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Efficient, Cost Effective Health Surveillance

Health surveillance is about having procedures in place to detect work-related ill health at an early stage.

Management of health and safety at work regulations, 1999 identify health surveillance as a process to be used to detect signs and symptoms of work-related ill health where:

  • There is an identifiable disease or adverse health condition related to the work concerned.
  • Valid techniques are available to detect indication of the disease or condition.
  • There is a reasonable likelihood that the disease or condition may occur under the conditions of work.
  • Surveillance is likely to further the protection of the health and safety of the employees covered.

You need to understand the following –

  • Why health surveillance may be required.
  • What to do with adverse results.
  • How to manage the process.
  • What records you need to keep.
  • Who does it.
  • Who requires health surveillance.

It is important that the above are used in the decision-making process for the necessity of health surveillance, to avoid un-necessary or inadequate testing which can be costly (cost of the health surveillance itself and then penalties from for instance the health and safety executive).

The health surveillance process can be a bewildering process. We can help guide you through the process and suggest where other specialists may need to be involved.

It often is confused with health screening, biological monitoring (the purpose of which is similar to health surveillance but is not predictive of emerging ill health) and fitness to work assessments (understandable as the result received from health surveillance indicates fitness to remain exposed to health hazards!).

Health surveillance stems from the identification and quantification of health hazards. To identify these the Health Safety Executive (HSE) is a good place to start; search for your industry, or your trade association.

As a basic guide if your employees are exposed to the following then you will need to make further assessments to inform the decision-making process about health surveillance being necessary:

  • Noise or vibration.
  • Ionising radiation.
  • Asbestos, lead or work in compressed air.
  • Solvents, dusts, fumes, biological agents and other substances hazardous to health

There is legislation that states at what level of risk or exposure health surveillance is essential such as Control of Substances Hazardous to Health (COSHH), Noise at work regulations, Control of vibration at work regulations, Control of lead at work regulations.

So, you have identified the hazard and quantified the risk, and understand that health surveillance is required. The next step is to consider what health surveillance is needed and at what level. We can help with this but will need to have the risk assessment results.

If the risk is low then it may be that someone in house can be trained to do it (for instance with skin assessment) with a qualified health professional overseeing and being available for advice or in more severe risk or exposures at the opposite level which requires a HSE appointed medical practitioner (such as for lead and asbestos). Between these levels are the use of questionnaires with health professional assessment and the conducting of health tests such as spirometry for lung function testing, audiometry for hearing assessment, use of dynamometer for grip strength in relation to HAVS. There are some occupational health industry frequency periods of health surveillance undertaken, such as below, but the frequency will also be affected by individual circumstances.

Audiometry frequency – baseline, annually for 2 years and then every 3 years unless causes for concern.

Lung function testing – baseline, then at 3 months, x2 6 months apart then annually unless any causes for concern.

Again, this is where we as your occupational health provider can help you.

It is important to have someone in house who is assigned responsibilities for the health surveillance programme and the recalling of employees at the correct frequency and time scheduling for health surveillance.

Once the health surveillance has been conducted it is necessary for you to complete a health record which you keep with the hazard exposure details for at least 40 years.

If adverse results are detected then it may be necessary to do further medical investigations and/or refer to specialists. In addition, you will need to reduce the exposure levels and assess the risk controls for effectiveness. It could be necessary for the employee to have no exposure for a period of time in which case preparing for this scenario in advance with alternative tasks and roles will ensure that in what is a worrying circumstance it is managed with ease and confidence.

Our bigger document – Health Surveillance for employers gives further details.

By Anna Harrington, OHA Clinician.

For more information on Health Surveillance for your employees please get in touch by calling 0800 020 9913 Or emailing