Health surveillance 

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Health surveillance is activity involving getting information about employees’ health to keep them safe at work.

Health surveillance shouldn’t be confused with health screening or wellness promotions and campaigns which are separate from your health and safety policy. It should be considered part of the overall management of work-related risks to health and safety.

Carrying out medical surveillance is required for compliance with various parts of UK health and safety legislation, such as the Control of Substances Hazardous to Health Regulations. Apart from the legal side, benefits of a health surveillance regime include protecting the health of employees with early detection of illness, musculoskeletal disorders or disease, and evaluating health hazards and current control measures with real data.

Health surveillance test results need to be interpreted by someone with the right knowledge, skills and experience and action taken to eliminate or minimise exposure to employees.

Key actions to develop a programme for health surveillance

  • Identify and assess health hazards in the workplace, who is at risk and existing control measures.
  • Check the reliability of control measures and whether all risks are captured and addressed, including noise, vibration, exposure to solvents, fumes, dusts, biological agents, asbestos, lead, ionising radiation and compressed air. Put a health surveillance programme in place if a risk to health is still there after implementing all reasonable precautions, and if the following criteria are met: - safekeeping of completed accident records (i.e. security of personal information);

    - evidence of a link between an identifiable disease or adverse health effect and a workplace exposure

    - it’s likely the disease or health effect may happen and/or

    - there are techniques for detecting early signs of the disease/health effect which doesn’t pose a risk to employees.
  • Get advice from an occupational health professional to help you work out which type of health surveillance programme would suit your needs.

    - Consider using a variety of different techniques, depending on working practices and processes.
  • Consult your workforce before setting up a health surveillance programme to make sure they understand the need and how they can help.
  • Provide suitable information, instruction and training for anyone who may be exposed to hazards identified in your risk assessments. This should include matters such as use of control measures, personal protective equipment (PPE), cleaning procedures, etc.
  • Decide the appropriate level of health surveillance for each type of exposure. There are several levels of health surveillance:

    - self-checks by an employee (to complement the following)

    - basic checks by a responsible person trained to identify straightforward signs and symptoms

    - examination by a qualified person, such as an occupational nurse or audiologist;

    - clinical examination by (or supervised by) a doctor

    - biological monitoring or biological effect monitoring by, or supervised by, a doctor.
  • New starters to hazardous work processes must undergo health surveillance before they start so a baseline assessment is available for them.
  • Continue health surveillance at appropriate intervals for as long as the individual is exposed to the risk, and keep records in accordance with  the HSE’s guidance. Some regulations state the required interval between examinations; otherwise your occupational health provider should be able to assist.
  • Take steps to prevent further harm to the individual where health surveillance shows that an employee’s health is being affected.
  • Remember to consider pre-existing conditions or circumstances that could make an individual more susceptible to risks in the workplace. e.g. being pregnant or breast feeding, having asthma or a skin condition, or taking certain medications. A specific risk assessment will be needed for them.

Templates that may help with health surveillance

Display screen equipment

Manual handling

Vibration

Risk assessments

Additional resources

Getting the standard right

Do your health and safety measures meet legislative requirements?
A-Z of legislation

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Related topics

Risk topics that should be kept in mind when considering a health surveillance programme include:
Confined spaces
Construction dust
Display screen equipment
Hazardous substances
Health and safety policy
Health and safety risk assessments
Legionella bacteria
Manual handling
Mental health
Noise
Personal protective equipment
Vibration

Useful links for health surveillance

Guidance on the various issues that you might look at within a health surveillance programme can be found at these websites:
ANC (Acoustics & Noise Consultants)
BCA (British Chiropractic Association)
BOHS (British Occupational Hygiene Society)
BSI (British Standards Institution)
CIEHF (Chartered Institute of Ergonomics & Human Factors)
Fit for Work
HSL (Health & Safety Laboratory)
IOSH (Institution of Occupational Safety and Health)
workSMART
HSE (Health and Safety Executive) - Health surveillance
HSE - Control of substances hazardous to health: Approved Code of Practice (L5)
HSE - The health and safety toolbox – How to control risks at work (HSG268)
HSE - Workplace exposure limits (for use with COSHH regulations) (EH40)
HSE - Involving your workforce in health and safety: Guidance for all workers (HSG263)
HSE - Consulting employees on health and safety: A brief guide to the law (INDG232)

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