Recent regulations include a number of changes
With the Control of Vibration at Work Regulations in force since October 2005 and the Control of Noise at Work Regulations which came into force in April this year there are a number of changes in legislation that employers need to take on board.
One of these new duties placed on employers to be included within the regulations is the requirement to provide health surveillance for workers where there is a risk to health. The specific nature of what is required is detailed in HSE’s guidance notes. There is no requirement for health surveillance for whole body vibration (WBV) as it is not considered appropriate. Valuable information can however be obtained from less formal measures than those detailed in a prescribed health surveillance approach, such as the collation of self-reported symptoms, known as ‘health monitoring’.
Health surveillance for noise exposed workers
The main health effect of concern caused by exposure to noise is Noise Induced Hearing Loss (NIHL). NIHL is a permanent irreversible effect and when combined with normal age related degeneration of hearing can have a real impact on an individual’s quality of life. This may be combined with tinnitus – a ringing, buzzing noise in the ears, which can be very distressing. Noise in the workplace may also cause annoyance, distraction and interfere with audible warning signals.
The regulation on health surveillance states that health surveillance will be required where the risk assessment indicates there is a risk to health. The guidance states that there is a risk to health at 85 dB. This means that all workers regularly exposed at or above the upper exposure action value (UEAV) should be under health surveillance. ‘Regularly’ is a term used to exclude those workers who may only be exposed say once a month or so infrequently that the risk would not justify provision of health surveillance. There is a provision within the guidance for health surveillance to be provided for susceptible individuals exposed between 80 and 85 dB. This needs to be requested by the worker who would have to demonstrate a particular vulnerability to early NIHL. This may be through family history of early deafness, previous audiograms or medical history. Health surveillance for NIHL is done through a method known as pure tone audiometry. This is a system of presenting pure tones to each ear at different frequencies to identify at what levels they can be heard.
Health surveillance has a number of benefits and contributions to make to a noise conservation programme. It aims to identify those individuals with early symptoms of damage relating to their exposure. Those affected need to be dealt with appropriately either through advice and guidance and/or medical care. Individuals should be advised on how to comply with the control methods in place and on other measures they can take to protect their own hearing such as the correct wearing and care of their hearing protection. Also by identifying these workers and analysing the results of health surveillance, trends can be identified where harm may be occurring in the workplace. This can highlight problems with the initial risk assessment or failures of control measures. Results of health surveillance should then feedback to the risk assessment and risk action plan and actions need to be taken to address any new risks arising or failures of controls.
Audiometric testing can be carried out by anyone with appropriate training as HSE’s categorisation scheme provides for referral of individuals who have problems that require further medical investigation. In setting up a health surveillance programme for NIHL you should preferably have a health professional overseeing the programme, such as an occupational physician, nurse with specialist training in audiometry or an audiologist. However, for small businesses or where the cost of employing a health professional would be too great it is possible to run the programme by having an appropriately trained non medical person conducting the testing as long as a system for referral for medical advice is in place. The British Society of Audiology have a training syllabus for how to perform workplace audiometry for NIHL and they have a number of approved course providers.
Health surveillance for hand arm vibration exposed workers
Employees exposed on a regular basis at or above the exposure action value (EAV) are likely to be at risk of developing vibration related diseases such as hand arm vibration syndrome (HAVS). The greater the exposure the greater the risk and the more the employer needs to do to control it. In the case of hand arm vibration (HAV) exposures below the EAV may present a risk for some people. Exposure at the HAV exposure limit value is believed to pose a high risk and the regulations require that exposure should be controlled to prevent this level being reached or exceeded.
Health surveillance should be provided for vibration-exposed employees who:
- Are likely to be regularly exposed above the action value
- Are likely to be exposed occasionally above the action value and where the risk assessment indicates that the frequency and severity of exposure may pose a risk to health
- Have a diagnosis of HAVS (even if exposed below the action value)
HSE’s guidance proposes a tiered system of on-going health surveillance for hand arm vibration. The first tier can be carried out by the employer and need not involve a doctor or a nurse. This would be a short simple annual questionnaire for employees. Only employees reporting symptoms would need to be referred to an occupational health professional or doctor. If no symptoms are reported on the screening questionnaire there is no need for referral for further assessment but the employee should complete the simple questionnaire again on an annual basis and it is recommended that after 3 years of a vibration exposed employee reporting no symptoms they should be referred for a consultation with an occupational health nurse to provide an opportunity to explore more fully any possible symptoms that the individual may have overlooked.
KEY FACTS BOX Health Surveillance for Noise
- Required for all workers regularly exposed above 85 dB (UEAV)
- Is pure tone audiometry
- Performed at three yearly intervals (annually for the first 2 years of employment)
- HSE categorisation scheme to simplify results into 1 of 4 categories of hearing ability
- Can be conducted by non-medical trained people with a system in place to refer to a doctor (which may be a GP) when problems are identified
Therefore initially no occupational health involvement may be necessary in order to ask employees to volunteer information about symptoms related to their vibration exposure. However, if any symptoms are reported the employee would need to be referred to a properly trained nurse or doctor who can decide whether the symptoms are due to HAVS. In the first instance any employee reporting symptoms should be referred to a competent qualified person (usually an occupational health nurse) for clinical assessment. A formal diagnosis of HAVS should only be made by a competent doctor who can also make a decision on fitness for continued work with vibration. An employee with HAVS should be reassessed at regular intervals and may need additional investigations in order to detect any progression of the disease.
The Faculty of Occupational Medicine (FOM) has adopted a syllabus of approved training for doctors and nurses involved in health surveillance for HAVS leading to a qualification that indicates suitable competency. An employer should enquire whether doctors and nurses have gained this qualification or achieved an equivalent level of competency and also have more general training on occupational health or occupational medicine. However, for a limited period following the introduction of these new regulations it may be that health professionals, who have not yet had this specialist FOM approved training, could still be used to conduct health surveillance.
An employee found to have HAVS should be informed of this by an appropriate health professional. An employer may be told about an individual’s diagnosis if that employee has given their consent. Even if there is no consent for disclosure of medical diagnoses an employer should expect to see grouped anonymised information as a result of health surveillance, which can be used to check the long-term effectiveness of the control measures. If the number of employees with HAVS has increased or the disease is progressing in affected individuals you need to review your risk assessment and action plan. If an employee is diagnosed with HAVS it can be expected that other employees in the same job or with similar exposure to HAV will also be at risk and be likely to need health surveillance. You will also receive information about fitness for continued work with exposure to HAV for each employee undergoing health surveillance.
KEY FACTS BOX Health Surveillance for HAV
- Required for all workers regularly exposed above 2.5m/s 2 A(8) (EAV)
- Tiered system – 1st tier is a questionnaire on symptoms that can be administered by the employer (no medical personnel required)
- If any symptoms reported need to move onto further tiers that require occupational health involvement
Health monitoring for whole body vibration exposed employees
There is no appropriate health surveillance for WBV exposure because there are no valid techniques available for the detection of changes in peoples backs that reliably indicate the existence of low back pain specifically related to this type of exposure. Useful information can, however, be obtained from less precise measures than those provided for by a formal health surveillance scheme. This is known as health monitoring and for whole body vibration exposure should involve a routine request for self reported symptoms from workers relating to musculoskeletal problems. As this health monitoring procedure does not fit with the requirements of the health surveillance regulation it is not a statutory requirement.
It is, however, considered good practice in the care of workers who may be exposed to WBV and other risk factors for low back pain in the workplace. It also helps an employer to comply with other parts of the regulations by providing useful information to supplement the risk assessment and aid risk management. The system can be used to collect, monitor and compare information between different groups of workers.
An employer has a duty under both sets of Regulations to keep a health record for each employee who undergoes health surveillance. This should be kept up to date for as long as each individual is under health surveillance, although it may be retained for longer. It is good practice to offer individual employees a copy of their health record when they leave employment, if the business ceases trading or the employee is no longer exposed to HAV or noise. The record should include:
- Identification details of the employee
- The employees history of exposure to noise and/or HAV
- The outcome of previous health surveillance in terms of fitness for work and any restrictions required
- Questionnaires if these are treated as non-confidential
Health records should not contain personal medical information, which must be kept in confidence in the medical record held by the occupational health professional.
Although previous general health and safety legislation required health surveillance for noise and HAV, the arrival of these new regulations mean that for the first time there is a specific legal requirement on employers to control the risks arising from exposure to these agents. This means many employers will now need to acquire the services of appropriately trained personnel to conduct such testing, be required to maintain health records and act upon anonymised feedback of the results of testing. All of this will take some familiarisation with what, when and how health surveillance should be conducted.
Hand Arm Vibration: Control of Vibration at Work Regulations 2005. Guidance on Regulations L140
Controlling Noise at Work: Control of Noise at Work Regulations 2005. Guidance on Regulations L108
Whole-body vibration. Control of Vibration at Work Regulations 2005. L141
Published: 10th Oct 2006 in Health and Safety International