Health Surveillance
It is well recognised that the effects of vibration can develop slowly over a period of time and may not initially be recognised by the individual affected, hence the requirement to start health surveillance at the exposure action value of 2.5m/s². The Council’s routine health surveillance for all workers whose work involves the use of hand held vibratory equipment involves several stages:
1. Employees using hand held/hand guided vibrating tools will be asked to complete a short questionnaire regarding any symptoms experienced. This will be carried out at pre employment by the occupational health unit and annually thereafter by the manager. This will be reviewed by the Occupational Health Department.
2. Any employee reporting symptoms, or reporting no symptoms after three years will then be required to fill out an additional more detailed questionnaire with a qualified Occupational Health Nurse.
3. The Occupational Health nurse will review all questionnaires and may refer employees to the Occupational Health Physician for further diagnosis.
4. Health surveillance for employees will continue throughout their period of employment involving the use of hand held vibratory work equipment.
5. Frequency of examinations will be dependant on their reported symptoms and at the discretion of the Occupational Health Physician.
6. All medical details will remain confidential, however management will be informed where further control measures should be considered for certain individuals.
7. Where employees are found to be susceptible to hand-arm vibration, consultation with the Senior Occupational Health Nurse should be undertaken to discuss possible solutions for reduction of vibration exposure.
8. Any employee identified with a requirement to reduce HAV exposure will be required to complete weekly vibration exposure assessment forms to be reviewed by line management and kept in personal files.
9. Where effective reduction in exposure can not be practicably achieved, this may mean following the Council’s policy on redeployment where appropriate.
It is the line manager’s responsibility to ensure that information regarding health surveillance appointments is passed to the employee.
It is the employee’s responsibility to attend such health surveillance appointments. Failure to meet appointments is costly and may result in disciplinary action being taken against frequent offenders
TIERS OF HEALTH SURVEILLANCE FOR VIBRATION
Health surveillance should be provided for vibration-exposed employees who:
· Are likely to be regularly exposed above the action value [EAV];
· Are likely to be exposed occasionally above the action value and where the risk assessment identifies that the frequency and severity of exposure may pose a risk to health; or
· Have a diagnosis of HAVS (even when exposed below the action value).
The Council’s Occupational Health unit provides specialist occupational health services to most of the Council’s business units. However, those units who have not ‘bought in’ to this service will need to arrange for alternative occupational health services if the need exists from vibration within their workplace.
Health surveillance for exposure to vibration is split into five levels: (see diagram on page 12).
Level 1 (pre employment health surveillance)
When a new employee applies to move into a role that involves vibration exposure, and in which health surveillance is required, their manager will need to know if they are fit for work with vibration. The employee should be asked to complete a simple questionnaire about possible symptoms and their medical history. This questionnaire is confidential and must only be viewed by the Occupational Health unit. They will then decide if the person needs to undergo a full assessment with an Occupational Health Adviser or an Occupational Health Physician. This procedure is the initial part of the health surveillance programme and is required for baseline health assessment of the individual. The advice on fitness for work with vibration will come from the Occupational Health unit.
Level 2 (routine annual health surveillance)
It is useful to appoint a *responsible person as part of the health surveillance programme to help communicate to the employees how the simple screening questionnaire operates. This person should be someone who is carefully selected to have experience of the working environment and is able to gain the confidence and cooperation of employees. They need not be qualified but will have received training from an occupational health professional. They should understand the health surveillance procedures and the importance of confidentiality. They should be able to describe symptoms of HAVS but should not attempt to diagnose disease. If an employee discloses that they have symptoms, the *responsible person should not make judgements about the cause of the symptoms.
A health monitoring questionnaire for lower back pain can be used in exactly the same way for those exposed to WBV.
Completed questionnaires could be sorted, and referrals handled in house, by the *responsible person, provided that this is acceptable to employees. It is appropriate for the questionnaires to be treated as confidential and returned to suitably competent health professionals for filing in the employee’s personal file.
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.
The HSE recommends 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.
*responsible person - this is likely to be a senior manager
Level 3 (occupational health referral from responsible person)
In the first instance, any employee reporting symptoms should be referred to a *qualified person (usually an occupational health nurse) for clinical assessment. The *qualified person can make an informed assessment of the nature of reported symptoms on the basis of a confidential interview and limited medical examination.
*qualified person - this is likely to be a suitably trained occupational health nurse
Level 4 (occupational health nurse referral to occupational health physician)
A formal diagnosis of HAVS should only be made by a competent Occupational Health Physician. An employee with HAVS should be reassessed at regular intervals and may need additional investigations in order to detect any progression of the disease. After formal diagnosis of HAV related injuries, form F2508A must be sent to the Health and Safety Executive [HSE] by the manager.
Level 5 (occupational health physician referral to specialist assessment
centre)
In certain instances where the Occupational Health Physician has diagnosed progressive debilitation from vibration exposure and has recommended cessation of vibration exposure, it may be deemed necessary to send the individual for specialist assessment to determine the extent of injury. However, if the management of exposure to vibration is adequately controlled, this level of surveillance is avoidable.