Health Surveillance Services

When are Health Surveillance Services Required?

Specific health surveillance services are required under regulations, such as:

  • Control of Substances Hazardous to Health (COSHH) Regulations 2002 (Regulation 11)
  • Control of Lead at Work Regulations 2002 (Regulation 10)
  • Ionising Radiations Regulations 2017 (Regulation 25)
  • The Control of Asbestos Regulations 2012 (Regulation 22)
  • Control of Noise at Work Regulations 2005 (Regulation 9)
  • Control of Vibration Regulations 2005 (Regulation 7)

Under certain circumstances, by law you may need the services of an ‘appointed doctor’ to conduct statutory medical surveillance, eg for lead and asbestos


Safety Nett Ltd provides guidance and advice in Health risk assessments and training for Supervisors and Managers in control of health risks.

Hazards to Health
Hazardous chemicals – if inhaled can cause asthma, bronchitis or cancer; if swallowed
can cause poisoning; if spilt onto the skin or splashed into the eyes can cause
dermatitis or severe irritation.

Sprains, strains and pains
can be caused by manual lifting of heavy loads. Upper limbdisorders (ULDs), so called repetitive strain injury (RSI), can happen if the workstation is poorly designed so that people have to adopt awkward body positions.


Our Mobile Van On-Site Services allow for tailored Occupational Health Surveillance Services including:

Health Surveillance

  • Audiometry for noise exposure
  • Lung function tests
  • Hand–arm vibration (HAV) syndrome questionnaire and tests for HAV exposure
  • Skin checks for dermatitis
  • Biological monitoring for lead and mercury in blood, and cadmium in urine
  • HGV medicals for Group 2 drivers (including drivers of construction plant)
  • Health checks for night workers
  • Questionnaire for the above and other health related issues

1. Audiometry

Loud noise at work can cause hearing damage and tinnitus. Noise can interfere with communication, cause fatigue and tiredness, reduce efficiency, affect morale and distract and disrupt job performance. Temporary or partial loss of hearing, which may persist for several hours, can be caused by short-term
exposure to high noise levels. Such exposure if repeated or prolonged may lead to permanent hearing damage.

Hearing loss is one of the most serious and widespread industrial diseases. According to the Health and Safety Executive (HSE), annually, around 15,000 workers have a Noise Induced Hearing Loss (NIHL). Permanent hearing damage can be caused immediately by sudden, extremely loud, explosive noises.
Hearing loss is not the only problem. People may develop tinnitus (ringing, whistling, buzzing or humming in the ears), a distressing condition which can lead to disturbed sleep.

Employers should provide health surveillance to workers frequently exposed above the upper exposure action values. The upper exposure action values are –

(a) a daily or weekly personal noise exposure of 85 dB (A-weighted); and
(b) a peak sound pressure of 137 dB (C-weighted).

Required if information comes to light that an individual may be particularly sensitive to NIHL.
Individuals notifies employer of a family history of becoming deaf early on in life
Noise Exposure over 80dB(a) where the individual is known to be at risk e.g. they already suffer from hearing loss or are particularly sensitive to damage Noise Exposure over 85dB(a)
(HSE L108 The Control of Noise at Work Regulations 2005 Guidance on Regulations p.84)

Health Surveillance
Safety Nett Ltd PDCA “Approach to NOISE Health Surveillance.

Below is our continuous improvement cycle approach to managing health surveillance for Noise at Work. Improvement is not a separate activity: It is built into our health surveillance work process.

2. Hand Arm Vibration (HAVS)

Hand-arm vibration is a common hazard in occupations involving the use of hand-held power, hand guided or hand-fed machines. Prolonged and regular exposure to this type of vibration can affect the operator’s health, resulting in painful and disabling disorders of the nerves, blood supply, joints and muscles of the hands and arms. These disorders are collectively known as hand arm vibration syndrome (HAVS).

Health and Safety Executive (HSE) research estimated that around five million workers were exposed to hand-arm vibration in the workplace. Approximately 1.7 million were believed to be exposed at levels above the exposure action value, with around 900,000 of these exposed above the exposure limit value in the Control of Vibration at Work Regulation 2005. About 288,000 people were estimated to have a particularly severe form of HAVS, vibration white finger.

When is health surveillance required?

“Health surveillance should be provided for vibration-exposed employees who:
• are likely to be regularly exposed above the action value of 2.5 m/s2 A(8);
• are likely to be exposed occasionally above the action value and where the risk assessment identifies that the frequency and severity of exposure may pose a risk to health; or
• have a diagnosis of HAVS (even when exposed below the action value).”
(HSE L140. The Control of Vibration at Work Regulations 2005 Guidance on Regulations p.69)

Health Surveillance

Safety Nett Ltd PDCA “Approach to HAVs Health Surveillance.”
Below is our continuous improvement cycle approach to managing health surveillance for HAVs. Improvement is not a separate activity: It is built into our health surveillance work process.

3. Health Surveillance Services For Occupational Asthma

Occupational asthma is a major occupational health problem in the workplace. However, if symptoms are detected early enough the employer can reduce employee exposure and can reduce their risk of developing full-blown asthma. Asthma is a very serious health problem that can ruin lives. Asthma can be caused in a workplace simply by breathing in certain hazardous substances like dust, gases, fumes and vapours that can damage your lungs.

Shortness of breath, wheezing and painful coughing are just some of the symptoms that occupational asthma sufferers may have to deal with every day. According to Health and Safety Executive (HSE), they are about 4,000 COPD deaths each year due to past exposure to gases, dusts and fumes at work. Diseases like COPD can take many years to develop after workplace exposures.

When are Respiratory health surveillance services required?

• If there is a disease associated with the substance in use (e.g. Asthma, Dermatitis, Cancers);
• If risk assessment identifies that there is adverse health effect due to exposure to chemical or biological hazards
• If it is possible to detect the disease or adverse change and reduce the risk of further harm;
• If the conditions in the workplace make it likely that the disease will appear.
• If a specific and sensitive test is available to identify the adverse health affect, and
• Steps to manage the inception of disease are available

HSE L5. The Control of Substances Hazardous to Health Regulations 2002 (as amended)

Health Surveillance
Safety Nett Ltd PDCA “Approach to COSHH Health Surveillance.
Below is our continuous improvement cycle approach to managing health surveillance for Occupational Asthma. Improvement is not a separate activity: It is built into our health surveillance work process.


Occupational skin disease is a common health problem which occurs when workers are exposed to certain hazardous substances. Repetitive skin irritation or skin sensitisation can lead to dermatitis. Guidance by the Health and Safety Executive (HSE) states that “if you detect the signs of dermatitis early enough, and reduce workers’ exposure to the substances responsible, you will reduce or cure the disease” (G403 HSE). However, if left untreated, dermatitis can become irreversible and lead to ending your career.

There are 3 types of contact dermatitis; Irritant Contact Dermatitis, Allergic Contact Dermatitis & Contact Urticaria Dermatitis. Regular Health checks are important in detecting early signs of skin damage.
No contact = No Dermatitis (Avoid contact with substances that are known to cause dermatitis)

When are health surveillance services required?

You should consider skin surveillance if workers:
• use substances or are in occupations listed below; or
• are working with products labelled R43 ‘May cause sensitisation by skin contact’, or R42/43 ‘May cause sensitisation by inhalation and skin contact’.


• Epoxy resins, latex, rubber chemicals, soaps and cleaners, metalworking fluids, cement, wet work, enzymes and wood can all cause dermatitis. Corrosive and irritating chemicals also lead to dermatitis. Solvents on the skin make other chemicals more likely to cause skin damage.


• Construction work, health service work, rubber making, printing, paint spraying, agriculture, horticulture, electroplating, cleaning, catering, hairdressing and florists are all associated with dermatitis.

• Hand immersion, particularly multiple short-term immersion using soap or detergent, is associated with dermatitis.

Health Surveillance
Safety Nett Ltd PDCA “Approach to Occupational Skin Disease Health Surveillance.
Below is our continuous improvement cycle approach to managing health surveillance for Occupational Skin Disease at Work. Improvement is not a separate activity: It is built into our health surveillance work process.

5. Post Appointment Screening

The Equality Act 2010 makes it illegal for employers to ask health or health related questions prior to making a conditional offer of employment. Section 60 of the Act provides that, other than in certain circumstances, employers must not ask about the health of job applicants before making a job offer.

Employers should not ask applicants to complete medical questionnaires at an early stage of the recruitment process – and should certainly not be
asking Occupational Health Advisors to get involved in assessing an employee’s health or fitness until a job offer has been made, other than where
a specific exception applies.

01. Conditional Job Offers

Under the Equality Act, Employers are permitted to make job offers conditional on satisfactory health checks. As such, employers may still ask health-related questions and require ¬employees to undergo medical checks once a job has been offered.
Where there are serious health and safety risks involved in the employer not being aware of a condition it may be appropriate for OH to inform the employer of information discovered during a pre-employment assessment
To protect professional credibility, our OH advisers will always make it clear to employees that information provided may be passed on to the employer in circumstances as stated above.

02. Our Pre-Employment Services

The first stage of pre-employment screening is the completion of a Health Questionnaire by the employee.
The Health Questionnaire asks questions about an individual’s medical history, any current health problems and the previous work-health hazard exposures.
The completed must be sent confidentially to our office using pre-addressed envelope issued with the Health Questionnaire, this information is then assessed by a qualified nurse with years of experience in Occupational Health.
The nurse will evaluate if there are any health issues for the person taking into consideration their prospective post and any adjustments that may need to be considered. For example – making allowance for people with regular hospital appointments as per the Equality Act 2010.

Further action may be recommended, such informing the employee of any health surveillance services needed in the future.
Occasionally, further information may be required, either by a telephone call to the employee, by requesting a report from their GP or Specialist or by requesting the employee to attend an appointment with one of our Occupational Health Nurse or Doctor.
In such a case, we will liaise with your HR and kept them informed that there will be a delay in our response in confirming the candidate’s fitness for the job while we await further information, however, the reason for this delay will remain confidential.

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