What’s involved?
An occupational health medical for confined space would typically assess the following*.
Medical format would be:
· Detailed medical questionnaire, discussed with OH advisor (usually a nurse) including discussions about respiratory, cardiac, musculoskeletal, sensory and psychological health past and current (as well as current medications that might have side effects and alcohol drug taking activity).
· Assessment of height, weight and body mass index (in some cases high BMI e.g. above 30 – 35, would prevent fitness standard being reached).
· Blood pressure (usual suggestion being less than 150mmhg systolic (top reading) and 95 mmhg diastolic (lower reading).
· Assessment of hearing ability by hearing test (to reach HSE standard 1 or 2).
· Assessment of visual acuity (achieving 6/12 aided or unaided with binocular (both eyes) vision depends on if a face fit is needed as to exact standard without correction.
· Colour perception (pass with red/green).
· Respiratory function by spirometry (lung function tests) achieving FEV1% greater than 70% (basically measurement assesses for asthmatic or chronic obstructive airways function).
· Mental health (through questioning).
· Urinalysis (to exclude diabetes).
· Mobility/co-ordination tests and questions (to ensure no obvious muscular issues).
· It may or may not include drugs and alcohol tests but this is debatable and depends on company policy.
· It may or may not include a fitness test (such as Chester step test) to ensure fitness to escape in a hurry, again depends on nature of space/task and company policy/agreed standard.
If the nurse is concerned about any result an onward assessment of fitness by a physician may be requested. As you can imagine, this is a little more detailed than asking an individual if they feel fit. An insulin dependent diabetic might feel fit; this does not mean they would state they were a diabetic if they did not themselves believe it to be relevant.
In addition, would be questionable if an insulin dependent diabetic is considered fit for confined space work given the risks. It is also worth pointing out that a high percentage of the population do not know their blood pressure is high.
Contrary to what many believe, Occupational Health does not set out to fail people, in an ideal world Occupational Health sets out to ensure standards are agreed, (through a collaborative approach with the business) and that once agreed, the standards are met to protect the individual as well as the company.
At the end of the medical, a fitness certificate should be issued specifically for the hazard the medical has been designed to assess (in this case safety critical work in a confined space).
The fitness certificate should indicate the following information to the employer:
1. That the employee is fully fit.
2. Or that they are fit with some specific restrictions needing to be implemented or risks guarded against.
3. That they are not fit for this activity.
Anita Churchouse
BSc(Hons)OH SCPHN RGN
Occupational Health Advisor
*Standards should be agreed with whoever is providing the actual medical as these may vary, (depending on nature of tasks as well as industry).This is an outline and uses standards commonly used.