Medical Surveillance in Occupational Health

A scheduled program or annual review, including a psychiatric examination, biological testing or medical examination of the workers by an occupational health professional or in specified situations, by an occupational health professional.

X-rays, hearing checks, or biological monitoring may be these diagnostic tests. It is only used for the identification of harmful effects of particular occupational hazards. It is not a general health examination from a doctor who can take care of any disease. 

Through regulation, medical monitoring is supposed to be carried out in workplaces where employees are vulnerable to specific risks. Noise, asbestos, certain substances, certain biological agents, and lead are the basic threats that involve medical surveillance. The employer is responsible for ensuring that medical supervision is performed by a medical practitioner and that the services are paid for.

A patient monitoring service may only be performed by an occupational health specialist who is a doctor or nurse with a certificate in occupational medicine.

 

Purpose

According to the Occupational Health and Safety Act no 8 of 1993 and the Mines Health  and Safety Act no 29 of 1996, an employer shall ensure that an employee is under the medical surveillance of an occupational health practitioner. The employer needs to provide occupational health to their employees to prevent the risk of liability and avoid the implication of noncompliance to the act.

Medical surveillance has four categories:

  • Pre-employment medical
  • Periodic medical
  • Transfer medical
  • Exit medical

The purpose of this process is to define the controls and process for conducting medical surveillance to ensure:

  • That the employee is fit to perform his/her specific work without endangering his/her own health and safety and that of others
  • To identify medical problems that may arise from exposure at the workplace

 

Responsibilities and Authorities

  • Occupational Health Medical Practitioner (OHMP)
  • Occupational Health Nurse Practitioner (OHNP)

 

Role players in medical surveillance

1. Manager:

Provide occupational health nurse practitioner with a copy of a person’s job specification

2. Occupational Health Nursing Practitioner

Conduct full medical examination according to the following

  • Occupational risk exposure profile
  • Employee  job specification
  • Finalise medical examination findings
  • Produce a medical certificate of fitness

3. Employees

  • Be responsible for their own Health and Safety
  • Avail themselves for Occupational health medical examinations
  • Carry out any lawful order and obey health and safety rules
  • Use their personal protective equipment as per occupational exposure

 

Process Inputs and Reference Documents

  • Referral letter from employee
  • Employee job specification sheet
  • Booking
  • Occupational Health and Safety Act no 85 of 1993
  • Mines Health and Safety Act no 29 of 1996

 

Process Steps

  • Medical surveillance program is a planned medical examination which is done at intervals determined by the occupational risk exposure profiles
  • Complete your prepared employee job specification to do a risk based medical examination
  • Refer to medical surveillance process flow for conducting a medical surveillance (NOTE: this may vary from company to company)

 

Medical Surveillance Process Flow Daily Clinic Procedure

Medical Examination
  • Occupational, past and present medical history
  • Physical examination of all the systems
  • Urine test
  • Height
  • Weight
  • B.M.I
  • Audiometry
  • Spirometry
  • Vision
  • X-ray when indicated
  • Other indicated tests
Vision Screening

Vision screen testing will be done according to protocol and must comply with the acts which shall consist of the following elements:

  • Vision acuity, far and near
  • Colour perception
  • Vision depth perception
  • Field vision
Audiometry

Audiometry testing will be done according to protocol and must comply with the acts which shall consist of the following elements:

Spirometry

Spirometry testing will be done according to protocol and must comply with the acts which shall consist of the following elements:

  • History of the employee: occupational, medical and lifestyle
  • Height and weight
  • Explain/demonstrate the procedure to the employee
  • Spirometry screening test
Medical Surveillance Process Flow

After the medical examination the occupational health nurse practitioner assesses the available medical evidence and the occupational medical practitioner determines one of the following:

  • Able to do the work without any harmful effect
  • Able to do the work
  • Able to do the work but with restrictions
  • Able to do the work but it might aggravate a pre-existing condition
  • Able to do the work but a danger to him/herself or others
  • Unable to do the work

 

Process Outputs

Medical Certificate of Fitness/Medical surveillance report, complies with legal procedures and records as identified in procedures:

Medical Certificate of Fitness/Medical surveillance report, complies with legal procedures and records as identified in procedures: