Lesson 3 – Medical Surveillance – Occupational Diseases

ASPECTS  OF MEDICAL  EXAMINATION FOR  THE  ASSESSMENT OF FITNESS  TO WORK

• The fitness to perform work at the mine shall be evaluated by 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.  A Transfer  medical examination will be performed when the occupation of an employee is changed.  A Short medical examination will be performed at the discretion of the OMP (see below).
• 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 Mines Limited unless  he has been certified fit by the OMP/OHP after examination (In possession of a “valid certificate of fitness”).
• For potential employees or contractors due to work on the mine for less than 30 days per year (continuous or accrued) a shortened medical examination may be implemented as per the discretion of the OMP.   Job­ specific risks and hazards will be considered with this decision.  A shortened medical examination will include a full clinical examination, but audiometry, spirometry and chest x-ray may be excluded.
• The following examinations will be performed at no charge to the employees of Barberton Mines Limited 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.

 

EXTENT AND FREQUENCY OF MEDICAL EXAMINATION

• Frequency of examinations will be based on the occupation exposure, risk and as per legislation (Regulations, SANS, etc.).
• The extent I detail of the medical examination (as determined by the OMP) will be determined by the specific occupation’s requirements and potential risk I hazards (as determined by the occupation hygiene risk assessment), as reflected in the exposure risk matrix.

 

Initial Examination

• The initial examination is used to establish a baseline against which subsequent changes in health status can be evaluated. Prospective and new workers  must undergo an  initial examination  with baseline tests by the OMP I OHP appropriate to the health hazards and exposures of the proposed occupation, as identified in existing and ongoing risk assessments for the relevant job.
• 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.
• For potential employees or contractors due to work on the mine for less than 30 days per year (continuous or accrued), a short medical examination may be implemented as per the discretion of the OMP. Job-specific  risks  and  hazards  will  be  considered  with  this  decision.    A  short  medical examination will include a full physical examination, but audiometry, spirometry and chest x-ray may be excluded.
• 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 OMP will act on health disorders detected immediately or by appropriate referral. Fitness-to-work decisions will be practicably delayed (within reason) until the state of maximum improvement has been reached. Employees will be  informed of the obligation  (compulsory)  to comply fully to prescribed medical treatment regimes during this process as well as during the period of employment (condition of fitness-to-work).

 

Extent of the Initial Examination:

• A questionnaire regarding the previous medical and employment history of the prospective employee.
• A respiratory questionnaire
• 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 (baseline audiogram where applicable).
• 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

• Periodic medical examinations  will be risk-based  and  occupation-specific, taking  into account  the physical requirements of the occupation, the work place hazard exposure and the results of hygiene risk assessment.
• The frequency of any periodic or 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 of the utmost importance to maintain the health of an employee.
• The factors influencing this frequency 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.

• The interval between examinations (normally 12 months) may only be extended with a maximum of 3 months (not exceeding 15 months) for individual cases under specific and reasonable conditions (e.g. practical constraints), at the discretion of the OMP.
• The interval between medical examinations (frequency of tests) is indicated in the medical surveillance/ occupational risk matrix (based on occupational hygiene data).
• 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 DMR, Department of Health, Compensation Commissioner (RMA) 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 may include:

Supervised work:

• may ensure that an employee with an occupational disease that can cause harm to fellow workers and self will be able to receive medical attention immediately. Where supervision is not possible, the employee may not be able to perform such work without risk.

 

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.     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.

 

Restricted work:

• e.g. 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.

 

Extent  of the periodic examination:

• A questionnaire regarding any significant medical, surgical or accident occurrence during the intervening time since previous examination.
• A respiratory questionnaire.
• 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 (see risk exposure matrix) 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.
• A visual acuity test- a Snellen chart or any other standard method to be used.
• Blood or urine tests for biological or biological effect monitoring
• Any other examinations or questionnaires will be performed at the discretion of the OMP.

The periodic examinations are integrated into the occupational health surveillance program as well as 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 ionizing 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.

 

Alterations in exposure or medical surveillance

• The OMP may consider declaring an employee fit to continue working subject to certain conditions e.g. closer supervision, more frequent monitoring, reduction in exposure.
• Where the standards of fitness are not met, the outcome and results of the medical examination will be discussed with the employee to ensure full understanding of risks and consequences.
• Should an employee be declared fit to work with restrictions,  despite  certain  impairments,  the importance and compliance will be discussed with the employee.
• The OMP will notify the employer of the restrictions in writing.

 

Transfer  Medical Examination

• The purpose of a transfer medical examination is to re-establish the employee’s fitness-to-work relevant to the new occupation, with its own inherent risks and hazards, as identified by the latest hygiene risk assessment.

 

Extent of the transfer examination:

• A transfer medical may contain all evidence of the periodical medical examination depending on the inherent job requirements, the inherent risks and hazards, and occupational hygiene data with regards to the new occupation. Some test results may still be valid and will be transferred in terms of requirements of the specific occupation’s medical surveillance.

 

EXIT MEDICAL EXAMINATION

• The exit examination is used to establish the health status of the employee leaving the employment of the mine.
• If an occupational disease is identified, appropriate management of such disease is to be instituted. All regulatory   requirements,   such   as   notifications  to  the   DMR,  Department  of   Health,  Compensation Commissioner (RMA) or the MBOD are to be complied with.
• An exit certificate shall be produced by the OHNP and signed by the OMP after the examination. This certificate will provide  a summary  of all relevant findings of 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.
• All employees or persons previously  employed at Barberton Mines Limited, have the right to appeal any finding of the OMP to the Medical Inspector in terms of Section 20 of the MHSA.  The Medical Inspector may, as far as possible, be assisted by the confidential disclosure of personal; medical information (Section 15 of the MHSA).

 

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 occupational hygiene 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.

 

 

CATEGORIZATION OF FITNESS TO WORK

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 permanently unfit for a particular category of work. The standard has temporarily not been met: an employee is temporary unfit for a particular category of work.
• The decision on fitness in accordance with this COP rests with the OMP. The fitness to work status of any employee may be cancelled by the OMP when there is reason to suspect that the health of the worker is such that his performance 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, and will be discussed  with the employee. Should referral for management  of disease be appropriate, the OMP will refer the patient to his own Medical Practitioner.   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).

 

Review of fitness after absence for medical reasons:

• All employees or contractors will be subjected to a review medical examination after a period of 7 days absence of the work whether occupationally related or non-occupationally related injury or illness. Sickness absenteeism certificated and medical reports will be used to contribute to the decision of fitness to work.

 

Impairment / Disability evaluation:

Where the OMP certifies  an employee as not fit to work,  the following should be  in writing to the employer:

• Whether the condition is permanent or temporary.
• Whether the condition may be accommodated or not.
• With regards to  accommodation,  specific  conditions  I  physical  requirements  which  should  be restricted.

 

MINIMUM STANDARDS OF FITNESS TO PERFORM WORK AT BARBERTON MINES LIMITED

• The OMP will 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. 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.