LECTURE NOTES: HEALTH ASSESSMENT & SURVIELLANCE Health & Safety Management Lecturing Resource

Health & Safety Management Lecturing Resource
for
Quarrying Related Degree Courses
LECTURE NOTES:
HEALTH ASSESSMENT & SURVIELLANCE
Objectives of this Section

To outline the difference between safety and health hazards.

To demonstrate a practical methodology for undertaking health risk
assessments

Understand the reasons for undertaking health surveillance.

To identify some common health hazards present in the quarrying
industry.
1.0
Introduction
Health and safety law places a duty on employers to ensure the health as well as the safety
of their employees. Yet across industry, each year many more people become ill as a result
of their work than are killed or injured in industrial accidents. Most diseases caused by work
do not kill, but can involve years of pain, suffering and discomfort for those affected. It has
long been recognised that health risks have not received the same attention as safety risks.
Cole (1996) 1gives several reasons for this. These are:
 the health risk may not be understood or well defined and the cause/effect relationship
not established.
 Health risks tend not to attract widespread publicity or demand the same urgent
attention as safety risks.
 Health risks appear to have little, if any, short term effect and it may be that ill-health
does not occur for many years after exposure.
 Health risks may be more difficult to address, resulting in attention being directed to
risks where control is more visible and likely to attract tangible benefits
 Comprehensive data on the occupational ill-health may simply not exist in many cases
and in practice, the true extent of occupationally related ill-health may be unknown.
Health problems may not be as obvious as a safety failure such as a structural collapse,
machinery accident or a fire & explosion. Most people may never see cases of occupational
ill health whilst at work. They may miss the connection between the effect and its causes, so
it is even more important to adopt a proactive approach to managing health risks.
1
Cole RJ (1996) HSE Strategy for Improved Health in the Mining Industry. In proceedings of the IMM
Conference on Health & Safety in Mining & Metallurgy. London: Institute of Mining & Metallurgy.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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Typical Health Risks
Risks to health from work activities include:

Skin contact with irritant substances, leading to dermatitis etc;

Inhalation of respiratory sensitisers, triggering immune responses such as asthma

Badly designed workstations requiring awkward body postures or repetitive movements
result in upper limb disorders, repetitive strain injury and other musculoskeletal
conditions;

Noise levels which are too high, causing deafness and conditions such as tinnitus;

Too much vibration, eg from hand-held tools leading to hand arm vibration syndrome and
circulatory problems;

Exposure to ionising and non-ionising radiation including ultraviolet in the sun’s rays
causing burns, sickness and skin cancer
There are a number of specific health and safety Regulations that deal with specific health
hazards. These all require a risk based approach and include:

Chemicals & hazardous substances: The Control of Substances Hazardous to Health
Regulations , 1999

Noise: Noise at Work Regulations, 1989

Manual Handling: Manual Handling Operations Regulations, 1992

Ionising radiation: Ionising Radiation (Protection) Regulations, 1985
Occupational Health
Occupational health is about protecting the physical and mental health of workers and
ensuring their continual welfare in their working environment. In addition to preventing ill
health, other important aspects of occupational health include:

Ensuring fitness and physical capability to perform a job safely;

Health education and promotion;

Providing medical services including health surveillance;

Rehabilitation after illness or injury.
Lecture Notes: Topic 6
Health Assessment & Surveillance
3
2.0
Health Risk Management
The principals for the management of health risks are the same as described in the last
topic, although there are some specific differences. A typical health risk management
process is described below, based on the diagram shown below (Bailey, 19962)
START
Workplace risk assessment
No Risk
Measure Exposure:
 airborne -OEL’s
uncertain risk
STOP
known risk
Select control measures for:
 exposure, and
 spread of contamination
elimination
engineering
administration
Review if:
 significant changes
 new information
 every 2-5 years
Monitoring Programme
 design
 implement
personal protective equipment
Ensure use of controls:
 information, instruction, training
 rules and procedures
 supervision
Ensure
continuing
effectiveness
of controls
The workplace risk assessment covers the elements of hazard identification and risk
assessment.
2
Bailey SR (1995), The Management of Occupational Hygiene, Occupational Health & Safety
Training Unit, University of Portsmouth.
Lecture Notes: Topic 6
Health Assessment & Surveillance
4
Hazard Identification
For each work activity all the heath hazards need to be identified. Most hazards can be
identified based on knowledge and observation of the work activity, though specialist advice
or assistance may be necessary. Useful advice is also available from other sources such as
data sheets supplied with equipment or chemicals.
The most common agents likely to present health hazards at quarries are listed below
3
according to work activity (This list is not exhaustive).
Dust
Noise
Vibration
Oil,
Fuel,
Grease
Skin
respiratory
senisiters
Manual
handling
Eyesight
Welding
fume
Asbestos
DSE
Weighbridge



Office Staff



Loading




?

Dumper




?

Plant



?
?

?



?
?

?
Foreman


?
?
?

Driller


?
?


Shotfirer


?
?


Fitter


?




Electrician


?




?
Manager


?
?


?
Shovel
Operator
Crusher
Operator
3

From QPA Health Surveillance Guide. Published by the Quarry Products Association
Lecture Notes: Topic 6
Health Assessment & Surveillance
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?
?
Risk Assessment
In order to be able to make an assessment of the risk of health hazards, the two major
elements that need to be considered are:
 The potential consequences of exposure to the hazard;
 The potential exposure to the hazard.


Hazardous
properties


Potential
severity
Physical
form;
Quantity
Activities
Potential of
Exposure
Risk of
Harm
Potential Severity
The potential severity of exposure to the hazard is related to the properties of the hazard.
For example:

The toxicity of a chemical;

The sound pressure level at the operators ear and the frequency of a noise source;

The intensity and penetrability of ionising radiation;
Lecture Notes: Topic 6
Health Assessment & Surveillance
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Potential Exposure
Potential for exposure means the opportunity to do harm. In assessing the potential
exposure to the hazard, it is necessary to consider:

The proportion of the work force who are or will be exposed to the hazard (in
particular the frequency of exposure and length of time of exposure).

Any risk reducing control measures that are in place and their effectiveness in
reducing the risk.
Again a subjective scale can be used to estimate the level of risk (e.g. HSE, 19974)
4
HSE (1997), Successful Health & Safety Management, HS(G)65, HSE Books.
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Estimating Risk
Risk = Severity of Harm x Likelihood of occurrence
Where Severity is rated according to:
(3) Major
Death or major injury or illness causing long term disability
(2) Serious
Injuries or illness causing short-term disability
(1) Slight
All other injuries or illnesses
The likelihood of harm may be rated according to:
(3) High
Where it is certain that harm will occur
(2) Medium
Where harm will often occur
(1) Low
Where harm will seldom occur
Where necessary some form of sampling and exposure measurements should be
undertaken to determine the extent of the hazard at the time of the assessment. These can
then be compared with any occupational exposure limits (such as TLV’s and OEL’s) that
have been set for the industry, as well as any in-house standards.
Such exposure
measurements may also assist in determining any remedial action that is necessary.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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Controlling the Risk
If the assessment of risk shows that further action is necessary, then control measures
should be selected according to the hierarchy of risk control, namely
Hierarchy of Risk Control

Elimination of the risk. This can be achieved through redesigning the activity or
equipment to eliminate the release of the hazard;

Reduction of the risk at source through engineering controls. This can be
achieved by enclosing the activity or equipment to capture and/or absorb the
hazard, dilute the hazard or release it into a safer place;

Minimising the risk through procedural controls. This involves implementing
systems and procedures so that work is carried out in a particular way that
limits exposure to the hazard.

Use of appropriate personal protective equipment (PPE).
The use of PPE is the last resort for the control of the exposure of employees to hazards.
This is because PPE only protects the wearer and then only if worn properly. Situations
where the use of PPE may be necessary are:
 Where adequate control of exposure cannot be achieved by elimination, reduction at
source or minimisation through administrative controls.
 As a ‘stop-gap; measure, where a risk assessment indicates that further control measures
are necessary and until those further measures have been introduced and are deemed
effective.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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Examples of Hierarchy of Risk Control: Noise5

Sound absorbent material around noisy machinery;

Use of sound absorbing wall and floor materials;

Cover the source of the noise (e.g. using hoods);

Arranging plant and equipment to create screens and reduce the
level of reflected sound;

Isolating workers from the noise source;

As a last resort provide comfortable PPE
Ensuring the use of Control Measures
Having introduced new control measures it is essential that they are adequately used by
employees, and so systems should be put in place to ensure that such measures are used
effectively. This is a responsibility of both the employer and employee and can be achieved
by ensuring that the workforce receive adequate instruction and training through:

Working procedures, codes of practice or other procedural controls;

Educating the workforce on the hazards and risks involved in their work and
how control measures will protect their health.

Effective supervision.
Employees must use these control measures in compliance with any such instruction and
training.
Systems should be put in place to ensure that the effectiveness of all the risk reducing
control measures does not decrease over time. Any engineering controls should be subject
to regular checking and maintenance. The frequency of this should be determined by the risk
assessment and based on the engineering reliability of the control measures and the
consequences of their failure with respect to exposure.
Proactive monitoring: Sampling & Exposure monitoring
Active monitoring is achieved through sampling and exposure monitoring in order to:
5
Glendon AI & McKenna EF (1995), Human Safety & Risk Management, Chapman & Hall, UK
Lecture Notes: Topic 6
Health Assessment & Surveillance
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 Check the effectiveness of risk reducing control measures, as a failure in these
measures results in an increased risk of harm occurring;
 Confirm that Occupational Exposure Limits are not exceeded;
 Tie in with the medical surveillance programme.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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3.0
Health Surveillance
Health surveillance means having a system to look for early signs of ill-health caused by
work in order to:

Detect adverse effects early;

Prevent further harm being caused.
Health surveillance is mandatory in some cases, such as work with certain chemicals or with
ionising radiation. It may also be appropriate where the risk assessment has identified a high
level of exposure to other hazards. The criteria for carrying out occupational health
surveillance are:

There is an identifiable disease or condition associated with the work;

There are valid techniques to detect the condition at an early stage;

There is reasonable likelihood that the disease or condition will occur in the particular
circumstances of the exposure;

That health surveillance will be of benefit to individuals or groups of workers.
Elements of a health surveillance programme (from QPA Health Surveillance Guide)
It is becoming increasingly common to carry out new employee health assessments to
ensure that the person is fit for the duties that they are required to perform. This may take
the form of health questionnaires together with medical examinations where appropriate.
Health questionnaires can also be administered as part of the surveillance programme,
along with the appropriate testing techniques (such as audiograms, lung function tests).
These techniques, along with the frequency at which the assessments take place depend on
the hazard and associated risk.
Health surveillance can be carried out at several levels depending upon the complexity of
the health effect being monitored.

Supervisors, with some training, can recognise the onset of many conditions and
have the advantage of being in daily contact with the workforce;

An occupational health nurse can administer standardised tests, such as audiometric
testing, lung function tests etc.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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
A doctor with appropriate qualifications and experience would be required to carry
out more detailed clinical examinations such as assessments of hand arm vibration
syndrome.
Suggestions for health surveillance for health hazards common to quarries are given in the
Quarry Product Association’s Health Surveillance Guide. Examples from the Guide are given
in the appendix to this section.
Lecture Notes: Topic 6
Health Assessment & Surveillance
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Appendix: Hazard information from QPA Guide
Dust
Noise
Substance/
Whilst dust is present in all quarries, the nature
Quarrying is a noisy industry, typical levels
Hazard
of the dust presents differing levels of risk. In
being:
general the highest risk is presented by dusts
Primary Crusher: 89-108 dB(A)
containing high levels of respirable crystalline
Hand Drill: 106 - 110 dB(A)
silica. Limestone may have no free silica. Flint
may be in excess of 90%.
Possible Ill
Exposure to dust can affect chest health and
Health
can result in pneumoconiosis or silicosis.
Long term irreversible hearing loss.
Effects
Control
Routine atmospheric dust monitoring is
The Noise at Work Regulations 1989 set out
Level
required. EH40 “Occupational Exposure Limits”
three action levels:
lists standards for various dusts. E.g.
1st Action Level – 85 dB(A) L EP,d
Occupational Exposure Standards
-assessment must be carried out
Limestone 10mg/m3 total inhalable dust/4
-ear protectors on request
mg/m3 respirable dust.
2nd Action Level – 90 dB(A) L EP,d
Coal: 2 mg/m3 respirable dust
-
reduction of exposure required
Kaolin: 2 mg/m3 respirable dust
-
ear protectors to be provided
Maximum Exposure Limit
-
ear protection zones required
Crystalline Silica: 0.3mg/m3 respirable dust
Peak Action Level – 140 dB(A) L EP,d
- as 2nd Action Level
Health
For new employees where a medical
For new employees where a medical
Surveillance
assessment is considered appropriate medical
assessment is considered appropriate
may include a respiratory questionnaire, lung
audiometer should be carried out.
function test and possibly x-ray if exposure to
It is good practice to carry out regular hearing
silica is likely.
checks on all employees whose daily personal
Where operatives are exposed to levels of
noise exposures equal or exceed 90 dB(A);
respirable crystalline silica greater than 0.1
many employers already do this. 90 dB(A) is
mg/m3, the Guidance in EH59 (latest revision)
the same as the ‘second action level’ in NaW
should be followed.
Regs – the level at which protection must be
worn. The risk of hearing damage rises
significantly at exposures above this level.
Therefore, even when hearing protection is
used, hearing checks (audiometry) should
normally be provided when noise levels reach
or exceed 95 dB(A), except where that
exposure is likely to be only temporary, for
example for a few weeks in a year.
Table (Cont’d)
Dust
Precautions
Noise
Avoid generation of dust in the first instance.
Purchase less noisy equipment and keep it
Avoid exposure to dust. Maintain seals/filters
maintained.
etc for control rooms, vehicle cabs and other
Reduce exposure below peak and second
‘dust refuges’.
action level.
Where exposure cannot be adequately control
Provide quiet refuges.
by other means appropriate respiratory
Educate the workforce.
protective equipment should be used.
Only approved PPE giving adequate
attenuation should be used.
All PPE must be properly maintained.
Additional
“Respirable Crystalline Silica: exposure
“Control of Noise in Quarries” HS(G)109 ISBN 0
Information
assessment document” HSE EH74/2 ISBN 0
7176 0648 1
7176 1659 2
“Health Surveillance in Noisy Industries”
“Control of respirable crystalline silica in
IND(G)193L
quarries” HS(G)73 ISBN 0 11 88 5680 4
“A guide to audiometric testing programmes”
“Occupational Exposure Limits” HSE EH40 –
HSE Guidance Note MS26 ISBN 0 7176 0942 1
consult current edition
“Keep the Noise down: advice for purchasers of
EH59 Respirable Crystalline Silica (1997
workplace machinery” HSE IND(G)263.
Revision) ISBN 0 7176 1432 8
“Managing asbestos in workplace buildings”
HSE IND(G)223
“The Control of Asbestos at Work” HSE L27
(1999 Revision) ISBN 0 7176 1673 8
Lecture Notes: Topic 6
Health Assessment & Surveillance
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