MEDICAL EXAMINATION FOR THE ASSESSMENT OF FITNESS TO WORK
CATEGORIES OF MEDICAL EXAMINATION
- This COP has been drafted to assist the OMP and other health workers in determining fitness to perform specific work at Barberton Mines and assessing the worker’s ability to continue the performance of such work at scheduled intervals thereafter.
- The fitness to perform work at the mine shall be evaluated at a series of standard examinations. These examinations will consist of: an Initial examination, Periodic examinations and when the worker leaves the employment or the mine, an Exit examination. The purpose of the examinations is to ensure that there is no disease or condition present or developing in the worker that could be aggravated by working on the mine.
- The presence of any such a condition should not pose an unacceptable health or safety risk to any individual employee or any other person on the mine. The health status of any individual worker should not place the health of that worker at increased risk in a particular environment nor place co workers or the public at increased risk.
- Any medical condition found at any examination should be evaluated in terms of the particular requirements for that specific job utilizing the person/job specification and job description. Some irregularities found at examination might be irrelevant to the performance of a specific job and may pose no risk to the worker or fellow workers.
- No person shall be allowed to perform any risk work at any of the operations of Barberton Mine unless he has been certified fit by the OMP after examination. (In possession of a “valid certificate of fitness”).
Initial Examination
- The initial examination is used to establish a baseline against which subsequent changes in health status can be evaluated at subsequent examinations. Prospective and new workers must undergo an initial examination with baseline tests by the OMP.
- New and prospective employees who have previously been employed in the Mining Industry must produce an exit certificate or a copy thereof from their previous employer. A certificate of Medical Fitness provided from other industrial sectors will also be accepted where applicable.
- All prospective employees who have been previously employed in the mining industry will be considered to be “employees” (as per Sect 20(6) of the MHSA) and will therefore be entitled to appeal to the Medical Inspector against any finding of unfitness to perform any category of work.
- The Initial Examination will be relevant to the health hazards and exposures of the envisaged occupation and to the results of relevant risk assessments.
- All prospective employees will undergo an initial examination and baseline tests, as considered by the OMP to be appropriate to the health hazards and exposures of the envisaged occupation as identified in existing and ongoing risk assessments for the relevant job.
The Initial Examination will consist of:
- A questionnaire regarding the previous medical and employment history of the prospective employee.
- A full physical examination with emphasis on the aspects of importance to the requirements of the envisaged occupation as identified in the person/job specification.
- A lung function test by means of spirometry. A full size chest X-ray.
- A screening audiogram – SABS 083 Code of Practice revised.
- A visual acuity test- a Snellen chart or any standard method to be used. Any other examinations at the discretion of the OMP.
Periodic Examination
- The frequency of any periodicor special examination shall be determined by the OMP. At the periodic examination, the OMP should be able to evaluate any subsequent disease or condition, which may have an influence on the ability of the worker to continue in his specific work. The early detection of any illness at these periodic examinations is or the utmost importance to maintain the health of an employee.
- The factors influencing this decision include :
–the specific hazards to which the worker is exposed,
–the nature and requirements of the work to be performed. Any previous medical, surgical or occupational history should also be considered before a decision regarding fitness to work will be made. The OMP may modify the frequency of such examinations based on examination results.
–The results of relevant risk assessments on the specific job category.
- If any occupational disease is identified during a periodic medical examination, appropriate management of such disease is to be instituted.
- All regulatory requirements, such as notifications to the DME, Department of Health or the MBOD
- are to be complied with.
- The standards of fitness requirements at the periodic examination should generally be the same as the initial standard of fitness requirements and be determined by hazards of the occupation.
- Any illness or impairment found at the examination should be considered in the light of the likely ability that the worker can continue working without endangering the health and safety of himself or any other worker.
The OMP should use his professional discretion in applying the standards of fitness during the periodic examination. The final conclusion on the standard of fitness of the employee will rely on:
The period of further exposure
- Some occupational diseases take a long time to develop and further deterioration of an employee’s health may continue even after the discontinued exposure to the hazard.
- Where serious permanent disablement could occur, further exposure to the hazard will be deemed unacceptable.
The experience of the worker
- A more knowledgeable and skilled worker, will generally be able to perform his job without significant risk to himself or to his fellow workers; health and safety. The skill of the worker may balance with the impairment in such way that the worker be deemed fit to carry on with his duties as required of him.
Protection of the worker
- The employee may be protected against further deterioration in his health and thus also reduce the risk to his fellow employees. This will include :
–Supervised work may ensure that an employee with an occupational disease that can cause harm to fellow workers and himself will be able to receive medical attention immediately.
–Supervised medication may eliminate or reduce risk to the health or the safety of employees, for example, a controlled responsible diabetic, without creating unacceptable risk.
The use of PPE.
- A serving driver for passengers and goods conveyance is no longer fit to work as a driver if there is more than 40 dB average pure tone (0.5, 1,2 and 3 kHz) hearing loss due to unacceptable risk to fellow employees.
- Where no supervision is possible or where there is a documented reluctance of the employee to comply with such measures, the OMP should consider these factors before declaring such employee fit for duty.
The periodic examination will consist of:
- A questionnaire regarding any significant medical, surgical of accident occurrences during the intervening time since previous examination.
- A full physical examination to determine the ongoing health status of employees with emphasis on the aspects of importance to the requirements of the employee’s occupation.
- Examinations are to be conducted in accordance with the medical surveillance plan requirements for that particular occupation and may include:
–A lung function test by means of spirometry.
–A full size chest X-ray subject to results of lung function test and hazardous chemical exposure.
–A screening audiogram – SABS 083 Code of Practice as revised
–A visual acuity test- a Snellen chart or any other standard method to be used.
–Any other examinations will be performed at the discretion of the OMP.
- The periodic examinations are integrated into the occupational health surveillance program and any biological monitoring of the employee that has to be performed to comply with any legal requirement.
These may include the surveillance of:
- TB;
- Silicosis;
- Noise induced hearing loss;
- Workers exposed to ionising radiation;
- Workers exposed to other specific hazardous substances for which regulations exist, such as lead and asbestos;
- Workers exposed to other potentially hazardous substances and conditions as determined in risk assessment and in accordance with the established medical surveillance plan.
Exit Examination
- The exit examination is used to establish the health status of the employee leaving the employment or the mine or works. An exit certificate must be provided to the employee by the OMP.
- If an occupational disease is identified, appropriate management of such disease is to be instituted. All regulatory requirements, such as notifications to the DME, Department of Health or the MBOD are to be complied with.
- An exit certificate shall be produced by the OMP after the examination. This certificate will provide a summary of all occupational medical surveillance conducted during the employment of the employee by Barberton Mines Limited. The presence or absence of any occupational disease will be reflected on the certificate.
- A copy of this certificate will be provided to the employee and a copy will be entered into the employee’s record of medical surveillance.
- The exit examination and tests will be appropriate to:
–the health hazards that the employee were exposed to; the inherent requirements of the specific occupation; the results of all relevant risk assessments.
–All records of any examination will be kept under the control of Barberton Mines Limited for the period as specified by the MHSA (for a period of 40 years after the last date of medical surveillance of the worker). These may be made available only in accordance with the ethics of the medical practice, or if required by law or court order, or if the employee has, in writing, consented to the release of the information.
- The following examinations will be performed at no charge to the employees of Barberton Mines by the Occupational Health Department of the mine:
–to prospective employees of Barberton Mines Limited an initial examination;
–to current employees a periodical medical examination;
–all other examinations as determined by the OMP and
–exit medicals to employees leaving the employment of Barberton Mines Limited.
CATEGORISATION OF FITNESS TO WORK
There are only two findings that may be made by the OMP:
- The standard has been met: an employee is fit for a particular category of work.
- The standard has not been met : an employee is unfit for a particular category of work.
The decision on fitness in accordance with this COP lies with the OMP. The fitness to work status of any employee will be cancelled by the OMP when there is reason to suspect that the health of the worker is such that the performance by him of risk work is likely to endanger his own health or safety, or the health or safety of other workers.
The grounds of such a finding and the effective date thereof will be recorded on the employee’s medical surveillance record. If the employee has been found unfit for work as a result of an occupational disease, the OMP shall institute appropriate procedures in terms of the COlD Act or the ODIMWA In this instance, (an occupational disease causing unfitness to work), the employer must conduct an investigation in terms of Section 11 (5) of the MHSA
An employee can direct an appeal to the Principal Medical Inspector of Mines within 90 days after a decision of unfitness by the OMP (MHSA Section 20).
Periodic examinations should be risk specific, taking into account the physical requirements of the worker’s occupation and the hazard and risk assessment of the workplace. Some disabilities or impairments may be irrelevant to performing a particular job category and the employee may be declared fit without posing a health or safety risk.
The interval between examinations will be determined by the OMP with regard to:
- the specific health hazards present,
- the requirements of the worker’s occupation, and the results of any relevant risk assessment.
The interval between examinations may only be extended under specific and reasonable conditions (to a maximum of 3 months) in liaison with and at the discretion of the OMP.
Periodic examinations may be modified by the OMP according to a worker’s health risks.
MINIMUM STANDARDS OF FITNESS TO PERFORM WORK AT A MINE ON INITIAL EXAMINATION
- The OMP should be governed by the principle that “The health of the employee should be. such, that in the performance of his work he should not endanger his own health or safety or the health or safety of other employees”.
- Each employee will be evaluated individually taking into account his specific occupation and the state of fitness/health required for this occupation, considering health hazards to which the employee will be exposed to. Consistency is important and the OMP will follow the guidelines provided.
- Mining and the processing of rock is a potentially hazardous occupation and calls for a high standard of health and fitness in those entering or re-entering the industry.
- The OMP may apply more or less stringent standards after taking into account the job requirements as well as the worker’s experience and individual circumstances.
- Prospective employees who at examination are found to be suffering from serious infectious diseases or other conditions which preclude him from working on the mine and works will be referred to his previous employer.
- The aim of pre-employment screening is to ensure that a healthy work force is employed as well as preventing the introduction of infectious diseases. This will include the workers of contractors working at Barberton Mines Limited.
- Withholding information on any previous medical conditions at pre-employment screening will be deemed as fraudulent and a person will be discharged on establishing dishonesty.
- At initial examination every prospective employee will be made aware of this fact. The prospective employee will sign his medical questionnaire, confirming that the information given by him is true and complete.
- Criteria for exclusion of prospective employees are based on clinical findings and on the history from the questionnaire. The OMP will determine and apply the standards taking into account the risk assessments and inherent requirements of the job category.
THE MANAGEMENT OF SPECIFIC DISEASES OR CONDITIONS
- It is impractical to cover all possible medical problems that an employee may develop after employment and therefore the OMP should use his professional discretion.
INFECTIOUS DISEASES
a. Gastro-Intestinal Infectious Diseases
- Persons with any infectious gastro-intestinal disease are to be certified unfit to prepare or handle foodstuffs until the OMP re-examines the employee and certifies the employee fit to resume such duties.
b. Active Infectious Pulmonary Tuberculosis
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- All prospective employees are required to have a chest X-ray as part of their pre-employment examination. Should tuberculosis be diagnosed in a prospective employee, the person will not be employed.
- If a prospective employee had been employed on a mine or works within the last twelve months, he will be referred back to the previous employer and that previous mine will be responsible for further investigation, treatment and submission to the MBOD for compensation purposes.
- If tuberculosis is found in a prospective employee, he has not passed the standard of fitness and will be sent back to TEBA or to his nearest medical facility with a referral letter in order to receive treatment for the disease.
INFECTIOUS DISEASES
AT PERIODIC EXAMINATION (CURRENT EMPLOYEES)
- Current workers found to have tuberculosis will be managed according to the Tuberculosis Control Protocol of the specific operation and will only be declared fit for work by the OMP. The degree of impairment caused by the disease will determine the further fitness to work.
- A re-evaluation to establish fitness to work will be carried out by the OMP after a suitable interval. The employee will be found Not Fit to work where there is a continuing infectivity or serious impairment.
- To assess the degree of damage by previous PTB, chest X-ray and lung functions should be assessed. There should be no more than 40% damage on chest X-ray and the lung function test should be no more than mild disease in the rating of respiratory impairment as per MOHAC guidelines.
- Whether one or both lungs have been seriously infected by TB, the employee should not be exposed to dusty environments.
c. Septic Lesions
- Persons suffering from chronic septic lesions should not participate in handling food.
ENDOCRINE AND METABOLIC DISEASES
Diabetes Mellitis
The finding that a worker suffers from diabetes should be regarded as a prospective disability due to:
- The progress’1ve nature of the disease.
- The development of complications (poor vision, impaired renal function, etc.)
- Potential side effects (blackouts, impaired heat tolerance, etc.)
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Non-insulin dependent diabetics (NIDDM) may be considered for safe surface jobs only should the blood glucose level be below 11g.dl.
AT PERIODIC EXAMINATIONS (CURRENT EMPLOYEES)
- Only NIDDM patients who are well controlled will be allowed to work. IDDM persons may be allowed but only in special circumstances and with restrictions placed on the type of work. A NIDDM patient may be allowed to perform Category A, risk work but each case shall be judged individually by the OMP. No diabetic will be allowed to perform any Category B risk work on the mine or works.
- Following any hypoglycaemic episode in a worker the worker will be re-educated and improved control must be established and a re-evaluation for fitness to work will be performed after a suitable interval.
d. Obesity
- Obesity adversely affects heat tolerance or the ability to exercise, mobility, general health or possible medical evacuation (the removal of a sick or injured obese person from accident location at workplace) may render a person unfit for a particular category of work.
- Workers with a mass of >1OOKg or <50Kg may be declared fit for work at the OMP’s discretion. The BMI chart can be used as a guideline.
THE MANAGEMENT OF SPECIFIC DISEASES OR CONDITIONS
DISEASES OF THE BLOOD AND BLOOD FORMING ORGANS
- Any significant disease of the haemopoietic system may preciude employment in certain categories of work.
- Specific attention should be given to labourers in strenuous work categories. a. Haemophilia
- When inhibitors (antibodies) are present in large amounts in the patient’s blood, the employee may require very high and expensive quantities of transfused clotting factors to stem bleeding. Life threatening haemorrhage is a constant risk.
- Traditional treatments involve mostly ‘on demand’ treatment, i.e. patients are treated only after bleeding symptoms are recognized. These bleeds ultimately result in severely impaired joints. It is known that crippling joint involvement can be avoided through periodic and regular transfusion.
- The haemophilia patient/employee needs to wear a medical identification band, clearly indicating the employee’s blood group and type of blood disease.
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Haemophilia patients may be considered, but it is imperative that the patient discloses the matter as the implications for the employee and his colleagues are quite severe.
AT PERIODIC EXAMINATIONS (CURRENT EMPLOYEES)
- These workers may be temporarily unfit for work pending treatment. Each case shall be judged individually by the OMP.
MENTAL DISORDERS
a. Acute and Chronic Psychosis
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Any new worker with an acute or chronic psychosis is unfit for risk work.
PERIODIC EXAMINATION (CURRENT EMPLOYEES)
- These workers may be temporarily unfit for work pending treatment and rehabilitation. A re-evaluation for fitness to work will be performed after a suitable interval.
b. Severe Anxiety or Depressive Illness
- Persons suffering from severe anxiety or depressive illness complicated by significant loss of memory or concentration, agitation, behavioural disturbance or suicidal thoughts should not be fit to work in categories of risk work.
c. Chronic Schizophrenia/Dementia
- Any organic brain syndrome should not be employed to work in risk categories.
d. Alcohol or Substance Abuse/Dependency
- Alcohol and drug screening should be performed on all risk category A and B workers.
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Unfit for any risk work.
PERIODIC EXAMINATION (CURRENT EMPLOYEES)
- Unfit for risk category A or B workers. These workers may be temporarily unfit for work pending treatment and rehabilitation.
- A re-evaluation for fitness to work will be performed after a suitable interval. An alcohol and substance abuse policy to be compiled.
DISEASES OF THE NERVOUS SYSTEM AND SENSORY ORGANS
a. Epilepsy and other Conditions of Altered or Impaired Consciousness
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Any medical condition which may result in an altered or impaired level of consciousness, including epilepsy renders a person unsuitable for employment in certain areas or occupations on a mine, such as underground, or operation of moving machinery or in dangerous situations such as working at heights, near water, high voltage electricity or any other potentially dangerous situations.
AT PERIODICAL EXAMINATIONS (CURRENT EMPLOYEES)
- Notwithstanding the above, an epileptic under medical treatment and without any events within a preceding period of two years may be considered for certain categories of work underground or on the surface. The worker will be re-educated and improved control established and a re evaluation for fitness to work will be performed after suitable intervals.
EAR, NOSE AND THROAT
- An ear, nose and throat examination is required (which includes intact tympanic membranes and functioning Eustachian tubes) and the minimum standards set below must be met for occupations involving changes in barometric pressure and/or exposure to noise.
- However, the OMP will decide each case on the risk versus the skill and experience of the worker concerned.
a. Audiometric Standards
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- All prospective employees will undergo a hearing test on pre-employment examination. No person with impaired hearing will be placed in a job where the possibility exist that he will be in danger because of poor hearing or where his hearing may be further damaged.
PERIODIC EXAMINATIONS (CURRENT EMPLOYEES)
- If a loss of hearing is discovered with a current employee, the employee’s hearing will be followed-up by additional examinations with specific regard to the risk assessment.
- If a worker is found to have significant hearing loss, he will be referred to a registered audiologist for diagnostic audiograms and the procedure of the hearing conservation program will be followed.
- Depending on the degree of hearing loss, removal from the source could be considered, however, a degree of flexibility should be exercised when deciding to take an employee from his work. The criteria to be used in determining whether the employee may continue in their present occupation should be based on whether the employee may endanger themselves or others due to hearing impairment. The absolute minimum for continued work in a noisy environment should be a binaural hearing loss average of 60 dB(A).
- If any degree of heating loss is detected the worker will be re-educated and advised to use personal, of other suitable protective hearing devices.
- Workers may have to be withdrawn form their work in the following circumstances : Binaural hearing loss average> 60dB(A) in certain occupations.
- Binaural hearing loss average of> 45dB(A). Unilateral deafness of 100% in either ear.
VISION
- Binocular vision is necessary for all categories of risk work. A normal visual field 50 degrees nasal and 70 degrees temporal vision is required.
VISUAL ACUITY
- should be tested using Snellen charts in normal illumination. VISUAL FIELDS can be tested by the confrontation method.
COLOUR VISION
- should be tested using Ishihara charts. Normal colour vision and normal visual fields are required for passenger, and drivers as well as for certain other occupations, such as electricians.
CARDIOVASCULAR SYSTEM
a. Cardiovascular Disease
- The worker must be free from acute or chronic heart disease, which may impair his ability to undertake the required physical exertion for a particular category of work.
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- Any applicant with uncontrolled hypertension >160/100 or complications from hypertension is unfit for employment.
AT PERIODIC EXAMINATION (CURRENT EMPLOYEES)
- A well-controlled hypertensive worker may work. Uncontrolled hypertensives or those with complications should be excluded from a got environment and strenuous work.
- Hypertension is viewed as uncontrolled at a systolic value of 180 or higher and a diastolic value of 110 or higher. There should be no loss of consciousness due to cardiac reasons.
RESPIRATORY SYSTEM
- The respiratory system should be free of acute or chronic disease, which may impair the ability to meet the required physical performance of a particular category of work.
- In individuals where there are mild abnormalities of lung function this test should not be the sole criterion on which an individual is precluded from mine work. If the individual otherwise appears to have a normal cardiorespiratory system and is able to meet the physical performance requirements of the specified occupation then he may be found fit for a particular category of work. Refer to the MOHAC Guidance Note for OMP’s on lung function testing.
- For screening purposes a lung function test is normal if FVC and FEV1 is greater than 80% of the predicted or the (FEV1/FVC) ratio is equal to or greater than 70%.
a. Silicosis
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- All new workers with silicosis will be judged on an individual basis. The degree of impairment caused by the disease and the risk inherent in the particular category of work will be taken into account in deciding on fitness to work.
- For screening purposes, a lung function test is considered normal if the FEV1 is greater than
- 80% of predicted or the (FEV1/FVC) ratio is greater than 70% of predicted.
- A new worker will not be considered fit for work if the chest X-ray is classified as worse than ILO
- 1/1, regardless of size of the silicosis nodules.
b. Occupational Asthma
- In addition to those employees who develop occupational asthma as a result of the workplace exposure to sensitizers, or irritants, many employees are unaware that pre-existing asthma may
- be worsened by the working environment.
Morbidity from occupational asthma is preventable. Early diagnosis holds substantial promise for effective intervention.
AT INITIAL EXAMINATION (PROSPECTIVE EMPLOYEES)
- A controlled asthmatic person may be considered. The importance of the correct use and availability of the medication needs to be stressed.
AT PERIODIC EXAMINATIONS (CURRENT EMPLOYEES)
- Only asthmatic patients who are well controlled will be allowed to work. An asthmatic patient may be allowed to perform risk work but each case shall be judged individually by the OMP.
- Following any asthmatic attack episode in an worker the worker will be re-educated and improved control must be established and a re-evaluation for fitness to work will be performed after a suitable interval.
DISEASES OF THE DIGESTIVE SYSTEM
- There should not be any significant disease of the digestive system, which may impair an employee’s ability to perform a certain category of work.
GENITO-URINARY SYSTEM
- There should be no cases of unexplained proteinuria, glycosuria, haematuria of any other urinary abnormalities, which may render the worker unfit to perform his particular work.
SKIN
- Occupational skin diseases mostly in the form of allergic and irritant (contact dermatitis) are the second most common type of occupational disease.
- A history or the presence of any septic or chronic skin condition which is likely to be aggravated by the worker’s working conditions, may render him unfit for his particular job category. Such conditions include psoriasis and all chronic forms of dermatitis.
Irritant Contact Dermatitis
- Irritant contact dermatitis is the most common occupational skin disease, usually resulting from toxic reactions to chemical irritants such as solvents and cutting fluids.
- As the prognosis of occupational irritant and allergic dermatitis is poor, prevention is imperative. Occupation contact dermatitis is likely to develop into chronic skin disease.
MUSCULO SKELETAL SYSTEM
- Musculo skeletal disorders affect -the soft tissues of the neck, shoulder, elbow, hand, wrist- and fingers. These include the nerves (e.g. carpal tunnel syndrome), tendons (e.g. tenosynovitis, peritendonitis, epicondylitis) and the muscles (e.g. tension neck syndrome). The fitness of the worker and his musculo-skeletal development and integrity should be such that he is able to undertake the required physical exertion to perform his particular job.
HEAT TOLERANCE
Where the wet bulb temperature exceeds 27.5° Celsius or the dry bulb temperature exceeds
- 37.0°C., the mandatory COP on Heat Stress Management shall apply. Employees who need to work in such environments, must meet all the physical requirements and pass the necessary screening test prescribed in the COP before they will be found fit to work.
- Heat stroke and heat exhaustion rendering an employee unfit for normal work for more than 48 hours are reportable to the DME.
AGE
- No person under the age of 18 will be allowed to work on the Mine or Works.
OCCUPATIONAL DISEASES IN THE SECOND DEGREE
- If an employee is found by the MBOD to be suffering an occupational disease in the second degree, he is found unfit to perform risk work of any nature on surface.
THE MANAGEMENT OF Ex-BARBERTON MINES LIMITED EMPLOYEES WITH AN OCCUPATIONAL DISEASE
- If an ex-employee suspects that he has an occupational disease, a benefit examination will be done at the MBOD.
- The employee will have a benefit examination performed and the relevant documentation will be forwarded to the MBOD or RMA for any possible compensation. If applicable, treatment will be started and the person will receive a referral letter to his nearest appropriate facility for continued management.
RADIATION
- Barberton Mines is committed, to manage potential radiation, hazards and ensure that employees’ health will not be adversely affected by accidental exposure to such sources.
HANDLERS OF TOXIC SUBSTANCES
- Workers exposed to hazardous chemical substances as identified and evaluated by the company appointed Occupational Hygienist should have normal renal, hepatic and haemopoetic function. Biological monitoring will be done on these workers at the discretion of the OMP and also in accordance with the relevant regulations.