Q.01

When is health surveillance required under COSHH?

COSHH regulation 11(1) says that where health surveillance is appropriate to protect employees who are, or are liable to be, exposed to a substance hazardous to health, the employer "shall ensure" those employees are under suitable health surveillance [1]. Regulation 11(2) says it "shall be treated as being appropriate" in either of two cases [1].

Route (a): Schedule 6 substances and processes. This applies where the employee is exposed to a substance in Column 1 of Schedule 6, is engaged in the process in Column 2, and there is a reasonable likelihood that an identifiable disease or adverse health effect will result [1]. The Schedule lists [2]:

SubstanceProcess
Vinyl chloride monomer (VCM)Manufacture, production, reclamation, storage, discharge, transport, use or polymerisation
Nitro or amino derivatives of phenol and of benzene or its homologuesManufacturing them, and making explosives with any of them
Potassium or sodium chromate or dichromateManufacture
Ortho-tolidine, dianisidine, dichlorobenzidine and their saltsManufacture, formation or use
Auramine, magentaManufacture
Carbon disulphide, disulphur dichloride, benzene (including benzol), carbon tetrachloride, trichlorethyleneUsed, or given off as vapour, in making indiarubber or articles made wholly or partly of it
PitchMaking fuel blocks of coal, coal dust, coke or slurry with pitch as the binder

For these cases, regulation 11(5) says surveillance "shall include medical surveillance under the supervision of a relevant doctor at intervals of not more than 12 months", or shorter if the doctor requires it [1].

Route (b): the general test. This applies to any substance hazardous to health when all of these are met [1]:

  1. An identifiable disease or adverse health effect may be related to the exposure.
  2. There is a reasonable likelihood that the disease or effect may occur under the particular conditions of the employee's work.
  3. There are valid techniques for detecting signs of the disease or effect.
  4. The investigation technique is of low risk to the employee.

What HSE's L5 Approved Code of Practice and guidance add:

  • Residual risk: L5 guidance says surveillance is also appropriate where employees face residual risk after all appropriate controls are in place and the three regulation 11(2)(b) conditions are met [3].
  • How to judge likelihood: the judgement should relate to the type and extent of exposure. It should rest on available knowledge such as epidemiology, toxicology, exposure data or extrapolation from similar substances or situations [4][5].
  • ACOP examples where route (b) applies [6]:
    • previous cases of work-related ill health in the workforce or workplace [7];
    • reliance on PPE such as gloves or respirators to control exposure. Examples are printers wearing gloves against press-cleaning solvents, and paint sprayers using two-pack paints wearing respirators to prevent asthma. The ACOP notes that "Even with the closest supervision there is no guarantee that PPE will be effective at all times" [7][8];
    • evidence of ill health in similar jobs across the industry, such as "wet-working" dermatitis in hairdressers and healthcare workers, or chrome ulcers in chrome platers [9].
  • Not exhaustive: L5 says this list is not complete. Employers should get advice on the specific risks found in their risk assessment, from HSE topic guidance, trade associations or other professional sources [10].
  • After exposure ends: for example with a carcinogen, the ACOP says it may be appropriate to continue surveillance after exposure stops, at least while the person remains your employee. This applies where an effect is expected after a latent period and can be reliably detected early [11].

Duties that follow once surveillance applies [1][12]:

  • Health records: keep one for each employee under surveillance, available for at least 40 years from the last entry (reg 11(3)).
  • Employees' duty: employees "shall" attend surveillance during working hours at the employer's cost (reg 11(8)).
  • If disease or an adverse effect is found (reg 11(9)), the employer shall:
    • make sure a suitably qualified person informs the employee;
    • review the risk assessment and the regulation 7 control measures;
    • consider moving the employee to alternative work;
    • provide for a review of the health of others similarly exposed.

Approach: I read regulation 11 and Schedule 6 of the Control of Substances Hazardous to Health Regulations 2002 (SI 2002/2677, as amended, revised GB text), and the health surveillance section of HSE's L5 Approved Code of Practice and guidance. L5 labels paragraphs 234 and 235 as guidance and paragraph 237 as ACOP text.

Q.02

What does it involve?

Under HSE's L5 Approved Code of Practice, health surveillance can be as little as keeping an individual health record. For known or suspected carcinogens not listed in Schedule 6, that is the stated minimum [13]. In most cases it involves more: "a suitable ongoing system to detect early signs of work-related ill health and check that controls are protective", made up of activities chosen from a set range [14].

The activities (L5 ACOP para 240) The employer picks some or all of these:

  • Reviewing exposure information, such as air monitoring or biological monitoring results and any related ill health [15].
  • Reviewing the risk assessment and changing it when necessary [16].
  • Checks by a responsible person such as a supervisor or manager. Examples are checks for chrome ulceration and skin checks for dermatitis [17].
  • Asking about symptoms, or inspection or examination by a suitably qualified person such as an occupational health professional. This can be as simple as symptom questionnaires, or it can include clinical examinations for early biological effects, such as lung function tests for asthma [18].
  • Medical surveillance: the specific type supervised by an appointed doctor under regulation 11(5). It may include clinical examination [19].

Schedule 6 cases. Medical surveillance is supervised by an HSE Appointed Doctor at intervals "not exceeding 12 months", or shorter if the doctor requires. The doctor decides what the examination involves [20].

Biological agents.

  • Employers should tell workers which infections are relevant to their work and what the symptoms are. They should also train workers to watch for early signs and get medical attention promptly [21].
  • Where effective vaccines are readily available, a pre-exposure screening programme with follow-up should show whether employees are immune. Records should hold vaccination dates and when boosters or follow-ups are due [22].

Who carries it out

  • The employer "must ensure" that whoever does health surveillance is competent (MHSW regulation 7) [23].
  • Some procedures may need a registered medical practitioner to supervise them. Others can be supervised by an occupational health nurse or by a responsible person. A responsible person is a competent appointee whose job includes reporting the conclusions to the employer [24].
  • HSE guidance says procedures should be easy to perform, reproducible and reliable, preferably non-invasive, acceptable to employees and low risk. Employers should get advice from occupational physicians, nurses or hygienists where appropriate [25].

Setting it up (L5 guidance)

  • Purpose: part of the stated purpose is to check that controls are working, by giving feedback on how accurate the risk assessment is and how well the controls perform [26].
  • Decide before you start: what results trigger action; the options for action (reassess the risk, improve controls, refer people for diagnosis or treatment, reassign people); and how records will be kept and results analysed [27][28].
  • Consult: talk to the workforce and their representatives before setting up the programme [29].

When an adverse effect is found (ACOP paras 246-248)

  • The employer should:
    • review the risk assessment and change the controls if needed [30];
    • check the health of employees doing similar work [31];
    • have a suitably qualified person explain to the employee the results, any changes to controls, any further specialist assessment, continuing surveillance, and any transfer to other work [32][33][34][35][36][37].
  • The doctor or occupational health professional should advise whether:
    • the employee should be moved to work with no exposure [38];
    • a medical examination is needed, and who should carry it out [39];
    • others with similar exposure should also be examined [40];
    • extra facilities or other arrangements are needed [41].
  • Consultation on alternative work: the employee or their representative should be involved before any decision on alternative work [42].

The health record (ACOP paras 251-252)

  • Employers "must" keep an up-to-date record for each employee under surveillance [43].
  • Identifying details, including permanent address and postcode, national insurance number, and the date current employment started [44][45][46][47].
  • Job history: a record of jobs in this employment involving exposure to substances that need surveillance [48].
  • Results: the results of procedures, with dates and who carried them out. Conclusions should cover fitness for work only: decisions on fitness for continued exposure or restrictions, and whether more surveillance is needed [49][50][51].
  • No confidential clinical data. Keep records for at least 40 years, on paper or electronically. Electronic records need a suitable back-up [52].
  • Access: employees may see their own records. With the employee's consent, their representatives may see them too [53].
  • Telling employees: the information given to them should cover why surveillance is done, their duty to attend at the set date and time, and how they can see their records [54].

Approach: I read the health surveillance section of HSE's L5 COSHH Approved Code of Practice and guidance (paragraphs 230-255) in the edition held in the datasets. The first part of the paragraph 230 list of objectives is cut off there, so I report only the objective shown.

Q.03