Health surveillance is the routine check that a job has not started to damage someone: the annual questionnaire for the man on the breaker, the hearing test for the piling gang, the look at the hands of the labourer who mixes all day. It is not a medical and not a way of finding out who to lay off. It is the employer's evidence that the controls in the risk assessment are working, and the early warning when they are not. Written from the side of the desk that receives contractors' paperwork, here is who needs it and what the file should hold.
Where the duty comes from
The general duty is the Management of Health and Safety at Work Regulations 1999, regulation 6: every employer provides health surveillance where its risk assessment shows it is appropriate. The specific regulations say when that is. The Control of Substances Hazardous to Health Regulations 2002, regulation 11, requires it where a substance can cause an identifiable disease and there is a valid way of detecting it: dermatitis from cement and resins, asthma from isocyanates. The COSHH test has a second limb — the disease has to be reasonably likely under the conditions of the work. The Control of Vibration at Work Regulations 2005, regulation 7, requires it where exposure is likely to reach the action value, and for anyone the assessment identifies as at risk below it. The Control of Noise at Work Regulations 2005, regulation 9, requires health surveillance, including hearing tests, wherever the assessment shows a risk to hearing: in practice everyone regularly at or above the upper action value, anyone occasionally above it whose protection cannot be relied on, and anyone particularly at risk at lower levels (existing hearing loss, certain medication). Lead has its own medical surveillance under the Control of Lead at Work Regulations 2002. Under the Control of Asbestos Regulations 2012, regulation 22, licensable work and notifiable non-licensed work both need a medical by a relevant doctor — an appointed doctor or employment medical adviser for licensable work, any registered doctor for non-licensed notifiable work — two-yearly and three-yearly respectively.
Two points matter on a site. The duty is each employer's, for its own people: a principal contractor cannot discharge a subcontractor's duty, but it can refuse to let exposed people start until the programme exists. And the trigger is likely exposure, not proven harm: a gang on breakers all day is on the programme before anyone reports tingling fingers.
Who needs what
- Vibrating tools — breakers, grinders, drills, compactors: HAVS surveillance in the tiered form HSE describes in L140 — tier 1 a baseline questionnaire, tier 2 an annual questionnaire, which a trained responsible person may give, tier 3 a clinical assessment by an occupational health nurse or doctor, tier 4 a diagnosis by a doctor.
- Noise — piling, cutting, chasing, working beside plant: audiometry, a baseline and then the interval the provider sets.
- Skin — cement, epoxy and MMA resins, solvents, bitumen, wet work: a regular skin check by a trained responsible person, who can be the supervisor, with referral when something is found.
- Breathing — lung function and a respiratory questionnaire, for asthma from isocyanates and wood dust, and for silicosis from silica, with the chest X-ray the provider decides; and RPE that has been fit-tested to the face that wears it, clean-shaven.
- Lead and asbestos — blood-lead monitoring, and the asbestos medical by a relevant doctor — an HSE-appointed doctor for licensable work.
What the records look like
There are two records, and the mistake most files make is holding the wrong one. The medical record — the questionnaire answers, the audiogram, the clinical findings — belongs to the occupational health provider and is confidential to the person. The health record belongs to the employer: name, job, exposure, type of surveillance, dates, and the outcome in fitness terms — fit, fit with a restriction, referred — with nothing clinical on it. COSHH regulation 11 requires that record to be kept for at least forty years from the last entry, and the lead and asbestos regulations say the same, which is why it is held apart from the site file that gets boxed at handover.
On the site, the principal contractor's register does one thing: it shows that every contractor whose people are exposed has a programme, with a provider named and a next-due date that is real. The assessments behind it — the tool list with vibration magnitudes written in from the manufacturer's data, the activity list with noise levels from a meter — are what put a person on the register. The daily exposure logs are a third, separate layer.
A restriction is the one thing that leaves the confidential file. If the provider says no vibrating tools for six months, the supervisor is told the restriction and not the reason, and the site honours it.
What a template does not do
A form gives the site the headings and the legal driver printed on the sheet. It does not know which of your people are exposed, it does not print an action value — you write the current figure in from the Regulations — and it does not replace the provider who does the surveillance. The competent person adapts it, and no document makes anyone compliant. Why we will never call a document "compliant".
Documents for this work
- The occupational health bundle — all eight documents
- Health Surveillance Register and Programme
- HAVS Risk Assessment by Tool and Task
- Noise Risk Assessment by Activity
- RPE Selection and Face-Fit Test Register
- Skin Surveillance and Dermatitis Check Record
- Occupational Health Referral and Fitness Certificate Record
- Hand-Arm Vibration Exposure Record and Noise Exposure Record — the daily logs the assessments sit behind