GENERAL CODE OF PRACTICE FOR MEDICAL SURVEILLANCE
1. Definition

Medical surveillance is a risk-based set of planned medical examinations:
o
Prior to placement in a risk area (part of the pre-placement medical examination)
o
Prior to leaving a risk area (exit)
o
Periodical: after having been exposed to a risk for a certain time or when the employer is
suspicious of the employee’s fitness for work.

The Nelson Mandela Bay Metropolitan Municipality medical surveillance Program includes: preplacement, periodical and exit medicals.
2. Purpose

Safe and hygienic placement of a person in the job.

Establishment of pre-existing conditions and the ensuing recommendations to the employee
and to the employer.

Detect disease at an early stage.

Assist NMBMM in taking action to reverse early effects or to slow the progression of the
disease.

Assess the effectiveness of workplace control measures.

Establish any effects the employment may have had on the health of an employee (during
employment –periodical medical examination- or at termination of employment –exit medical
examination).

Establish and implement preventative measures for which the employer is responsible:
vaccination, medical test schedules.
3. Legal status

Occupational Health and Safety Act, Basic Conditions of Employment Act and guidelines,
codes or regulations in terms of these statutes.

Where NMBMM operates a quarry, the Mine Health and Safety Act applies.
4. Employer policies

Occupational Health and Safety policy, which must include reference to the practice and
procedures of medical surveillance.
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
Recruitment, Selection and Placement Policy.

Fitness for work policy.
5. Standards

Statutory: Occupational Health and Safety Act; Mine Health and Safety Act

As determined by the NMBMM- or - occupational medicine practitioners.

In view of the fact that NMBMM’s legal obligations (to apply ‘reasonably practicable’ measures
of medical surveillance) are based on the knowledge and expertise of the Occupational Health
team and that the knowledge of the team is imputed to the NMBMM, all members of the team
will consult with one another and with relevant experts in the fields of pathology.
6. Timing

Pre-employmen: medical examination: after a conditional offer of employment has been given
to the applicant and within 2 weeks of starting to work.

Pre-placement medical examination: prior to or within 2 weeks after a transfer from one risk
area to another.

Periodical medical examination: employees are subjected to a risk-based medical examination
by an occupational medicine practitioner, at intervals determined by the occupational exposure.
See attached schedule

Exit medical: before, or as soon as possible after, termination of employment. Any preplacement or periodical medical examination performed within a 6 month’s period prior to the
employee’s exit, may be regarded as an exit medical examination, if acceptable to the
Occupational Medical Practitioner.
7. Contents

A general medical questionnaire.

An occupational history questionnaire.

A hazard-specific questionnaire.

A physical examination, including vision evaluation by an Occupational Medical
Practitioner.

Special tests: blood tests, audiometry, lung function testing, PA full plate chest X-ray,
electrocardiogram, urine tests, swab test
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8. Testing standards

A general medical questionnaire.

An occupational history questionnaire.

A hazard-specific questionnaire (night and shift, dangerous and heights work, chemical,
biological).

A physical examination, including vision evaluation:– certain anthropomorphic measures
are done by the occupational nursing practitioner, the overall examination is to be done by
an occupational medicine practitioner

Special tests:
o
Blood tests: glucose, haemoglobin, biological indicators, immunisation status control
o
Urine test: Combur Stix, cannabis, biological indicators
o
Swab tests: biological requirements
o
Audiometry: NIHL Regulations of the OHS Act, SABS 083 and COIDA
o
Chest X ray
o
Lung Function Testing: Mine Occupational Health Advisory Committee
Guidance No 2, 1998
o
ECG: standard 12 lead ECG
9. Outcomes:
An applicant or employee may be:

Fit for the work.

Fit, but required to return for re-examination within a shorter period of time.

Fit, provided certain special precautions are taken.

Temporarily or permanently unfit for the job.
10. Medical reports:

The Occupational Medical Practitioner or Occupational Health Practitioner will communicate the
result of the occupational medical examination to the employee; where applicable, the consent
for communication with management will be obtained at the same time.

For every occupational medical examination, the responsible Occupational Medical Practitioner
will issue a written (hard- or soft copy) report.

If the occupational medical examination identifies an occupational non-conformance, the
Occupational Medical Practitioner or Occupational Health Practitioner will communicate directly
with the manager in charge of the employee.
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
The contents of the information released to the NMBMM and to management will be relevant to
the medical surveillance and will only be released with the informed consent of the employee.

The employee may receive a copy of all medical reports, if requested.

The employee’s private medical practitioner may receive a copy of all medical files, provided the
employee consents in writing.

A trade union representative may receive a copy of the medical reports, provided the employee
consents in writing, to release the information.
11. If the employee refuses to be examined:

The duty to perform medical surveillance is placed on NMBMM as employer.

The NMBMM will impose the duty of medical surveillance on all relevant employees. As
every employee must co-operate with the employer in order to enable the employer’s duty or
requirement to be performed or complied with and every employee has to carry out any
lawful order given, obey the health and safety rules and procedures laid down by the
employer in the interest of safety and health, it is accepted that an employee may not refuse
to undergo medical surveillance.

The NMBMM occupational medicine and health practitioners may not issue a fitness for work
statement, where no medical examination has been performed. The NMBMM, as employer,
may not permit an employee who requires to be under medical surveillance to work in an
area where such testing is mandatory.
12. If the employee does not agree with the medical findings:

An employee who does not agree with the finding of a medical surveillance examination may
request a second opinion.

This dispute will require resolution in terms of the NMBMM policies and procedures
(Recruitment, selection and placement, fitness for work policies, disciplinary and grievance
procedure).
13. Assessment of fairness
The fairness of this medical surveillance protocols, of the distribution and execution of the
examinations and of the management of the outcome protocols must be assessed against the
background of what is considered ‘reasonably practicable.
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