hazardous properties of substances.
Ultimately, these aims should:
•
ensure that information is generated on the hazards posed by the substance (so that risk assessments can
consider all the hazards posed by that substance),
•
ensure information is available to users/regulators/public on that substance to:
–– encourage responsible manufacture and supply, and
–– encourage the chemicals industry to develop substances less dangerous to health and the environment.
MORE...
More information on REACH is available on the HSE website at:
www.hse.gov.uk/reach/whatisreach.htm
Purpose of Classification of Hazardous Substances, the
Globally Harmonised System (GHS) and the Classification,
Labelling and Packaging Regulation (CLP)
This section looks at the classification of chemicals according to their health effects. Historically, this has been carried
out in different ways in different regions of the globe - with Europe adopting a different system from the US, for
example - with the result that a substance imported into Europe from elsewhere in the world would potentially have
to be re-classified and re-labelled in order to meet the EU requirements.
In an effort to standardise in this area, the United Nations have implemented a Globally Harmonised System of
Classification and Labelling of Chemicals (GHS). This has been implemented in the EU and Great Britain through
legislation. The standards of note are:
•
United Nations Globally Harmonised System of Classification and Labelling of Chemicals (GHS).
•
European Regulation (EC) No. 1272/2008 on Classification, Labelling and Packaging of Substances and
Mixtures (CLP).
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Chapter 1.3.2 of GHS outlines the assessment of the intrinsic hazards of a chemical in only three steps:
•
Identification of relevant data regarding the hazards of a substance or mixture.
•
Review of the data to determine the hazards.
•
Decision as to whether the substance will be classified as hazardous.
Alongside the benefits of using chemicals, there is the potential for adverse effects on people and the environment.
Given the large number of chemicals available, individual Regulations for each chemical would not be practicable.
The purpose of classification, therefore, is to provide information that enables the safe use of these chemicals by
identifying their hazardous nature and appropriate protective measures.
For a large number of chemicals, there will already be data from previous tests - GHS acknowledges this and states
that the data should be accepted in order to reduce the number of tests conducted (and therefore the number of
test animals affected). It also acknowledges that there may be reliable epidemiological data from human exposure
which could be used.
CLP places a duty on manufacturers and suppliers to:
•
Classify dangerous chemicals (both substances and mixtures) using
the new scientific criteria agreed under GHS according to three
different criteria:
–– physico-chemical properties (e.g. explosive),
–– health effects (e.g. acute toxicity), and
–– environmental effects (e.g. toxic to the aquatic environment).
•
Provide information to the end user in the form of a label that will
make use of new hazard-warning symbols (pictograms) agreed under
GHS.
•
Package the chemical safely.
CLP requires labelling to inform end
users of hazards
Hazard and Precautionary Statements
The regulation also requires the identification of hazard and precautionary statements that will appear on the label of
the substance/mixture. Hazard and precautionary statements are represented by H- and P-numbers respectively, for
example:
H301 - Toxic if swallowed.
H320 - Causes eye irritation.
P102 - Keep out of reach of children.
P271 - Use only outdoors or in well-ventilated areas.
The purpose of a hazard statement is to provide a simple, readily understandable phrase that describes the nature of
the hazard presented by the hazardous substance or mixture. The purpose of precautionary statements is to describe
recommended measures or prevent harm arising as a result of exposure to the hazardous substance or mixture.
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CLP Label Elements
CLP labels must generally contain:
•
Name, address and telephone number of the supplier.
•
Nominal quantity (when made available to the general public).
•
Product identifiers (e.g. name and CAS number); hazard pictograms.
•
Signal words (e.g. ‘danger’ or ‘warning’).
•
Hazard statements and any applicable precautionary statements (covering prevention, response, storage and
disposal).
•
Supplemental information.
Example Chemical Label
Below is an example of a label for sulphuric acid (this is purely illustrative, to show the sort of information displayed).
CLP labelling for dangerous chemicals
Health Hazard Classes
In this section, we will consider the different health hazard classification used in Part 3 of GHS, Chapters 3.1 through
3.10. One of the objectives of GHS is to allow for ‘self classification’ by providing definitions of the hazardous
properties of a substance that can be used to maintain a consistent approach to classification.
Acute Toxicity
Acute toxicity refers to those adverse effects occurring following oral or dermal administration of a single dose of a
substance, or multiple doses given within 24 hours, or an inhalation exposure of four hours.
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DEFINITION
TOXIC
Produces serious, acute or chronic ill health or death at very small or small doses.
Under GHS, acute toxicity is assessed and assigned to one of five categories, with one being the most toxic and five
being the least toxic. Toxicity is determined by animal testing on the basis of potential oral, dermal and inhalation
toxicity. So, for example, a substance assigned a ‘Category 1 acute toxicity - oral’ will have an LD50 of 5mg/kg body
weight or less (i.e. in animal tests, half of the test population of animals died as a result of ingesting 5mg for each kg
of their body weight or less). Specific label elements are determined as a result of the assessment and are shown in
the following table:
Category 1
Category 2
Category 3
Category 4
Category 5
Symbol
Skull and
crossbones
Skull and
crossbones
Skull and
crossbones
Exclamation
mark
No symbol is
used
Signal word
Danger
Danger
Danger
Warning
Warning
Oral
Fatal if
swallowed
Fatal if
swallowed
Toxic if
swallowed
Harmful in
contact with
skin
May be
harmful in
contact with
skin
Dermal
Fatal in
contact with
skin
Fatal in
contact with
skin
Toxic in
contact with
skin
Harmful in
contact with
skin
May be
harmful in
contact with
skin
Inhalation
Fatal if inhaled
Fatal if inhaled
Toxic if
inhaled
Harmful if
inhaled
May be
harmful if
inhaled
Hazard
statement:
Table 3.1.3 - Label Elements for Acute Toxicity
(Source: www.unece.org/fileadmin/DAM/trans/danger/publi/ghs/ghs_rev04/English/
ST-SG-AC10-30-Rev4e.pdf)
The two symbols, ‘skull and crossbones’ and ‘exclamation mark’, referred to in the table are
as displayed in the diagrams.
It should be noted, however, that whilst category four and five substances do not attract the
familiar ‘skull and crossbones’ associated with toxic materials, these are still considered toxic
and should be handled and used with caution.
‘Danger’
Skin Corrosion and Irritation
According to GHS, 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 four hours.
‘Warning’
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DEFINITIONS
CORROSIVE
Destroys living tissue by direct chemical attack.
IRRITANT
Causes inflammation, in particular of the mucous membranes.
Skin irritation is the production of reversible damage to the skin following the application of a test substance for up
to four hours.
Corrosive substances often have a high or low pH, i.e. they are acids or alkalis. Under GHS, substances classified as
corrosive will be assigned the ‘corrosion’ symbol.
Corrosives are further categorised into three subcategories: 1A, 1B and 1C. Subcategory 1A corrosives cause
irreversible skin damage apparent less than 1 hour after the application of the chemical to the skin for less than three
minutes.
By contrast, GHS states that skin irritation is the production of reversible damage to the skin on contact. Often, one
of the key determining factors in distinguishing between a corrosive substance and an irritant is concentration.
Many acids and alkalis are corrosive in their neat or concentrated form, but only irritant in their more dilute form. As
dilution increases, so the irritant effect decreases.
Substances classified as irritant will be assigned the ‘exclamation mark’ symbol.
Serious Eye Damage and Eye Irritation
It is not only the skin that can be affected by corrosive or irritant substances - serious
eye damage can occur on exposure to corrosive substances, often as liquid splashes or
corrosive gases.
According to GHS, 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
(front) surface of the eye, which is not fully reversible within 21 days of application.
‘Corrosive’
Eye irritation is the production of changes in the eye following the application of a test
substance to the anterior surface of the eye, which are fully reversible within 21 days of
application.
Substances that cause irreversible eye damage are assigned the same corrosion hazard
warning symbol as for corrosives. Those that cause reversible eye damage are assigned
the ‘exclamation mark’ symbol as for irritants.
Respiratory or Skin Sensitisation
‘Irritant’
According to GHS, a respiratory sensitiser is a substance that will induce hypersensitivity of the airways following
inhalation of the substance.
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DEFINITION
SENSITISING
Can cause an allergic response following either single acute overexposure or repeated chronic overexposures.
A skin sensitiser is a substance that will induce an allergic response following skin contact.
Some chemical agents are able to produce an allergic reaction in certain individuals. Antibodies are produced which
are capable of triggering an allergic reaction each time the person is subsequently exposed to very small quantities of
the causative agent. Two body systems are prone to sensitisation by chemicals:
•
Skin - the sensitising chemical passes through the epidermal barrier, causing antibodies to be formed. This
produces the symptoms associated with sensitisation dermatitis. Once this happens, the skin reaction will occur
whenever there is further contact with the sensitising agent.
Under GHS, skin sensitisers will be assigned the ‘exclamation mark’ symbol as used for skin and eye irritation.
•
Respiratory system - allergic sensitisation occurring in the respiratory system results in asthma. The mechanism
of occupational asthma is an abnormal immunological response to foreign material which acts as an antigen (i.e.
a foreign substance which causes the body to produce antibodies). The inhalation and absorption of the antigen
causes the production of specific antibodies that trigger the release of histamine, causing bronchial constriction.
Under GHS, respiratory sensitisers will be assigned the ‘health hazard’ symbol.
Germ Cell Mutagenicity
According to GHS, a germ cell mutagen is a chemical that may cause mutations in the
germ cells of humans that can be transmitted to the progeny.
Mutagens cause changes (mutations) to DNA structure in the cells of a person. The
damage to DNA caused by a mutagen may possibly go on to cause cancer. DNA
mutation happens constantly in the cells of the body. Most mutations are benign and
of no consequence since they occur in parts of the genetic code that are not used.
Occasionally, a mutation may occur in an important area. This often leads to cell death
(either directly, or as a result of cancer prevention mechanisms). Occasionally, however,
mutations occur in cells that have harmful effects:
‘Health hazard’
•
In the ordinary body cells (somatic cells). This may cause cancer.
•
In the germ line cells (eggs in the ovary of a woman, or the sperm-producing cells in the testes of a man). This can
lead to heritable genetic defects being passed down to offspring and is known as germ cell mutagenicity.
The GHS labelling varies according to the category of the germ cell mutagen:
•
Category 1A substances are known to cause heritable genetic mutations from human evidence from historical
exposures.
•
Category 1B substances are believed to cause heritable genetic mutations from strong evidence from animal
studies.
•
Category 2 substances are where there is some concern that they may cause heritable genetic mutations from
evidence from animal studies.
Under GHS, all germ cell mutagens will be assigned the ‘health hazard’ symbol as used for respiratory sensitisers.
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Carcinogenicity
DEFINITION
CARCINOGENIC
Can induce the growth of malignant cancer tumours.
According to GHS, a carcinogen is a substance or a mixture of substances which induce cancer or increase its
incidence.
Simply put, carcinogens cause cancer. A carcinogen attacks the mechanism which controls reproduction of normal
cells. It causes changes in a cell’s DNA, resulting in ‘abnormal’ cells which divide uncontrollably (and so produce
growth of ‘abnormal’ tissue). The cells grow, spread, invade and destroy the surrounding tissue. Carcinogens evoke
irreversible effects which continue after exposure to the carcinogen has ceased. The action of ordinary toxic agents
usually stops when the exposure ceases and recovery generally follows.
The effects of a carcinogenic agent will not appear for many years after exposure; periods between five and 50 years
are given for different agents. During this time, there is little or no warning of the eventual outcome.
With carcinogens, there is no threshold of harm and any level of exposure has the potential to cause cancer. However,
in practice the chances depend on a number of factors, including potency, absorption, distribution and metabolism.
Under GHS, there are three categories of carcinogen, depending on the level of available evidence suggesting that
cancer can arise from exposure. The labelling varies according to the category of the carcinogen:
•
Category 1A carcinogens are known to cause cancer from human evidence from historical exposures.
•
Category 1B carcinogens are presumed carcinogens due to the presence of strong animal evidence of cancercausing potential.
•
Category 2 carcinogens are suspected carcinogens for which there is insufficient human or animal evidence to
place them in Category 1.
Under GHS, all carcinogens will be assigned the ‘health hazard’ symbol as for respiratory sensitisers and germ cell
mutagens.
Reproductive Toxicity
DEFINITION
TOXIC TO REPRODUCTION
Can cause sterility, miscarriage or birth defects.
According to GHS, reproductive toxins result in either:
•
Adverse effects on sexual function and fertility in adult males or females.
•
Developmental toxicity in unborn or breastfeeding children.
Many organic lead compounds have been linked to increased levels of sterility, miscarriage and birth defects. Birth
defects occur as a result of the chemical interfering with critical stages in the development of the child as it grows
in the womb. Importantly, this is not due to mutation, as the child is genetically ‘normal’. The drug thalidomide is
another example of a reproductive toxin (though not a workplace example).
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GHS classifies reproductive toxins which damage fertility or the unborn child into three categories, 1A, 1B and 2,
along similar lines as those used for germ cell mutagens and carcinogens. All three categories will be assigned the
‘health hazard’ symbol under GHS, as used for germ cell mutagens and carcinogens.
Note that no symbol is assigned to a substance which may cause harm to breastfed children (although there should
be a hazard statement to this effect on the container and data sheet).
Specific Target Organ Toxicity - Single and Repeated Exposure
According to GHS:
•
Specific target organ toxicity (single exposure) is defined as specific, non-lethal target organ toxicity arising
from a single exposure to a substance or mixture. All significant health effects that can impair function, both
reversible and irreversible, immediate and/or delayed and not specifically addressed by other classifications, are
included.
•
Target organ toxicity (repeated exposure) means specific target organ toxicity arising from a repeated
exposure to a substance or mixture. All significant health effects that can impair function, both reversible and
irreversible, immediate and/or delayed and not specifically addressed by other classifications are included.
Some substances have toxic effects on target organs and systems. This can be as a result of a single exposure or
multiple exposures over a lifetime. Human and animal evidence may indicate the potential for a substance to be toxic
to a particular target organ or system.
One common example (though not a workplace one) is alcohol. Alcohol is an organic chemical which in
some cultures is consumed as a drink for recreational purposes. The short-term (acute) effects depend on the
concentration and quantity consumed, but usually include intoxication. This intoxication arises from a single exposure
and affects the brain and nervous system (the target system). In extreme cases, a single large dose can prove fatal,
although usually the body removes the toxins via the liver. Repeated exposure can result in chronic effects, such as
cirrhosis of the liver (another target organ) and is also linked to some cancers.
Occupational exposure to some substances can result in a similar pattern of effects, e.g. inhalation of organic solvent
vapours may result in intoxication (targeting the brain and central nervous system) and may prove fatal at high doses.
The liver may also be affected by repeated exposures.
Under GHS, substances which are target organ toxins (through single exposure or repeated exposure) are classified
into Categories 1 or 2 and will be assigned the ‘health hazard’ symbol.
Aspiration Hazard
As we have already covered, some chemicals are harmful by aspiration (inhalation of a liquid directly into the lungs).
Such chemicals can have very serious or even fatal consequences if aspirated.
Under GHS, this classification does not exist. However, it does exist in the EU regime under CLP. Under this regime,
aspiration hazards will be assigned the ‘health hazard’ symbol.
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MORE...
Additional information is available from the HSE at:
www.hse.gov.uk/chemical-classification
www.hse.gov.uk/chemical-classification/legal
CLP and GHS are explained in more detail at:
https://echa.europa.eu/web/guest/home
Labelling and Safety Data Sheets
For many substances, the classification and labelling information required by the manufacturer/supplier already exists
in the form of European harmonised classifications. These are available in Part 3 of Annex VI of CLP. Specifically,
Table 3.1 of Part 3 of Annex VI of CLP contains the harmonised classification and labelling information under the
CLP system (incorporating GHS).
So, for many chemicals, the classification has already been done and the manufacturer/supplier simply looks up the
chemical in Table 3.1 and reads the data entry.
An example of an extract from Table 3.1 of Part 3 of Annex VI of CLP is given with an interpretation of the
information:
Section taken from CLP Annex VI Table 3.1
(Source: eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2008:353:0001:1355:EN:PDF)
For the entry hydrogen:
•
Index number - a code number relating to the atomic number of the chemical and its physical form.
•
International Chemical Identification - the internationally recognised name of the chemical, plus common names
where appropriate.
•
EC number - the official identification number of the chemical within the EU.
•
CAS number - the Chemical Abstracts Service number - an internationally recognised code number for the
chemical that is not EU-specific.
•
Hazard Class and Category Code - the classification and category of hazard. In this case, hydrogen is a Gas under
pressure (Press. Gas) and a Category 1 Flammable gas (Flam. Gas 1).
•
Hazard statement Code - the code number relating to the specific hazard statement that describes the hazard
associated with the chemical for the purposes of classification. In this case, H220 stands for ‘Extremely flammable
gas’.
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•
Pictogram, Signal Word Code - the hazard-warning symbol(s) that should be presented on the label, along with
the signal word that should appear on the label. In the case of hydrogen, two symbols are required:
GHS02 represents the flame symbol.
GHS04 represents the gas cylinder symbol.
The signal word code ‘Dgr’ stands for danger.
The signal word code ‘Dgr’ stands for Danger.
•
Hazard statement Code - the code number relating to the specific hazard statement that should appear on the
label. In this case, H220 stands for ‘Extremely Flammable gas’. Note that this code appears in both the classification
column and the labelling column.
The GHS/CLP Health Hazard Symbols
CLP requires the use of standard hazard symbols on labels to aid in the communication of the hazard type. These
symbols conform to GHS:
Used for substances that are fatal or toxic when inhaled, ingested or on skin
contact.
Used for substances that are harmful (when inhaled, ingested or on skin contact),
irritant (when inhaled or on contact with skin or eyes) or sensitising on skin
contact.
Used for substances that are corrosive (to skin or eyes).
Used for substances that are carcinogenic (category 1A, 1B and 2), mutagenic
(category 1A, 1B and 2), toxic to reproduction (category 1A, 1B and 2),
sensitising (respiratory system), capable of causing organ damage (single and
repeat exposures), or represent an aspiration hazard.
Workers and consumers benefit from communication in the form of a product label. The elements to be included
in a label should be the hazard pictogram, signal words, hazard statements and precautionary statements as core
information on the label. Other information provided on the label should be limited to a minimum and should not
call into question the information provided by the main elements.
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Safety Data Sheets (SDSs)
ILO Recommendation R177 identifies the contents of safety data sheets:
“The criteria for the preparation of chemical safety data sheets for hazardous chemicals should ensure that they contain
essential information…”
In Europe, this is enacted through Article 31 of the Registration, Evaluation, Authorisation and Restriction of
Chemicals Regulation (REACH) requires suppliers of substances and mixtures classified as ‘dangerous for supply’ to
provide safety data sheets (SDSs, or Material Safety Data Sheets (MSDSs) as they were formally known prior to GHS.
SDSs must also be provided upon request in certain other cases. SDSs must contain information under 16 mandatory
headings:
1. Identification of the substance/mixture and of the
company/undertaking.
2. Hazards identification.
3. Composition/information on ingredients.
4. First-aid measures.
5. Fire-fighting measures.
6. Accidental release measures.
7. Handling and storage.
9. Physical and chemical properties.
10. Stability and reactivity.
11. Toxicological information.
12. Ecological information.
13. Disposal considerations.
14. Transport information.
15. Regulatory information.
16. Other information.
8. Exposure controls/personal protection.
For ease of recall, these sections can be summarised as:
•
Supplier details (s1).
•
Components and overall hazards (s2, 3).
•
What to do if things go wrong:
–– First-aid measures (s4).
–– Fire-fighting measures (s5).
–– Accidental release measures (s6).
•
How to stop things going wrong (s7, 8).
•
Basic properties, i.e. physical, chemical, toxicological, etc. (s9, 10, 11, 12).
•
How to dispose of it (s13).
•
How to transport it (s14).
•
Label and regulatory information (s15).
•
Anything else (s16).
The SDS thus provides important information relevant to the ill effects of hazardous substances, such as exposure
controls, toxicological information, first aid, chemical properties and any personal protective equipment necessary.
It is recommended that you obtain a copy of a SDS (EU-compliant) from an EU supplier/manufacturer, so that you
will have a much better idea of the sort of information that is included. Suitable examples can readily be found for
download from the websites of many chemical manufacturers.
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SDSs must be supplied (in paper or electronic form) free of charge when the substance is first provided. They must
be kept up to date and revised and re-issued accordingly.
In certain circumstances, relevant exposure scenarios must also be supplied as an appendix to the SDS. As the name
suggests, these are specific manufacturing/use scenarios (where exposure to the substance is likely) together with
their respective control recommendations. They are produced (usually by the manufacturer/importer of the chemical
substance) as part of the Chemical Safety Assessment process (and recorded in the Chemical Safety Report) required
by REACH.
The Chemical Safety Assessment is carried out to show that the risk from exposure to the substance or mixture
is controlled when risk management methods are applied. The Chemical Safety Report should be readily
understandable and have clear conclusions.
Factors to Consider when Assessing Health Risk
Section 4.2 of the ILO Code of Practice - Ambient factors in the workplace emphasizes three stages in the assessment
process.
At the first stage of the assessment:
•
Identify the hazardous substances present or likely to be present.
•
Identify the activities taking place.
•
Identify hazardous substances that can be easily eliminated.
•
Obtain information on the hazards of the substance and its by-products (fume/gas etc.).
•
Consider the ambient conditions the substance will be used in, e.g., barometric pressure/temperature.
•
Consider change in phases of the substance - solid to liquid to gas.
•
Obtain information from suppliers in accordance with the provisions of Chapter 5 of the ILO code of practice Safety in the use of chemicals at work. Where this is not practicable, consider other reliable sources of information.
•
Consider the provisions in other appropriate ILO Conventions, recommendations or Codes of Practice,
where relevant, when dealing with minerals or synthetic fibres, e.g. Asbestos Convention (No. 162), and
Recommendation (No. 172).
•
Take into consideration specific work situations where workers are likely to be exposed, for example hazardous
fumes from welding.
•
Take into account exposure limits set by competent authorities.
At the second stage of the assessment:
•
Take account of routes of entry, the rate work is performed, the length of exposure, and the influence of ambient
factors.
At the third stage of assessment:
•
Determine a programme of measuring airborne contaminants to:
–– Determine the extent of exposure.
–– Check the effectiveness of control measures.
•
Make arrangements for regular inspection.
•
Review the assessment in line with Section 3.2 of the ILO code.
•
Employers must keep dated records of airborne measurements and methods used to gain the data.
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This risk assessment must be carried out by the employer to identify the control measures necessary to comply
with national legislation. In the UK the Control of Substances Hazardous to Health Regulations 2002 (COSHH).
Require the following 5 step approach.
COSHH assessments can be considered as a five-step process:
1. Gather information about the substances, the work and the working practices.
2. Evaluate the risks to health.
3. Decide on the control measures needed to comply with COSHH.
4. Record the assessment.
5. Review and update as necessary.
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A flow diagram summarising the Five-Step Approach to COSHH Assessment, adapted from HSG97 A step by
step guide to COSHH assessment, HSE, 2004 (www.hse.gov.uk/pubns/priced/hsg97.pdf)
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Assessments carried out under UK COSHH or the ILO code must be recorded.
The ILO code requires that the assessment be reviewed:
•
When there is reason to suspect it is no longer valid:
–– Due to complaints from workers.
–– Following an accident
–– Due to updated information (on ambient conditions or the nature of hazards).
–– Following plant modification.
•
When there is a significant change.
•
When the result of monitoring shows it is necessary.
We will now consider some of the factors that must be considered when carrying out a chemical exposure
assessment, in particular during the first two steps of the process.
Hazardous Properties of the Substance
The first step in the assessment process is to gather information about the hazardous substances that are present.
This must include not only substances that are brought into the workplace, but also those that are created during
work activities (such as fumes from welding) or as a waste product.
Information about each hazardous substance can then be gathered from various sources, such as:
•
Labels.
•
Safety Data Sheets (SDSs).
•
Legislation, semi legal codes and guidance (such as EH40 in the UK).
•
Direct from the manufacturer/supplier.
•
Chemical information databases.
These information sources can then be used to identify the hazard classification of the substance (e.g. whether it is
toxic or carcinogenic), the routes of entry that the substance may take and the subsequent health effects, relevant
Occupational Exposure Limits (OELs) for the substances or its components, its volatility and other physical properties,
etc.
Type and Level of Exposure
Gathering information about the substance and its hazardous properties is only one part of Step 1 of the assessment.
Information about how the substance is actually used, stored, handled and disposed of is also vital.
One critical factor to consider is the type of exposure that might occur. This will be determined by the physical
forms of the substance that might be present or created, and the various routes of entry that might then apply.
Remember: the most significant routes of entry into the body are through the nose, mouth, skin, eyes and ears.
Methods of entry include absorption, ingestion, inhalations and penetrative injuries, such as a hypodermic needle
puncture wound.
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The nature of the work activity will play an important part here.
For example, if a raw material is in powder form then inhalation is a possible method of entry through the nose; if in
liquid form then inhalation is unlikely, unless the liquid is:
•
Volatile, in which case vapour will be generated at ambient temperatures.
•
Heated during work activity, in which case vapour will be generated.
•
Sprayed, or otherwise atomised, to produce an aerosol.
For the liquid form, other routes of entry might be of greater concern, such as skin contact followed by absorption or
ingestion.
In some instances, the level of actual exposure will need to be known or estimated. This is particularly important
when the substance is airborne and inhalation is of concern, since there may be an OEL relevant to the substance (see
Learning Outcome 9.9).
The level of exposure can sometimes be estimated using knowledge of the volatility of the substance, the
temperature at which it is used (or even the dustiness of a powder) and the time taken to carry out the work.
MORE...
The UK’s HSE website has a microsite dedicated to COSHH:
www.hse.gov.uk/coshh
Specific guidance documents:
L5 (6th edition) - ACoP and Guidance on the Control of Substances Hazardous to Health Regulations 2002
available at:
www.hse.gov.uk/pubns/books/l5.htm
and HSG97 - A step by step guide to COSHH assessment available at:
www.hse.gov.uk/pubns/priced/hsg97.pdf
In other instances, the level of exposure will have to be measured directly using monitoring equipment. In
these circumstances, other control measures will have to be taken to allow the work activity to proceed so that
measurements can be taken. For example, a powder-handling process might be carried out using PPE as a control
until such time as the actual level of dust exposure can be ascertained by direct measurement. The PPE might then be
removed if measurements confirm that exposure levels are acceptable.
Duration and Frequency of Exposure
The duration of exposure can be a critical factor in determining the dose of substance that enters the body. This
is particularly the case when the substance is airborne and inhalation is a significant method of entry. Duration of
exposure can also be of concern when handling substances that can permeate the skin (for the same reason), and
even when handling wet chemicals with gloves on (since some chemicals may permeate through the glove material
and the gloves will have a breakthrough time; see Learning Outcome 9.8).
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Frequency of exposure is important for several reasons:
•
It can have a direct effect on dose received. For example, a five-minute work activity that creates a vapour cloud
that might then be inhaled but that is carried out once a day, gives a far lower daily exposure than the same work
activity repeated once every 30 minutes.
•
It can influence the selection of an appropriate control method. For example, an exposure that occurs once a
year during routine maintenance might be controlled using PPE, whereas the same exposure occurring every day
would have to be controlled by other more effective means.
•
Some substances are more likely to have a harmful effect following frequent exposures. For example, dermatitis is
more likely following repeated exposure to wet cement.
Numbers of People
The number of people likely to be affected by the substance, either directly or indirectly, must be taken into account.
This should include workers directly involved with the activity and those who might be incidentally exposed. The
employer owes a duty not only to their workers, but also to workers from other organisations (e.g. contractors) and
others such as visitors and members of the public.
Effect of Mixtures
If exposure is to a mixture of chemicals, how will this affect the health risk?
For example, if a work activity involves exposure to chemical A (toxic) and chemical B (irritant), how will either of
these chemicals affect the hazard properties of the other, should exposure occur simultaneously?
•
One compound may decrease the toxicity of another (e.g. an antidote to a poison).
•
One compound may simply add to the toxicity of another (additive effect).
•
One compound may enhance the toxicity of the other so that the resultant toxicity is greater than the sum of the
individual toxicities (potentiation or synergy).
Note that this is very different to asking what new hazardous substance might be made if the two chemicals are mixed
together and then react to form a product (e.g. acid + bleach = chlorine gas).
Unusual Activities
The assessment must take into account any unusual activities that are known to occur or that are reasonably
foreseeable. This includes cleaning and maintenance work and emergencies, such as power cuts and spillages.
Note that the employer should make suitable arrangements to deal with accidents, incidents and emergencies. The
arrangements required should be identified during the assessment.
Occupational Exposure Limits (OELs)
Where there is potential for exposure to a substance that has an OEL, it will be necessary to identify that limit (from
the relevant legislation and guidance) so that the actual exposures that might occur in the work activity can be
compared to it. This topic is dealt with in more detail in Learning Outcome 9.9.
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Existing Controls
The assessment, like other forms of risk assessment, must reflect the real situation as it exists in the workplace.
Therefore, any control measures that are already in place should be taken into account when assessing exposure.
For example, when assessing potential exposure to a hazardous powder during a weighing activity, the fact that the
work is being carried out in a partial enclosure with Local Exhaust Ventilation (LEV) attached should be taken into
account as this control method alone may provide adequate protection.
However, when any existing control measures are considered in the assessment, their actual effectiveness must be
taken into account.
Particular attention must be paid to the likelihood and consequences of the failure of any existing control measures.
For example, the mechanical failure of an enclosure with an LEV system attached may be a rare event (provided the
system has been subject to routine planned preventive maintenance) but it could have significant consequences for
those working near the enclosure. Similarly, PPE is often used as the principal control measure, but PPE is not always
worn or used correctly and, if it fails, it fails to danger.
Surveillance and Monitoring Results
Where there is potential for exposure to certain types of hazardous substance (e.g. flour dust or lead), the employer
may be required to conduct health surveillance of exposed employees. For example, workers exposed to flour dust
(a respiratory sensitiser) might undergo a periodic medical, including a lung function test to assess whether they are
developing symptoms of asthma as a result of their exposure. (This topic is dealt with in more detail in
Learning Outcome 9.1.)
In a similar way, where there is potential for exposure to certain types of hazardous substance (e.g. carbon monoxide),
the employer may be required to conduct monitoring of airborne concentrations. For example, the personal exposure
of welders to welding fumes might be monitored to compare actual exposures to statutory limits.
Where health surveillance and monitoring are being carried out in a workplace, the results can be useful:
•
When assessing the potential for exposure to new hazardous substances (on the basis that results may indicate
that current preventive or protective measures for existing substances are good or poor).
•
When reviewing existing assessments.
MORE...
The ILO guide on controlling chemicals can be accessed here:
www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@safework/documents/
normativeinstrument/wcms_107823.pdf
Individual Susceptibilities
It is not only the particular properties of the chemical agent in question that determine the risk to the worker; an
equally important consideration is the individual susceptibility of the worker. Some examples of this are:
•
Atopic individuals - some people are hypersensitive to allergens and may be more prone to asthma attacks,
hay fever or eczema. This can be useful for screening out individuals from work where they might encounter
sensitising substances that they are likely to be very sensitive to.
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•
Women of child-bearing capacity - certain hazardous substances (e.g. lead and mercury) have specific effects on
the unborn child. These substances will be identified with hazard statements such as:
–– H360 - may damage fertility or the unborn child.
In these circumstances, appropriate controls must be established by the risk assessment to ensure that harmful
exposure does not occur. This may mean that a higher level of protection is afforded these individuals, or that
they are excluded from undertaking work with a risk of high exposure.
•
Age - younger workers are vulnerable to chemicals that affect the reproductive system (e.g. insecticides/
pesticides) and so may have to be given a higher level of protection or excluded from certain activities.
•
Sensitisation - this occurs when the immune system has been exposed to an allergen (something that will
produce an allergic response), remembers it and launches its defence mechanisms when the allergen re-appears.
Common occupational sensitisations are:
–– Respiratory sensitisation, where occupational asthma can be caused by repeated exposure to an asthmagen
(e.g. flour dust).
–– Skin sensitisation, where secondary or allergic dermatitis occurs as a result of repeat exposures to a skin
sensitiser (e.g. glutaraldehyde).
Sensitisation can occur in any individual irrespective of health, age or atopy. For example, a common sensitisation
is allergic dermatitis in construction workers due to exposure to cement. Where an individual is known to be
sensitised to a substance, they must be protected from further exposures as this may trigger a sensitisation
reaction and make the condition worse.
Review of the Assessment
The assessment should be reviewed whenever there is reason to suspect that it is no longer valid or where there has
been a significant change in the work to which the assessment relates.
Examples include:
•
After an incident, such as fire or spillage.
•
After the results of monitoring.
•
As a result of health surveillance.
•
When new information on risks is available.
•
After a significant change in the workplace or work method.
•
Changes to the form of the substance, e.g. from powder to pellets.
•
A new employee with no experience of the process.
The significant findings from the review should be recorded and any revision changes to the steps taken to reduce
exposure should be implemented.
The Prevention and Control of Exposure
The prevention and control of exposure to hazardous substances is the subject of chapter 6.4 and 6.5 of the ILO CoP
- Safety in the use of chemicals at work, combined with chapter 4.3 of the ILO CoP - Ambient factors in the workplace.
The CoP - Safety in the use of chemicals, approaches chemical safety through a hierarchy of control measures.
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DEFINITION
OCCUPATIONAL EXPOSURE LIMIT (OEL)
OELs can be viewed as a maximum or ceiling concentration of a substance in air which must not be exceeded
on a time-weighted average basis. OELs are further explained in Learning Outcome 9.9.
These chapters from two ILO CoPs follow on from the risk assessment requirements to define when control of
exposure to a hazardous substance can be considered adequate.
Control of exposure to most hazardous substances will only be treated as adequate if:
•
the appropriate OEL is not exceeded; and
•
the adequate controls have been applied.
Where the hazardous substance is either carcinogenic/mutagenic (i.e. carries the hazard statements H350, H340 or
is capable of causing occupational asthma (i.e. carries the hazard statement H334) then control will only be deemed
adequate if:
•
the appropriate OEL is not exceeded;
•
Adequate controls have been applied in accordance with ILO CoP or national laws, and;
•
exposure is reduced to as low a level as is reasonably practicable.
So, for most substances assigned an OEL, employers can achieve adequate control by applying the CoPs and ensuring
that the OEL is not exceeded. For carcinogens, mutagens and asthmagens, employers must ensure that the control
measures in place reduce employee exposure as far below the OEL as is reasonably practicable. Thus, for these
latter substances, a higher degree of control is required and may be the subject of specific national laws, e.g. the UKs
COSHH Regulations, and be enforceable.
The Hierarchy of Controls
The CoP - Safety in the use of chemicals, approaches chemical safety through a hierarchy of control measures which can
be approximated to:
•
Eliminate the substance.
•
Substitute the substance.
•
Ensure good design and installation of the process.
•
Achieve total enclosure of the process.
•
Introduce engineering controls.
•
Introduce work systems (minimise numbers involved).
•
Use PPE.
Elimination
The employer is required to completely eliminate exposure to hazardous substances where this is reasonably
practicable:
•
Hazardous substances can sometimes be replaced with materials that do the same job but present no health risk
(e.g. replacing solvent-based paint with a water-based one).
•
Alternatively, it may be possible to modify work methods or processes to eliminate the health risk (e.g. outsource
a paint-spray operation rather than doing it in-house).
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Substitution
The employer is required to substitute hazardous substances or processes. This might be done by:
•
Replacing one hazardous substance with a particular health hazard classification (e.g. toxic) with another with a
lower classification (e.g. irritant).
•
Substitute one physical form of a substance with a different form of the same substance (e.g. granulated pottery
glazes rather than powder).
The CoP requires that care should be taken to consider all the known risks of the proposed substitutes and take
appropriate precautionary measures for that substitute.
Good Design and Installation of the Process
An analysis of the process may identify activities that produce harmful substances. It may identify processes or work
systems which minimise the generation of the hazardous substance. It may also suggest that changing the work
method may minimise or suppress the generation of the substance. For example, where harmful solvents are being
generated, brush-painting rather than spraying will considerably reduce the level of airborne contaminant. A change
to work process as simple as using a vacuum cleaner to clean up wood dust, as opposed to sweeping with a brush, can
have a dramatic effect on airborne concentrations of the hazardous substance and therefore worker exposure.
Total Enclosure
Total enclosure or containment is an effective control since no-one can then be exposed to the hazard. For example,
total enclosure of a process that generates dust or fumes will prevent the escape of airborne contaminants that
could be inhaled by operators in the vicinity. When an area has been totally isolated, it may still be necessary to
access equipment or material within that area. The use of robotically-controlled, remote-handling systems may be
incorporated, allowing access without disturbing the integrity of the enclosure.
Partial enclosure may also be possible with the use of local exhaust ventilation systems.
Engineering Controls
Two of the most commonly used engineering controls are:
•
Local Exhaust Ventilation (LEV) - where an airborne substance is extracted from the workplace at the point of
generation.
•
Dilution ventilation - where the airborne substance is allowed to escape into the workplace, but then air
changes dilute the concentration down to an acceptable safe level.
Both of these forms of ventilation will be explained in detail later in Learning Outcome 9.8.
Provision of safe storage for substances (use of drip trays, etc.) is required, such as, re-sealable containers, containers
with spring loaded lids to reduce fume. Consideration of safe disposal may also require engineering controls.
Work Systems
The ill-health effects arising from exposure are often related to the length
of time of exposure, as well as the concentration of substance. Reducing
exposure time can minimise dose.
As a general principle, the cumulative dose should be reduced to as low a
level as possible by organising the work pattern to provide periods of nil
exposure.
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exposure to harmful substances
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Another method is job rotation, where the exposure of any particular individual is reduced by sharing the dose with
other workers.
Reducing the number of people exposed to a particular hazardous substance is a sensible control measure in all
circumstances.
However, there may be instances where it is particularly important to restrict exposure to certain individuals only. For
example, where the substance:
•
Is carcinogenic, mutagenic or toxic to reproduction.
•
Is a sensitising agent to which certain individuals might be more susceptible.
Minimising the number of people exposed might have to be done by segregating parts of the workplace where the
substance is to be stored, used and handled and restricting access to authorised people only.
Work systems should prohibit eating, chewing, drinking and smoking in contaminated areas. Work systems should
also allow sufficient time for the use of welfare facilities for: washing, changing, laundering, and storage of clothing
Work systems would also include procedures for regular cleaning of contaminated surfaces, and procedures to follow
which limit the area of contamination in the event of spills and leaks.
Personal Protective Equipment (PPE)
MORE...
For more information about the hierarchy of control measures outlined above, take a look at Working with
substances hazardous to health (INDG136) at:
www.hse.gov.uk/pubns/indg136.pdf
PPE is a commonly used control measure for hazardous substances. It may be used as the only control, or it may be
used in combination with other procedural and engineering controls. PPE should only be considered as an option
when all of the other measures outlined above have been considered and applied so far as is reasonably practicable.
Common types of PPE used to control exposure to hazardous substances include:
•
Respiratory Protective Equipment (RPE).
•
Gloves and gauntlets.
•
Eye and face protection.
These are discussed in more detail later in Learning Outcome 9.8.
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STUDY QUESTIONS
1. What is the UN GHS?
2. What do we mean by the term ‘toxic’?
3. What is the purpose of Risk/Safety Phrases and Hazard/Precautionary Statements and where can they be
found?
4. Identify the information that must be included on a safety data sheet.
5. What factors should be considered when assessing risks to health?
6. What specific personal factors affect the hazard/risk to individuals from chemical agents?
7. Outline the hierarchy of controls for exposure to hazardous substances.
(Suggested Answers are at the end.)
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Summary
Prevention and Control of Exposure to Hazardous Substances
We have examined how:
•
The key principles of EU REACH Regulation have been retained in UK REACH Regulations.
•
The United Nations have implemented a Globally Harmonised System of Classification and Labelling of
Chemicals (GHS), which aims to standardise the laws governing the classification and labelling of chemicals
globally, with the principle ‘one chemical - one label worldwide’.
•
Suppliers and manufacturers of chemicals have to classify, label and package chemicals according to EC
Regulation no. 1272/2008 Classification, Labelling and Packaging of Substances and Mixtures Regulation
(CLP) in line with GHS.
•
Harmonised classification and labelling information is available for many substances in Table 3.1 of Part 3 of
Annex VI of CLP Chapter 3 of GHS.
•
Labelling requires the application of suitable phrases and symbols.
•
Safety data sheets, a legal requirement under REACH, contain 16 categories of information to allow the end user
to undertake their exposure assessment.
•
Standard health hazard classes are used to classify the health effects of chemicals according to GHS. They are:
acute toxicity, skin corrosion, skin irritation, serious eye damage, eye irritation, respiratory sensitisation, skin
sensitisation, germ cell mutagenicity, carcinogenicity, reproductive toxicity, specific target organ toxicity (single
and repeat exposure) and aspiration hazard.
•
A risk assessment is carried out where work is liable to expose employees to substances hazardous to health; the
ILO CoP Ambient factors in the workplace provides information on how an employer can carry out this assessment.
•
The assessment should be reviewed when:
–– There is reason to suspect that it is no longer valid.
–– There has been a significant change in the work.
•
Control of exposure to most hazardous substances can only be considered adequate when the OEL is not
exceeded, and the ILO CoP have been used. However, for carcinogens, mutagens and asthmagens, an additional
requirement is that exposure must be to the lowest level reasonably practicable.
•
A simple hierarchy of controls approximating to the CoP is:
–– Eliminate exposure.
–– Substitution of the substance.
–– Good design and installation of the process.
–– Total enclosure.
–– Engineering controls.
–– Work systems - Minimise numbers exposed.
–– PPE.
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Learning Outcome 9.6
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Understand the role of epidemiology and toxicological testing.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Outline the role of epidemiology and toxicological testing.
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Contents
Epidemiology and Toxicological Testing
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Use of Epidemiology and Toxicological Testing in Classification
Human Epidemiology
Alternatives to Animal Testing
Dose/Response Relationship
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Epidemiology and Toxicological Testing
Epidemiology and Toxicological Testing
IN THIS SECTION...
•
Epidemiology and toxicology are two branches of medical science that have allowed the recognition and
classification of chemical health hazards to occur.
•
Epidemiological studies look at the prevalence and spread of disease in populations. Many epidemiological
studies follow cohorts of people over periods of time. Three such types of study are: the case-control study, the
prospective cohort study and the retrospective cohort study.
•
Animal testing of chemicals often involves acute toxicity testing (such as the fixed dose procedure used for
classification). These studies have their limitations.
•
Alternatives to animal testing include, in vitro testing using bacteria, such as the Ames test for mutagenicity, and
predictive modelling, such as QSAR and read-across methods.
•
One of the key tools of toxicology is the dose/response curve that demonstrates the relationship between the
dose of chemical administered and the ill health response that occurs.
•
Dose/response curves can be used to derive three important characteristics of a chemical; LD50, LC50 and the
NOAEL.
Use of Epidemiology and Toxicological Testing in
Classification
DEFINITIONS
EPIDEMIOLOGY
The study of the patterns of ill health in populations.
TOXICOLOGY
The study of the adverse effects of chemicals on living organisms and the symptoms, mechanisms, detection
and treatment of those effects.
The classification of chemicals into their various categories of hazard is based largely on the scientific study of their
toxic effects. This information is based on hard scientific data gathered in research facilities around the world. Much
of this information has been gathered by animal testing, some using other investigative techniques that will be
outlined later.
This approach to the classification of chemicals has been successful in identifying and quantifying the nature of
thousands of substances over time.
At the same time, epidemiological studies have, on occasion, revealed a link between a particular chemical and ill
health in humans. Classic examples of this are asbestos, and lead in petrol. Increases in the prevalence of ill health, first
noticed by health professionals, triggered a toxicological investigation that confirmed epidemiological results; there
was a causal link between exposure and disease. Legislation ensued.
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Epidemiology and Toxicological Testing
In this way, toxicology and epidemiology complement one another as approaches to studying the ill health effects
of exposure to chemicals and substances. Whilst toxicology data is the principal tool used in the classification of
chemicals, epidemiology still has a role to play in identifying overlooked links between exposure and ill health.
Human Epidemiology
Epidemiology is concerned with the distribution of a particular occupational disease and the search to identify the
various factors that may be involved. A number of different types of study are available. We will consider three of the
main studies that are conducted over a period of time (referred to as longitudinal studies).
CASE STUDY
An Early Example of Epidemiology
In the summer of 1854, cholera broke out in London, being particularly severe in the slums around Soho. Dr.
John Snow used the opportunity to carry out the first true epidemiological investigation into the spread of a
disease. Cholera victims suffer from severe diarrhoea and vomiting, with death typically occurring after a few
days and very high mortality rates.
During the course of the epidemic, Snow plotted the household of every death in the area around Soho. By
plotting the incidence of deaths onto a map, he was able to demonstrate that the nodal point was the Broad
Street pump. This led to his conclusion that the water from this pump was responsible for the cholera outbreak.
Snow persisted in his theory, despite opposition from many eminent scientists of the time who believed that
miasmatic gases rising from the foul smelling open sewers and the Thames were responsible for the deaths. He
was eventually successful in having the Broad Street Pump case-control disabled, whereupon the local outbreak
stopped.
Case-Control Study
This type of study is retrospective, beginning with a definition of a group of cases (people with the disease) and
relating these (along with controls - people without the disease) to the past exposure history. The main drawback of
this type of study is obtaining accurate exposure history, which may need to go back as far as 40 years.
With the case-control study, the investigation compares a group of individuals who have the disease or condition with
another group who does not. The comparison is made with respect to past characteristics of both groups and, of
course, the outcome is known.
NOW
Group of interest (case)
Comparison group (control)
(Have disease)
(Free of the disease)
Examine exposure history
Examine exposure history
Compare and draw conclusions
Case-control study
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The case-control method may be used, for example, to investigate the frequency of asbestos workers who have
respiratory problems or lung disease against a control group drawn from the general population. It is quicker and less
expensive than a prospective (or follow-up) cohort study (see below) and is often used as the first step to see if
there may be an association between a suspected cause and a known effect. It is also useful in investigating a disease
of low prevalence. Unfortunately, case-control studies are generally less informative than prospective studies and
spurious associations are likely to occur.
Prospective Cohort Study
This method is prospective (following the group forward in time) and avoids the problem of tracing exposure history
retrospectively, as with the case-control study.
A prospective cohort study is a specific type of follow-up study, where a population is defined in advance for
exposure characteristics, followed for a period of time and then the outcome measured. These studies are designed
to observe incidence of occupational ill health and should, naturally, extend over a period of time longer than that
required for the outcome to develop.
Such studies are used to determine whether there is an association, for example, between exposure to asbestos (the
cause) and the incidence of lung cancer (the effect) and uses two groups (cohorts) of subjects:
•
Exposed to the agent of interest.
•
Unexposed to the agent of interest (the control group).
The incidence of lung cancer is then calculated for each group and if significantly more people suffer in the exposed
group then there is strong evidence for cause and effect.
NOW
Original cohort - Exposed
Original cohort - Unexposed
(Free of the disease)
(Free of the disease)
Follow-up (years)
FUTURE
Diseased
Disease-free
Diseased
Disease-free
Prospective cohort study
Prospective cohort studies are concerned with the relationship between the cause, as evidenced by the history and
nature of the exposure, and the effect, i.e. the presence of the disease.
Prospective cohort studies provide a more accurate account of exposure related to deaths or disease and a direct
estimate of the risk associated with the causal factors.
However, it may be necessary to wait many years for the development of the disease (mesothelioma might take as
long as 40 years to manifest itself) and some of the cohort may be lost over the period of study.
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Retrospective Cohort Study
Here, the population is selected based on past exposure records. It is very similar to the prospective cohort study,
except that an historic cohort is assembled; that is, they create the cohort from historical records. The current
outcomes of that exposure are then examined and investigated for both exposed and unexposed groups. It is, of
course, much faster than the prospective method, because the ‘follow-up’ period has already occurred in the past!
PAST
Original cohort - Exposed
Original cohort - Unexposed
(Free of the disease)
(Free of the disease)
Check for occurrence of disease
NOW
Diseased
Disease-free
Diseased
Disease-free
Retrospective cohort study
Limitations of Epidemiology
The main problems of epidemiological studies include:
•
The ‘healthy worker’ effect, whereby the control group has a different health status compared with the cases
to be studied (pre-employment health screening has the effect of excluding less healthy individuals and
consequently raising the general health of employed persons in comparison to those not in work).
•
A poor response rate which reduces the sample size and its statistical significance.
•
A high turnover of study populations.
•
The latency period between exposure and effect, which is longer than the study period.
•
Poor quality of health effects data and/or exposure data.
•
No effect of exposure noted, which may be a consequence of a poor or small study population.
Toxicological Testing
Animal Testing
Toxicity tests tend to share certain basic principles. They usually involve exposing experimental animals to the test
substance under controlled conditions. The relevant test methods are described within the European Union Test
Methods Regulation (EC 440/2008). These Regulations are themselves based on the Organisation for Economic
Co-operation and Development (OECD) Mutual Acceptance of Data framework which member states of the OECD
should comply with. The OECD produces a list of member states signed up to the Mutual Acceptance of Data
Framework accessible from the OECD website (www.oecd.org). The animal test methods include tests for:
•
Acute toxicity - testing for the short-term onset of effects following a single exposure by various routes, such as
oral (ingestion), inhalation, dermal (i.e. skin), dermal irritation/corrosion and eye irritation/corrosion.
•
Skin sensitisation - testing for potential of contact dermatitis.
•
Repeated dose (28 days) toxicity - testing for the medium-term onset of effects, following multiple exposures
by various routes, such as oral, inhalation and dermal.
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•
Sub-chronic repeated dose (90 days) toxicity - testing for the longer-term onset of effects following multiple
exposures by various routes, such as oral, inhalation and dermal.
•
Chronic toxicity - testing for the long-term onset of effects, following lifetime multiple exposures by various
routes, such as oral, inhalation and dermal.
•
Mutagenicity - testing to determine if the substance has the ability to cause genetic damage and the potential to
induce cancer.
•
Carcinogenicity - if mutagenicity tests prove positive, the animal is subjected to lifetime exposure to the
substance and, at post-mortem, an examination is carried out to detect tumours.
•
Reproductive toxicity - to examine the effect of the substance on the development of the embryo and foetus,
to identify gross anatomical abnormalities.
These are just a selection of the many test categories.
One of the main types of toxicity tests is described as follows.
Acute Toxicity Tests and the Fixed Dose Test
Acute toxicity tests are designed to determine the effects which occur within a short period of time after dosing.
There are various types of acute test, one of the most important of which is the fixed dose test for determining
hazard classification.
The fixed dose procedure is considered more humane than classical Lethal Dose 50% (LD50 ) testing (described
in detail later). Far fewer test animals are used in the procedure. It is described in Test Methods Regulation (EC
440/2008).
The test substance is administered orally to test animals at one of four dose levels - 5, 50, 300 and 2,000mg/kg, using
a sample of animals. The animals are observed for 14 days.
The actual test is preceded by a ‘sighting’ or ‘range-finding’ study to help determine the starting dose for the main
study. In this, the dose is administered to single animals sequentially - with 24 hours between administering the next
highest dose to the next animal. The dose is increased by successive orders of magnitude, in factors of ten, in order to
establish the range of toxic effects. A more refined main study can then be carried out.
The initial test dose should be chosen to identify toxicity but without mortality occurring. The test determines what is
called the discriminating dose - the dose which causes evident toxicity, but not mortality, and which must be 5, 50,
300 or 2000mg/kg. The result is then compared with regulatory criteria in order to classify the chemical toxicity.
Advantages of Animal Testing
There are many advantages to animal testing; for example, it:
•
Does not rely on exposing people to chemicals, thereby preventing
human disease and suffering.
•
Can be quicker and cheaper than epidemiological studies on human
populations.
•
Provides good-quality information about the effects of exposure to
certain chemicals that could not be determined by other types of study,
such as in-vitro studies.
•
Allows the long-term effects of exposure to low doses to be studied,
replicating the actual types of exposure that workers might experience
at work.
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Animal testing has many advantages,
including providing good-quality
information about exposure effects
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Limitations of Animal Testing
These studies are not without their limitations:
•
Responses vary between species, so the application to humans may be questionable.
•
Testing on animals raises ethical questions and should be avoided where possible.
•
Diseases like cancer may have a number of contributing factors (e.g. lifestyle).
•
These studies may take a long time and be expensive (though not usually as long or as expensive as human
epidemiological studies).
Alternatives to Animal Testing
In-Vitro Studies
Toxicology tests that can be done in vitro (this means in a test tube, or on a petri dish) rather than in vivo (in a living
animal) have the advantage of being relatively quick and cheap. These types of tests make use of bacteria, yeast, or
cell or tissue cultures grown outside of a living animal, to test the toxic effects of chemicals. In these types of tests
cells are grown in a culture medium containing nutrients and are then subjected to testing. The way that the cells
respond to and metabolise the test chemical can be studied by observing cell growth and behaviour, and analysing the
chemical composition of the growth medium and the cells themselves.
One good example of this sort of test is the Ames test for mutagens:
•
The test makes use of a strain of bacteria that have a defective histidine gene. This gene is normally responsible
for the production of histidine inside the bacteria. However, in the defective gene, one single mutation has
knocked out the gene’s function.
•
Histidine is an amino acid. If the bacteria cannot make or get histidine then they die.
•
The bacteria are normally grown in a medium that contains histidine (since they are unable to make it for
themselves).
•
When the test is conducted, the bacteria are mixed with the chemical that is being tested.
•
They are then plated out to grow in a medium without histidine.
•
If the bacteria grow then they must have made their own histidine. The only way this can have occurred is if the
defective histidine gene was mutated back to the active version. The chemical is a mutagen.
•
If the bacteria die then the defective histidine gene has not been changed back to its active form. The chemical is
not a mutagen.
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.
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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 databases of information on known chemicals and human
biochemistry. Like read-across, QSAR is quicker and cheaper than most forms of in vivo testing and epidemiological
study.
Grouping and ‘Read Across’
Substances that have common properties, or that follow a regular pattern of results, can be grouped together.
Applying the grouping concept means that properties may be predicted from information and testing undertaken on
a similar substance. The transfer of information from one substance to another is known as ‘read across’.
The OECD have developed guidance for grouping chemicals whose toxicological properties are similar which allows
for an estimation of untested chemicals by read-across.
If grouping and read-across are applied appropriately, experimental testing can be reduced because the requirement
to test every substance would be correspondingly reduced.
Dose/Response Relationship
DEFINITIONS
DOSE
The amount per unit body mass of toxic substance to which the organism is exposed.
RESPONSE
The resultant effect.
Toxic substances have very different effects on organisms, including the minimum level at which an effect is
detectable, the sensitivity of the organism to small increases in dose, and the level at which the harmful effect (most
significantly, death) occurs.
Such factors are indicated in the dose/response relationship, which is a key concept in toxicology. In order to define a
dose/response relationship, we must specify the particular effect, e.g. death, and also the conditions under which the
effect is obtained, e.g. length of time after administration of the dose.
If we consider a specific example, we can see that:
•
At low doses, no organisms will show a response, i.e. they all live.
•
At higher doses, all organisms show a response, i.e. they all die.
•
In between, there is a range of doses over which some organisms die and others do not.
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It is possible to plot a graph of dose against response (see example below).
Dose/response curve
The S-shape is typical of a dose/response curve. In the graph shown above:
•
At zero dose, none of the test animals die.
•
At 10mg/kg less than 5% of the test animals die.
•
At 40mg/kg 100% of the animals die.
By extrapolating from the 50% mortality point, we can see that the dose of chemical predicted to kill 50% of the test
population is 23mg/kg.
This point is referred to as LD50 - Lethal Dose 50%.
You should appreciate that LD50 is not an exact value and in recent years there has been much discussion as to its
usefulness and necessity in toxicology. The LD50 values may vary for the same compound between different groups of
the same species of animal.
However, the value is of use in comparing how toxic a substance is in relation to other substances. The following table
gives examples of LD50 values for a variety of chemical substances.
LD50 Values
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Compound
LD50 (mg/kg)
Ethanol
10,000
DDT
100
Nicotine
1
Tetrodotoxin
0.1
Dioxin
0.001
Botulinus toxin
0.00001
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An alternative figure often referred to in toxicology data is LC50. This refers to Lethal Concentration 50% and is the
concentration of an aerosol that, when inhaled, killed 50% of the test population.
The S-shaped dose/response curve can be further analysed mathematically to determine doses that have a higher
or lower probability of fatality. The determination of LD90 from the dose/response curve, for example, enables
estimation of the dose that will kill the majority (i.e. 90%) of a sample of animals.
Remember that the LD50 classification is only a very rough guide to relative toxicity. It tells nothing about sublethal
toxicity and the data is only strictly valid for the test population, e.g. rats and the route of exposure, e.g. ingestion. The
LD50 tells us nothing about the shape of the dose/response curve on which it is based. It is possible for two chemicals
to have the same LD50 but one may have a much lower lethal threshold and kill members of the exposed population
at concentrations where the other has no effect.
The use of the classical LD50 testing method has declined with the use of fixed dose testing.
One significant use of the dose/response curve is it allows for the identification of the dose below which no effect or
response is measurable. This is often called the threshold dose and can be clearly demonstrated with responses such
as lethality. This concept of a threshold dose for the toxic effect is an important one and implies that there will be a
dose at which the response does not occur in any member of the population. The term for this is the No Observed
Adverse Effect Level (NOAEL). The NOAEL is important for setting Occupational Exposure Limits (OELs), which are
designed to represent a level of exposure at which there is no evidence of harm.
Testing for carcinogenic potential is more complex, since there is no simple dose/response relationship. It is not
possible to assign a dose below which it can be said that the exposure is safe. There is no threshold below which
cancer does not occur: it must be assumed that any exposure to carcinogenic substances has the possibility of an
adverse effect and it is then necessary to estimate the risk of cancer at various doses.
STUDY QUESTIONS
1. Explain the difference between the case-control epidemiological study and the prospective (follow-up)
cohort study.
2. Describe an example of a retrospective cohort study.
3. Outline the range of toxicity tests that might need to be carried out on a substance.
4. Explain the methodology and purpose of the fixed dose acute toxicity test.
5. Describe a test that can be used to detect genetic mutation.
6. Explain what is meant by the term ‘dose/response relationship’.
7. Sketch a dose/response curve and use the curve to explain the terms ‘LD50’ and ‘LD90’.
(Suggested Answers are at the end.)
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Summary
Summary
Epidemiology and Toxicological Testing
We have described how:
•
Epidemiology and toxicology are two branches of medical science that have allowed the recognition and
classification of chemical health hazards to occur.
•
Epidemiological studies look at the prevalence and spread of disease in populations. Many epidemiological
studies follow cohorts of people over periods of time. Three such types of study are; the case-control study, the
prospective cohort study and the retrospective cohort study.
•
Animal testing of chemicals often involves acute toxicity testing (such as the fixed dose procedure used for
classification). These studies have their limitations.
•
Alternatives to animal testing include: in vitro testing using bacteria, such as the Ames test for mutagenicity, and
predictive modelling, such as QSAR and read-across methods.
•
One of the key tools of toxicology is the dose/response curve that demonstrates the relationship between the
dose of chemical administered and the ill health response that occurs.
•
Dose/response curves can be used to derive three important characteristics of a chemical; LD50, LC50 and the
NOAEL.
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Learning Outcome 9.7
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Summarise how organisations should manage exposure to asbestos and lead in the
workplace.
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Outline the specific requirements for working with asbestos and lead.
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Contents
Specific Requirements for Working with Asbestos
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Asbestos Health Risks
Control of Asbestos
General Preventive Measures
Personal Protection
Cleaning of Plant and Premises
Packing, Transport and Storage
Waste Disposal and Collection
Use of Specialist Contractors
Supervision of the Health of Workers
Information, Labelling, Education and Training
Lead
Health Surveillance for Workers
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Specific Requirements for Working with Asbestos
Specific Requirements for Working with Asbestos
IN THIS SECTION...
•
Asbestos causes several serious ill health conditions: asbestosis, lung cancer, mesothelioma, and pleural thickening.
•
Chapters 5 to 11 of the ILO Code of Practice - Safety in the Use of Asbestos outline the controls that should be
implemented when working with asbestos:
–– The general methods of control which should be employed include: elimination of exposure, or reduction to
the lowest possible level through the use of engineering controls, such as enclosure and LEV extraction.
–– Where exposure can’t be controlled to an acceptable level, respiratory protective equipment (RPE) and
personal protective equipment (PPE) should be used.
–– Plant and equipment should be cleaned so as to remove contamination from surfaces.
–– Asbestos-containing materials should be stored in secure bags, clearly labelled with the recognised asbestoswarning labels. This applies to products as well as wastes.
–– Asbestos materials should be transported in secure containers.
–– Disposal should be via an approved waste disposal site and disposal contractors should be supervised.
–– Health surveillance should be carried out: before workers begin asbestos work, at regular intervals, and on
ending employment, in order that their health status is monitored.
–– Workers (including those who implement asbestos controls) should be trained in the hazards, risks, and
controls associated with asbestos exposure.
•
Lead is a toxic metal that can cause damage to the central nervous system.
•
Control of exposure to lead often requires biological monitoring (taking blood or urine samples) as a form of
health surveillance, and the observation of action levels and suspension levels for concentrations of lead in blood
and urine.
•
Different levels of protection are necessary for young persons and women of reproductive capability.
Asbestos Health Risks
Asbestos is a generic name given to a collection of naturally-occurring
minerals that have been used extensively as fire-resistant building and
lagging materials. Though the use or importation of asbestos has been
banned since 1999, the material was widely used before that date and so
many buildings, structures and articles will contain asbestos.
The three principal mineral forms of asbestos are blue (more correctly
known as crocidolite), brown (amosite) and white (chrysotile). The naming
of asbestos by colour as an easy way of referencing the type of mineral is
usual. However, the appearance of asbestos incorporated into an AsbestosWorking with asbestos
Containing Material (ACM) cannot normally be used as an indication of
the type of asbestos present. Crocidolite may be ‘blue’ asbestos, but it may
not appear blue when observed in an ACM. The actual type can usually only be determined by technical analysis.
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Historically, asbestos has been incorporated into many building parts, such as:
•
Roofs (e.g. corrugated asbestos cement sheets).
•
Ceilings (e.g. ceiling tiles).
•
Walls and ceilings (e.g. fire breaks).
•
Floors (e.g. vinyl floor tiles).
•
Pipes (e.g. rainwater downpipes).
•
Decorative plasters (e.g. artex).
•
Insulation (e.g. pipe lagging).
It may also be found as asbestos rope or gaskets in old equipment, such as furnaces, chemical pipework, or boilers. It
is also a common friction lining in machinery (e.g. brake linings, clutch plates, etc.).
Asbestos is hazardous by inhalation. Four forms of disease are associated
with asbestos exposure: asbestosis, lung cancer, mesothelioma and pleural
thickening. The symptoms of these diseases do not become apparent
until years after exposure has occurred (typically 10-15 years for asbestosis
and 30-40 years for mesothelioma). Though asbestos use is now banned
or seriously restricted in most countries, it remains a serious health risk
as it is still present in many buildings. Any work on existing structures
where asbestos is present involves the potential to disturb it. Demolition,
refurbishment, installation and even minor repair work can expose
workers to asbestos by inhalation.
•
Asbestos can still be found in many
workplaces
Asbestosis - a collagenous pneumoconiosis, induced when the fibres
are inhaled into the lung alveoli and then migrate into the surrounding tissues. The fibrotic reactions caused by
asbestosis lead to a progressive development of inelastic scar tissue and thickening of the pleural membranes.
The main symptoms of asbestosis are breathlessness, coughing, pain between the shoulder blades or behind
the sternum (breast bone). In the later stages of the disease, lung function is markedly reduced and, with
complementary heart strain, death may ensue.
•
Lung cancer - a cancer of the lung tissue. The risk to a person working with asbestos of contracting lung cancer
has been shown to be ten times that of the general population. The combined effect of smoking tobacco and
working with asbestos is another well-documented factor in the development of lung cancer. In this case, the risk
to the asbestos worker who smokes compared with the non-smoking general public is 90 to 1.
•
Mesothelioma - a cancer of the pleural membranes surrounding the lungs. It appears that asbestos fibres are
able to migrate through lung tissue following inhalation and can have a toxic effect in adjacent tissues.
•
Pleural thickening - thickening of the lining tissue of the lung (sometimes known as diffuse pleural thickening)
that causes breathing difficulties.
People at risk from asbestos include those working with lagging and heat insulation materials; construction and
demolition; and vehicle repair (clutch and brake assemblies).
Control of Asbestos
The ILO Code of Practice - Safety in the Use of Asbestos (CoP) is a guidance document which seeks to:
•
Prevent the risk of occupational exposure to asbestos.
•
Prevent harmful effects arising from asbestos dust exposure.
•
Provide reasonably practicable control procedures.
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It is also highly likely that there will be national legislation governing the use and control of asbestos materials, which
would take precedence over this guidance in the workplace.
The CoP calls for the formation of a competent regulatory authority, who should be notified of all work with
asbestos-containing materials that is likely to generate dust.
General Preventive Measures
The first control proposed is the replacement of ACMs with non-asbestos alternatives, which should be selected on
the basis that they are harmless or less harmful. The primary consideration should be the associated health hazards of
the replacement materials.
Methods of Control
All efforts should be made to eliminate the exposure of workers to asbestos, or reduce it to the lowest possible level.
Engineering controls should include:
•
Process separation, automation or enclosure.
•
Bonding asbestos fibres with other materials to prevent dust generation.
•
General ventilation of the working areas with clean air.
•
Local ventilation of processes, operations, equipment, and tools, to prevent dust dissemination (ventilation is
covered in more detail in Learning Outcome 9.8).
•
Use of wet methods, where appropriate.
•
Separate workplaces for certain processes.
Work practices should be implemented where it is possible that asbestos dust may be generated. These include:
•
The use and maintenance of engineering controls.
•
Damping of asbestos materials before handling.
•
Regular cleaning of work areas to remove contamination.
•
Proper use of PPE.
Control Programme
Each employer should establish a written control programme which includes:
•
A description of each operation in which airborne asbestos is emitted, including the:
–– Processes and machinery used.
–– Materials handled.
–– Control devices.
–– Number of exposed workers.
–– Job responsibilities of each worker.
–– Operating procedures.
–– Maintenance practices.
•
A description of the specific means for controlling exposure to asbestos dust.
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•
Engineering plans, safety data sheets, study reports, or other relevant technical information.
•
Air monitoring data on the efficiency of control measures.
•
A description of the work practices or administrative controls needed.
•
A detailed schedule for implementation of the control programme.
Design and Installation
The materials, processes and equipment should be designed so that
asbestos exposure is eliminated or reduced to the lowest practicable level.
Such controls include segregating the asbestos operations from the rest
of the process to reduce the potential for asbestos dust to accumulate.
Direct handling of asbestos-containing materials should be avoided and,
where practicable, the process should be totally enclosed and operated
at negative pressure (using an internal exhaust) which will prevent the
release of fibres. In practice, this would usually require the construction
of a ‘tent’ with a filtered extraction system, ensuring that the enclosure
remains at negative pressure. Workers would enter this area via an airlock
and would be decontaminated on leaving.
Removal and bagging of ACM. Note the
protective clothing and the use of RPE
Dust emission and worker exposure should also be measured, in order to demonstrate that the required standard of
control has been achieved.
Where total enclosure is not practicable, Local Exhaust Ventilation (LEV) should be provided and maintained.
However, this must be subject to strict controls to ensure that the extraction systems are designed and used correctly,
with regular performance checks implemented to ensure efficient operation of the LEV.
General Ventilation
General ventilation should be ensured, to provide a clean supply of air to replace air extracted from the workplace.
The exhausted air must be filtered thoroughly and not returned to the workplace unless strict controls are in place to
check and assure the air quality and levels of asbestos contamination.
Personal Protection
Respiratory Protection
Respiratory Protective Equipment (RPE) should only be used as a temporary or emergency measure, and not as an
alternative to a technical control, or when workers are likely to exceed exposure limits. In these instances, workers
should be informed and required to wear the RPE, whilst employers should supervise to ensure its correct use.
Provision and maintenance of RPE should be without cost to the employee.
There are a number of types of RPE available, including half mask air-purifying respirators, positive pressure systems,
and breathing apparatus - these should be selected giving consideration to the maximum concentration of airborne
asbestos likely to be encountered, together with comfort and fit.
Workers using RPE should be trained in its use and maintenance, and the RPE should be regularly cleaned, checked,
maintained, and stored in an appropriate container.
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Protective Clothing
Protective clothing should be provided when there is a potential for workers’ own clothing to be contaminated. It
should completely cover the workers’ own clothing and should also cover the head. Where protective clothing is
reusable, separate locker rooms should be provided to segregate clean clothing from contaminated workwear, with
vacuum cleaners provided to carry out decontamination of clothing at the entrance to the locker area. Respirators
should remain on during the decontamination process. Shower or washroom facilities should be provided between
the ‘dirty’ and ‘clean’ locker areas, to fully remove contaminants, and personal clothing only put on in the clean
locker room. Appropriate, competent, laundering facilities should be provided by the employer for the contaminated
workwear, and the washing of such items at home should be strictly prohibited.
Cleaning of Plant and Premises
Employers should ensure that, as far as is practicable, work premises remain clean and free from asbestos
contamination and waste. Cleaning should be carried out by methods which prevent dust generation, e.g. vacuum
cleaning, and at a time when no other workers are present. The vacuum-cleaning equipment used for cleaning and
decontamination of workwear must be fitted with appropriate filters to prevent fibre release, collection bags should
be disposable, and provision made for safe containment of a burst bag.
Workers who transport, collect, or dispose of asbestos wastes should be equipped with suitable PPE, and any
contaminated vehicles or equipment decontaminated by a dustless method, such as vacuum cleaning.
Packing, Transport and Storage
The CoP provides detailed guidance on the packing of asbestos materials for storage and transport. In summary, any
asbestos materials should be packed in impermeable bags, clearly marked with an approved asbestos warning and
constructed so as not to degrade or release fibres. They should be stored in an area not exposed to the elements
which may damage the bags through weather damage or ultraviolet (UV) degradation. Additional controls should
be implemented when transporting materials, to ensure that the bag contents are not released or bags damaged,
although provision should also be made for the repair of damaged bags.
Waste Disposal and Collection
Wastes should be collected into appropriate impermeable bags or containers in a way that prevents the release of
asbestos dusts. This will depend largely on the type of material to be disposed of, e.g. during large-scale stripping
operations it may be practical to place plastic sheeting on the floor which can be folded over and sealed to contain
the materials for disposal. In any instance, the wastes should be sealed, isolated, and identified as wastes containing
asbestos materials. The bags should be stored and transported as previously described.
Whilst the CoP also provides detailed guidance on the final disposal of asbestos waste, and gives details of landfill
controls to be implemented, again this is likely to be covered in national legislation. The key requirement is that
employers should ensure that any waste disposal site is capable of accepting asbestos wastes.
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Specific Requirements for Working with Asbestos
Use of Specialist Contractors
Work on asbestos-containing materials should always be done by competent people using appropriate work methods
and precautions.
Many national governments have a system of licensing:
•
Contractors for higher-risk work (where risk of exposure is significant) must be licensed.
•
The client must check the competence of specialist contractors, to ensure they are licensed to undertake work
with asbestos.
•
Lower-risk work can be done without a licence.
Adequate controls to supervise asbestos contractors should be implemented.
Supervision of the Health of Workers
Asbestos workers should be subject to health surveillance - this should take the form of an initial examination before
starting work with asbestos (i.e. on recruitment, or before assignment to an asbestos role), and at periodic intervals.
On leaving employment, an examination should also be carried out to determine the state of health at the point of
finishing work. Health surveillance records should be confidential and retained by the physician.
Information, Labelling, Education and Training
The CoP recognises that there is a link between cigarette smoke and
asbestos in asbestos workers who also smoke, resulting in a greatly
increased risk of bronchogenic (lung) cancer (this is an example of a
synergistic effect). It is, therefore, important that workers are made aware
of this specific risk if they will potentially be exposed to asbestos dust in
the workplace.
All asbestos-containing materials should be labelled with recognised
warning labels using an appropriate symbol. Shown here is an example
of the label used in the UK - other countries will use their own labelling
systems.
All workers should receive training when starting employment and
on a regular, ongoing basis to inform them of the potential sources
of asbestos dusts, potential health effects, the risks associated with
asbestos and smoking, and control methods. This should be delivered in
an appropriate manner using a variety of media. All personnel involved
in the management of asbestos and prevention of disease should also
be trained, including managers and safety professionals. Occupational
health physicians employed to carry out surveillance should also be
appropriately trained.
Example of an asbestos warning label
Source: INDG223 Managing asbestos in
buildings: a brief guide, HSE, 2012 (www.
hse.gov.uk/pubns/indg223.pdf)
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MORE...
The ILO Code of Practice - Safety in the Use of Asbestos is available from the ILO website at:
www.ilo.org/safework/info/standards-and-instruments/WCMS_107843/lang--en/index.htm
The Asbestos Essentials website contains a series of task-sheets that explain how to undertake some of the
more common asbestos work activities safely - see:
www.hse.gov.uk/pubns/guidance/a0.pdf
There is a range of useful documents available from the HSE, including L143 Managing and working with asbestos
(2nd edition), which applies to all asbestos work and, in particular, that which disturbs or is liable to disturb
asbestos-containing materials, available at:
www.hse.gov.uk/pubns/priced/l143.pdf
There is also an HSE microsite for asbestos which provides lots of useful information:
www.hse.gov.uk/asbestos
Lead
The occurrence of lead in the environment is largely because of human activity. Lead is an element in the Earth's
crust and can be released by mining and smelting. Lead is still widely used, for example, the production of leadacid batteries, pigments, ammunition, cable sheathing, lead crystal glass, radiation protection, and in some solders.
Remobilization of historic sources, such as lead in soil, sediment, and water from mining areas is also a source of lead.
As a fume or very finely divided dust, lead inhalation becomes a serious risk as a potential mode of entry.
Control of Exposure to Lead
Control of exposure to lead is best illustrated by examining the regulatory regime in Great Britain as an example. In
Great Britain, the control of lead is subject to the Control of Lead at Work Regulations 2002 (CLAW).
These Regulations require the employer to:
•
Carry out a suitable and sufficient risk assessment.
•
Introduce control measures to eliminate or reduce exposure.
•
Prohibit eating, drinking and smoking in contaminated areas.
•
Maintain control measures.
•
Carry out air monitoring.
•
Carry out medical surveillance.
•
Provide information, instruction and training.
•
Develop procedures to deal with accidents, incidents and emergencies.
The Regulations state that:
•
The risk assessment must identify when an employee’s risk of exposure to lead is significant. Significant in this
context means:
–– Exposure is over half the Occupational Exposure Limit (OEL) for lead.
–– There is a substantial risk of ingestion of lead.
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–– They come into contact with lead that can be absorbed through the skin.
•
Control measures will only be considered adequate provided the relevant OEL has not been exceeded.
•
Medical surveillance must be conducted for all employees where:
–– Their exposure to lead is liable to be significant.
–– Their blood-lead or urinary-lead concentrations exceed one of the given values.
–– A doctor certifies that they must be under medical surveillance.
The medical surveillance requirements under CLAW require not only that a medical examination is undertaken but
also create a statutory requirement for biological monitoring. This means that blood and urine samples have to be
taken routinely for all employees identified with significant exposures.
It is worth pointing out here, though, that two different types of biological limit value exist for lead:
•
Action level - above which the employer must take steps to reduce employee exposure.
•
Suspension level - above which the employer must remove the employee from further lead exposure if
informed to do so by the doctor.
It is also worth noting that, under CLAW, different action and suspension levels exist for:
•
Women of reproductive capacity - this means any woman who is physically and medically capable of becoming
pregnant.
•
Young persons - any 16 or 17 year old.
•
Any other employee - everyone else.
Health Surveillance for Workers
Organisations should develop a framework for workers' health surveillance to take place under controlled conditions,
preferably by an occupational health service set up in accordance with the ILO's Occupational Health Services
Convention, 1985 (No. 161), and Recommendation (No. 171).
The ILO guidance: ‘Technical and Ethical Guidelines for Workers’ Health Surveillance’ lists diseases caused by lead,
and cancers caused by asbestos, as occupational risks where the collection of health information can be used to assess
the effectiveness of implemented control measures.
The use of biological monitoring tests for asbestos and lead are cost effective to undertake but they are not a
substitute for surveillance in the working environment.
STUDY QUESTIONS
1. Outline three diseases associated with asbestos.
2. What does the The ILO Code of Practice - Safety in the Use of Asbestos (CoP) is a guidance document , try
to achieve?
3. What engineering control methods could be used to reduce the risk presented by asbestos?
(Suggested Answers are at the end.)
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Summary
Specific Requirements for Working with Asbestos
We have described how:
•
Asbestos causes several serious ill health conditions: asbestosis, lung cancer, mesothelioma, and pleural thickening.
•
Chapters 5 to 11 of the ILO Code of Practice - Safety in the Use of Asbestos outline the controls that should be
implemented when working with asbestos:
–– The general methods of control which should be employed include: elimination of exposure, or reduction to
the lowest possible level through the use of engineering controls, such as enclosure and LEV extraction.
–– Where exposure can’t be controlled to an acceptable level, respiratory protective equipment (RPE) and
personal protective equipment (PPE) should be used.
–– Plant and equipment should be cleaned so as to remove contamination from surfaces.
–– Asbestos-containing materials should be stored in secure bags, clearly labelled with the recognised asbestoswarning labels. This applies to products as well as wastes.
–– Asbestos materials should be transported in secure containers.
–– Disposal should be via an approved waste disposal site and disposal contractors should be supervised.
–– Health surveillance should be carried out: before workers begin asbestos work, at regular intervals, and on
ending employment, in order that their health status is monitored.
–– Workers (including those who implement asbestos controls) should be trained in the hazards, risks, and
controls associated with asbestos exposure.
•
Lead is a toxic metal that can cause damage to the central nervous system.
•
Control of exposure to lead often requires biological monitoring (taking blood or urine samples) as a form of
health surveillance, and the observation of action levels and suspension levels for concentrations of lead in blood
and urine.
•
Different levels of protection are necessary for young persons and women of reproductive capability.
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Learning Outcome 9.8
NEBOSH International Diploma for Occupational Health and Safety Management Professionals
ASSESSMENT CRITERIA
• Describe different types of ventilation systems, say when these are required and the
obligation to provide different types of personal protective equipment (including
respiratory protective equipment).
LEARNING OBJECTIVES
Once you've studied this Learning Outcome, you should be able to:
• Explain the uses and limitations of dilution ventilation and the purpose and operation of
local exhaust ventilation, including assessing and maintaining effectiveness.
• Explain the effectiveness of various types of Personal Protective Equipment (PPE) and the
factors to consider in selection of PPE.
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Contents
Ventilation
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Introduction to Ventilation
Local Exhaust Ventilation (LEV)
Stages to Carrying out Examination and Testing
Interpretation of Reports
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Personal Protective Equipment and Respiratory Protective Equipment
9-192
Introduction to Personal Protective Equipment
Respiratory Protective Equipment (RPE)
Types of Respirator
Types of Breathing Apparatus (BA)
Selection of RPE
Skin and Eye Protection
Selection of Skin and Eye Protection
Storage and Maintenance of PPE
Training Requirements
Duty to Ensure PPE is Worn Correctly
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Ventilation
IN THIS SECTION...
•
Dilution ventilation is a form of engineering control, where the airborne concentration of a substance is kept to
acceptable levels, by changing the air volume (passively or with fans).
•
Local Exhaust Ventilation (LEV) systems work by removing contaminated air at the point of generation, and are
made up of five basic parts: hoods, ducts, air cleaner, fan and discharge.
•
LEV can be classified into three types, depending on the nature of the hood: enclosing, receiving and capturing.
•
Elements of the LEV system have to be carefully designed and selected, to ensure correct and efficient operation.
•
A range of air-cleaning devices can be used to remove contaminant from the captured air before discharge. Bag
filters, cyclones, electrostatic precipitators and scrubbers are typically used for particulates; and tower scrubbers,
incinerators and charcoal filters used for gas and vapour.
•
LEV systems capture contaminant from a specific zone adjacent to the inlet hood. If contaminant is generated by
work outside of this capture zone, then the contaminant will not be efficiently drawn into the LEV system.
•
LEV systems must be subjected to thorough examinations and tests to ensure their ongoing effectiveness. This
thorough examination comprises a three-stage process:
–– Stage 1 - visual examination of the system.
–– Stage 2 - quantitative assessment of performance by measuring parameters, such as face velocity, transport
velocity and static pressure. Devices, such as anemometers, pitot tubes and manometers are used to measure
these parameters.
–– Stage 3 - qualitative assessment of performance using dust lamps or smoke to visualise air movement.
•
The resulting Report of Thorough Examination and Test must be interpreted and acted upon.
Introduction to Ventilation
We have already seen (in Learning Outcome 9.5) that the hierarchy of
control measures available to prevent exposure to hazardous chemicals
includes:
•
Elimination of the substance, or replacement with less toxic substances.
•
Engineering controls, such as total enclosure and ventilation systems.
•
Personal Protective Equipment (PPE).
Although elimination of the substance (e.g. by change of work method),
or replacement of the substance with a less hazardous one, are preferred
options, in practice engineering controls and/or PPE are the measures most
widely employed.
Replacement of hazardous chemicals
with less toxic ones helps prevent
exposure to harm
Examples of commonly used engineering controls include:
•
Dilution ventilation.
•
Local Exhaust Ventilation (LEV).
This section looks at these ventilation controls.
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Uses and Limitations of Dilution Ventilation
Dilution Ventilation
Dilution ventilation operates by simply diluting the contaminant concentration to an acceptable level. This is achieved
by efficiently changing all of the air in a workplace over a given period of time, i.e. air changes per hour.
Dilution ventilation is sometimes achieved using a passive system, where natural air movement in a room or building
is used. With active systems, workplace air is extracted by the use of fans set in the walls or roof.
These systems remove gaseous contaminants (sometimes fumes) and have two main applications; these are to:
•
Reduce the concentration of a contaminant to below the Occupational Exposure Limit (OEL).
•
Keep the concentration of a flammable substance to below its lower explosive limit.
Where both a harmful and flammable substance is encountered, e.g. propanone (acetone), then achievement of the
first objective will also control the second.
Passive dilution ventilation
Dilution ventilation has fairly limited use as an effective control strategy in occupational hygiene. However, it can be
used with reasonable success, provided the contaminants conform, where applicable, to the following:
•
The OEL of the harmful substance is high.
•
The vapour pressure of any liquid hazardous substances is low, i.e. it has a low evaporation rate.
•
The rate of formation of a gaseous product is slow.
•
Operators are not in close contact with the contamination generation point. In particular, the point of generation
must be distant from any person’s breathing zone (a notional spherical zone in front of the person’s nose and
mouth from which inhaled air is drawn into the lungs).
•
A hazardous substance is carried swiftly away from the operator, e.g. by hot gases.
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When contaminants are to be removed from a workplace using dilution ventilation, two important criteria have to be
considered:
•
The first is the rate of contaminant generation, and hence the number of air changes per hour required.
Relevant factors involved in contaminant generation of vapour from liquid include the:
–– Vapour pressure and potential to evaporate at the operating temperature of the system.
–– Surface area of the liquid in contact with the workplace air.
–– Potential increased surface area, e.g. contact adhesives generate vapour at a much greater rate after they have
been spread over a surface.
•
The other criterion is the position of the extraction fans.
The important factor that controls the positioning of the extraction fan unit
is the density of the contaminant. The vapour density of many common
solvents is greater than one (1), therefore they tend to layer over the lowest
floor area in the workplace. For such conditions, fans should be positioned
in the walls at a low level. Where there is a fire hazard, e.g. in the use of
ethoxyethene (ether), the motors of the fans should be flameproofed to at
least a zone 1 classification, i.e. an area where an explosive mixture is likely
to occur during normal working.
Where the density is less than one (1), the contaminant will rise; for this
situation, the fan must be positioned high on the workplace walls or in the
roof. Simple axial (propeller-type) fans are often used for simple dilution
ventilation systems, as illustrated in the image.
Propeller fan
Source: HSG258 Controlling airborne
contaminants at work - A guide to Local
Exhaust Ventilation (LEV), HSE, 2017
(www.hse.gov.uk/pubns/priced/
hsg258.pdf)
A major problem in setting up an efficient dilution ventilation system is the
formation of dead areas. These are areas in the workplace which, owing to
the airflow pattern produced by the extraction fan and the inlet of make-up air, remain dormant and so the air is not
changed. Dead areas can be detected by the use of smoke tracer tubes. A high density of smoke will remain in the
unventilated areas.
A secondary problem with dead areas is that they can move from one position in the workplace to another. Such
moves can be produced by changing inlet for the make-up air, i.e. in cold weather the inlet may be spread over the
workplace via the cracks in windows and doors. In hot weather, indiscriminate opening of doors and windows will
produce a quite different flow pattern. Moving the position of machinery or workbenches can also cause the same
problem. To help reduce the problem, controlled air make-up inlets can be constructed.
Where large quantities of air are being used to carry out the dilution process, then consideration must be given to
recycling heat losses from the workplace. It can be achieved by using heat exchange systems, whereby make-up air is
heated by the exhausted air.
Air Changes Per Hour
In a situation where dilution ventilation is to be used as a control measure it will be necessary to specify the air
changes per hour needed to achieve the required rate of dilution. The air changes per hour gives the rate of dilution
ventilation and is normally expressed as the number of room volume changes achieved in one hour.
Air changes per hour is calculated as:
(total volume of air that passes through a room in one hour) / (total volume of the room)
The air that passes into a room is often referred to as the ‘throughput air’ or ‘make-up’ air.
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So, for example, for a room with dimensions of 5m x 5m x 3m the room volume can be calculated as 5 × 5 × 3 =
75m3.
If this room is ventilated by an active system with 1,000m3 of throughput/make-up air per hour, then the air changes
per hour can be calculated as 1,000 / 75 = 13.3 air changes per hour.
If the specification for the ventilation system is to achieve a dilution rate of between 10 and 15 air changes per hour,
then the system would be well within specification.
Local Exhaust Ventilation (LEV)
Local Exhaust Ventilation (LEV) operates by removing contaminated air at the point of generation, and ducting it
away from work areas. The contaminated air might then be cleaned and is then exhausted to the atmosphere.
In general, a local exhaust ventilation system is made up of five main parts:
•
Hood(s) - the purpose of the hood is to collect airborne contaminants at, or near, where they are created (the
source).
•
Ducts - the purpose of the duct is to carry the airborne contaminants away from the work area.
•
Air cleaner - the purpose of the air cleaner is to filter and clean the extracted air.
•
Fan - the purpose of the fan is to provide a velocity to the air sufficient to allow the capture hood to capture the
contaminant, and for the air flow in the ducting to be sufficient to transport the contaminant.
•
Discharge - the purpose of the stack, or discharge point, is to allow an exit point for the air pulled through the
system. As the air velocity reduces, the heavy particles will drop to the bottom of the discharge point. The lighter
contaminants will be dispersed from the top of the discharge point. The discharge point allows for the safe release
of cleaned, extracted air into the atmosphere.
A typical system is shown below.
A typical LEV system
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LEV systems can be very small, such as those fitted to hand tools, or very large, such as a walk-in paint-spray booth.
Various types and sizes of LEV systems are illustrated in the following figures.
On-tool extraction - soldering iron
On-tool extraction - hand sander
Fixed capturing hood
Moveable capturing hood
Small booth
Walk-in booth
Source: INDG408 Clearing the air - A simple guide to buying and using Local Exhaust Ventilation (LEV),
HSE, 2016 (www.hse.gov.uk/pubns/indg408.pdf)
Hoods
LEV systems are often classified according to the type of hood used to receive the contaminant. Though hoods come
in a wide variety of types these can be classified into three main categories:
•
Enclosing hoods,
•
Receiving hoods, and
•
Capturing hoods.
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• Enclosing Hood
These are the most effective hoods. A full
enclosure is where the process is completely
enclosed, e.g. a glove box. A partial enclosure
contains the process with openings for material
and/or operator access, e.g. walk-in booths and
fume cupboards.
• Receiving (Receptor) Hood
The process usually takes place outside the hood. The
hood receives the contaminated air, which has a speed
and direction that is usually process-generated. This
speed and direction is taking the contaminated air into
the hood. Hoods can be fixed or moveable. A canopy
hood over a hot process is an example of a receiving
hood.
An enclosing hood
A receiving hood
Source: HSG258 Controlling airborne contaminants at
work - A guide to Local Exhaust Ventilation (LEV), HSE,
2017
(www.hse.gov.uk/pubns/priced/hsg258.pdf)
Source: HSG258 Controlling airborne contaminants at work - A
guide to Local Exhaust Ventilation (LEV), HSE, 2017
(www.hse.gov.uk/pubns/priced/hsg258.pdf)
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•
Capturing (Captor) Hood
The process, source and contaminant cloud are outside
the hood. The hood has to generate sufficient airflow to
‘capture’ and draw in the contaminated air. Hoods can
be fixed or moveable. This is the most common type of
LEV hood.
Within these three categories, there are many different
types of design to suit different workplace applications and
types of contaminant.
Some general principles can be applied to LEV hood design:
•
Enclose the source of the contaminant as much as
possible, as this increases LEV effectiveness significantly.
•
Position the hood as close as possible to the
contaminant source and in a way to take advantage of
the speed and direction of the contaminated air.
•
Match the hood size to the process and contaminant
cloud size.
•
Keep the contaminant cloud away from the worker’s
breathing zone; inhalation of contaminated air must be
minimised.
•
Minimise eddies within the hood.
•
Make sure the hood is comfortable to use and practical for the way the worker actually does the job.
•
Trial and test LEV before putting into full use.
A capturing hood
Source: HSG258 Controlling airborne contaminants at
work - A guide to Local Exhaust Ventilation (LEV), HSE,
2017 (www.hse.gov.uk/pubns/priced/hsg258.pdf)
Ducting
Ducting should be as straight as possible. Where bends or joins are required, gentle bends and acute angle joins are
good practice. Ducting should be well supported and care taken to see that where solids are extracted, airflow is
sufficient to prevent deposition of solids, which might cause the system to collapse. Access ports should be provided
to allow for regular cleaning.
Examples of good and bad duct design
Source: HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV), HSE, 2017 (www.
hse.gov.uk/pubns/priced/hsg258.pdf)
The design of the junction on the left allows air to flow smoothly down both ducts and meet with minimal
turbulence. The design on the right has a right angle T junction which will cause turbulence as the two airstreams
meet.
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Filter or Purifying System
It is important that the appropriate system is used, especially if neutralising toxic gases. For particulate solids, physical
methods of separation are required, such as cyclones or bag filters. Care must be taken to see that the correct type of
filter is used (e.g. cyclones are not suitable for very fine particles). Owing to the dynamic nature of cyclones and the
resultant generation of static electricity, the potential for dust explosions can be high.
A bag filter - one of the simplest filtration methods used in LEV systems
Source: HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV), HSE, 2017 (www.
hse.gov.uk/pubns/priced/hsg258.pdf)
Ideally, the air cleaner or arrestor, will remove contaminants to well below any relevant OEL. Total removal of the
contaminant is rarely possible.
There is a wide variety of cleaning devices suitable for different applications. The choice of device used depends on
many factors, the most important of which is the nature of the contaminant.
The most common group of air cleaning devices is particle collectors. These fall into four types:
•
Fabric filters - which use socks or bags to filter out the particulates in much the same way as a bag-style domestic
vacuum cleaner does.
•
Cyclones - cone-shaped collectors spin particles out of the contaminated airflow (as used in a Dyson vacuum
cleaner).
•
Electrostatic precipitators - that give particles an electrostatic charge and then attract them out of the
airstream, using plates with the opposite charge.
•
Scrubbers - where the particles are wetted and then washed out of the airstream.
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The alternative group of air-cleaning devices are gas and vapour collectors. These fall into three main types:
•
Destruction - where the gas and vapour is destroyed by burning or thermal oxidation.
•
Tower scrubbers - where the contaminated air is passed through a vertical column containing a matrix, through
which water is passed - this removes the contaminant from the airstream.
•
Recovery - where the gas or vapour is filtered out (often using activated charcoal filters) and can then be
reclaimed.
Ventilation Fans and Motors
It is important that the correct type of air mover (a fan or an air moving engine) is installed to suit the design of the
ventilation system. The capacity of the air mover engine, or fan motor, is important; it must have sufficient power to
cope with normal working conditions but have sufficient margin to deal with overload situations. Centrifugal fans, as
shown in the following figure, are typically used in LEV systems.
A centrifugal fan
Source: HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV), HSE, 2017 (www.
hse.gov.uk/pubns/priced/hsg258.pdf)
Discharge to Atmosphere
Extracted air must not re-enter buildings unless the contaminant has reached negligible concentrations. The position
of the discharge point (exhaust stack) and the velocity and direction of the discharged air are therefore important.
Discharged air must leave the discharge duct at a high enough speed to make sure it is dispersed. Discharge is
normally via a ‘stack’.
Typical stack design
Source: HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV), HSE, 2017 (www.
hse.gov.uk/pubns/priced/hsg258.pdf)
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Buildings have a boundary layer of air around them where the air is very slow moving and eddies occur. Air within
this boundary layer does not rapidly move away from the building and dilute; instead it ‘clings’ to the building. If the
discharged air is exhausted into this boundary layer, then contaminated air can be re-circulated back into the building.
Therefore, tall stacks are preferred. However, tall stacks may not gain planning approval - the Environment Agencies
(EA, SEPA) or local authorities may have stipulations for stack height.
It is also possible that the employer may need a permit from the environmental regulator for discharges to the
atmosphere. This might be required under the Environmental Permitting (England and Wales) Regulations 2016.
Source Strength and Capture Zones
Worker exposure to an airborne contaminant depends on many things, including source strength and the distance
from the source. Source strength is the combination of the volume rate of release of the contaminant cloud, the
cloud volume, shape and speed, and the concentration of the contaminant.
Two important characteristics of any LEV system are the capture zone and the capture velocity. The capture zone is
the area around the inlet to the LEV system from which the system is extracting contaminated air. Capture velocity is
the velocity required at a contaminant source to overcome the movement of the contaminant cloud and draw it into
the hood. Fast-moving contaminant clouds are very difficult to control with a capturing hood. They normally require
a partial enclosure or receiving hood.
Example capture velocities are given below.
Contaminant cloud release
Example of process
Capture velocity range, m/s
Into still air with little or no energy
Evaporation, mist from
electroplating tanks
0.25 to 0.5
Into fairly still air with low energy
Welding, soldering, liquid transfer
0.5 to 1.0
Into moving air with moderate energy
Crushing, spraying
1.0 to 2.5
Into turbulent air with high energy
Cutting, abrasive blasting, grinding
2.5 to >10
Based on table from HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV),
HSE, 2017 (www.hse.gov.uk/pubns/priced/hsg258.pdf)
Since the actual velocity achieved at a capturing hood is determined by the shape of the hood, the rate of airflow
into it and the distance from the inlet at which the velocity is measured, it is important that the capture velocity for a
contaminant is known, so that the correct specification of capturing hood can be determined.
Effective
Partly effective
Ineffective
Based on extract from HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV),
HSE, 2017 (www.hse.gov.uk/pubns/priced/hsg258.pdf)
These pictures illustrate how distance away from the hood influences the amount of contaminant captured.
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The dust produced has a particular capture velocity above which it will be drawn into the LEV, but below which it will
not be effectively extracted.
As the working zone (where the chisel is being used, in the previous example) moves away from the LEV hood, so
the actual velocity of air achieved in that zone drops. The area indicated by the yellow dotted line is the capture zone
inside which the dust will be effectively extracted.
Capture velocity is not normally measured as a part of routine LEV testing, since it is a property of the contaminant
and forms a part of the initial design specification for the LEV.
LEV Thorough Examinations
A new LEV system should be carefully examined and tested as part of the commissioning procedure to ensure it is
able to meet its design specification:
•
All hoods should be examined in detail to ensure they effectively capture or contain the contaminant. This may be
done by using smoke generation to follow the airflow around a hood, or by taking airflow measurements.
•
Manometers (pressure gauges), such as U-tubes (see later), can be used to measure static pressures at
hoods or enclosures. They can also be used to measure pressure drops across filters or air-cleaning plant.
The measurements will confirm the suitability of airflow distribution and be in agreement with the design
specification.
•
Where the LEV system is designed to extract dust, it should be checked for duct velocity, to ensure that ducts will
remain free of dust settlement.
•
The air-cleaning plant and fan should also be checked for compliance with the design specification.
These measurements will also form a basis on which performance is assessed during routine checks and local
statutory examination and testing that may be required. The frequency of routine checks should be linked to the
type of engineering controls used in the LEV system and the extent of the risk if the system failed or deteriorated.
The description of the inspection activity will be set out in the system logbook. An LEV logbook will contain schedules
for regular checks and maintenance, records of the checks and maintenance carried out, and checks on compliance
with the correct way of working with the LEV system.
Legal Requirements
There may be specific legislation that requires the routine thorough examination and test of LEV systems. In Great
Britain’s regime, for example, the Control of Substances Hazardous to Health Regulations 2002 (COSHH),
requires thorough examination and testing to be performed at least once in every 14 months. Similar basic
requirements for inspection and testing of LEV are contained in the Control of Lead at Work Regulations (14
months) and the Control of Asbestos Regulations (6 months).
For certain processes, such as blasting of metal castings, a more frequent examination interval may be specified.
The examination and test is to ensure that the control measures continue to perform as originally intended.
Competence of those Carrying out Testing
The statutory thorough examination and test must be carried out by a competent person. This is usually an external
contractor, but can be an engineer working for the employer (LEV owner). In the UK, competent in the context of
an LEV test engineer may mean possessing qualifications through the British Occupational Hygiene Society (BOHS),
Chartered Institution of Building Service Engineers (CIBSE), or the associated Institute of Local Exhaust Ventilation
Engineers (ILEVE). There is a UKAS accreditation scheme for LEV Thorough Examination and Test (TExT) that can
also be used as proof of competence.
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Understanding the Risks from the System
When in operation, the LEV system should be safe to inspect, maintain and clean. This may mean hazards can be
presented by poor accessibility, skin contamination from waste removal, and changing filters without spreading
contaminants into the workplace.
The operation of the LEV system is likely to cause a significant noise hazard. The noise of the LEV operating and the
noise of other processes taking place may trigger action values for the management of noise. Noise will originate
from the fan motor, air moving motor, fan blade design, turbulence in ducting and air flow around small capture
hoods.
The LEV examiner must be aware of the health risks associated with residues (e.g. of dust) still contained in the LEV
system as well as risks presented by rotating parts, working at height (stack examination), electricity and any manual
handling, e.g. of ducting/fan motors, etc.
The dusts being collected and the residues of collected dusts may also present the risks of fire and/or explosion,
depending on the hazardous nature of the dust.
The employer and examiner should cooperate to reduce risk, so far as reasonably practicable, for both the examiner
and operators who may be affected by the work. Safe systems of work may require permits-to-work and safe access.
The employer should also provide information about personal protective equipment requirements.
Stages to Carrying out Examination and Testing
Employers and employees should cooperate with the person conducting the tests. During the physical examination
the LEV system should be accessible, not blocked by stored work, etc.
Cooperation also means providing any sources of information that the examiner may need to competently perform
the inspection.
Information should be provided on monitoring that has taken place, or any alterations to the system that have been
made. The examiner should have a copy of the commissioning report and any log books on routine testing.
Stage 1 - Visual Inspection of LEV
LEV systems have to be maintained in efficient working order. One of the ways in which the performance of an LEV
system can be checked is by visual inspection. This gives a qualitative indication of performance.
A visual inspection of an LEV system might include examination of:
•
All external parts of the system for damage, wear and tear.
•
Internal duct and hatch seals.
•
Filter material and any built-in filter pressure gauges.
•
Filter cleaning devices, to ensure they work properly.
•
Water flow and sump in a wet scrubber.
•
Monitors and alarms fitted to the system.
•
The fan and associated drive mechanism, e.g. fan belt.
In particular, indications of ineffectiveness are looked for, such as:
•
Deposits of settled dust in and around the LEV hood.
•
Excessive system vibration or noise.
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The exact nature of any visual inspection carried out as a check on LEV would vary, depending on the type of LEV, the
frequency of the check and the competence of the person carrying it out. For example, a machine operator might be
tasked with carrying out a daily visual check of the external parts of a system prior to use.
During a thorough examination of LEV, the first stage of the process would be a visual examination of all of the above
matters.
Stage 2 - Measuring Technical Performance
Quantitative methods are used to measure the technical characteristics of the LEV system for comparison against its
design specification.
Transport Velocity
Transport velocity is the air velocity required to convey particles and prevent deposition in ducts. LEV will often
have a transport velocity (or duct velocity) stated in its specification, most particularly when it is used to extract dust,
fumes or fibres (i.e. particulates rather than gas or vapour).
The transport velocity is an important parameter to measure, because if the airflow velocity in ductwork falls too
low, particles will no longer be transported through the system and will be deposited in the duct. Example transport
velocities are given in the following table.
Type of contaminant
Gases and non-condensing vapours
Indicative transport velocity, m/s
No minimum value
Condensing vapours, fume and smoke
Up to 10
Low or medium density, low moisture content dusts
(plastic dust, sawdust), fine dusts and mists
Up to 15
Process dust (cement dust, brick dust, wood shavings,
grinding dust)
Around 20
Large particles, aggregating and damp dusts (metal
turnings, moist cement dust, compost)
Around 25
Airflows in ducts can be measured using an anemometer (air velocity meter). One problem with using an
anemometer to measure duct velocity is inserting the anemometer into the duct. If a large rotating vane anemometer
were used for this purpose, it would require a large opening to be made in the duct, which would change the
operational characteristics of the system and make the measurement meaningless.
Consequently, the type of anemometer typically used to measure duct velocity is the pitot static tube. This is a
device that measures velocity pressure inside the ventilation system, i.e. the pressure caused by the movement of air
in the duct. The reading is then converted to velocity using a simple formula.
The measuring head consists of two concentric tubes, one facing and one perpendicular to the airflow. The tubes are
connected to each side of a manometer, and so measure the pressure difference between the static pressure in the
duct and that generated by the airflow.
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Pitot static tube
Static Pressure
Static pressure is the air pressure measured perpendicular to the airflow direction, i.e. the difference between inside
and outside air pressure. Static pressure is frequently used in the specification of all types of LEV and is routinely
measured as one of the indicators of performance.
Static pressure is measured using a pressure gauge, of which there are several types, such as:
•
Manometer - a device that measures pressure by displacing a column of liquid in a U-shaped tube. The
manometer is calibrated so that liquid displacement can be related to actual static pressure. A point to note is that
the manometer always measures a pressure difference. If the end of the manometer is open, it measures pressure
relative to atmospheric pressure. If the manometer is connected across a filter, it will measure a pressure drop,
which gives some indication of the obstruction to the airflow across the filter, and therefore how blocked the
filter might be.
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U-tube manometer
•
Diaphragm gauge - which gives a reading on a dial as a result of direct pressure on a diaphragm.
In addition to all of the parameters detailed above, the characteristics of the fan (such as speed of rotation) can
also be used to quantify performance.
The ultimate proof of satisfactory performance of any exhaust ventilation system is that it maintains an
acceptable work environment, where atmospheric concentrations of airborne contaminants are kept below
occupational exposure limits. Consequently, periodic air monitoring, or even continuous monitoring, will
confirm that effective protection is being maintained, and will identify signs of deterioration so that remedial
action can be taken before harm occurs.
Face Velocity
Face velocity is the average velocity of air at the open front face of a hood or booth. LEV will often have a face
velocity stated in its specification.
Face velocity is measured using an anemometer.
Three types of anemometer are typically used:
•
The rotating vane anemometer is like a small windmill, usually between 25 and 100mm in diameter and
enclosed in an annular shroud.
•
The heated head anemometer relies on the airflow to cool a sensitive head, which consists of a hot wire,
thermocouple or thermistor. The degree of cooling is related to the air velocity. A cowl is used to direct the
airflow across the head, which is usually quite small.
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•
The deflecting vane anemometer (or swinging vane anemometer) features a moving element, consisting of a
pointer and a vane mounted on a taut-band suspension. The vane is able to swing inside an air chamber, where its
movement creates very little friction. The flow through the anemometer is created by the velocity pressure at the
point being measured. This type of anemometer is able to operate without batteries or a power source.
The method of measuring face velocity is:
•
The face of the inlet is divided up into an imaginary grid of the dimensions 100 to 150mm square.
•
The air velocity is measured at the centre of each imaginary rectangle on the face of the inlet and the results
noted on a sketch.
•
Readings can be averaged and each reading compared to the average to note the degree of variation.
•
Variations over 20% of the average indicate that the airflow distribution is uneven and requires adjustment.
Measuring face velocity using an anemometer
Stage 3 - Assessing Control Effectiveness
Qualitative techniques are used to assess the effectiveness of the LEV system. These often involve the visualisation of
air movement using different techniques.
Dust Lamp (Tyndall Illumination)
Most dust particles are too small to be seen with the naked eye, particularly those which are inhalable or respirable.
So, under normal lighting conditions, it is difficult to detect a dust cloud visually.
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The Dust Lamp (or Tyndall lamp) is a device that allows dust particles to be visualised. This allows identification of:
•
A dust emission which is taking place.
•
The behaviour and direction of the dust cloud, in order to determine whether it is likely to enter a worker’s
breathing zone.
The principle of this technique is based on the phenomenon that most of us have observed when a strong shaft of
sunlight enters a room and suddenly we can see clouds of house dust particles that were not visible before. The light
beam is reflected from the dust particles and makes them readily visible (known as the Tyndall effect).
The method of use is:
•
A powerful parallel-beamed light, supported on a tripod, is used to illuminate the suspected dust cloud.
•
The dust cloud is viewed from a direction slightly oblique to the main light beam and a screen is used to shield the
image of the lamp itself (see diagram).
•
The dust cloud can be observed directly or photographed.
Illumination of a dust cloud using the Tyndall Effect
Although no numerical measurements are made, the equipment enables us to observe exactly how and where the
dust is generated. Its main use is to see how well extract ventilation systems are working and what effect any changes
to the system have if unsatisfactory capture is observed.
Photographs of a soldering operation
Source: Based on HSG258 Controlling airborne contaminants at work - A guide to Local Exhaust Ventilation (LEV), HSE,
2017 (www.hse.gov.uk/pubns/priced/hsg258.pdf)
Left - normal workplace lighting conditions
Right - with Tyndall illumination
Note how the tiny respirable particles in the metal fume are made visible by the dust lamp.
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Smoke
Smoke can be artificially produced and released into a work area to visualise air movement and to simulate the
movement of particles. Smoke can be produced from pellets, smoke tubes or smoke generators:
•
Smoke tubes produce a small amount of smoke as a single cloud. Some produce an acidic mist. They are often
useful for testing smaller hoods.
•
Smoke generators can produce variable amounts of smoke for prolonged periods. They use oil, propylene glycol,
etc. that can leave residues. They are usually unsuitable where smoke detectors are fitted, unless these can be
isolated. Smoke generators have many uses, including assessing the effectiveness of large enclosing hoods.
•
Smoke pellets produce a moderate amount of smoke for a short period. They are inappropriate to use with
flammable substances nearby. They are useful for testing canopies and flues.
Report on LEV Testing
Following the test, the examiner will stick a label on each hood of the LEV system, detailing when it was tested and
when it should be re-tested. Red FAIL labels are stuck to hoods that fail to pass the test. The examiner must record
information on each test and pass this to the employer.
Records must be kept for five years.
For LEV, the following information must be kept as a record of each thorough examination and test:
•
Name and address of the employer responsible for the plant.
•
Identification and location of the LEV plant, process and hazardous substance concerned.
•
Date of last thorough examination and test.
•
Information about the LEV plant which shows:
–– Its intended operating performance for controlling the hazardous substance.
–– Whether the plant continues to achieve the same performance.
–– If not, the repairs required to achieve that performance.
•
Methods used to make the above judgments, e.g. visual pressure measurements, airflow measurements, dust
lamp, air sampling and filter integrity tests.
•
Date of examination and test.
•
Name, designation and employer of person carrying out the examination and test.
Interpretation of Reports
During the interpretation of reports, there are a number of general issues that should be checked, to see whether:
•
An appropriate strategy and method of sampling has been used. Standard strategies and methods are published
by the HSE and other authorities (such as the World Health Organization (WHO)). Where these exist, they must
be adhered to, in order to ensure the scientific and legal validity of any result obtained.
•
The equipment used was appropriately maintained, certificated and calibrated.
•
The assessment was carried out at a place and time that would give results representative of real workplace
conditions (this requires an understanding of the types and patterns of work that the engineer may not have a full
appreciation of).
•
The results have been correctly evaluated against the correct legal standards. These can be checked by reference
to relevant documents such as legislation and international standards.
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STUDY QUESTIONS
1. Explain what is meant by dilution ventilation and comment on its value as a measure to control
contaminants.
2. Explain why it is important to monitor the performance of an LEV system.
3. Describe why a manometer might be used to measure the pressure drop across the filter in an LEV system.
4. State the information to be included in a report of statutory examination and test of an LEV system.
(Suggested Answers are at the end.)
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Personal Protective Equipment and Respiratory Protective Equipment
Personal Protective Equipment and Respiratory
Protective Equipment
IN THIS SECTION...
•
Personal Protective Equipment (PPE) is commonly used to control exposure to hazardous substances.
•
Under the relevant national Regulations, PPE must be suitable (appropriate, ergonomic, correct fit and European
or UK conformity marking) and compatible with other PPE worn.
•
Respiratory Protective Equipment (RPE) is commonly used to control inhalation of airborne contaminants.
•
RPE can be categorised into two main types: respirators and Breathing Apparatus (BA).
•
Respirators come in many different forms but can be generally classed as half-mask, full-face or powered.
Different variations of each type can give protection against both particulates and gases.
•
Breathing Apparatus also comes in many forms, but can be classed as fresh air hose, compressed airline or selfcontained.
•
The level of protection offered by RPE is indicated by the Assigned Protection Factor (APF), a measure of the
ratio of contaminant inside to outside the face-piece.
•
The APF can be used in combination with contaminant concentrations and Occupational exposure Limits (OELs),
to indicate the degree of protection offered by an item of RPE and hence its suitability.
•
When selecting RPE, the following factors must be considered:
–– Atmosphere and substance-related factors, such as potential for oxygen deficiency.
–– Task and work area-related factors, such as work rate and duration.
–– Wearer-related factors, such as fit/comfort and acceptability.
•
Most items of RPE require some form of face-fit test to ensure that an adequate seal exists between the item and
the wearer’s face.
•
Skin is often protected from hazardous chemicals using clothing, such as gloves.
–– Gloves must be carefully selected to ensure their suitability. Several characteristics of gloves need to be
understood to make an informed choice; breakthrough time, permeation rate and degradation rating.
•
Reference should be made to the relevant standard.
•
Eye protection, in the form of safety spectacles, goggles and face shields, is also frequently used to give protection
from hazardous substances and must be carefully selected with reference to relevant standards.
•
When selecting skin and eye protection, the following factors must be considered: substance-related factors, such
as compatibility with the chemical against which protection is required; task-related factors, such as duration of
operation and breakthrough times; wearer-related factors, such as fit/comfort and acceptability.
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Introduction to Personal Protective Equipment
Personal Protective Equipment (PPE) is commonly used as a control measure where workers are at risk of exposure to
hazardous substances.
DEFINITION
PERSONAL PROTECTIVE EQUIPMENT (PPE)
“... all equipment (including clothing affording protection against the weather) which is intended to be worn or held by
a person at work and which protects him against one or more risks to his health or safety, and any addition or accessory
designed to meet that objective.”
From Great Britain’s Personal Protective Equipment at Work Regulations 1992
In this section, we will examine some of the types of PPE of most relevance to protecting workers from hazardous
substances. Before we do it is worthwhile to consider some of the generic principles that can be applied to all types of
PPE.
The employer must:
•
Supply suitable PPE to his employees where risks cannot be controlled by other more effective methods.
•
Suitable in this context means:
–– It is appropriate for the risks involved, the conditions where it will be used, and the duration of time over
which it will be worn.
–– It takes account of ergonomic factors and the health of the user.
–– It fits the user.
–– It controls specific risk without increasing overall risk.
–– It complies with any relevant national or international standards (e.g. if used in the EU, then it is CE-marked to
the relevant standard).
•
Ensure that when two or more items of PPE have to be worn together
they are compatible.
•
Undertake an assessment of the suitability of PPE, taking into account
the required protection it must offer, and compatibility.
•
Ensure that PPE is maintained (this includes cleaning or replacement)
in a proper working state.
•
Provide suitable storage accommodation for PPE when it is not in use.
•
Provide information, instruction and training to workers on the PPE
they are expected to wear.
•
Enforce the use of PPE.
PPE is a common control measure
Employees must use the provided PPE in accordance with their instruction and training, and report loss or defects to
their employer.
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Types of PPE for Use With Hazardous Substances
PPE should be used as a last resort in a safety management system. If PPE is still required after all other controls have
been implemented, then it must be carefully selected, and workers trained in its use. The type of PPE selected should
consider who is exposed, what are they exposed to, how long will they be exposed, and how much are they exposed
to.
Types of PPE
Eye protection types include: safety spectacles, goggles, face screens, face shields, and visors.
Head and neck protection types include: industrial safety helmets, bump caps, hairnets, scarves (for welding), and
firefighters' helmets.
Ear protection types include: earplugs, earmuffs, and semi-insert/canal caps.
Hand and arm types include: gloves, gloves with a cuff, or gauntlets and sleeving that covers part or all the arm.
More detail on the selection of safety gloves is provided in the section on skin protection.
Feet and leg types include:
•
Safety boots and shoes with protective toe caps and penetration-resistant soles.
•
Mid-sole wellington boots.
•
Specific footwear, e.g. foundry boots and chainsaw boots.
Footwear can have a range of sole patterns to reduce slips, contain chemical resistant soles, or be anti-static,
electrically conductive or thermally insulated.
Lung protection can be achieved by respirators, and self-contained breathing apparatus.
Whole body protection can be achieved by conventional or disposable overalls, boiler suits, aprons, and chemical
suits.
Respiratory Protective Equipment (RPE)
The use of Respiratory Protective Equipment (RPE) to prevent the inhalation of harmful airborne contaminants
constitutes an extensive subject in its own right, so here we shall concentrate on the various types of respiratory
protection available, and the factors affecting selection. An important point to note about respiratory protection is
that there are two fundamentally different types:
•
Respirators use filters to remove contaminants from the air being breathed in. They can be either:
–– non-powered respirators - relying on the wearer’s breathing to draw air through the filter; or
–– powered respirators - using a motor to pass air through the filter to give a supply of clean air.
The main issues affecting choice of respirator are:
–– The suitability of the purifying medium, i.e. filtration of dust particles and absorption of gases and vapours.
–– How well it purifies the air, i.e. efficiency and protection factor.
–– Leakage of contaminant into the respirator, i.e. face fit and seal.
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•
Breathing Apparatus (BA) supplies pure respirable air from an uncontaminated source (such as an air cylinder
carried by the worker).
The main issues affecting choice of BA are:
–– Ergonomic matters arising from the work and location of use.
–– The duration of use.
Respirators and BA are available in a range of styles, dividing into two main groups:
•
Tight-fitting face-pieces (often referred to as 'masks') rely on having a good seal with the wearer’s face. These
are available as both non-powered and powered respirators and BA.
A face-fit test should be carried out to ensure the RPE can protect the wearer.
•
Loose-fitting face-pieces rely on enough clean air being provided to the wearer to prevent contaminant leaking
in (only available as powered respirators or BA). Examples are hoods, helmets, visors, blouses and suits.
Types of Respirator
Half-Mask Respirator
This type of face-mask covers the nose and mouth only, leaving the eyes
exposed. Half-mask respirators can be subdivided into two types:
•
particle filters; and
•
gas filters.
The simplest form of half-mask respirator is the disposable half-mask type.
This consists of a piece of filtering material worn over the nose and mouth
and secured by twin elastic headbands. A flexible metal strip enables the
user to bend it over the bridge of the nose to fit. A typical example is shown
in the image.
The simple structure is designed to provide a cheap, disposable unit. They
are light to wear, permit ease of breathing and speech, do not interfere
excessively with vision and can be worn with eye protection but are only
designed to protect against particles.
Disadvantages are that:
Disposable half-mask - particle filter
Source: HSG53 Respiratory protective
equipment at work - A practical guide,
HSE, 2013 (www.hse.gov.uk/pubns/
priced/HSG53.pdf)
•
An adequate face-fit test cannot be carried out.
•
The face seal cannot be fully achieved over beards.
•
It can be uncomfortable to wear, due to moisture build-up on the filter material.
•
Used respirators may need a safe disposal procedure.
Other types of half-mask respirators are made with a flexible rubber or plastic face-piece which covers the nose
and mouth fitted with a replaceable cartridge filter (often referred to as a ‘canister’) to remove the airborne
contaminant. Filters are available to protect against particles and gas/vapour.
Some respirators have a single cartridge; others have twin cartridges. The respirator is strapped to the head with
adjustable headbands. Exhaled air is released through non-return exhaust valves.
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See the following illustrations.
Re-usable half-mask - particle filter
Re-usable half-mask - gas/vapour filter
Source: HSG53 Respiratory protective equipment at work - A practical guide, HSE, 2013
(www.hse.gov.uk/pubns/priced/HSG53.pdf)
A worker wears a half-mask respirator to seal asbestos lagging around a pipe
MORE...
Simple guidance on respirators aimed at employees is contained in the HSE pocket card INDG460 Is your mask
protecting you? which is available at:
www.hse.gov.uk/pubns/indg460.pdf
Face seal is achieved in good quality respirators by the use of a pneumatic cushion around the outer edge. As with
disposable respirators, beards and unshaven faces reduce face-fit efficiency.
Cartridge-type half-mask respirators can be used for protection against particles or gas and vapour, so cartridges are
colour-coded by manufacturers to help reduce the possibility of their incorrect use. Manufacturers also provide charts
to indicate the correct type of cartridge for specific hazards.
Owing to the quite substantial structure of half-mask respirators and the cartridge protection system, breathing is not
easy, speech communication is reduced and vision is slightly impaired, especially in twin-cartridge types.
Another issue with the use of cartridge filters is not knowing when their working life has ceased.
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Full-Face Respirator
This type of face mask covers the nose and mouth in a face-piece and has a visor with a full-face seal to completely
enclose the eyes and much of the face.
Full-face respirators can be subdivided into two types:
•
particle filters; and
•
gas filters.
They have replaceable cartridges and the face-piece is secured to the head by a set of flexible, adjustable headbands.
Wide vision is provided in most modern face masks by a tough Perspex visor.
Full-face mask - particle filter
Full-face mask - gas/vapour filter
Source: HSG53 Respiratory protective equipment at work - A practical guide, HSE, 2013
(www.hse.gov.uk/pubns/priced/HSG53.pdf)
The main reason for choosing a full-face respirator over a half-mask respirator is that the former offers eye and face
protection. There will be various work scenarios where this might be necessary, e.g. when the work activity involves
exposure to an irritant vapour or dust that will irritate the eyes and cause tear production (which in turn will cause the
nose to run - not great when wearing a respirator of any type). Alternatively, it might be necessary to protect the eyes
simply from nuisance dust.
One of the most significant drawbacks with all of the above respirators is that, in order to draw air in through the
filter, the wearer has to breathe in. This creates negative pressure inside the face-piece. Any leaks (due to poor facefit or damage) will allow contaminated air inwards because of this negative pressure.
Powered Respirators
With this type of respirator, clean air is pumped into the face-piece, so alleviating the problem of negative pressure.
This positive air pressure also reduces user fatigue and allows longer work periods between rests.
There are two main designs for the system:
•
Masks - full- or half-masks connected directly or by flexible tube to a centrifugal pump, which draws air through
a filter.
•
Helmets - with a wide-vision, high-impact visor secured to the head by a harness and chin strap. The system is
loosely sealed by a fabric skirt around the neck and over the shoulder. A motorised fan set in the helmet or on a
belt draws contaminated air through a filter. The motors are usually powered by re-chargeable batteries.
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Powered clean-air mask
Powered clean-air helmet
Source: HSG53 Respiratory protective equipment at work - A practical guide, HSE, 2013
(www.hse.gov.uk/pubns/priced/HSG53.pdf)
Types of Breathing Apparatus (BA)
Breathing Apparatus (BA) can be classified into three general categories.
Fresh Air Hose BA
Fresh air hose BA can be described as a breathing apparatus that provides a supply
of unpressurised fresh air from an uncontaminated source. The user is connected
to a fresh air supply by an air hose of up to 20 metres and draws air through by
breathing effort. The system is not self-contained, so it enables work to be carried
out over an indefinite period, provided it is only a short distance from fresh air.
The apparatus usually consists of a full-face mask with a short length of wide-bore
hose joined to a metal elbow, secured to a waist belt. The wire-reinforced air hose is
connected to the elbow and the free end secured in uncontaminated air. Breathing
air down the length of the hose can be difficult (especially if it is kinked). This can
be overcome to a degree by using fan-assisted face masks or powered hoods.
Compressed Airline BA
Fresh air hose breathing
apparatus
Source: HSG53 Respiratory
protective equipment at work
- A practical guide, HSE, 2013
(www.hse.gov.uk/pubns/
priced/HSG53.pdf)
Compressed airline BA is similar in design to fresh air systems but the respirable
air comes from a compressed air source. The compressed air supply may be from
a cylinder or from a compressor. Cylinders are often mounted on a trolley and
provide a mobile supply unit. Air from compressors is more usual in static situations where it can be piped around a
site with outlet connectors at convenient points.
As the supply uses higher pressures than fresh air systems, much smaller and longer supply hoses can be used, up to
80 metres for some. The airline can be connected via a pressure-reducing valve to full or half face-piece respirators,
hoods, coverall suits or protective visors. Positive pressure helps to reduce work-rate fatigue and the ingress through
leaks of harmful airborne contaminants.
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A very important safety control for compressed
airline systems is the purity of the air. Filters must be
incorporated into the system to prevent contamination
from dusts, toxic and corrosive gases, and vapours. The
filters must be situated to control flow of air to the user
and control of air into the inlet of a compressor unit.
Compressed airline systems give complete respiratory
protection in dusty, toxic and oxygen-deficient
atmospheres.
There are two types of respirator design for compressed
airline systems:
•
Powered helmet
The constant flow BA, which receives a continuous
flow of air from the supply. Any air not used for
Source: HSG53 Respiratory protective equipment at work
A practical guide, HSE, 2013 (www.hse.gov.uk/pubns/
respiration is exhausted from the face-piece. This
priced/HSG53.pdf)
system is used only where there is a compressor
supply considered to be inexhaustible. It cannot be considered a very economical way to use compressed air.
•
The demand flow BA, which is a very economical system in that respirable air only flows into the mask when the
user inhales.
Self-Contained Breathing Apparatus (SCBA)
Self-Contained Breathing Apparatus (SCBA) provides air or
oxygen to the user from cylinders or some other form of
container, which is carried in a harness on the user’s chest
or back. The system provides respiratory protection in toxic,
corrosive, dusty and oxygen-deficient atmospheres.
There are three main types of self-contained breathing
apparatus, classified mainly on the basis of duration of use:
•
Escape SCBA
This is an open-circuit system consisting of a compressed
air cylinder at about 200 bars, fitted with a pressure gauge
and a reducing valve. Some models have an on/off control
valve; others are controlled by demand valves. Air is fed via
a short airline to an ori-nasal face-piece set in a full faceDemand valve breathing apparatus
piece which incorporates a wide-vision visor. Respiratory
Source: HSG53 Respiratory protective equipment at
air supply is controlled by a demand valve which allows
work - A practical guide, HSE, 2013
airflow when the user inhales. Exhaled air is vented via an
(www.hse.gov.uk/pubns/priced/HSG53.pdf)
exhalation non-return valve. Most systems operate with
positive pressure in the face-piece, so that ingress of the contaminated atmosphere is prevented. Many facepieces incorporate a speech diaphragm to improve communication.
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Most escape breathing apparatus sets operate for ten minutes, hence the
common name ten-minute escape sets. Longer-duration units are available
for specific purposes. Most escape sets incorporate a warning whistle, to
indicate that the cylinder has reached about one-third of its capacity. Except
for disaster situations, e.g. fire or explosion, escape sets should always be
used with atmospheric monitoring devices, set to provide warning when the
contaminant has reached a certain concentration. The escape set can then be
put on and an escape made in an orderly manner. Where escape sets are used
for disaster situations, their capacity should be checked daily; when used as
back-up emergency equipment, they should be issued in a state of readiness.
•
General SCBA
Again, using compressed air cylinders, this is designed to work in hazardous
atmospheres for periods of 40 minutes or so at normal working rates. It
has an open-circuit system with equipment similar to an escape set, but the
A fire-fighter wearing selfcylinder (sometimes two) is mounted on a special harness backpack. The
contained breathing apparatus
cylinders have an on/off control and a pressure-reducing valve, which supplies
positive-pressure air to the face mask at all times. Respiratory airflow is controlled by inhalation via a demand
valve. A pressure gauge, connected to the high-pressure outlet, is positioned on the front of the cylinder harness
so the user can check the cylinder capacity during operation. A warning whistle is always provided. It operates
automatically at a pre-set, low-level pressure.
Where breathing apparatus sets are used for rescue purposes, the cylinders are attached to full safety harnesses,
that allow the users to be lowered into or pulled from shafts, tanks or restricted spaces.
•
Re-circulating SCBA
Re-circulating BA (or re-breathers) provides longer duration use. Some units can last up to three hours. They have
a closed-circuit, regenerative respiratory breathing system supplied either by oxygen from a cylinder or from a
liquid oxygen container.
The general principle of operation is that exhaled air (which contains less oxygen than normal respirable air
(21%), but still has quite a high oxygen concentration (>17%)) is not lost to the atmosphere through a nonreturn valve (as is usual). Instead the exhaled breath is scrubbed clean of carbon dioxide (CO2). The CO2 free air is
then ‘sweetened’ with oxygen (from a cylinder) to bring the oxygen concentration back up to normal respirable
concentration (21%). This reclaimed air is then re-supplied back to the user. In effect, the same volume of air is
‘re-breathed’ many times.
Selection of RPE
Many factors have to be taken into account when choosing RPE. The main factors are:
•
Atmosphere-/substance-related factors.
•
Level of protection required and the Assigned Protection Factor (APF).
•
Task and work-related factors.
•
Wearer-related factors.
•
Quality-related factors.
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Atmosphere/Substance-Related Factors
Where the risk is very serious (e.g. with chemicals that are toxic by
inhalation), the concentration of the hazardous agent inside the facepiece must be reduced to ‘as low as reasonably practicable’ (and at least
below any occupational exposure limits). Accordingly, RPE with the highest
protection factors must at least be considered. However, it may not be
reasonably practicable to use RPE with the highest available assigned
protection factor because of its other limitations.
For example, when removing asbestos lagging from pipes, the primary
means of controlling airborne asbestos concentrations is by using damping
down. To control residual fibre concentrations, it is not advisable to use
Asbestos pipe lagging
airline-breathing apparatus (even though it offers very high protection)
because the line may become entangled in the pipework too easily. Self-contained breathing apparatus is also not
practical because it is bulky and will not allow enough time to complete the job. A powered full-face type respirator
may be the best choice here; it offers a good level of protection for residual airborne concentration and also takes
account of the restrictions of the job (high work rate, obstacles, etc.).
Where there is a risk of oxygen deficiency, the use of filtering respirators is inappropriate - breathing apparatus
that assures a fresh supply of clean air is the only acceptable solution. Respirators are not recommended for use in
confined spaces as, once the filter is exhausted, the wearer will be exposed to the contaminant until they are able to
leave the confined space.
Filter Selection
Filtering respirators are intended to remove specific contaminants from the atmosphere - as a result of this, the
wearer will not be protected if the wrong filter cartridge is selected. Examples of filter types include:
•
Particulates.
•
Acid gases.
•
Organic (solvent) vapours.
•
Ammonia.
These will, however, differ between manufacturers and, in some cases, filters are available which cover a combination
of contaminants.
Level of Protection Required and the Assigned Protection Factor (APF)
For respiratory protection, the measure of its ability to protect the respiratory system is given by its Assigned
Protection Factor (APF), which is the ratio of the concentration of contaminant in the working atmosphere to the
measured concentration within the face-piece when the equipment is in use. The ratio can be represented as follows:
Concentration of atmospheric contaminant
Concentration of contaminant in the face-piece
The higher the ratio, the better the level of protection.
APFs represent levels of protection that can be realistically achieved under working conditions if the wearers are
correctly trained and supervised and if the equipment is correctly fitted and functioning properly.
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The following table gives general values for the types of equipment we have discussed here. Remember that these
values are indicative only; the actual APF will depend on manufacturer, filter type, etc.
PF
required
Respirators
Half-
Half-
Full face
Full face
Powered
Powered
Fresh
Constant
Demand
mask,
mask,
mask,
mask gas
(fan-
(fan-
air
flow
valve BA
particle
gas
particle
filters
assisted)
assisted)
hose
airline
filters
filters
filters
masks
hoods
BA
TM1
TH1
LDH1
TM2
TH2
LDH2,
FFP1,
4
Breathing apparatus
P1
FMP1,
P1
10
FFP2,
FF gas,
FMP2,
FM gas,
P2
Gas
P2
FFP3,
20
Gas
FMP3,
LDM1,
P3
LDM2,
Halfmask
P3
TM3
TH3
Full
LDH3,
face
LDM3,
mask,
40
Hood
Hood,
Full mask
200
Suit
Airline,
2000
selfcontained
Source: based on HSG53 Respiratory protective equipment at work - A practical guide, HSE, 2013
(www.hse.gov.uk/pUbns/priced/hsg53.pdf)
MORE...
L25: Guidance on the Personal Protective Equipment at Work Regulations 1992
HSG53: Respiratory protective equipment at work
INDG479: Guidance on respiratory protective equipment (RPE) fit testing
Both are available from the HSE website at:
www.hse.gov.uk/pubns
The protection factor is not absolute, but gives a relative ability to provide protection. If a respirator has an APF
of 10 and it is used in a contaminant concentration of 100ppm, then the user would be subjected to respirable air
containing 10ppm of contaminant. If the APF is 5 and the concentration of contaminant 50ppm, then the respirable
air would still contain 10ppm of contaminant. The protection provided by each piece of equipment is the same.
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You must aim to reduce the concentration of the contaminant within the face-piece to at least below the applicable
occupational exposure limit (OEL).
TOPIC FOCUS
Using APF to Choose RPE
Using the protection factor as the basis for a choice of RPE requires knowledge of the:
•
Acceptable concentration of the contaminant that can be inhaled, based on the WEL or OEL for the
contaminant.
•
Actual or likely concentration of the contaminant in the work area.
The workplace exposure limit is used in conjunction with the actual atmospheric contaminant concentration to
calculate an APF value.
For example, if the WEL for a harmful vapour was 20ppm and the highest concentration of atmospheric
contamination was 160ppm, then:
APF =
160ppm
20ppm
=8
This means that a suitable type of RPE with a minimum APF of 8 would be needed just to achieve the WEL
inside the face-piece. In practice, you may impose a further safety factor to achieve better control. Thus, for
example, selecting RPE with an APF of 20 would give a good level of protection.
When selecting RPE, the APF is a primary concern. However, the variety of different types of respirator and BA
available, many of which have a number of different APF values assigned, can make the selection process confusing.
Consequently, the HSE has published guidance on the selection of RPE in HSG53, which sets out the following
process:
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Selecting RPE that is adequate and suitable
Source: HSG53 Respiratory protective equipment at work - A practical guide, HSE, 2013
(www.hse.gov.uk/pubns/priced/HSG53.pdf)
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Task and Work-Related Issues
Whilst we have considered the capabilities of the RPE, other work-related issues should also be considered:
•
Work rate - RPE can be hot and heavy to wear (especially in the case of SCBA), so workers who are working at a
high rate will become fatigued if wearing RPE for a prolonged period of time. Care should be taken to select the
most appropriate type of RPE for the task, e.g. airstream helmets/visors will provide a stream of cool, filtered air
over the face of the wearer, which can be cooling in a hot environment.
•
Duration - the use of RPE can be fatiguing and so workers may not be able to work for extended periods of time
in RPE without rest breaks.
•
Temperature/humidity - the use of RPE in hot and humid conditions can accelerate fatigue, so selection of RPE
which provides a supply of cool, filtered or purified air is preferable.
•
Vision - where clear, unobstructed vision is required, it may be preferable to opt for a full-face respirator rather
than a half-mask respirator with goggles due to the tendency of goggles to mist over. Filters on respirators may
impede the workers’ view of a task during close work. It is advisable to allow workers to select from a range of
RPE options in order to ensure that they have clear vision.
•
Communications - using RPE restricts the ability to communicate. Where communication is essential, such as in
the fire service, radio communications devices can be obtained to use within the BA sets.
•
Mobility and space constraints - where workers are required to be highly mobile, the RPE must not hinder
their movement. The use of airline systems may therefore be inappropriate due to the potential for the airline to
snag or restrict movement, and SCBA may prove too bulky or heavy in some circumstances. However, the use of
respirators may also be inappropriate if the contaminants involved make breathing apparatus necessary.
•
Tools - where tools are used, they must be able to be used freely without impacting upon the RPE. For example,
airlines may be damaged by cutting equipment.
•
Explosive atmospheres - work in potentially explosive atmospheres must be carried out using equipment
suitably rated for this task.
Battery power packs worn by the operator must be protected so that they can’t ignite a flammable vapour.
Compressors may need to be located outside of the flammable area with only the airline entering the work area.
Communications equipment must also be suitable for use within flammable atmospheres.
Wearer-Related Issues
An employer can select the best RPE in the marketplace, but it is rendered useless if the operators refuse to wear it or
are unable to use it. The following issues should be considered:
•
Fit and comfort - people have differently shaped faces, so what feels comfortable on one person might not be
comfortable on another. Providing a choice of RPE to the workers may help to overcome some reluctance in
using the equipment.
•
Beards - beards prevent the wearer from obtaining an adequate seal around the face, so it may be necessary
to prohibit the wearing of beards which impinge upon the seal, or to prohibit a person with a full beard from
working in an area where RPE is necessary.
•
Spectacles - the wearing of spectacles can impair the seal on a full-face respirator or BA set, as the spectacle legs
pass through the seal to hook over the ears. Special BA spectacles can be obtained, which are inserted into the
visor rather than hooked over the ears, allowing a seal to be obtained.
•
Face marking - whilst not harmful, RPE can cause red marks due to the pressure applied to the face. If this is a
problem, alternative styles of RPE may alleviate this issue.
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•
Compatibility with other PPE - half-mask respirators may be
incompatible with other PPE, such as goggles and visors, in which case
the use of a full-face respirator may be more acceptable. RPE also
requires a tight fit to the head, so it may be incompatible with some
head coverings worn for religious reasons.
•
Medical conditions - due to the demands placed upon the wearer,
users of RPE may need to undergo medical examinations in order
to ensure that they are physically fit enough to undertake the work.
Natural rubber latex (NRL) proteins (found in a range of medical
gloves) have the potential to cause asthma and dermatitis. Serious
allergic reactions, such as anaphylaxis, are also possible. When a person
has become sensitised to NRL, further exposure, even to low levels, may
cause a reaction that triggers allergic symptoms.
Items of PPE used together must be
compatible
Quality-Related Issues
RPE is safety-critical equipment and therefore good quality is essential. In order to ensure quality, RPE must be
compliant with the relevant national and international standards, such as European EN standards.
Face-Fit Testing
It has been conclusively demonstrated by research that the stated protection factor for respiratory protection may not
be reached in practice. This is due largely to the poor face-fit of many respirators, especially half-mask types. Owing
to mass production, a generalised fit is made in the hope that pneumatic or rolled edge seals will make a better fit
around anomalous facial structures.
In an effort to improve effectiveness the face-fit test was introduced. It is only applicable to those types of RPE that
rely on a tight fit of the face-piece to the wearer’s face for effective performance, e.g. filtering face-piece, half-mask,
full-face mask, etc. It does not apply to the loose fitting types, such as powered hoods/blouses, which don’t rely on
a tight fit but instead rely on high airflow rates through the face-piece. There are basically two types of fit-testing:
qualitative and quantitative. Each has a number of methods from which to choose:
•
Qualitative fit-testing is a simple pass/fail subjective assessment of leakage around the face seal and can be
conducted very easily by the user. These are only suitable for filtering face-piece and half-mask respirators and are
not considered suitable for full-face respirators.
A typical qualitative face fit test involves a worker being exposed to a bitter tasting atomised spray inside a plastic
hood placed over their head. The worker is first tested without wearing their respirator to verify that they are
sensitive to the bitter taste of the spray (some people can’t taste it). They are then tested whilst wearing their RPE
and are required to carry out several actions to challenge the face fit of the RPE (such as nodding and talking). If
they can taste the bitter chemical then the RPE fit fails the test.
•
Quantitative tests provide a direct numerical measurement of fit (called a 'fit factor') and are recommended for
full-face masks. Methods here include: laboratory chamber; and portable fit-test device (working on the basis of
either a particle counter or controlled negative pressure).
All face fit testing must be carried out by competent people using recognised test equipment and methods. The
British Safety Industry Federation (BSiF) have established Fit2Fit, an accreditation scheme in collaboration with HSE,
to provide recognised face fit testing, training and certification.
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Face fit testing should be carried out when a new item of RPE is first issued to a worker, to prove that an adequate
fit can be achieved. It is good practice to repeat this fit testing periodically to ensure that a good fit can be achieved
over time. Some organisations repeat fit testing on an annual basis in pursuit of best practice. If a worker’s face should
change shape, for example as a result of injury or surgery, then the face fit test should be repeated to prove that a
good fit can still be achieved.
Face fit testing should not be confused with the operational use test that a worker should carry out on their RPE
every time that they put it on for use.
Skin and Eye Protection
There are many situations where hand protection, in the form of gloves or gauntlets, is used occupationally. Such
items can provide protection against a range of hazards, such as high and low temperatures, chemicals and rough
handling work.
Skin Protection
When safety gloves are being selected for use, it is very important to choose the material of construction that is
designed to give protection against the particular hazard. Where chemicals are handled, suppliers will provide a good
guide as to the type required. Glove resistance charts are often available (see the following example).
Chemical
Natural Rubber
Neoprene
Nitrile
Normal PVC
E
E
E
E
Nitric acid (up to
50%)
NR
NR
NR
G
Benzene
NR
F
G
F
Diesel fuel
NR
F
G
F
Wood preservatives
NR
G
G
F
Ethanoic acid
Key to ratings:
E
-
excellent
G
-
good
F
-
fair
NR
-
not recommended
You will note in the table the wide variation in suitability of differing
materials for the chemical listed.
Glove manufacturers use three technical terms to characterise the chemical
resistance properties of gloves:
•
Breakthrough time - the time a chemical takes to permeate through
the glove material and reach the inside. Permeation is a process by
which a chemical can pass through a material without going through
pinholes or pores or other visible openings. This tells you how long you
can use a glove for.
•
Permeation rate - the amount that then permeates through. The
higher the rate, the more of the chemical will move through the glove.
Choose a low rate.
© RRC International
A laboratory worker uses nitrile
gloves to prevent contact with
chemical reagents being handled in a
fume cupboard
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•
Degradation rating - some chemicals can destroy the glove material. It may get harder, softer or may swell.
Degradation indicates the deterioration of the glove material on contact with a specific chemical. Choose gloves
with an excellent or good degradation rating.
For rough work, not involving contact with chemicals, and for hot/cold protection in the temperature range 10°C to
150°C, terrycloth gloves provide good protection and are comfortable to wear. Leather gloves are more durable but
less comfortable to use, unless the fit is very good. Leather gloves/gauntlets are good for high temperatures, while
for very low temperatures (-10°C to -80°C) special low thermal conductivity fabrics with good flexibility have been
developed.
Various practical issues arise with hand protection:
•
Loss of dexterity and tactile sensation is a considerable problem for some operators. In the chemical industry,
the use of gloves for dispensing from small containers (below 0.5 litre) is not recommended, except for very
hazardous materials such as phenol, bromine or hydrofluoric acid. It is considered that loss of dexterity is a greater
risk in terms of spillage than not providing gloves. If spillage does occur, then the ability to wash quickly reduces
the risk to very small limits. However, in some cases, ultra-thin gloves are available which offer limited protection
against the chemicals being used and retain good dexterity.
•
Local heating of the hands, with resulting sweating and opening of the skin pores, provides ideal conditions for
chemicals to cause corrosive burns and to be absorbed into the body following skin contact. Loss of protection
through pin holes which are not easily seen is a common way for materials to enter the gloves. The time taken to
remove contaminated gloves can also reduce the effectiveness of first-aid treatment.
•
Another possible way in which harmful materials can enter gloves results from their removal during a hazardous
operation. Removal usually occurs as a result of the operator seeking a little respite from the discomfort of their
use.
These must all be considered when making a selection.
Barrier creams can be used to protect the hands against dermatitis. They are particularly useful where non-hazardous
wet chemicals are in use where the constant wetting of the hands creates the dermatitis risk. They may also provide
protection where a high level of dexterity is needed and the risk from the hazardous material is low.
Antiseptic hand creams are useful for post-exposure when used as part of a good hygiene regime.
Eye Protection
Protection is required from hazards that can cause damage to the eyes, such
as impact from flying particles, dust, chemical splashes, molten metal, mists,
sprays and gases, welding, non-ionising radiation, and laser light.
Work activities should be assessed to identify such hazards, then the level
of risk estimated to allow the correct type of protection to be selected. The
risk assessment should include not only persons directly in the process or
activity, but also any other persons who may be at risk.
Listed below are the principal types of processes or activity that could
present risks to the face or eyes and where appropriate protection would be
required:
•
Handling or coming into contact with acids, alkalis and corrosive or
irritant substances.
•
Working with power-driven tools where chippings are likely to fly, or
abrasive materials be propelled.
•
Working with molten metal or other molten substances.
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•
Welding operations where intense light or other optical radiation is emitted at levels liable to cause risk of injury.
•
Working on any process using instruments that produce light amplification or radiation.
•
Using any gas or vapour under pressure.
Before eye protection is used, it is vitally important that the hazard is fully understood. The protection chosen must
provide full protection against the hazard to which the eyes are exposed. You must remember that not only are the
eyes vulnerable to direct frontal attack from radiation, projectiles or liquids, but the same problem exists, although
to a lesser degree, by attack from the sides of the eyes. Liquids can splash up the cheeks and run down from the
forehead. Thus highlighting the importance of understanding the potential hazard that you have to control.
Factors Affecting Choice of Type of Protection
Various forms of eye protection are available, depending on the type of hazard encountered, and are grouped in the
following general classifications:
•
Spectacles fitted with side pieces.
•
Goggles, which provide full eye enclosure and are secured by a flexible headband.
•
Face shields and visors, which provide both eye and face protection. They are secured by an adjustable head
frame or may be fixed to a safety helmet.
The design will depend on the hazard they are used to combat.
Spectacles
Spectacles can be used where there are low risks from radiation, solid projectiles and liquids:
•
For radiation, the lenses will be specially designed to absorb the problem radiation, i.e. ultraviolet or infrared.
Such spectacles are used by glassblowers, as they are light and comfortable, as well as provide adequate
protection. Models are marketed for welding but they would only be suitable for infrequent or small-scale
welding operations.
•
Where solid projectiles are encountered, e.g. for machinists, chippers or grinders, the spectacle lenses are
specially toughened to withstand impact. Although they are comfortable to wear, their effectiveness depends
upon fit. On many faces, there are unprotected areas under the eyes and over the bridge of the nose, which
reduces the protection factor considerably.
•
For liquids, spectacles provide limited protection and should be used only where the potential risks are low. They
can be used for general chemical laboratory purposes, where the risks are often fairly low. Where the risk level is
increased, then spectacles should be replaced or supplemented with a high grade of eye protection. Spectacles
provide the least of the problems associated with eye protection, i.e. reduction in visual field, misting and
becoming dirty or scratched.
Where safety spectacles provide adequate protection, the use of sight-corrected or prescription lenses becomes a
consideration. The provision of prescription lenses for employees is a useful area where management can show a
positive concern for eye protection.
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Goggles
Goggles can provide almost complete protection for the eyes from all the
potential hazards that occur from radiation, projectiles and liquids. The
effectiveness of the protection usually depends on the fit under the eyes
and over the bridge of the nose. The basic design of goggles consists of a
one-piece, clear visual section in front of the eyes, surrounded by a safe,
flexible frame which seals across the forehead, around the temple and
the cheekbone and over the bridge of the nose. This structure effectively
protects the eyes by containing them within their own secure environment.
It also allows operators to wear their own prescription spectacles under
the goggles. This does cause a small problem in that the side seal over
the temples is reduced. Vision is more restricted than with spectacles and
misting over of the eyepiece becomes a problem.
Goggles
Where goggles are worn to combat harm from projectiles, the frame is
Source: L25 Personal protective
often perforated to help ventilation and reduce misting. Where radiation or
equipment at work (3rd ed.), HSE, 2015
(www.hse.gov.uk/pubns/priced/l25.
liquids are the problem, special bubble cap ventilators have been designed,
pdf)
which allow airflow but prevent ingress of liquids or radiation. You should
note that the differing designs are required to protect against specific
hazards. Hence the need for an adequate understanding of the hazard and for effective supervision to check that the
correct type of protection is being worn.
Face Shield/Visor
For some operations, e.g. welding and handling harmful liquids, not only
do the eyes require protection but also the face and forehead. Face shields
are able to satisfy this need. Where corrosive liquids are involved, the shield
forms a wide curved screen and gives effective protection from splashes.
Welding visors are more complex in that they are constructed of an opaque
visor with a lens section set into the structure. The lens can be changed
according to the type of welding operation. Arc welding or cutting up to
about 100 amperes will use a different filter from that required when 300
amperes are used. The different lenses are required to deal with the varying
intensity of radiation and the differing type of wavelength spectrum
produced.
The European Standard, BS EN 166:2002 - Personal Eye Protection.
Specifications, lays down specification requirements for eye protection
against certain hazards. This standard must be used when selecting eye
protection and the protection chosen must be CE-marked to this standard.
Alternatively, commercial suppliers of eye protection should be familiar
with the standard and able to give advice.
Face shield
Source: L25 Personal protective
equipment at work (3rd ed.), HSE, 2015
(www.hse.gov.uk/pubns/priced/l25.
pdf)
Selection of Skin and Eye Protection
Many factors have to be taken into account when choosing PPE. These can be categorised into four main groups:
•
Substance-related issues.
•
Task-related issues.
•
Wearer-related issues.
•
Quality-related issues.
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Substance-Related Issues
Substance-related issues include the:
•
Type of protection required - the type of protection selected must reduce the risk from a particular hazard.
To choose the right type of equipment, it is important to have a full understanding of the hazard under
consideration. For example, before protective footwear is selected for use in a chemical environment, the
corrosive or solvent nature of the chemicals encountered must be known, so that the chosen footwear is not
made from materials that will be adversely affected.
•
Level of protection required - the PPE chosen must be able to reduce the hazard to an acceptable level. When
choosing gloves or gauntlets, the level of protection provided by the item will be indicated by the quality; for
example, the item may have a quality mark (such as the European CE-mark). However, the level of protection
actually required by the nature of the work may call for a more qualitative judgment.
Task-Related Issues
Task-related issues include:
•
Duration of work - PPE may only be able to resist chemical ‘attack’ for a limited period of time (known as the
‘breakthrough’ time) so consideration must be given to the duration of work which will be undertaken, as this will
affect the length of time the PPE is exposed to the chemical substance. Compatibility and breakthrough charts
from the manufacturer will indicate the length of time the PPE can be exposed to the chemical.
•
Dexterity and durability - sometimes, the most durable PPE may not be the most appropriate for a task. Gloves
affect the dexterity of the wearer; the thicker (or more durable) the glove, the greater the impact on dexterity.
Therefore, there may be occasions where using thinner gloves may be preferable and safer.
•
Gloves and gauntlets - though the terms are sometimes used interchangeably, gloves are shorter and end at the
wrist, whereas gauntlets are longer and cover the forearm to the elbow. If there is a risk of contamination of the
forearm, gauntlets should be selected.
Wearer-Related Issues
One of the key failings of PPE is that it can be used incorrectly, or indeed not used at all! Users must be trained in
the correct use and fitting of PPE, but if wearer-related issues are considered at the selection stage, the potential for
misuse can be reduced:
•
Fit - in order to achieve the necessary level of protection for any PPE, it is important that it fits the user correctly.
The correct fit of an item of PPE can often be determined by asking the wearer to subjectively determine
whether it fits or not.
•
Compatibility - the PPE chosen must not interfere with, or impede, the use of other PPE that also has to be worn
at the same time. Consequently, it is necessary to assess the various situations under which the PPE will be used,
to ensure that it will be compatible with all the other items that might foreseeably be worn.
•
Personal issues - PPE must be selected with the individual in mind. There may be many reasons why certain PPE
is not suitable for a particular individual. There may also be instances where the requirements of the workplace
run contrary to the ability of individuals to wear certain PPE. In these circumstances, the individual may be
excluded from certain areas/processes or prohibited from entering the workplace.
•
Wearer acceptability - the effectiveness of an item of PPE is ultimately determined by whether or not users
actually wear it. If the equipment is uncomfortable or interferes with the user’s ability to work, then, irrespective
of its cost or efficiency, it will be bypassed. Wearer acceptability can be improved by involving workers, or their
representatives, in the selection process. This consultation will give end users the opportunity to voice their
opinions and assist in the selection procedure. This can often be best achieved by selecting a set of items that
provide the required level of protection, and then involving workers in trials so that they can then choose the
item they think is most suitable.
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•
Management commitment to the use of PPE must be seen to be positive. Management must show clear
leadership by using PPE at all appropriate times. They must also provide adequate resources for PPE provision.
This may mean buying higher-quality items rather than the cheapest available, and ensuring that replacement
stocks are always kept.
•
Clear and consistent supervision of the use of PPE must be demonstrated.
Quality-Related Issues
PPE and RPE are used as a last line of defence against a hazard. If PPE/RPE is still needed after implementing other
controls, it must be purchased following careful selection and must be of a sufficiently high quality to offer the
desired level of protection. There are international quality standards that can be used when purchasing PPE/RPE, such
as British and European EN standards.
Storage and Maintenance of PPE
Provision must be made for the safe storage of PPE away from sources of contamination - after all, PPE that is coated
with contaminants on the inside is not going to be an effective form of protection for the wearer! It is common
practice to provide a locker or storage area for PPE and RPE.
PPE must be maintained in safe working order. The level of maintenance will be determined by the item,
manufacturer’s recommendations and the conditions of use.
Many items of PPE are designed to be used once and then disposed of; this would not entail any maintenance. In
other instances, items have to be periodically examined to determine their condition and some level of dismantling,
cleaning and/or replacement of parts may have to take place. For safety-critical items, such maintenance should be
carried out according to schedules and records of the maintenance must be kept. All those involved in maintenance
activities must be competent.
Though usually issued to individuals and not shared, there are some circumstances where PPE might not be issued on
a personal basis (e.g. in the case of SCBA) and, in these instances, good standards of hygiene must be assured through
disinfection of the face mask.
RPE must be cleaned, disinfected and thoroughly examined periodically. Records of such inspections and disinfections
should be maintained. Maintenance should be in accordance with the manufacturer’s recommendations, but typical
maintenance checks for RPE include:
•
Checking face seals and replacing them if necessary.
•
Checking airflow (this may involve checking inlet valves for respirators or air supply to BA sets).
•
Checking respirator filters are in date.
Training Requirements
If workers are to use PPE effectively, they have to be provided with information, instruction and training. In particular,
they will need to know:
•
What the risks are that the PPE can give effective protection against (including limitations).
•
How and when the PPE should be used.
•
How and when to clean, inspect, maintain or replace the PPE.
•
Requirements for storage of the PPE.
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Failure to provide this in a comprehensible form will result in poor (and perhaps even dangerous) practices
developing. The ‘comprehensible form’ may include a practical demonstration of how the PPE should be worn.
Since different items of PPE will have different training requirements, it may be sensible for the employer to take this
into account when selecting PPE in the first place. If two items of PPE give the same level of protection, but one is
more complex and will require considerably more training resources, then it might be better to choose the simpler
option.
Duty to Ensure PPE is Worn Correctly
The ILO Code of Practice - Safety in the Use of Chemicals at Work, requires that, if adequate protection against exposure
to hazards cannot be ensured by engineering methods, suitable personal protective equipment, and protective
clothing, should be provided, and maintained by the employer.
The code also requires workers to be fully instructed in the use of PPE and make proper use of, and to take good care
of, the PPE provided to them.
The employer is required to provide supervision to ensure the equipment is properly used.
Member states may have national laws and Regulations that make these statutory requirements.
STUDY QUESTIONS
5. When choosing PPE for the workforce, what factors should the employer consider when determining its
suitability?
6. What is meant by compatibility in relation to PPE?
7. Describe the fundamental difference between respirators and breathing apparatus.
8. Identify the advantages of a powered clean-air respirator over a conventional cartridge (canister) - type
respirator.
9. What factors would you consider when choosing eye protection?
10. Identify three possible problems associated with wearing protective gloves.
(Suggested Answers are at the end.)
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Summary
Ventilation
We have described how:
•
Dilution ventilation is a form of engineering control, where the airborne concentration of a substance is kept to
acceptable levels, by changing the air volume (passively or with fans).
•
Local Exhaust Ventilation (LEV) systems work by removing contaminated air at the point of generation, and are
made up of five basic parts: hoods, ducts, air cleaner, fan and discharge.
•
LEV can be classified into three types, depending on the nature of the hood: enclosing, receiving and capturing.
•
Elements of the LEV system have to be carefully designed and selected, to ensure correct and efficient operation.
•
A range of air-cleaning devices can be used to remove contaminant from the captured air before discharge. Bag
filters, cyclones, electrostatic precipitators and scrubbers are typically used for particulates; and tower scrubbers,
incinerators and charcoal filters used for gas and vapour.
•
LEV systems capture contaminant from a specific zone adjacent to the inlet hood. If contaminant is generated by
work outside of this capture zone, then the contaminant will not be efficiently drawn into the LEV system.
•
LEV systems must be subjected to thorough examinations and tests to ensure their ongoing effectiveness. This
thorough examination comprises a three-stage process:
–– Stage 1 - visual examination of the system.
–– Stage 2 - quantitative assessment of performance by measuring parameters, such as face velocity, transport
velocity and static pressure. Devices, such as anemometers, pitot tubes and manometers are used to measure
these parameters.
–– Stage 3 - qualitative assessment of performance using dust lamps or smoke to visualise air movement.
•
The resulting Report of Thorough Examination and Test must be interpreted and acted upon.
Personal Protective Equipment and Respiratory Protective Equipment
We have described how:
•
Protection offered by RPE is indicated by the Assigned Protection Factor (APF), a measure of the ratio of
contaminant inside to outside the face-piece.
•
The APF can be used in combination with contaminant concentrations and Occupational exposure Limits (OELs),
to indicate the degree of protection offered by an item of RPE and hence its suitability.
•
When selecting RPE, the following factors must be considered:
–– Atmosphere and substance-related factors, such as potential for oxygen deficiency.
–– Task and work area-related factors, such as work rate and duration.
–– Wearer-related factors, such as fit/comfort and acceptability.
•
Most items of RPE require some form of face-fit test to ensure that an adequate seal exists between the item and
the wearer’s face.
•
Skin is often protected from hazardous chemicals using clothing, such as gloves.
–– Gloves must be carefully selected to ensure their suitability. Several characteristics of gloves need to be
understood to make an informed choice; breakthrough time, permeation rate and degradation rating.
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Summary
•
Reference should be made to the relevant standard.
•
Eye protection, in the form of safety spectacles, goggles and face shields, is also frequently used to give protection
from hazardous substances and must be carefully selected with reference to relevant standards.
•
When selecting skin and eye protection, the following factors must be considered: substance-related factors, such
as compatibility with the chemical against which protection is required; task-related factors, such as duration of
operation and breakthrough times; wearer-related factors, such as fit/comfort and acceptability.
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Unit ID2
Suggested Answers - Part 1
No Peeking!
Once you have worked your way through the study questions in this book, use the suggested
answers on the following pages to find out where you went wrong (and what you got right),
and as a resource to improve your knowledge and question-answering technique.
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Learning Outcome 9.1
Question 1
•
To gain or maintain a competitive advantage.
•
Maximising the efficiency of workers with physical or mental health conditions.
•
Provide the support necessary for workers to achieve their full potential.
Question 2
The bio-psychosocial model is a way of considering ill health as being more than simply a case of a biological disease.
It takes a more holistic view that includes biological, psychological and social aspects of the condition:
•
Biological refers to the physical or mental health condition.
•
Psychological recognises that personal/psychological factors also influence functioning and the individual must
take some measure of personal responsibility for his or her behaviour.
•
Social recognises the importance of the social context, pressures and constraints on behaviour and functioning.
Question 3
‘Vocational rehabilitation’ is the process of returning a worker back to meaningful work as a way of aiding their
recovery and return to health, following a period of physical or mental ill health. It can also be a way of improving the
health of an individual through getting them into work and keeping them in work.
Question 4
The typical functions of an occupational health service are:
•
Pre-employment screening - general health assessment of both general fitness and specific job fitness.
•
Health surveillance - routine checks or tests focusing on specific aspects of health as a result of exposure to a
specific hazard.
•
Return-to-work rehabilitation programmes - management of the rehabilitation of specific workers back into work.
•
Sickness absence management - recording and analysis of absence data and involvement in sickness absence
procedures.
•
Counselling - formal or informal listening service with in-house or external referral as required.
•
Risk assessments - involvement in some general workplace assessments and conducting specific assessments, such
as those for pregnant women.
•
Health education and promotion - running campaigns and providing support on various public health issues.
•
Providing advice - to employers and workers on specific health issues and queries.
•
Treatment services and first aid - such as management of main treatment facility and assessment and
management of first-aid provision.
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Question 5
The possible benefits from undertaking a health assessment are:
•
Return to work is facilitated.
•
The employee is enabled to undertake their job.
•
Concerns are discussed which enables greater control of personal well-being.
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Suggested Answers to Study Questions
Learning Outcome 9.2
Question 1
Short-term symptoms that might arise in workers who are suffering high levels of stress are:
•
Raised heart rate.
•
Increased sweating.
•
Headaches.
•
Dizziness.
•
Blurred vision.
•
Aching neck and shoulders.
•
Skin rashes.
•
Lowered resistance to infection.
Question 2
Organisational factors that could be responsible for creating avoidable workplace stress include:
•
How work is organised - such as awkward shift patterns, unpredictable working hours, unsociable working hours,
excessively long working hours and disruptive changes to shift patterns.
•
Workplace culture - such as lack of recognition of stress as an issue to be managed, a culture of belittling or
penalising weakness or signs of stress, poor leadership, lack of support for staff facing change, lack of resources,
inadequate training, poor communications within the organisation and poor management structure.
Question 3
Anxiety is a feeling of unease, such as worry or fear that can be mild or severe. Depression is when you have feelings
of extreme sadness, despair or inadequacy that last for a long time.
Question 4
•
Speaking to workers as soon as it is recognised that there may be an issue.
•
Use routine management tools to identify and tackle issues.
•
Supporting workers who become emotionally distressed.
•
Supporting workers with on-going mental health conditions.
•
Encouraging workers to develop coping strategies to help manage their condition.
•
Use of ‘advance statements’.
•
Ensuring workers know where to get help and support.
(Only three were required.)
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Question 5
Discuss issues, such as:
•
Flexibility towards individual wishes.
•
Trying to vary working conditions to increase ownership of the job.
•
An open attitude from management.
•
Fair treatment for staff.
•
Training.
•
Resources to cope with new environments.
Question 6
Measures that can be taken to reduce individual stress by improving work relationships include:
•
Developing a written policy for dealing with unacceptable behaviour at work and communicating this to staff.
•
Implementing procedures to resolve conflict at work.
•
Introducing a confidential reporting system for unacceptable behaviour.
•
Establishing grievance and disciplinary procedures.
•
Selecting or building teams that have the right blend of expertise and experience for new projects.
•
Providing training to help staff deal with difficult situations.
•
Celebrating success.
Question 7
Education promotes the development of thinking, increases knowledge, develops personality, and changes attitudes.
Education and support programmes also ensure workers are aware of the purpose of proposed interventions and
what will as a consequence of the intervention.
Many of the secondary interventions aimed at the management of psycho-social risks require the provision of
education and training.
Question 8
Any four from:
•
Champion health initiatives.
•
Act as a point of contact for workers.
•
Encourage workers to become involved.
•
Empower workers to become involved.
•
Work in consultation with management, workers, occupational health professionals and HR departments.
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Question 9
Line managers must be able to adopt the approach that supports their teams to achieve a state of well-being.
Line manager’s behaviour is a significant influence on organisational culture and on the worker’s work experience.
Positive line manager-worker interactions will prevent disruptive issues (such as mental ill health and absence)
occurring.
Line managers who are appropriately trained can deal with mental ill health issues at an early stage to prevent
deterioration.
Question 10
The ILO Code of Practice definition is: “Any action, incident or behaviour that departs from reasonable conduct in
which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work.”
Question 11
Handling money/valuables (cashiers); people working with the public in caring/teaching professions (nurses);
carrying out inspection or enforcement duties (traffic wardens); working with potentially violent people (mental
health workers); working alone (home visitors).
Question 12
Factors such as when the assailant:
•
Is under the influence of drink or drugs.
•
Is in pain or distress.
•
Is under significant stress.
•
Is being forced or coerced.
•
Is committing theft.
•
Is committing sexual assault.
•
Has a mental health condition.
(Only four were required.)
Question 13
•
Find out if there is a problem.
•
Decide what action to take.
•
Take action.
•
Check what you have done.
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Question 14
•
Change the job.
•
Use cash-free systems.
•
Change layout of public working areas.
•
Redesign counters.
•
Vet credentials of clients and customers.
•
Use panic buttons, personal alarms, etc.
•
Use security measures such as protective screens.
•
Cameras, etc.
•
Plan work schedules of vulnerable staff, etc.
Question 15
(a) Some of the hazards a lone worker might encounter could be:
•
Working at height off of temporary access equipment, such as portable ladders or trestles.
•
Restricted access and egress.
•
Confined spaces.
•
Dangerous machinery.
•
Dangerous chemicals, dusts or biological hazards.
•
Electricity.
•
Flammable or explosive substances.
•
Very cold or very hot environments.
•
Heavy objects which are too large for one person.
•
Violent or aggressive patients or clients.
•
Violent or aggressive animals on farms or in zoos.
•
Dangerous road conditions such as snow, ice, low sun or other, aggressive drivers.
(b) Risks a lone worker may face could be:
•
Falling from height.
•
Becoming trapped or engulfed in a liquid or free-flowing solid such as rice or grain.
•
Being overcome or asphyxiated by fumes in a confined space.
•
Becoming entangled in machinery.
•
Being burned or overcome by dangerous chemicals or their fumes.
•
Being electrocuted.
•
Being burned or involved in an explosion.
•
Suffering from heat exhaustion or hypothermia.
•
Damaging limbs, muscles or bones lifting heavy objects.
•
Being attacked by violent or aggressive patients or clients.
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•
Being attacked or savaged by violent or aggressive animals.
•
Suffering injuries as a result of being involved in a road traffic accident.
Lone workers also face the risk of physical and mental problems due to the nature of their role.
Question 16
Control measures employers can put in place to deal with the risks involved in lone working might include:
•
Ensuring risk assessments identify lone working tasks on and off site and the potential hazards.
•
Eliminating the hazards of working alone by using a buddy system. People should work in pairs at difficult or outof-the-way sites, including home and community visits.
•
Information on high-risk geographical areas or jobs should be given to staff (particularly new members) and
records of staff whereabouts should be kept. Safe completion of jobs should be reported.
•
Good communications at all times: mobile telephones and two-way radios can be useful in some cases.
•
Electronic and visual monitors, which can also offer some protection.
•
The introduction of a Personal Alarm Security System (PASS).
•
Alarms: many counter, service and care workers have access to panic buttons and a range of other emergency,
personal distress and violent attack alarms are available.
•
Re-organise the way jobs are done to provide a safer system of work.
•
Review procedures regularly to make sure they are working.
•
The necessity for handling cash or dangerous materials should be continually reassessed.
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Learning Outcome 9.3
Question 1
Forms of health surveillance are:
•
A pre-employment medical to identify symptoms of HAVS and other non-occupational diseases.
•
Periodic medical examinations for those workers exposed to hand-arm vibration, including the identification of
possible symptoms of HAVS.
Question 2
The advantages of audiometry are:
•
Early detection of individuals with hearing loss that will allow those individuals to be further protected, to prevent
deterioration.
•
Early detection of poorly controlled noise exposure in the workplace that will allow other workers to be further
protected before hearing loss occurs.
•
Negative test results (i.e. no hearing loss) will confirm that the hearing conservation programme in place in the
workplace is working effectively.
•
Establishment of a pre-employment baseline that will protect the employer in the event of a claim for
compensation.
•
Compliance with legal requirements.
(Only two were required.)
Some disadvantages of audiometry are:
•
As a form of health surveillance, it is inherently reactive, in that it simply confirms hearing loss after it has
occurred (rather than preventing that hearing loss).
•
It can be inaccurate for technical reasons, or due to an unco-operative test subject.
•
It can be difficult to operate in practice when large numbers of workers have to be tested.
•
Classification of a worker into Category 2, 3 or 4 may act as the trigger for a claim for compensation.
(Only two were required.)
Question 3
The fatigued worker may have:
•
Slower reaction time.
•
Reduced ability to process information.
•
Memory lapses.
•
Absent mindedness.
•
Increased errors and accidents.
•
Reduced productivity.
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Question 4
Health surveillance for someone working at height can detect:
•
Dizziness.
•
Epilepsy.
•
Diabetes.
•
Psychiatric conditions.
•
Musculoskeletal conditions.
Question 5
Surveillance can take the form of observing warning signs, such as:
•
Frequent absences from the workplace.
•
Changes in behaviours.
•
Dips in productivity.
•
Increase in accidents or near misses performance or conduct issues.
Question 6
Biological monitoring means:
The measurement of a substance or its metabolite (substance formed when the body converts the chemical) in a
biological fluid (breath, urine or blood), e.g. monitoring for isocyanates in urine
Question 7
The actions to establish an effective alcohol and drugs policy are:
•
Develop and present a business case for introducing a policy.
•
Present a business case to the senior leadership team.
•
Obtain active support from the leadership team.
•
Use a working party who are likely to have some responsibility for implementing the policy to develop the policy.
•
Consultation on the policy.
•
Link the policy to other policies such as sickness absence, and disciplinary procedures.
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Question 8
The benefits from pre-employment screening are:
•
The identification of physical or psychological problems that may affect the person’s ability to undertake the
duties of the role.
•
Allows the employer to meet any statutory health surveillance requirements which can be used as a baseline
measure to detect changes during employment.
•
Discover if a person is at risk of combining medications with alcohol.
•
Identify any reasonable adjustments that may be required.
•
Advise candidates of why certain job roles may not be suitable for them.
•
Use the baseline data for future assessment.
(Only four were required.)
Question 9
Disadvantages associated with alcohol and drug testing in the workplace are (any six from):
•
A positive alcohol or drug test reveals only a potential past condition, not necessarily a present one.
•
Urine or blood sampling for drug use are ineffective in revealing intoxication, preventing accidents, and
dissuading drug use while at work.
•
Drug and alcohol testing measures consumption within a wide time-frame, and thus may have no implications on
workers’ actual level of impairment while at work.
•
Testing before work starts does not detect drug use while at work.
•
Testing does not dissuade drug or alcohol use after the test is complete.
•
Applicants may take a break from consumption, so they are clean for the pre-employment drug screen.
•
False positives on random drug tests are common because certain medications and foods can replicate the
signatures of banned substances.
•
There may be negative repercussions for workers whilst giving the false impression of safety.
•
Some countries have legalised the use of some drugs, especially for medical purposes, which may cause conflict at
work.
•
Random drug and alcohol testing may make it harder to recruit suitable employees.
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Learning Outcome 9.4
Question 1
Inhaled air passes through the nose or mouth, down the trachea, bronchi and bronchioles, into the alveoli. Here, the
very thin lining of alveoli and blood vessels allows oxygen to diffuse into the bloodstream where it then diffuses into
red blood cells and is bound to haemoglobin.
Question 2
To deliver oxygen to all parts of the body and remove impurities and waste products.
Question 3
The heart (the pump); the blood vessels (pipes for carrying the fluid) and the blood itself (the fluid that circulates).
Question 4
When light strikes the retina, electrical impulses are generated and transmitted via the optic nerve to the brain.
Question 5
Local effects are confined to the specific area of the body where contact with chemicals occurs. Systemic effects occur
at target organs or target systems of the body distant from the site of contact.
Question 6
The respiratory system’s main defences are nasal hair, mucous, sneeze reflex, mucociliary escalator and, in the lungs
themselves, phagocytosis. The inflammatory response is also a defence mechanism, as is acquired immunity.
Question 7
•
The inhalable (or total inhalable) dust fraction is the fraction of airborne dust that enters the nose and mouth
during breathing, and is therefore available for deposition in the respiratory tract.
•
The respirable dust fraction is the fraction of airborne dust that penetrates to the gas exchange region of the
lung. Typically, these are dust particles of less than 7µm diameter.
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Learning Outcome 9.5
Question 1
The Globally Harmonised System of Classification and Labelling of Chemicals (GHS) is a non-legally-binding
international agreement on the labelling and classification of chemicals, with the aim that each chemical will have the
same label worldwide.
Question 2
Produces serious, acute or chronic ill health or death at very small or small doses.
Question 3
They are to ensure that the user is made fully aware of the potential risks or hazards associated with a chemical
or mixture and the precautions to take. They can be found on product labels, safety data sheets and, for many
substances, they originate from the harmonised classifications found in Table 3.1 of Part 3 of Annex VI of CLP.
Question 4
Supplier/manufacturer details, hazards, composition and/or ingredients, first-aid recommendations, fire-fighting
procedures, accidental release procedures, handling and storage, exposure controls, personal protection, physical and
chemical properties, stability and reactivity, and toxicological, ecological, disposal, transport, regulatory and other
information.
Question 5
Several factors must be considered during this assessment, such as:
•
Hazardous properties of the substances.
•
Type and level of exposure.
•
Duration and frequency of exposure.
•
Number of people exposed.
•
Effect of mixtures.
•
Unusual activities and emergencies.
•
Relevant Workplace Exposure Limits (OELs).
•
Effectiveness of existing controls.
•
Results of monitoring and health surveillance.
•
Individual susceptibility.
Question 6
Whether the individual is atopic and therefore more prone to sensitisation; whether they are pregnant or a new
mother or whether they are a woman of reproductive capacity; whether they are a young person; and whether they
are already sensitised to a substance.
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Question 7
The hierarchy of controls for exposure to hazardous substances is:
•
Eliminate exposure.
•
Substitute the substance.
•
Modify work process.
•
Total enclosure.
•
Engineering controls.
•
Minimise numbers exposed.
•
PPE.
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Learning Outcome 9.6
Question 1
In a case-control study, the risk factors of people with a disease are compared with those without a disease. It is a
retrospective study. Members of the two cohorts are chosen on the basis that they either have the disease in question
(case) or are disease-free (control).
A prospective cohort study follows two groups (cohorts) over a period of time (usually years). One cohort is known
to be exposed to the agent in question; the other cohort (control) has no exposure to this agent. Both groups
undergo medical surveillance to look for disease that might be linked to the agent in question.
Question 2
A good occupational example would be asbestos exposure and lung disease.
Two populations are identified which differ only by the fact that one group has been historically exposed to asbestos
and the other has not. Evidence of exposure is collected from health records. Medical surveillance is then carried
out to gather data about the prevalence of lung disease in these two groups. This is reinforced with other health
data. Statistical analysis is then carried out to see if a link between lung disease and historic asbestos exposure can be
proven to exist.
Question 3
Acute toxicity (oral, dermal, inhalation, dermal irritancy/corrosion, eye irritancy/corrosion; skin sensitisation;
repeated dose (28 days) toxicity; sub-chronic repeated dose (90 days) toxicity; chronic toxicity; mutagenicity;
carcinogenicity and reproductive toxicity.
Question 4
Acute toxicity tests measure the effects which occur within a short period after dosing. The dose of the substance is
successively increased and the effects are measured.
For the fixed dose acute toxicity test, the test substance is administered orally to test animals at one of four dose
levels - 5, 50, 300 and 2,000mg/kg. The animals are observed for 14 days and any deaths or serious ill health are
observed. The results are then compared with regulatory criteria in order to classify the chemical toxicity.
Question 5
The most well-known test is the Ames test. This involves exposing the mutagen to a specific strain of bacteria that will
not normally grow in a histidine-deficient growth medium. Mutagens will cause a mutation in the bacteria allowing
them to grow in a histidine-free medium.
Question 6
This measures the response (usually, percentage killed) of a given animal species to logarithm of a known dose of a
toxic substance.
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Question 7
The curve should be S-shaped, as shown in the dose/response curve figure below:
Dose/response curve
The LD50 and LD90 of a given substance is the dose that kills 50% and 90% respectively of the animal population
tested.
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Learning Outcome 9.7
Question 1
•
Asbestosis - asbestos fibres lodge deep in the lungs and cause scar-tissue formation. If enough of the lung is
scarred then severe breathing difficulties occur. Can prove fatal. Increases risk of cancer.
•
Lung cancer - asbestos fibres in the lung trigger the development of cancerous growths in the lung tissue. Usually
fatal.
•
Mesothelioma - asbestos fibres in the lung migrate through the lung tissue and into the cavities around the lung
and trigger the development of cancerous growths in the lining tissue. Always fatal.
•
Diffuse pleural thickening - thickening of the lining tissue of the lung (sometimes known as pleural plaques)
that causes breathing difficulties. Not fatal.
(Only three were required.)
Question 2
•
Prevent the risk of occupational exposure to asbestos.
•
Prevent harmful effects arising from asbestos dust exposure.
•
Provide reasonably practicable control procedures.
Question 3
Engineering controls should include:
•
Process separation, automation or enclosure.
•
Bonding asbestos fibres with other materials to prevent dust generation.
•
General ventilation of the working areas with clean air.
•
Local ventilation of processes, operations, equipment, and tools, to prevent dust dissemination (Ventilation is
covered in more detail in Learning Outcome 9.8).
•
Use of wet methods, where appropriate.
•
Separate workplaces for certain processes.
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Learning Outcome 9.8
Question 1
Dilution ventilation is a method of diluting the concentration of a contaminant by changing the workplace air
regularly. This might be done passively or with the use of fans to power the air movement. This method is only
suitable where there is a relatively low concentration of high WEL contaminant which is given off slowly. It is not
suitable where operators are in close contact with the source of contamination.
Question 2
To ensure that the system is working to its design specification. This should, in turn, ensure that the system is
maintaining an acceptable work environment by keeping levels of airborne contaminants below set standards. In the
absence of monitoring, the system may stop working effectively and this may go unnoticed.
Question 3
To give an indication of blockage or reduced efficiency of the filters. This may indicate that the filters need to be
changed and cleaned.
Question 4
•
Name and address of employer responsible for the plant.
•
Identification and location of the LEV plant, process and hazardous substance concerned.
•
Date of last thorough examination and test.
•
Information about the LEV plant which shows:
–– Its intended operating performance for controlling the hazardous substance.
–– Whether the plant continues to achieve the same performance.
–– If not, the repairs required to achieve that performance.
•
Methods used to make the above judgments, e.g. visual pressure measurements, airflow measurements, dust
lamp, air sampling and filter integrity tests.
•
Date of examination and test.
•
Name, designation and employer of person carrying out the examination and test.
Question 5
•
It is appropriate for the risk and conditions.
•
It takes account of ergonomic requirements.
•
It will fit.
•
It does not increase overall risk.
•
It meets relevant standards.
•
It is CE-marked.
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Question 6
Compatibility means that where more than one piece of PPE is required, the wearing of one does not affect the
effectiveness of another.
Question 7
Respirators are designed to purify respirable air by filtering air taken from the immediate surroundings of the wearer,
whilst breathing apparatus supplies respirable air from an uncontaminated source.
Question 8
The pump attached to a powered respirator provides a positive air pressure reducing fatigue, allows longer work
periods and minimises the risk of ingress of contaminants.
Question 9
Account needs to be taken of the hazard which the eye protection is intended to protect against, the conditions
under which it would be used, the ergonomic requirements and compliance with standards. Compatibility with other
items worn is also an issue.
Question 10
Loss of dexterity and feeling; overheating of the hands; sweating leading to dermatitis or opening of the skin pores;
possible removal of the gloves whilst carrying out a hazardous operation.
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