There are several different kinds of health surveillance. Each is related to specific conditions, typically associated with particular workplace hazards and activities. The main types of health surveillance are listed below.
Lung function testing
A lung function test uses special equipment to measure how well the lungs are working. It compares lung performance with earlier results for the same person as well as giving a guide against ‘average’ results for people in general. Lung function tests can be used to monitor workers in a wide range of activities where the presence of fumes, respirable dusts, vapours or gases could adversely affect the lungs. The tests can be performed by a suitably trained person but need to be interpreted by an occupational health professional.
This test is particularly helpful when investigating occupational asthma and/or incidents of sensitisation (i.e. where someone becomes ‘super sensitive’ to a substance to the point where exposure to only a trace of the substance will bring on symptoms otherwise only associated with much higher exposure levels). (See hazardous substances.)
Skin inspections
An inspection to help detect the early signs of dermatitis can be carried out by a line manager trained to assess indications of skin disorders.
Dermatitis can occur in employees working with a wide range of substances and materials including solvents, metalworking fluids and epoxy resins etc.. The inspection involves a visual examination of exposed skin (normally hands and forearms and possibly the face/neck) for any reactions together with an indication of the size of the affected area.
The results should be recorded and signed/dated by both the employee and the person making the inspection. In cases where any deterioration is noted the affected employee should immediately be referred to an occupational health professional for treatment and advice on how to prevent recurrence (see hazardous substances).
Full medical
Medical surveillance by an occupational health professional can include:
- ad hoc and/or regular clinical examinations, for example, to look for health effects from exposure to some chemicals;
- annual medical examinations to assess an individual's fitness for work, for example, under the Ionising Radiations Regulations 1999; and
- medical examinations under specific regulations, e.g. for asbestos or lead.
In certain circumstances medical surveillance has to be undertaken by doctors appointed by HSE, for example, where workers are exposed to lead, asbestos, ionising radiation or certain chemicals. On rare occasions, a medical may be undertaken by HSE medical inspectors (for information on Employment Medical Advisory Service.
Audiometry
Health surveillance is required for all employees regularly exposed to noise levels above the upper exposure action value and for individuals at greater or additional risk if exposed between the lower and upper exposure action values.
Health surveillance for the effects of noise is normally completed through audiometric testing by a qualified person, in line with the requirements of The Control Of Noise At Work Regulations 2005(see noise).
Hand-arm vibration syndrome (including vibration white finger)
Suggested health surveillance for employees exposed to hand-arm vibrations is described in Part 5 of the guidance to the Control Of Vibration At Work Regulations 2005(see HSE's Control of risks from hand-arm vibration INDG175).
The approach involves examining to a number of stages or tiers (1 to 5) with an increasing involvement in details and expertise needed. As a guide, Tier 1 is a short questionnaire used as a first check for people moving into jobs involving exposure to vibration with Tier 5 being an optional referral of the employee for certain tests for HAVS.
The results of this surveillance should help the occupational health professional assess fitness for work (see vibration).
Health monitoring
There are currently no techniques that would reliably detect early indications of ill-health caused by certain workplace actives, e.g. musculo-skeletal disorders arising from manual handling. Nevertheless valuable information can be obtained from less precise measures such as reporting, monitoring and investigation of symptoms. This is known as ‘health monitoring’.
It is good practice to put in place systems that allow individuals to make early reports of manual handling injuries or back pain. Where appropriate, these can be supplemented, for example, by monitoring sickness absence records, lifestyle and health promotions and annual health checks. Further advice is in HSG61 Health Surveillance at Work (see also musculo-skeletal disorders (MSD) and manual handling).
Biological monitoring
Biological and biological effect monitoring measure and assess the take-up of, or the effects of, exposure to substances such as lead or other chemicals, by testing blood, urine or breath samples (see hazardous substances).
Ionising radiation dosage monitoring
Permitted dose levels are specified in regulation 11 of the Ionising Radiations Regulations 1999. Checks have to be made periodically by an approved dosimetry service to ensure that all exposed workers do not exceed the stated maximum dose levels (see hazardous substances).
HSE publication HSG61 Health Surveillance at Work contains more detailed guidance on many of these issues.