Health Surveillance: what you need to know

15 August 2024

The Health and Safety Inspectorate (HSI) has identified that occupational health surveillance is not being conducted when legally required. This issue cuts across several sectors including food production, stonemasonry, construction, and carpentry.

Enforcement action has been taken as a result

Legal requirements

There is a belief that health surveillance is not a legal requirement in Jersey. This is incorrect.

Health surveillance is a reasonably practicable measure employers are required to take. It should form part of your overall system of occupational health management as required by Article 3(1) of the Health and Safety at Work (Jersey) Law, 1989.

What is health surveillance?

Health surveillance is a scheme of repeated checks used to identify ill-health caused by work. It is required as part of the goals set by health and safety law even where you have exposure control measures in place. Control measures may not always be reliable, despite appropriate checks, training and maintenance.

Health surveillance schemes require the input of competent occupational health professionals.

Health surveillance is not the same as health monitoring, health promotion or health screening:

it is only required for workers who need it
it is a lagging indicator of potential problems with your exposure control measures
it allows workers to raise concerns about how work affects their health
it provides the opportunity to reinforce workers’ training and education
it contributes to your risk assessment(s)
it helps identify actions to prevent further harm and protect workers

When is health surveillance necessary?

As an employer, you should have an ongoing health surveillance scheme if:

an identifiable disease or health effect may be linked to the exposure at work
it is likely that the disease or health effect may occur under the particular conditions of the work
there are valid techniques for detecting signs of the disease or effect
the technique used to detect whether something is wrong is safe & practicable to conduct

Health surveillance is a legal requirement in specific circumstances when there is still some residual risk to worker’s health. Where, despite the control measures you may have put in place, they are likely to be exposed to:

noise
vibration
substances that are hazardous to health

Health surveillance is used to identify occupational diseases, such as:

chronic obstructive pulmonary disease (COPD)
occupational asthma
dermatitis
silicosis
hand-arm vibration syndrome
noise-induced hearing loss

The biological monitoring of paint sprayers who routinely spray paint / hardener mixtures containing isocyanates also falls under the umbrella of health surveillance.

Medical surveillance

Medical surveillance forms part of an overall scheme of health surveillance where work is undertaken with high hazard substances or processes. This includes:

licensable asbestos work
lead
commercial diving projects
ionising radiation

The importance of worker engagement

Consultation with workers and their representatives can help increase workers' commitment to health surveillance and compliance with control measures. Health surveillance only works with their co-operation.

Ask workers what they think the health hazards are in your workplace. They can:

help you identify workplace risks
make sure your controls are practical

Make sure workers understand:

the systems you have put in place to control identified risks and your health surveillance scheme
why health surveillance is important and what it is for
what will happen if ill health is identified
they can attend health surveillance appointments during work time
you, as the employer, must pay for the surveillance
their own duties in law (for example attend appointments to help your business comply with its legal duties)
what action you may take if they refuse to attend appointments

Establishing a health surveillance scheme

You should put an ongoing health surveillance scheme in place where your risk assessment shows it is necessary. When setting this up, you should:

consider all the health hazards for which health surveillance may be required
know which workers could be exposed to each health hazard
ensure they receive the appropriate range of health surveillance

You will also need to:

take advice from an occupational health professional
identify who will lead and manage your health surveillance scheme
agree roles, responsibilities and communication arrangements
consider the practical details, for example shift patterns and remote workers

Acting on the results of health surveillance

Until you receive feedback from the occupational health professional, your health surveillance is not complete.

Feedback should include advice on 'fitness for task' with the relevant exposure(s) and when further health surveillance is required for each worker undergoing health surveillance.

This is usually in the form of a health record or a ‘fit note’, which is a legal record of the outcome of health surveillance. You should enter this information into the individual health records that you must keep for as long as you employ the worker.

It is good practice to offer workers copies of their health record when they leave your employment or if you cease trading. HSI Inspectors are allowed to check and be provided copies of fit notes.

You must act on the results to protect workers where health surveillance shows they have work-related ill health. If further investigation is required, this should be done in a timely manner in discussion with the occupational health professional.

You must also review your risk assessment and control measures to prevent other workers developing work-related ill health.