Health surveillance under COSHH and employer legal duties
Health surveillance is required under COSHH when legal criteria apply. Learn which workers need checks, how to set them up and what records to keep.
Health surveillance in the workplace is a programme of repeated, work-related health checks to detect occupational ill health early, as HSE explains. In Great Britain, it is a legal requirement when the conditions in COSHH regulation 11 apply.
It is not an automatic annual medical for everyone who handles chemicals. Employers use their risk assessment to identify who needs checks, with competent occupational health advice on suitable procedures. Surveillance supports exposure prevention and control. It can't replace them. HSE's guidance says the findings must contribute to the risk assessment and to effective controls.
This guide covers England, Scotland and Wales under the 2002 COSHH Regulations. Northern Ireland has separate COSHH regulations.
Is health surveillance a legal requirement?
There are two routes under regulation 11. A substance does not have to appear in Schedule 6 for surveillance to be required. Equally, finding its name in that Schedule does not settle the question without checking the specified process and health risk. Both routes come from regulation 11(2).
The general test
Under regulation 11(2)(b), all three conditions must hold:
- An identifiable disease or adverse health effect may be related to the exposure.
- There is a reasonable likelihood of that disease or effect occurring under the employee's particular working conditions.
- Valid techniques exist to detect indications of the disease or effect, and the investigation technique poses a low risk to the employee.
These are the statutory conditions, rather than a general recommendation to offer health checks. The employer must arrange suitable surveillance when the duty applies.
The working conditions matter. HSE's guidance says control measures may not always be reliable, despite appropriate checking, training and maintenance, so surveillance findings still have to contribute to the risk assessment and to effective controls. A surveillance programme does not make inadequate controls acceptable.
The Schedule 6 route
Regulation 11(2)(a) covers exposure to a listed substance in its specified process, where there is a reasonable likelihood that an identifiable disease or adverse health effect will result. Check the substance and process together against Schedule 6.
Examples include vinyl chloride monomer in specified activities, including manufacture, storage, transport and polymerisation. Other entries include manufacturing potassium or sodium chromate or dichromate, and manufacturing fuel blocks with pitch as a binder. These examples are not the complete list. Schedule 6 gives the precise substance and process pairings.
Regulation 11(5) applies where the employee is exposed to a Schedule 6 substance and is engaged in a process specified there. Surveillance must then include medical surveillance under the supervision of a relevant doctor, at intervals of not more than 12 months, or shorter if that doctor requires it. That rule is not a universal annual timetable for every COSHH programme.
A relevant doctor is an appointed doctor or employment medical adviser. An appointed doctor is a registered medical practitioner appointed in writing by HSE, for the time being, for these Regulations. An ordinary occupational health doctor does not automatically meet that definition. The definitions are in regulation 2.
What does health surveillance involve?
Checks should match the occupational health risk. HSE gives skin-condition checks and lung-function assessments as COSHH health surveillance examples. A questionnaire can form part of a programme, but a generic annual form does not establish that the checks suit the exposure.
For skin risks, HSE identifies indicators such as skin sensitisers, previous occupational dermatitis or urticaria, reliance on PPE, frequent or prolonged water contact, and hexavalent chromium exposure associated with chrome ulcers. Wet work in hairdressing and healthcare provides examples. These are risk-assessment indicators, not instructions to give every worker in those sectors identical tests.
Not every check needs a doctor. A trained responsible person, who can be a suitably trained employee, can carry out defined skin checks, keep secure records and report positive findings. They need training and ongoing support from an occupational health professional, and they can't interpret their observations clinically. HSE's skin guidance separates that role from clinical assessment.
Establish the scheme with competent occupational health input. Some procedures need a competent doctor or nurse. A GP offering occupational health services must be competent in occupational medicine, and a general health check is not statutory surveillance just because a doctor performs it. Both points are in HSE's COSHH guidance. Agree suitable intervals for the risk and procedure rather than assuming every check should be annual.
Health monitoring is not always health surveillance
People use "health monitoring" for more than one thing. HSE says health surveillance is not the same as health monitoring, health promotion or health screening. A wellbeing check does not become occupational health surveillance because it happens at work.
Measuring airborne exposure also differs from checking a worker's health. But biological monitoring can still sit inside surveillance. The COSHH definition expressly includes biological monitoring, and HSE says biological monitoring and biological-effect monitoring can play a role in exposure assessment and in surveillance.
Setting up a health surveillance programme
Use this health surveillance checklist to organise the scheme. It follows HSE's employer guidance, rather than prescribing a standard form for every workplace.
- Identify the health hazards and potentially exposed workers in your risk assessment.
- Decide which surveillance procedures fit those risks, with occupational health advice where needed.
- Assign someone to lead the programme. Agree who performs checks and who assesses the findings.
- Consult workers and their representatives. Include arrangements for shift and remote workers.
- Set suitable intervals, referral routes and arrangements for communicating findings.
- Obtain advice on fitness for the relevant work, restrictions and future checks.
- Keep secure employer health records. Use the findings to review the assessment and exposure controls.
Make attendance arrangements part of the programme. Under regulation 11, employees must attend necessary surveillance when their employer requires it. Attendance must be during working hours and at the employer's cost. For medical surveillance under regulation 11(5), employees must provide health information reasonably required by the relevant doctor.
Health records and confidential medical information
Keep the individual employer health record for at least 40 years from the last entry. Regulation 11(3) requires HSE-approved particulars. The clock does not start at recruitment, first exposure or the employee's departure. Employees can access their health record on reasonable notice under regulation 11(4).
The employer's record differs from the confidential medical file. HSE describes health records as including identification, employment and exposure details, relevant hazards and surveillance dates. They also record fitness for continued exposure, restrictions and future surveillance needs.
Managers need the outcome relevant to the work: whether exposure can continue, any restrictions and when further surveillance is needed. They do not need the full clinical file to keep the employer's health record. Settle that split with the occupational health provider before the first check.
Clinical notes, confidential clinical results and wider medical information belong in the medical record held by the occupational health professional. Employer access to that medical record requires the worker's written consent, as HSE's record-keeping guidance says. Do not use the surveillance register to collect complete medical histories, or apply the employer's 40-year rule to every clinical file.
What happens after an adverse finding?
An adverse finding needs follow-up. Where a relevant doctor or occupational health professional considers a disease or adverse effect to result from hazardous-substance exposure, regulation 11(9) requires action.
The employer must ensure a suitably qualified person informs the employee and advises on further surveillance. Review the risk assessment and exposure controls, taking account of professional or HSE advice. Consider alternative work without further exposure. Arrange a review of similarly exposed workers' health, including examination where recommended. A finding does not automatically require dismissal or reassignment.
For medical surveillance under regulation 11(5), regulation 11(6) requires the employer to follow a relevant doctor's recorded prohibition or conditions on exposure, unless a relevant doctor cancels that entry. Regulation 11(7) requires continued medical surveillance after exposure ends only where a relevant doctor has certified that in the health record, and only while the employee remains employed, unless that entry is cancelled.
RegAffairs AI's answer on COSHH health surveillance sets out the regulation 11 tests against the official text.