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Health & Safety




A practical guide for managers in small and medium-sized enterprises

Health & Safety




small and medium-sized enterprises

A practical guide for managers in

TheHealth andSafety Commission and Executive are convincedthat good health andsafety managementis the key to achieving real improvementsin all aspectsofhealth andsafety at work, and that thisshould lead to greater efficiency andcost savings. Improvinghealth andsafety managementcontinuesto be oneof our priority tasks.I believethat this guide will help smalland medium sizedemployersin particularto recognise that managingwork-related health risks neednot he difficult, and that theycan do it successfully. Theresults willbenefitboth individualemployees andthe companyas a whole.

Frank J Davies CBE, OStJ Chairman,HealthandSafety Commission


Heal!!: risk inanageineizi


Stage 1 Stage 2
Stage 3

Findingout if you have a problem Decidingwhat to do Takingaction



Stage 4

Checking what you have done

Whereto go for help

Final checklist
40 42


Further reading

HSE regional offices 48

Health risk ?naflagelneflt


Thisbooklethas been prepared to help the owners and managersof smallandmedium sized enterprisesto controlhealth risks arising from work. It is based on informationandexperience gainedby HSE, and actualcasestudies are used to illustrateparticularpoints. Management needs to be competentto deal effectively with occupationalhealth risks.

Each year more peoplebecomeill as a result of their work than are killedor injured in industrial accidents (Box 1). Whilemost diseasescausedby work do not kill, they can involve years ofpain, suffering and discomfort for those affected. This might include musculo-skeletal problems, respiratorydisease,dermatitisandnoise inducedhearing loss.
Box 1 Approximately1 million people suffera workplace injuryeach year. 2 million people sufferill health caused or made worse bywork. 30 millionworking days a yearare lost due to workplace injuriesand ill health. Altogether

As a manageryou willbe concernedifyouremployees'health is affected by theirwork. Managementskills canbe applied to preventingill health as part of running a business. The linkbetween the workplacecauseandlater illhealth is not alwaysobvious. This booklet provides a frameworkandsome examples to help you to improvethe controlof health risksin


Health risk management

Table 1
Hazards to health

Hazardous chemicals if inhaled can cause asthma, bronchitisorcancer; splashed into the eyes can cause dermatitisorsevere irritation.

ifswallowed can cause poisoning; if spilt onto the skin or

Sprains, strains and pains can be caused by manual lifting of heavy loads. Upper limb disorders (ULDs), so called repetitive strain injury (RSI), can happen if the workstationis poorly designed sothat people have to adoptawkward body positions.ULD5 can also occuras a resultof repetitive orfast movements, poor posture and high forces.

Noisenoise levels which are too high (eg having to shoutto be heard) can lead to deafness or conditions suchas tinnitus (ringingin the ears). Vibration too much vibration,eg fromcontinual use of powered hand tools, can lead to debilitating diseases suchas vibration white
lonising radiation eg exposure to X-rays,can cause burns, sickness and cancer. Non-ionising radiation suchas infra-red and ultraviolet radiation and lasers can all damagethe eyes and skin. Microwaves can cause excessive heating ofexposed partsofthe body.

Extremes oftemperature,pressureand humidity can affectpeople's abilityto work safely and can cause harmfulchanges within

their bodies, suchas heat stress and 'the bends' (pressure).

Hazardous micro-organisms eg bacteria, if inhaled, swallowed, accidentally injected into the skin, splashed into the eyes orallowed to contaminate skin cuts can cause disease, aiergy ortoxic effects. Whilethe majorityof micro-organisms are narmiess some can lead to

potentially fatal conditions suchas legionnaires' disease and Weil's disease.

Stress can affect all employees, not just managers. It is oftenbehind a lot of sickness absences. Itcan contributeto coronary heart
disease and illness caused by high blood pressure.

Marty employerswait for a health problemto arise before doing somethingabout it, but this canresult in:

employeesbeing made ill or even killed, lost time; unplanned changesto thework;

bad publicity;
investigationbyhealth andsafetyinspectors; employeestakingearly retirement, employeeswith a reduced quality of life; court fines and legal fees; compensationclaims;
increased insurancepremiums.

Health risk management Whatthe law requires 5

Thereare legal duties onemployersto prevent ill health which canbe causedby work. The twomainpiecesoflaware the Health aridSafety at Worketc Act 1974 (HSWAct) andthe Managementof Healthand Safety at WorkRegulations 1999(MHSW Regulations) as amended. Under the HSW Act, employers have to ensure so far as is reasonablypracticable the health and safetyofemployees andothers who maybe affected by their work. The Act applies to all work activities andpremises. Employers are required to provide suitableplantandsystemsofwork, to train, instruct,inform andsuperviseemployees so that their health at workis not affected. Employees have responsibilities under the HSW Act not to endanger themselves or others. TheMHSW Regulations build on theHSWAct andincludeduties to assessrisks andmake arrangementsfor health and safety by effective:
planning; organisation; control;

monitoringand review.

HSC'sApprovedCode ofPractice on the MHSW Regulations gives guidance on what is meant bythese terms. This guide gives more detail,particularlyin relationtohealth risks.

The MHSW Regulations also contain duties for health surveillance which is about lookingfor early signsof ill health causedby hazardsat work. In addition all employersare required to appoint a competentpersonto assist in complying with health andsafety legal requirements andin the design anduse of protectivemeasures. The personappointed to assist could be one of your managerswho hasbeen properlytrained to do this, although if the risks are complicated, or their managementinvolvesspecial knowledge,you may need to involve peoplefrom outsideyourbusiness(see Table2, p 38). In addition there are several laws (Box2) that relate to specific risks to health at work, such as lead,asbestos,chemicals andnoise, andsome that relateto particularindustries(Box3). Look at them to find out what you must do.
Box 2 Examples of health and safety legal requirements for specific health risks at work
Control of Substances Hazardous to Health (COSHH) Regulations 1999 Control of Leadat Work Regulations 1998

lonisingRadiations Regulations 1985 Control ofAsbestos at Work Regulations 1987 Noise at Work Regulations 1989
The Manual Handling Operations Regulations 1992 The Health and Safety (Display Screen Equipment) Regulations 1992

Health risk management

Box 3


A company employing 250people in the manufacture of

bathroom fittings described the health and safety legislation relating to their industryas providing 'a frameworkfor action'. The legislation pointed to those

risks theyshouldgive priorityto and howto take steps to

manage the risks. Being a traditional industrytheywere able to draw on a range of existingspecificguidance and established



What is health risk management?


Healthriskmanagementis about identifyingandcontrolling health risksbefore they cancause problemsandlead to the losses describedin paragraph 4. To do this you need to:

findoutifyou have a problem;

decide what to dobased on what you have found out; act andputthe decisions into practice; checkthatthe actionhas made the intended improvements.

This is what good health risk managementis all about.


Forthisapproachto work there needs tobe commitmentat the top of yourorganisationto achieving better health riskmanagement. This shouldbe expressedin a clear policyfor health andsafetywhich influences all your activities in a practical way. It should be clear about who is responsiblefor what, and the arrangementsfor identifying hazards, assessing risks and controlling them. Managersneed to demonstratetheir commitmentto other membersof the workforceandbe the drivingforce behind makingimprovements. If you are not motivated neither willbe the rest of the workforce. As a manageryou are the keyto what does or doesn't happen to improvehealth at work.

Health risk management

Box 4

?nasurveycarriedoutofsmall companies who hada good

control ofhealth risks the one common factor identifiedwas ffiecommitment shownby top management.' Quote from HSE inspector.






Goodhealth risk managementis also about teamwork.Talk to the workforceand involve them in sortingout problems and encourageearly reporting.Usethe knowledgeand skills withinyourcompany; ask employees, their representatives, and membersof the health andsafety committee for their viewsand ideas. Tell the workforceabout any changesin face to face talks, via postersand companyleaflets. Remember that employeesmay need to be retrained following any changes, and safety representatives either appointed under the Safety Representatives and Safety Committees Regulations 1977or the HealthandSafety (Consultation with Employees) Regulations 1996willneed to be consultedin advance.


Lookfor the hazards. 'Hazard' is anythingthat can cause harm (see Table1).

Thestartingpoint inmanaginghealth risksis findingthe hazards in your workplace, andthere maybe a wide range. Somehazardstohealth are not as immediately obviousas others. For example some substances give offinvisiblevapours and dusts, large quantitiesof which may be producedduring handlingactivities. To pinpointhazards: walk around the workplace take a freshlook at the way employees work,look at what they work with, look at what is already done to protect their health (Box 6 gives an example

ofhowto do this);

talk to employees askthemif theirworkaffects their health;

getadvice from suppliersof equipment,chemicals andother materialsusedat work (Box5);

read safety datasheets,manufacturers'andsuppliers' guidance.

Remember, radiation andmicro-organisms cannotbe detectedjustby looking.

Health risk management

Box 5
Suppliers of hazardous substances are required to provideinformationto users which includes: safety data sheets; proper labelling designed to make hazardsand necessarycontrolsclear. Some suppliers mayalso provide: trainingin the use of their products;

workplace surveys on exposure to health hazards.

A fee may be charged for trainingand

surveys, so ask your suppliers what help they can give you. For furtherinformation aboutthis see Chemicals (Hazard Information and Packagingfor Supply) (Amendment) Regulations 1997 known

as CHIP.
Suppliers to work equipment are also required to provide users with hazard data

including: noise and vibrationemissions; advice on safe use.


Box 6

Manual handling

As you walkaround the workplace, look out for the followingactivities: strenuous pullingor pushing; whether more than oneperson is required for
the task; over-reaching; repetitive handling;

reaching above shoulder height; getting into awkward postures; lifting heavy or awkward loads; carrying for long distances; lifting in awkward places.
Looking for these activities will help you decide if you have manual handling problems

in the workplace.
Provisionof asimplemanualhandling aid can eliminate theneedto carry loads.


Healthrisk management

Changesto the law or new guidance canbe a spur to tackling long standing problems(Box7).

Box 7
Managers at a hospice were alerted to new legislation on manual handling and ways of


professional literature. They identified that the nurses had not been properly trained in howto lift patients safely, and as afirst step designed and introduced




- .. .i

/ I-.

a thorough trainingprogramme.



If, for example, you handle a lot of chemicals, do not assume that your hazards to health will be associated only with chemicals. Find outwhether thereare other health hazards at your workplacesuch as noise from the process andmanual handling problems in movingbulk chemical materials. At the back of this booklet is a listof other HSE guidanceto help you tackle particularrisks.

Lifestyleand work

Somehealth problemscan be causedboth at workand at home. Handlingchemicals in the workplacecan cause dermatitis,as can washingpowder used at home. Lifting heavy loads at work can cause backinjury, as can,for example, movingfurnitureat homeand leisure activities. Someexisting health conditionscan he made worse by work;a heavy smokeris more likely to sufferbreathing problems following exposure to chemicals at work. Be awareof the overlapsbetweenwork and non-workhealth risks. Legally, as an employer you need to tackle only work-related risksbut many companiesdo not distinguishbetween the two. Theydeal with health risksat work andalso promote the need for employeesto look after their health by, for example, givingadvice on smoking and drinking,diet, and exercise. This is onecompany'sreason: 'If someonedoes not turn up for workbecauseof a had backcaused by work here or in their garden, the resultfor us is thesame no work'.



HealtIi risk management


Haveyou looked at how work is carried out in your workplace? Have you found which hazards exist? Have you looked at available information, eg labels, suppliers' safety data sheets? Have you found out whatyour employees and their safety representatives think aboutthe effectof work on their health? Have you considered who can helpyou?



Havingfound out what health hazardsare presentin your workplace you need now to decide what needs to he done so that youremployees'health is not harmed. It maybe that what you already do is enough but you cannotdecide this properlyuntil you have gone through the
following steps.

Who might be harmed?


First, you need to identifywho may he at risk.Think about those workers, for example, who handle chemicals, operate noisymachines or who have to lift heavy or awkwardloads manually.Don't forgetthe risks to cleaners, maintenance andpart-timeworkers.Could other people be harmedby what goes on in your place of work, for instance sales representatives, suppliers,customersand membersof the public?


Health risk management

How big are the risks? 20

Thenext step is to decidehowbig are the risksto health inyourworkplace. 'Risk' is the chance or likelihood ofsomeonebeingharmed by a hazard. For example, paints containing isocyanates are a hazard to health. Breathingin isocyanates can cause asthma. The health risk is the chance that someone'slungs willbe damaged. Whether this happens willdepend upon: the amountofisocyanate in the air; how often thejob is done. Is it all day everydayor onceor twicea year? the work method how thepaintis used, eg if it is sprayed the risk willbe greater than if brushed on; the number ofpeople that couldbe affected is justone person workingwith the paint or many?Could their workaffectothers? what could go wrong? are the precautions(exhaustventilation,personalprotectiveequipment)alreadytaken sufficient? How do they comparewith good practice andHSE or 'trade' guidance?



Answeringthese sortsof questionis what is meant by risk assessment. Further guidancecan be found in the freeHSE leaflet Five Stepsto Risk Assessment. It is useful to write down the results of risk assessments as you may need to look at them again. You are requiredto record 'significant findings' ifyou have five or more employees.
Remember also to review yourrisk assessmentwhen the work changes andnew materialsare handled. It is easier to review it if it is writtendown.


Box 8

Summary of risk assessment steps

Lookfor the hazards; decide who might


be harmed and how; decide whether existing precautions are adequate or more should be done; record your findings; review your assessment.



Health risk management 23

Riskassessmentwillhelp you to decidewhich health risks shouldbe givenpriority, for exampleifa largenumber of employeescouldbe affectedorif thereis a risk of a serious disease. The aimis to identifywhatsteps need tobe taken to control or reduce risk. Many companiesmistakenly think thatrisk assessmentis an end in itself. Thepurpose is to help you decidewhetherwhat you already do to controlhealth risksis enough or whetheryou needto do more(Box 9). Recordsof accidents, ill health and sickness absence help you identifyhealth risk effects and decidehow seriousthey are. Look for trends - does the sameproblemkeep croppingup? Is it
Box 9
When the Control of Substances Hazardous to Health (COSHH) Regulations were introduced, a firm offorestry contractors decided that



theyneeded a company plan to implement the Regulations and that guidance would be issued to all staff. The company's Health and Safety Committee produced general risk s for the difterenttypes of chemical used in spraying during forestrywork.The guidance was
then developed to include practical advice on - precautions to be taken for each chemical and

the spraying method involved.


Box 10 Losttime accidents

Condition Strained smallof back Strained muscle right leg Strained back muscle Strained shoulder and knee Pulled muscle top of leg Strained back

Twisted himself lifting pipes Pulling ... hose into crate Lifting Slipped Overstretching Stepping onto platform

always associatedwith the same process? Is more than oneperson affected? Find out what is reallycausing someoneto be offwork. One

companyrealisedit hadhealth problemsatworkbecauseof the number of people leavingearly to visittheirGP.


Tn one factory (Box 10), the losttime accidentsinvolvingsprains andstrains were recorded in one

month. Eachincidentresulted in someone being off work.If this is a typical month there will be 36 incidentsof peoplebeing offwork with strains and sprainseach year. Employees were off for 3 days on averagewhich means 108 days of work are lost each year. Thinkof the cost involvedto the company. This accidentinformationconfirmedthat there were a numberofhandling problemsat this workplace. Theycould be avoidedby trainingor changingthe work processto avoid twisting, overstretching andheavy lifting, eg by providingliftingdevices.


Health risk management WhatIf a worker Is III?


Supposean employeeis off work for severaldays. Thena note fromhis/her GP confirms that the employee is suffering from dermatitisto the hands and wristsand is likely to be offwork for several weeks. Whatdo you do about this? Aninvestigationwillhelp you decidehowto prevent ithappening again (Box11).

A factory worker was off work.His OP had diagnosed dermatitis. An investigation atthe factoryshowed that he used a chemical solventwith the rubberproduced at the factory.A reaction between the solventand the rubberhad released a substance which wasthoughtto have caused the dermatitis. The workerhad not been wearingthe protective gloves provided, and had become sensitised so that from then on exposure to the compound could lead to further dermatitis. The employee was retrained and assigned to differentwork.The company thoughtaboutusingsafer chemicals, but this wasnot possible. The work procedure was changed so that protective gloves were always worn by those handling solventand rubber.



You need to find out whether an employee'sill health could have been caused or made worse by work. Askthese questions:

What workhas the employeebeen doing andhow long for? Doesthe employee workwith harmful materialsor insucha way that his/herhealth couldbecome affected? Whendid signsofill health occur? What is the opinionof his/her GP andanyoccupational health advisers? Have the risksofthe work activity been assessed? Doesthe riskassessmentindicatethat precautionsare needed?

Is the employee trainedboth for thejobandin the use of anyequipmentusedto control


Is protectiveclothing provided andused for the work?

Could activities outside of workhave causedill health?


Health risk management

Box 12 Health surveillance.

Following an assessment of the risk to employees health due to hand arm vibration, a foundrydecided the followingactionswere needed: firstly, it soughtto eliminate, as far as possible, the need for

fettling, by introducingmodifications to casting design; secondly, it soughtto reduce harmful vibrationfrom tools and machines by retrofittinganti-vibration mountings and by assuring future purchases oftools had lowerlevels of harmful

thirdly, a system of healthsurveillance wasadopted in line with

the recommendations of Hand-arm vibration, and a pre-employment medical assessmentwas instituted. Although several employees in the company's long-established workiorcewere identified with early symptomsof vibrationwhite finger,it was decided that there was no needfor their relocation at

this stage. The results from the ongoing health surveillance would give early warningofthe progression ofsymptoms,or any new cases and redeployment to otherwork wouldthen be considered. Additionally, the results would give feedback as to the effectiveness of the control
measures taken.



Healthsurveillance is about systematically watchingout for early signsof work-related ill health in employeesexposedto certain health risksso that measurescanbe takento protect theirhealth. It is not a substitutefor controlling health risks at work andwillonly workiffindingsare acted upon. It comprises a rangeof techniques from simplemethods, such as lookingfor skin damageon hands from using certainchemicals, through more technical checks such ashearing tests, to more involvedclinical examinations. It is requiredby law for certain jobs. Check the legal requirementsor seek adviceif in doubt. Healthrecordsshould be kept. Employees and their representatives should be involved in the early developmentof health surveillance programmes.As certain procedurescan includetakingsamplesandother personalinformation, respectingconfidentiality is
essential (Box 12).


Health risk management


Haveyou identified and assessedall the risks to health in your workplace? Do the risk assessments coverall work procedures where there maybe a health risk? Havethe risk assessments identified all employees who may be at risk? Haveyou used the risk assessments to helpdecide what practical steps should be taken to manage risksto health? Do you find outthe causes of work-related again?

ill health and use the findingsto prevent it happening




If you decidethat improvementsare needed, then act on yourdecisions. Startby seeing whetheryou can get rid ofwhateveris causingthe health risks (Boxes13 and14).

Box 13

A company preparing fish for sale by retailers used the COSHI-I Regulations to start a review of all the
chemicals they handled. They stopped using any chemicals that were not essential in fish processing and also found alternatives that were lesshazardous and moreacceptable to the

workiorce.Theyalso foundthat as they used a smaller range of chemicals they needed less storage space and saved money by not buying chemicals theyrarelyused.


Health risk management

Box 14

A rubber factorywas aware of the risks associated with handling carbon black in rubberprocessing: also as it is usually supplied as a fine powder it made the workplace very dirty. Managers decided that
theywould stop handling carbon blackand buy in rubber pre-mixed with carbon black. The benefits

a hazardous material was no longer handled; a shorterprocess time; a cleaner workplace;

lesstime spentcleaning up.

If you cannotdo this the next step is to controlthe risksandso reduce the chance of the health of employeesbeingaffected. Forexampleexposureto chemicals can he controlled by automatedhandling,enclosing the process or local exhaustventilation. Theriskfrom heavy liftingcanbe removedby the use oflifting aids. Nurses in hospitals, for example, use patient-lifting aids. Exposureto noise levels can he reduced by enclosingnoisy machines and equipment with noiseproofenclosures. Problems associated with repetitive manual work can be solvedby redesigningor organisingthe work differently (Box 15).




Box 15

Redesign of work process or station

An employee's job wasto answer telephone enquiries and check customer details by usinga computer terminal.The employee complained of pain in her left shoulder, left arm, neckand back. Observation of the employee's method ofwork showed that the work involved continual reaching across the body due to the positions of the telephone andcomputerkeyboard. Keyboard operations were carried out while the telephone receiver wascradled between the neck and left shoulder to free both hands. The computer screen was positioned to the right of the employee and as it could not be raised properlythis added to the poor neck posture.The employee did not have a comfortable sitting positionas her chair was not adjustable and a footrest had not been provided.
These changes were made:

the screen was placed directly in frontof the employee, it was also raised so that the top ofthe screen waslevel with her eyes; an adjustable chair and footrestwere provided: the employee was instructed in how to adjust herchair properly; the employee was supplied with a headset and instructed in its use which freed both hands fortyping.

A month afterthe changes had been made the employee

reported that her pains and discomforthad gone.


Health risk management


Sometimes it is necessary to provide personal protection (PPE) such as respirators,ear defendersand face visors, as well as othermeasures. Forexamplea local ventilationsystem maybe provided for pouring a hazardouschemical so that theoperator does not breathe in the fumes. However,if the chemical can also cause skin burns, protective clothing, gloves anda visor may be needed. Because PPE protectsonly the wearer, and only if properly worn all of the time, it is better to give priority to measures which protectnumbers of employeesrather than individuals. PPE can be expensive to buy and maintain. Employees will need to he trained and supervisedso that it is properlyworn at all times. The use of PPE at work is governedby the Personal Protective Equipment at Work Regulations 1992. If PPE is used in your workplace check the requirementsof these Regulations. It should alwayshe consideredas a last not a first resort.



It is better to give those who have to wear personalprotection a choice. Manycompanies make the mistakeof requiringemployeesto wear it hut giveno choice about type, or fail to explain why it is necessary or to providetraining in how it should he worn and periodically checked, cleaned andmaintained. Not surprisingly, the use of personal protection stops fairly quickly.
Managerscan set a good exampleby wearingPPE themselves even though they might expect to be exposed for only a short time.


If you are thinking of movingto different premisesor changingthe layoutof the workplace, this is an ideal time to think about risksto health (and safety), andmake decisions about how to improveworkingconditions (Box 16 and 17).


Iii un



A new management teamat a factorymanufacturing coffins decided that improvements were needed to
working methods and efficiency. Theyreorganised the factory, resited machines, bought new ones and got rid of others. The machines were laid out according to the orderof the process. Sanding was identified as particularly dustyand wasrelocated to a separate building and exhaust ventilation to capture dust wasprovided. The changes resulted in greater efficiency, improvements to both working
conditions and health and safety.


Health risk management

Box 17

A company with 80 employees took the opportunityto improve working conditions whenthey moved to
new premises. The company manufactured fibreglass products and handled harmful chemicals suchas styrene. Theywere aware of the requirements of
COSI-IH and also wished to be certified under the

quality standard BSEN ISO 9002. Budgeting for health and safety was included in the costsfor the move. Advice was sought from suppliers and consultants. As a consequence ofthe move, new plant was installed and new work practices introduced to control fumes, reduce waste and improve efficiency. Exposureto styrene was reduced by around 50%. -

...- ,p__ 4r






Once you have gone through the processes of deciding what to do andtaking action, you need to checkthe result. There is littlevalue in makingchangeswithout knowingif theyare working.


Thereare a numberof practical checks that you can make. These includechecking that, for

anyset target for reducinghealth riskshas been reached (Box 18);

Box 18
One company set itself a target

of reducing noise levels over a period of two years. Theywanted to reduce levels to below 90 dB(A) as required by the Noise atWork Regulations. Noise enclosures were fitted around noisy machines. The noise levels were then checked to see if the below 90 dB(A) target
had been reached it had. The workforcefelt that management had demonstrated theywere serious aboutimprovingworking conditions. The workforceplayed a majorpart in the design and development

of the noise enclosures.

Health risk inanagemeut

ventilationsystems,noise enclosures, automated handlingequipmentare working properly(Box 19); recordsof sicknessabsence and work-related ill health show a reducednumberof cases

personalprotectionis being properlyused, cleanedand maintained.

Box 19

Acompany installed ventilation equipment controldust made to

during the weighing out of powdered chemicals. Airflow rates of the ventilation equipment and airborne levels of the chemicals handled were measured routinely. A fall in air flow

ratesor high levels of dust were used as a trigger for an investigation to find outwhy the controlequipment was not working properly.



Remember that if for any reason you:

make changesto the workprocess; introducenew materialsinto the workplace; changethe way in which risksare controlled;

you will need to check whetherthesechangeshave reduced or increased risks to health. Do not assumethat everyonewillmake changesandpick up new skills withoutinstructionand


: ::

An engineering company produced small assembly components. The production process consisted of repetitive operations with employees' hands and armsin awkward positions. Sickness absence and ill-healthrecords showed a numberof employees affected by upper limb disorders(ULD). Changeswere made to the production process to reduce repetitive operations and to the layout of the work areas. A check on sickness absence and ill-healthrecords showed that employees were taking lesstime off work with strain injuries.


Health risk management


Do noise levels, levels of airborne chemicals, performance of ventilation equipment and checks

on housekeeping showthat health risks are beingcontrolled?

Do maintenance records showthat controlssuch as noise enclosures and ventilating plant are

being properly maintained?

Do maintenance records showthat personal protective equipment suchas respirators and hearing protection is being properlymaintained? Do records of sickness absenceand ill health showan improvement?



show to yourselfthat you have done so.

Finally, rememberthat health risk managementshould he seen as a rollingprogrammeof improvement. You may not he able to give satisfactory answers to all of the earlier questionsor those in the following checklist. If this is the case, use this guidance to help identify exactly what prioritiesyou set, decidehow to do this and then do it. Thenask the same questions againto see how you have improved. It takes time andcommitment, hut you can improveand


Health risk management



You may well be ableto solve yourown problemsbut if you do need outside help there are various organisations to turn to such as trade associations, employersorganisations, trade unionsor yourlocal ChamberofCommerce. Thetype ofproblem willindicate the nature of the specialist help you may need. Table2 (p 38) hasbeen drawnup to help you. Some organisations operate as consultants andspecialise in particularaspects of work-related ill health. Others offer a wide range of services.

Usethe free HSE leaflet Needhelpon healthand safety?to help you choosethe right consultancyfor your needs.
Box 21
The ownerofa garage recognised that the assessment and management of the health risks of his workplace weretopicssuitable for discussion with the Chamber of Commerce in his town.

Ata workshop someof the

problems and solutions were discussed with otherlocal businesspeople.



Adviceon thecontrolofhealth risksat workcan also be providedby HSE inspectorswho can give adviceon the preventionandcontrolof risksandon legal requirements. The Employment Medical AdvisoryService (EMAS)is a team of doctorsand nurses who can advise on health problemsarisingfrom work andtheirprevention. They canalso advise on fitness for work, first aid andthe roleofoccupational health services. Details of HSE regionaloffices are given at the backof this guide.


Ifyourbusinessis an office, shop, warehouse,consumerservice, restaurant,hotel, or leisure

entertainmentvenue, you should contactyour local authoritywhoseaddress is in the telephone directoryfor advice.
Box 22 An engineering company knew from a survey of noise 'evels that theyhad a serious noise problem with machines used to chop up lengths of wire. The company sought advice from HSE who
supplied a list of noise consultants.They selected a noise engineer who helped them design and make noise enclosures for the machines. Theyalso measured the noise levels which were significantly reduced: the company considered the expenditure to be goodvalue.

Health risk management

Table 2 Occupationalhealth specialists
Specialists Engineers Help theycan give Ventilation engineers advise on the design and effectiveness of general and local exhaust ventilation to control exposure toairborne hazards to health suchas mists, dusts,gases, vapours and fumes. Noise engineers advise on the cause and reduction of noise and vibration. Water treatment engineers advise on the design and treatment ofwatersystems controlthe risk of microbialcontamination (eg Legionella). Occupational

to avoid and

Occupational health nurses

Assessment and practical advice on the prevention or reductionof risks to health from chemical, biological and physical agents arising fromworkactivities. Assessment of risks to health; health surveillance;

fitnessfor work; first aid.

Occupational Diagnosis of work-related disease; assessment of risks to health and advice on managing thoserisks; health surveillance;

health doctors

fitnessfor workand rehabilitation;




Advice on:

the prevention of musculo-skeletal disorders, eg backinjuriesand upperlimb disordersat


the suitabilityfor use ofequipment and workstations; the physical work environment, eg lightingand temperature; work organisation, eg machine paced work, as it affects health; workplace, task and productdesign.

Radiationprotection Advice on compliance with the lonising Radiation Regulations: advisers advice on monitoring, risk assessment and production methods:
conducting environmental monitoring; some also advise on non-ionising radiation. Non-ionislng Specialist consultancies, university radiation protection officers and hospital physicists can be approached for advice on measures to prevent or controlexposure. Assessment of biological agents likelyto be present; advice on risk and controlmeasures to prevent or controlrisks to health; sampling for micro-organisms. Each oftlwscgroups has its ownprofessional bodywho may

radiation Microbiologists

beable to advise on selection andappropriate



Health risk management

You have already been given some questionsto help you spot hazards, assessrisks and check what you have done. You can also checkhow well you are managingwork-related health risks overallby answeringthesequestions:

Dodirectorsandsenior managersknow what they want to achievein relationto workrelatedhealth risks? Whatprioritieshave beenset?
Are those in the organisationresponsiblefor work-related health risks aware of their responsibilities?

Is the roleof in-houseandexternalsourcesof expertise clear?

How are responsibledirectors, managersetc accountable?

Is there active involvement of employees, health and safety representativesand committee members, in-house and externalspecialists in spottingwork-related health risks, making risk assessments anddecidingon methods of control?


Is everyonewho needs to be, told about risks to their health at work?

Are employees properlytrained to: avoid risksto theirhealth at work, make proper use of controlmeasures, make proper use of PPE? Has a competentadviser beenappointed?
Are there any arrangementsfor monitoring exposure? Is there a plan to makeprogressiveimprovements? Are checks carried out on whether plans are being implementedandprioritiesbeing tackled?

What are the arrangementsfor health surveillance?

Is there a proper systemfor recordingandanalysingcases of work-related ill health and sicknessabsence?

Are cases of ill health and sickness absence investigatedso that lessonscan be learnt and steps taken to preventa similar problemarisingagain?


Health risk management

The following list of HSE publicationsis only a small selection of those available - a comprehensive list is available from HSE Books. Free leaflets are also available from HSE Books.
Managing health risks Management ofhealth and safetyat work. ManagementofHealth and Safety at Work Regulations 1999. Approved CodeofPracticeandguidanceL21 (Second edition) 2000ISBN 0 7176 24889 Successful health and safety and safety management HSG65(Second edition) 1997ISBN0 7176 12767 Essentials ofhealth and safetyat work 1994ISBN0 71760716 X Managing health and safety: Five steps to success 1NDG275 1988 (free leaflet)

Guidanceon the law General COSHHACOP (Control ofsubstances hazardous to health) and Carcinogens ACOP (Control ofcarcinogenic substances) and BiologicalAgentsACOP (Controlofbiologicalagents). Controlof Substances Hazardousto HealthRegulations1999ApprovedCodesof Practice L5 (Third edition) 1999 ISBN0 717616703 Control ofleadat work. Approved Code ofPractice, Regulations andguidanceCOP2(Secondedition)

ISBN 0 7176 15065 Work with ionisingradiation.lonising RadiationsRegulations 1999. Approved Code ofPracticeand guidanceL1212000 ISBN0 7176 17467 Thecontrolofasbestos at work. Control ofAsbestos at Work Regulations1987. ApprovedCode of PracticeL27 (Third edition)1999 ISBN0 7176 16738

Introducingthe Noise at Work Regulations: A briefguide to the requirements forcontrollingnoise at work INDG75(rev) 1989 (single copies available free, multiplecopies available in pricedpacks of 15, ISBN 0 7176 09618) Manual handling. Manual Handling OperationsRegulations1992. Guidanceon RegulationsL23 (Second edition)1998ISBN 0 7176 24153 Displayscreen equipmentwork. Healthand Saftty (DisplayScreen Equipment) Regulations 1992. Guidanceon Regulations L26 1992 ISBN 0 7176 0410 1 Personalprotectiveequipmentat work. PersonalProtective Eqiiipnzent at Work Regulat ions 1992. Guidanceon Regulations L25 1992ISBN 0 7176 04152 A shortguide to thePersonalProtective Equipmentat Work Regulations 1992INDG174 1995(single copies available free, multiplecopies available in priced packsof 10, ISBN 0 7176 0889 1) Approved guide to the classification and labelling ofsubstances dangerous supply L100 (Fourth for edition)1999 ISBN0 71761726 2 Legionnaires disease. The controloflegionella bacteria in water siiste,ns. Approved Code ofPracticeand guidanceL8 (Second edition)1995ISBN 0 717617726
Risk assessment Fivesteps to risk assessment: A step bystepguide to a saferand healthierworkplace INDG163(revl) 1998 (single copies available free, multiplecopies available in priced packsof 10,

ISBN07176 15650) Othergeneralguidance

EH4O/2001: Occupational exposurelimits 2001 (revisedannually) 2001 ISBN0 7176 1977X

Health surveillance at work HSG61 (Second edition) 1999ISBN 0 7176 1705X


Health risk management Protectingyourhealthat work INDG62(rev)1996 (single copies available free, multiplecopies available in pricedpacks of 10, iSBN 0 7176 11698) Health surveillance under COSHH: Guidancefor employers 1990ISBN 0 7176 04918 RIDDORexplained HSE 31(revl) 1999(single copies available free, multiplecopies available in priced packs of 10, ISBN0 717624412) Firstaidat work. The Health and Safety (First Aid) Regulations 1981 ApprovedCode ofPracticeand guidanceL74 1997ISBN0 7176 10500 Guidanceon particular hazards Work relatedupperlimb disorders: Aguide to preventionHSG6O 1990 ISBN 0 717604756 Manual handling: Solutions you can handle HSG1151994ISBN 0 71760693 7 A pain in yourworkplace? Ergonomic problems and solutionsHSG121 1994 ISBN0 717606686 Reducingnoise at work. Guidanceon the Noise at Work Regulations 1989L108 1998ISBN07176 1511 Vibration solutions:Practicalways to reduce the risk ofhand-armvibrationHSG17O 1997 ISBN0 71760954 5 Hand-arm vibration HSG88 1994ISBN0 71760743 7 Health risksfrom hand-armvibration:Advice on vibration whitefingerfor employeesand the selfemployed INDG126(revl) 1998(single copies available free, multiple copies available in priced packs,ISBN 0 7176 15545) Health risksfrom hand-armvibration:Advicefor employeesINDG175(revl) 1998(single copies available free, multiplecopies available inpriced packs of 10, ISBN 0 7176 15537) the Copiesofvideos,A matter oflifeand breath:Occupational asthma - the causes, effectsand how to it andHardto handle(abouthand-armvibration),are available for purchaseor for hire prevent from HSE Videos, Dept HV, P0 Box 35, Wetherby, WestYorkshire LS237EX (Tel: 0845 741 9411, Fax: 01937541083)

Prevention ofviolence to staffin banks and buildingsocieties HSG100 1993 ISBN 0 7176 0683X 1Jew and expectant mothers at work: A guidefor employers HSG122 1994ISBN0 71760826 3 Medical aspectsofoccupational skin disease MS24(rev) 1998 ISBN0 7176 15456 Preventingviolence to retail staffHSG133 1995 ISBN0 71760891 3 Violence and aggression to staff in the health services 1997ISBN 0 71761466 2 Passive smokingat work INDG63(revl) 1992(single copies available free, multiplecopies available in priced packsof 10, ISBN 0 717608824) Violenceat work INDG69(rev)1996 (single copies available free, multiple copies available in pricedpacks of 10, ISBN 0 7176 1271 6) FVluit yourdoctor iieed to know INDG 116 1992(free leaflet) Harmfulsubstances ,4sbestos:EX/o5l1rL'limitsand immeasuremnemit

ofairboriw dust C micemitratiomis ElhO (rev) 1995 ISBN 0717609073 Controloflead at work COP2 1998ISBN0 7176 15065 Provision,use and maintenance ofhygiene facilitiesfor work wit/i asbestos insulationand coatings1990 EH47 (rev) ISBN0 11 8855670 In situ timbertreatment using timber preservatives GS46 1989 ISBN0 11 885413 5 Introductionto local exhaust ventilationHSG37 (Second edition) 1993ISBN0 7176 1001 2 The maintenance, examination and testing oflocal exhaust ventilation HSG54 (Second edition)1998 ISBN 0 717614859 A step by stepguide to COSHHassessment HSG97 1993ISBN 0 717614468 Seven steps to successful substitution ofhazardoussubstancesHSG11O 1994 ISBN 0 717606953 CHIP 2for everyone. Chemicals (Hazard Information and Packaging for Supply)Regulations1994 HSG126 1995ISBN 0 717608573

Health risk management

The safeuse ofpesticidesfor non-agriculturalpurposes. Control ofSubstances Hazardousto Health Regulations1994. ApprovedCode ofPracticeL9 (Second edition) 1995ISBN 0 717605426 Aguide to the Asbestos (Licensing) Regulations 1983as amended. The Asbestos (Licensing) Regulations 1983. Guidanceon RegulationsLii (Second edition) 1999 ISBN0 71762435 8 71w control ofasbestos at work. Control ofAsbestos at Work Regulations 1987. Approved Codeof

PracticeL27 (Third edition)1999 ISBN0 717616738 Working with asbestos in buildings1NDG289 1999 (single copies available free, multiplecopies available in priced packs of 10, ISBN0 717616975) Work with asbestos insulation,asbestos coatingand asbestos insulating l'oa,l. Con frl ofAsbestosat Work Regulations 1987. Approved CodeofPractice L23 (Third edition) 1999 ISBN0 71760674 6 sensitisersL55 1994ISBN0 71760661 9 Preventingasthmaat work. How to controlrespiratonJ Codeofpracticefor the safe use ofpesticides onfarins and holdings(HSC/MAFF) (available Pesticides: from TheStationery Office,PublicationCentre, OrdersDept, P0 Box 276, LondonSW8 5DT Tel: 020 78739090) ISBN 0 2428924 Breathefreely: A workers' information card on respiratorysensitisers(available in packs of 25, ISBN0 71760771 2) COSHH:A briefguide to the RegulationsINDG136(revl) 1999(single copies available free, multiplecopies available inpriced packs of 10, ISBN 0 7176 2444 7) Grain dust in non-agriculturalworkplaces TNDG14O1993 (free leaflet) Healthsurveillance programmes employeesexposed to metalworkingfluids INDG1651994 (free for leaflet) Health risksfrom metalworking fluids INDG1671994 (free leaflet) Management ofmetalworking fluids INDG1681994 (free leaflet) The complete idiot's guide to CHIP INDG181(revl) 1999 (single copies available free, multiple copies available in pricedpacks of5, ISBN 0 7176 24390)



Why do I need a safetydatasheet? INDG1821994 (single copies available free, multiplecopies available in priced packsof10, ISBN0 7176 0895 6) Read the label: How tofind out chemicals are dangerous1NDG186 1995(single copies available free, multiple copies available in pricedpacks of 10, ISBN 0 71760898 0)

Getting help Need help on healthand saftty? 1NDG322 2000 (single copies available free,multiple copies

available in pricedpacks,ISBN 0 7176 17904) An introductionto theEmployment Medical Advisori Service HSE5 (revi) 2000 (free leaflet)

The future availability and accuracy of the references listedin this publication cannot be guaranteed. Thepublicationslisted above may be obtainedfrom:
HSE Books

P0 Box 1999

Suffolk COlO 2WA Tel: 01787881165

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priced publications may be obtained from all good booksellers.


Health risk management


London and South East

St Dunstan'sHouse, 201-211 Borough High St SE1 1GZ Telephone: 020 75562100

HomeCounties 14 Cardiff Road, Luton, Beds LU1 1PP Telephone: 01582444200 Midlands McLaren Building, 35 Dale End, Birmingham B4 7NP Telephone: 0121 6076200

Walesand West Phase 1, Government Buildings, Ty Gias, Lianisiwn, Cardiff CF14 5SH Telephone: 029 20 263000
Yorkshire and North East Marshall's Mill, Marshall St. LeedsLSI1 9YJ Telephone: 0113 2834200 NorthWest

GroveHouse,Skerton Road, Manchester M16 ORB Telephone: 0161 952 8200 Scotland Belford House, 59 Belford Road, EdinburghEH4 3UE Telephone: 0131247 2000




risk management

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Health risk management

This booklethas beenpreparedto help the owners and managers of small and medium sized enterprisesto control health risks arising from work. It is based on information and experiencegained by the Healthand SafetyExecutive,and actual casestudies are used to illustrateparticular points.
Management needs to be competentto deal effectively with occupational health risks.

As a manager you will be concernedif your employees' health is affected by their work. Management skills can be applied to preventingill health as partof running a business. The link betweenthe workplace cause and later ill health is not always obvious.This booklet providesa frameworkand some examples to help you to improvethe control of health risks in your workplace.

HSG 137


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