Nature of Occupational Health

T​he Meaning of Health, Occupational Health and Well-Being

There are several definitions of “health”, but you have to remember that these are subjective and can
mean different things to many people. The term may be used to indicate the state of individuals’,
families’, communities’ or even the wider populations’ health.
Health
However, in 1948, the World Health Organisation (WHO) defined health as: “…a state of complete
physical, mental and social well-being, not merely the absence of disease or infirmity”
Occupational Health
The International Labour Organisation (ILO) and the World Health Organisation (WHO) define
occupational health as: “the promotion and maintenance of the highest degree of physical, mental and
social well-being of workers in all occupations by preventing departures from health, controlling risks,
and adapting work to people and people to their jobs.
Well-Being
The UK’s Economic and Social Research Council (ESRC) have defined well-being as: “… a state of
being with others, where human needs are met, where one can act meaningfully to pursue one’s goals,
and where one enjoys a satisfactory quality of life”.
Categories of Occupational Health Hazard
1. Physical
2. Chemical
3. Biological
4. Psycho-social
5. Ergonomical
Prevalence of Work-Related Sickness and Ill Healh
It is estimated that, globally, there are 2.3 million work-related deaths annually.
In ​industrialised countries, the share of deaths caused by n​on-communicable disease​s are the
overwhelming cause.
Economic costs of work-related injury and illness vary between ​1.8 and 6.0% of Gross Domestic
Product (GDP)​,
Prevalence by Types of Ill Health Statistics released by the HS​E
Musculoskeletal disorders have decreased over the last decade but still account for 40% of the 1.2
million cases of work-related illnesses with around 180,000 new cases per year.
• Reports from GPs suggest there could be over 35,000 new cases of work-related skin disease per
year.
• Stress accounts for around 40% of work-related illness and the incidence of cases has remained
broadly flat over the past decade.
• Around 18,000 workers suffer hearing problems believed to be workrelated, with around 120 individuals
per year qualifying as new cases of noise-induced deafness under the Industrial Injuries Disablement
Benefit scheme.

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• Deaths from asbestos exposure continue to increase in Great Britain, a legacy of heavy exposure in the
past, resulting in
Statistics on work-related ill health can come from a variety of sources
• The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) - which
require the reporting of specific occupational diseases by the employer.
• Labour Force Survey (LFS) - is a national survey of private households in the UK each quarter. The
survey is managed by the Office for National Statistics.
• The Health and Occupation Reporting (THOR) network - a voluntary surveillance scheme for
work-related ill health under which specialist doctors systematically report all new cases that they see in
their clinics.
• The Industrial Injuries Scheme - administered by the Department for Work and Pensions (DWP) to
compensate workers who have been disabled by a prescribed occupational disease.
• Death certificates - as a source of information on deaths from asbestos-related and other occupational
lung diseases
Occupational Health and Public Health - Relation
These emerging health issues are of interest and consequence to various employers because of the
application of health and safety law. The employers affected and the actions that they have to take vary
depending on the nature of the health issue. For example, pandemic ‘flu is of interest to health care
employers whose staff will have to provide front line services to patients; laboratory managers where
diagnostic and research work is carried out on the virus and other employers whose staff might come
into contact with symptomatic members of the public (such as local authority employees).

Management of Return to Work

Basic Principles of the Biopsychosocial Model
Biological ​refers to the physical or mental health condition.
Psychological ​recognises that personal/psychological factors also influence functioning and the
individual must take some measure of personal responsibility for his or her behaviour.
Social ​recognises the importance of the social context, pressures and constraints on behaviour and
functioning
Fitness-to-Work Standards
In some cases, this minimum level of fitness is necessary to prevent unacceptable risk to the worker
carrying out the work. An example of this is working at height, where workers suffering from heart
conditions or recurrent dizziness would be at far greater risk of a fall. In other cases, this minimum level
of fitness is necessary to prevent unacceptable risk to other people (such as fellow workers or members
of the public) who might be affected by the worker. An example of this is lorry driving or train driving
where workers suffering from uncorrected eyesight could put others at risk. As a consequence, many
organisations have established fitness-to-work standards that workers are then assessed against in
order to ensure that their level of fitness is acceptable for the specific type of work that they are to do.
Pre-Placement Health Assessments
Questionnaires
Medical examination

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 Results of Pre-Placement Assessment
Fit
Unfit
Provisionally fit
Managing Long-Term and Short-Term Frequent Sickness and Incapacity for Work
1. Managing Short-Term Frequent Absence
a. Proactive Application of the Policy
b. Return-to-Work Interviews to Establish Real Reasons for Absence
c. Procedures to Deal with Unacceptable Absence Levels and/or Breach of the Policy
d. Use of Trigger Mechanisms to Review Attendance
e. Early Involvement of Occupational Health Professionals
2. Managing Long-Term Absence
a. Identification of Someone to Undertake Initial Enquiries
b. Keeping in Contact with the Individual
c. Flexibility and Restricting Sick Pay
d. Detailed Assessment by Relevant Specialists
e. Health, Occupational or Rehabilitation Interventions
f. Changes to Work Patterns or the Environment
i.Temporary Changes
ii.Permanent changes

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Management of Return to Work
Stage 1 – Initial Enquiries

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The employer should identify someone who is suitably trained and impartial to undertake initial enquiries
with the absent employee (e.g. an occupational health physician or nurse or a human resource
specialist)
Ideally, this should happen within 2 and 6 weeks of a person starting sickness absence (or following
recurring episodes of short- or long-term sickness absence).
Stage 2 – Detailed Assessment
The assessment should be co-ordinated by a suitably trained case worker/s with the skills and training to
act as an impartial intermediary.
Stage 3 – Interventions and Services
The case worker must coordinate and oversee the delivery of the various interventions and services
identified by the detailed assessment. Some of these interventions may be ‘light’ in nature, but others
may be intensive and may involve both physical and psychological therapies (such as Cognitive
Behaviour Therapy (CBT)).
Vocational Rehabilitation
Vocational rehabilitation is whatever helps someone with a health problem to stay at, return to and
remain in work.”
The focus is to help people retain or regain the ability to participate in work, rather than to treat any
illness or injury itself. It is now well recognised that, as well as providing economic benefits, engagement
in work has health benefits for the individual, and can aid recovery from physical or mental health
problems.
Benefits of Vocational Rehabilitation
Employer Benefits
● Simple measures to prevent and manage ill health can lead to a decrease in employee absence
● Healthy working environments can contribute to reduced employee absence through sickness
and stress.
● Employees who feel cared for are often more satisfied and perform better, which can have the
effect of reducing staff turnover and increasing productivity. •
● Getting employees back into work after illness reduces the loss of experienced staff and the cost
of recruiting new staff. •
● Being known as an organisation that cares about employees can enhance business reputation
and helps attract staff and customers.

Employee Benefits
● Better physical health. •
● Better mental health. •
● Increased financial security.
Overcoming Barriers of Rehabilitation
Biological barriers –
Psychological barriers
Social barriers

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Risk Assessment Prior to return to wor​k
● Specific needs of the individual with respect to their ill health or disability. •
● Design of the job and the working environment, such as access to the workstation and layout of
the premises, heating, lighting, etc. •
● Work equipment and workstations to be adjusted to individual needs and use of assistive
technologies. •
● Health hazards that may affect the individual – chemicals, respiratory sensitisers, etc. •
● Work organisation, specific training needs and methods of communication. •
● Psycho-social aspects, such as stress, bullying, etc

Occupational Health Services

Types of Occupational Health Service
A full occupational health servic​e, staffed by a full-time doctor, with a supporting nurse(s) (perhaps
working on a shift basis)
An occupational health servic​e staffed by an occupational health nurse(s) (perhaps on a shift basis)
with regular visits by a doctor and clinics (perhaps weekly).
A​n outsourced occupationa​l health service provided by a private occupational health-service provider.
Occupational Health Physician
Occupational Health Nurse
Occupational Health Adviser
Occupational Health Technician
Occupational Hygienist

Typical of Services Offered by an Occupational Health Service

Pre-Employment/Pre-Placement Screening
Health Surveillance
Return-to-Work Rehabilitation Programmes
Sickness Absence Management
Counselling
Risk Assessments
Specific Risk Assessments
Health Education and Promotion
Providing Advice
Treatment Services and First Aid
Management of Infectious Diseases
Immunity Assessment and Vaccination

Health Assessment & Health Surveillance and Medical Surveillance

General health assessments​ are often carried out by organisations as a form of pre-placement
assessment. These may take the form of self-assessment health questionnaires with follow-up by an
occupational health doctor or nurse where specific issues are raised by the answers given

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Health surveillanc​e is a more specific assessment of a worker’s medical fitness that focuses on one
specific aspect of health in relation to a particular hazard or hazard group. The intention of health
surveillance is to determine a worker’s state of health with regards to the hazard and then to track that
aspect of their health forward in time through repeat assessments.
The difference between ​medical surveillance and health surveillan​ce is determined by the person
carrying out the surveillance. Medical surveillance is a specific statutory requirement under certain
pieces of legislation and has to be conducted by a doctor appointed by the authorities in a particular
country, e.g. in Great Britain, a doctor appointed by the HSE.
Health Needs Assessment HNAs are c​arried out to identify the occupational health priorities that are of
concern to workers, which may also include safety concerns. HNAs can be used to identify the
occupational health priorities that are of concern to the workplace, so that an appropriate occupational
health service response can be planned and implemented
Carrying Out an Occupational Health Needs Assessment
● to secure the commitment and support from senior management and obtain the resources, such
as time, meeting space
● HNA surveys commonly take the form of self-completion questionnaires, but information can also
be obtained from interviews or focus groups.
● Once the method of data collection has been established, you need to decide on the survey
sample.
● . When designing the question sets, there are certain factors that need to be considered - Job
role & work process \

● ​ ystem
Respiratory​ S
○ Digestive System
■ Ingestion
■ Digestion
■ Absorption
■ Excretion
○ Circulatory​ ​System
■ The Blood
■ The Heart
■ The Blood Vessels
○ Lymphatic System
○ Nervous System
○ Skin
■ Epidermis
■ Dermis
○ The Eye

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 ○ The Nose
● The Routes and Methods of Entry
○ Inhalation
○ Skin Contact
○ Ingestion
○ Other Routes
■ Aspiration
■ Mucous membrane of the eye
■ Ear
● Local and Systemic Effects and Target Organs
○ Local effects-confined to the specific area of the body where contact
○ Systemic effects-occur in organs or parts of the body distant from the site where initial contact with the toxic substance
was made.
○ Target organs and target systems –Toxic substances do not often present the same degree of toxicity to all organs;
their toxicity may be concentrated in a few organs or systems
● Defence Responses​ - Innate (or ‘Non-Specific’) Immune Response - Adaptive ( ‘Acquired’) Immune Response
● The Respiratory System Defences
○ Nasal hairs​, which filter out the larger particles (>10μm).
○ Coughing and sneezin​g, which result in the forceful ejection of inhaled substances.
○ The mucociliary escalator – particles are trapped by mucous secreted by goblet cells lining the conducting airways
(particles between 7-10μm);
○ Macrophages ​- specialised attacking white blood cells in the alveoli. Smaller particles and aerosols between 0.5 and
7m pass into the respiratory units where they are deposited.

In some instances, the filtration mechanism outlined earlier is not effective at removing the substance.

○ Inflammatory Response
○ Respiratory Inflammation
○ Acquired Immunity

○
● Physical Forms and Routes of Entry
○ Solids
■ Massive form
■ Dust
■ Fibres
■ Fumes
○ Liquids
■ Massive form
■ Mist
○ Gases
■ Vapour
● Inhalable dust​ (or total inhalable dust) is the fraction of airborne dust that enters the nose and mouth during breathing,
● Respirable dust ​is the fraction of airborne dust that penetrates to the gas exchange region of the lung.

● Classification of Hazardous Substances, the Globally Harmonised System (GHS) and the Classification, Labelling and
Packaging Regulation (CLP)

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 ○ European Regulation (EC) No. 1272/2008 on Classification, Labelling and Packaging of Substances and
Mixtures (CLP)

● The Health Hazard Classes

○ Acute Toxicity ​Acute toxicity refers to those adverse effects occurring following oral or dermal administration
of a single dose of a substance, or multiple doses given within 24 hours, or an inhalation exposure of 4 hours.
○ Skin Corrosion and Irritation
■ IA ​y exposure < 3 minute with irreversible skin damage not > 1 hr
■ IB
■ IC
○ Eye Damage
■ Serious eye damage- ​eye damage not reversible within 21 days
■ Eye Irritation- ​Changes in eye but reversible within 21 days
○ Respiratory or Skin Sensitisation
■ Skin sensitiser - ​A skin sensitiser is a substance that will induce an allergic response following skin
contact. The sensitising chemical passes through the epidermal barrier, causing antibodies to be
formed.
■ Respiratory system – allergic sensitisation occurring in the respiratory system results in asthma.
The mechanism of occupational asthma is an abnormal immunological response to foreign material
which acts as an antigen (i.e. a foreign substance which causes the body to produce antibodies).
The inhalation and absorption of the antigen causes the production of specific antibodies which
trigger the release of histamine, causing bronchial constriction.
○ Germ Cell Mutagenicity According to GHS, a germ cell mutagen is a chemical that may cause mutations in
the germ cells of humans that can be transmitted to the progeny.
○ Carcinogens -According to GHS, a carcinogen is a substance or a mixture of substances which induce
cancer or increase its incidence.
○ Reproductive Toxicity • ​Adverse effects on sexual function and fertility in adult males or females.
Developmental toxicity in unborn or breastfeeding children.
● Specific Target Organ Toxicity
○ Specific target organ toxicity (single exposure) is defined as specific, non-lethal target organ toxicity arising
from a single exposure to a substance or mixture.
○ Target organ toxicity (repeated exposure) means specific, target organ toxicity arising from a repeated
exposure to a substance or mixture.
● Specific Hazardous Substance Examples
○ Asbestos ​-a collagenous pneumoconiosis, induced when the fibres are inhaled into the lung alveoli and then
migrate into the surrounding tissues. The fibrotic reactions caused by asbestosis lead to a progressive
development of inelastic scar tissue and thickening of the pleural membranes.
○ Lung cance​r – a cancer of the lung tissue. The risk to a person working with asbestos of contracting lung
cancer has been shown to be ten times that of the general population.
○ Mesothelioma – a cancer of the plural membranes surrounding the lungs. It appears that asbestos fibres are
able to migrate through lung tissue following inhalation and can have a toxic effect in adjacent tissues.
○ Diffuse pleural thickening – thickening of the lining tissue of the lung (sometimes known as ‘pleural
plaques’) that causes breathing difficulties.

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● Factors to Consider when Assessing Health Risk ​-This risk assessment must be carried out before the work is
undertaken and should allow the employer to identify the control measures necessary to comply with relevant legal
standards and good practice. Those control measures must be implemented. The assessment can be considered as a
five-step process:
○ 1. Gather information about the substances, the work and the working practices.
○ 2. Evaluate the risks to health.
○ 3. Decide on the control measures needed to comply with legal standards.
○ 4. Record the assessment.
○ 5. Review and update as necessary.

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○

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● Factors to be considered when assessing the exposure -
○ Hazardous Properties of the Substance - SDS, Legality
○ Type and Level of Exposure
■ Physical forms
■ Route of entry
■ Nature of the work activity
■ Level of actual exposure
○ Duration and Frequency of Exposure
○ Numbers of People
○ Effect of Mixtures
■ May decrease the toxicity of one by another
■ May simple add the toxicity (additive)
■ May enhance the toxicity of one by another so total toxicity is more than additive - termed as
(potentiation or synergy).
○ Unusual Activities
○ Occupational Exposure Limits (OELs)
○ Existing Controls
○ Surveillance and Monitoring Results

● Human Epidemiology - Epidemiology is concerned with the distribution of a particular occupational disease and the
search to identify the various factors that may be involved. A number of different types of study are available. We will
consider three of the main studies that are conducted over a period of time (referred to as longitudinal studies).
○ ​The Case-Control Study
○ Prospective Cohort Study
○ Retrospective Cohort Study
● Toxicological Testing
○ Animal Testing
○ Alternatives to Animal Testing In-Vitro Studies
○ Predictive Studies - With similar substance then will do in-vitro test
■ Acute Toxicity Tests and the
■ Fixed Dose Test

● Elimination of Exposure
○ Changing the method of work so that the operation that involves exposure is no longer necessary:
○ Modifying a process so that a hazardous by-product or waste material is no longer produced:

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 ○ Substituting a non-hazardous substance that presents no risk to health:
○ Reduce exposure time
● Methods of Control of exposure
○ Good Design and Installation Practices
■ Total Enclosure
■ Segregation of the Process
■ Process Modification
■ Local Exhaust Ventilation (LEV)
■ Dilution Ventilation
○ Work Systems and Practices
■ Minimise Numbers Exposed
■ Reduce Exposure Duration
■ Cleaning Regimes
■ Maintenance
■ Storage and Transportation of Chemicals
■ Disposal
○ Personal Protection
■ Personal Protective Equipment (PPE)
■ Prohibition of Eating/Drinking/Smoking
■ Hygiene Facilities
■ Signs and Notices
■ Emergency Arrangements
● Additional Control Measures for Carcinogens and Mutagens
○ Total enclosure
○ Prohibition of heating
○ Cleaning floors
○ Warning signage
○ Labelling of storage containers

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○
● Dilution Ventilation - Reduce the concentration of a contaminant to below the occupational exposure limit. Keep the
concentration of a flammable substance to below its lower explosive limit.
○ Factors to be considered ​-
■ is the rate of contaminant generation and hence the number of air changes per hour required. The
factors are vapor pressure, exposed area,
■ The other criterion is the position of the extraction fans.
○ passive system
○ Active System
● Local Exhaust Ventilation (LEV) -
○ Hood(s) – to collect airborne contaminants at, or near, where they are created (the source).
■ Enclosing Hoods -These are the most effective hoods. A full enclosure is where the process is
completely enclosed, e.g. a glove box.
■ Receiving receptor - The process usually takes place outside the hood. The hood receives the
contaminated air, which has a speed and direction that is usually process-generated.
■ Capturing (Captor) Hood - The process, source and contaminant cloud are outside the hood. The
hood has to generate sufficient airflow to ‘capture’ and draw in the contaminated air. Hoods can be
fixed or moveable. This is the most common type of LEV hood.

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○
○ Ducting - to carry the airborne contaminants away from the work area. Ducting should be as straight as
possible. Where bends or joins are required, gentle bends and acute angle joins are good practice.
○ Filter or Purifying System - It is important that the appropriate system is used especially if neutralising toxic
gases. For particulate solids, physical methods of separation are required, such as cyclones or bag filters.
Care must be taken to see that the correct type of filter is used (e.g. cyclones are not suitable for very fine
particles). Owing to the dynamic nature of cyclones and the resultant generation of static electricity, the
potential for dust explosions can be high.

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○
○ Particle collectors.​ These fall into four types:
■ Fabric ​filters – which use socks or bags to filter out the particulates in much the same way as a
bag-style domestic vacuum cleaner does.
■ Cyclones – cone-shaped collectors that use centripetal force to spin particles out of the
contaminated airflow (as used in a Dyson vacuum cleaner).
■ Electrostatic ​precipitators – that give particles an electrostatic charge and then attract them out of
the airstream using plates with the opposite charge.
■ Scrubbers​ – where the particles are wetted and then washed out of the airstream.
○ devices are gas and ​vapour collectors​. These fall into three main types:
■ Destruction​ – where the gas and vapour is destroyed by burning or thermal oxidation.
■ Tower ​scrubbers – where the contaminated air is passed through a vertical column containing a
matrix through which water is passed – this removes the contaminant from the airstream.
■ Recovery – where the gas or vapour is filtered out (often using activated charcoal filters) and can
then be reclaimed.
○ Ventilation Fans and Motors - It is important that the correct type of fan is installed to suit the design of the
ventilation system. The capacity of the fan motor is important; it must have sufficient power to cope with
normal working but have sufficient margin to deal with overload situations. Centrifugal fans, as shown in the
following figure, are typically used in LEV systems.
○ Discharge to Atmosphere -​Extracted air must not re-enter buildings unless the contaminant has reached
negligible concentrations. Discharged air must leave the discharge duct at a high enough speed to make sure
it is dispersed. Discharge is normally via a ‘stack’.
● Source Strength, Capture Zones and Capture Velocity

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○
● LEV Thorough Examinations (frequency minimum ​- 14/month and 6/month for asbestos)
○ Airflow measurement
○ Static pressure measurement - Manometers (pressure gauges) or U-tubes (see later) can be used to measure
static pressures at hoods or enclosures. They can also be used to measure pressure drops across filters or
air-cleaning plant.
○ Duct velocity
○ Air cleaning unit
● Three Stages to Carrying Out Testing
○ Stage 1 - A visual inspection
○ Stage 2 – Measuring Technical Performance
■ Transport Velocity -is the air velocity required to convey particles and prevent deposition in ducts.
LEV will often have a transport velocity (or duct velocity) stated in its specification most particularly
when it is used to extract dust, fumes or fibres.
■ Static Pressure-​is the air pressure, measured perpendicular to the airflow direction, i.e. the
difference between inside and outside air pressure. Static pressure is frequently used in the
specification of all types of LEV and is routinely measured as one of the indicators of performance.
■ Face Velocity Face velocity is the average velocity of air at the open front face of a hood or booth.
LEV will often have a face velocity stated in its specification.
○ Stage 3 – Assessing Control Effectiveness ​-Qualitative techniques are used to assess the effectiveness of
the LEV system. These often involve the visualisation of air movement using different techniques.
■ Dust Lamp (Tyndall Illumination)
■ Smoke
○ Report on LEV Testing
○ Interpretation of Reports
○ LEV Roles and Responsibilities
■ LEV owner –​ this will be the party who owns and operates the LEV system​.
■ LEV supplier ​– this will be the party or parties who design and then install the LEV system for the
owner. LEV systems must be designed to meet the specific needs of the work activity​.
■ LEV service provider ​– this is the test engineers (or company) responsible for examining and
testing the LEV system, either for commissioning purposes or for routine statutory thorough
examination and test purposes.

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■
● Respiratory Protective Equipment (RPE)
○ Non powered
○ Powered
■ Breathing Apparatus (BA)
■ Tight-fitting face-pieces
■ Loose-fitting face-pieces (none powered only)
● Types of Respirator
○ Half-Mask Respirator
■ Particle filters, and
■ gas filters.
○ Full-Face Respirator
■ Particle filters, and
■ gas filters.
○ Powered Respirators
■ Masks - full- or half-masks
■ Helmets​ - with a wide-vision, high-impact visor secured to the head by a harness and chin strap.
○ Types of Breathing Apparatus (BA)
■ Fresh Air Hose BA
■ Compressed Airline BA
● The constant flow BA
● The demand flow BA
■ Self-Contained BA (SCBA)
● Escape SCBA
● General SCBA
● Re-circulating SCBA
● Selection of RPE
○ The main factors are:
○ Atmosphere-/substance-related factors.
■ Particulates.
■ Acid gases.
■ Organic (solvent) vapours.
■ Ammonia.
○ Level of protection required and the Assigned Protection Factor (APF).

○
○ Task and work-related factors.
○ Wearer-related factors.
○ Quality-related factors.

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●

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20
● Task and Work-Related Factors
○ Work rate ​–
■ duration-temp and humidity - vision - communication - mobility - tools - explosive atmosphere
○ Wearer-Related Factors
■ Fit & comfort, beards, spectacle, face masking, compatibility with othe rPPE, medical conditions
○ Quality related factors
■ Fit test
● Qualitative
● Quantitative
● Skin Protection
○ Specifications of PPE
■ Break through time
■ Permeation time
■ Degradation rating
○ Practical issues with hand gloves
■ Loss of dexterity and tactile sensation
■ Local heating of hands,
■ removal during a hazardous operation.
● Eye Protection
● Factors Affecting Choice of Type of Protection
○ Spectacles fitted with side pieces. •
■ Radiation
■ Solid projectiles
■ liquid
○ Goggles, which provide full eye enclosure and are secured by a flexible headband.
■ Radiation
■ Solid projectiles
■ liquid
○ Face visors
■ Radiation
■ Solid projectiles
■ Liquid
● Selection of Skin and Eye- Protection Many factors have to be taken into account when choosing PPE. These can be
categorised into four main groups:
○ Substance-related factors. •
○ Task-related factors. •
○ Wearer-related factors. •
○ Quality-related factors

● The Meaning of Occupational Exposure Limits (OELs)​-“…concentration in the air of a harmful substance which does
not, it is believed in the light of present scientific knowledge, cause adverse health effects – including long-term effects and
effects on future generations – in workers exposed for eight to ten hours per day and 40 hours per week; such exposure is
considered acceptable by the competent authority which establishes the values, although concentrations below the

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 exposure limit may not completely guarantee protection of the health of all workers; the exposure limit therefore does not
constitute an absolute dividing line between harmless and harmful concentrations but merely serves as a guide for the
prevention of hazards”.
● Long-Term and Short-Term Exposure Limits​(LTELs) Long-term exposure limits are designed to control the chronic
ill-health effects of long-term exposure to harmful substances; the sort of exposures that might occur routinely on a daily
basis over a period of weeks, months or years in a workplace.

●
● Short-Term Exposure Limits (STELs) - ​Short-Term Exposure limits are designed to control the acute ill-health effects
that might result from exposure to a high concentration of a contaminant over short period of time. The short-term
exposure limit is based on a 15-minute TWA. If the 15-minute TWA exposure can be calculated then it can be compared to
the STEL.
● International Examples of Occupational Exposure Limits​-There are no internationally recognised standard exposure
limits at present – different countries have implemented their own limits based on the interpretation of the dose-response
data obtained. The names, definitions, methods for calculating exposures and the legal status of the limits vary between
these countries. It is therefore important to select the correct OEL for the country in question and use the correct codes of
practice in interpretation

●
● Role of the Occupational Hygienist​ - The work of the occupational hygienist generally involves: •
○ Identification of health hazards (such as toxic chemicals, heat or noise). •
○ Measurement of the hazard by data collection (e.g. personal dosimetry). •
○ Evaluation of the risk by comparing estimated exposures to legal standards (e.g. use of OELs). •
○ Identification of control measures and their implementation, use, testing and maintenance.
● Competence - It is important that before an employer retains the services of an occupational hygienist, their competence
is checked. The level of competence needed will depend on the service required. The employer must make an informed
choice based on: •
○ Training and qualification. •
○ Experience in the field in question. •
○ Background knowledge and education. •
○ Certification or accreditation to relevant standards. •
○ Membership of professional organisations.
○ For example: – In the UK, the British Occupational Hygiene Society (BOHS)
● Monitoring Strategy of toxic substance - The basic philosophy is “do not measure unless you know what you are
measuring and what you will do with the results”.

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●
● Initial Appraisal
○ Stage 1: Gather information about: the substance
○ Stage 2: Conduct some simple qualitative tests
■ This helps establish if there is a ​risk to healt​h, for example: •
■ Smoke tubes​ - show air movements. •
■ Dust lam​p - makes fine dust visible and helps identify emission sources. •
■ Smell ​- can be unreliable.
○ Basic Survey - You can then use semi-quantitative methods to estimate personal exposure (to give a rough
numerical estimate). These range from stain tubes (‘Drager tubes’) to more complex methods such as
photoionisation detectors, which can be worn by individuals to analyse exposure to organic vapours (these
methods will be discussed later). Alternatively, fully quantitative, validated, laboratory-based sampling and
analysis can be used (as discussed later), or a mixture of methods. Anemometers and other such devices can
be used to measure the performance of LEV systems.
○ Detailed Surve​y This is used, for example, when: •
■ Dealing with carcinogens, mutagens and respiratory sensitisers. •
■ Exposure is highly variable between employees doing similar tasks. •
■ The initial appraisal and basic survey indicate:
● – TWA concentrations are very close to the OEL; and
● – the cost of additional controls needs to be justified with more detailed evidence of the
exposure profile.
○ Re-Appraisal ​-The monitoring conducted during basic and detailed surveys may indicate some problems with
controls. Once remedial action has been taken, you need to see if the changes have had the desired effect
● Routine ​Monitoring ​Once you have implemented effective controls, you may decide to use routine monitoring to ensure
that controls stay effective. The frequency and type of routine monitoring required will vary depending on: • Legal
standards – some substances must be routinely monitored, e.g. in the UK continuous monitoring for vinyl chloride
monomer is specified in the regulations. • The degree of confidence that the controls are adequately controlling risks. For

23
 example, if the measured exposure is close to the OEL (rather than well below it), then monitoring may be needed to
ensure compliance.
○ Personal and Static Monitorin​g - Workplace exposure limits relate to personal exposure to the hazardous
substance. So, in many instances, it is necessary to carry out personal monitoring (or personal dosimetry) to
determine what an individual worker’s exposure to the airborne contaminant might be
○ Direct Reading Instruments - Direct reading instruments can be used to measure the concentration of
various chemicals in ​air​. These instruments rely on a variety of techniques such as: •
○ Chemical reaction​s designed to produce a colour change, which enables a
qualitative analysis to be made (often referred to as ‘colourimetric’). •
○ Electrical detectio​n, in conjunction with chemical or electro-chemical processes.
○ Physical method​s based on the absorption of ultraviolet or infrared radiation, in
proportion to the concentration of the contaminant.
○ Stain Tube Detectors -​Stain tube detectors are a type of colour metric direct reading instrument. They
provide a convenient method of analysing gas and vapour contamination in air. The principle of operation is
very simple: a known volume of air is drawn over a chemical reagent in a glass tube. The contaminant reacts
with the reagent and a coloured product, a stain, is produced.

○
○ Personal Sampling for Solid Particulates The sampling equipment (sometimes referred to as a ‘sampling
train’) consists of an air pump, connecting hose and sampler (sampling head containing a filter): •
■ Air pump - must meet certain minimum standards and is usually a unit that can be worn by a worker
on a beltor in a pocket and is capable of drawing air at a steady fixed rate for 4-8 hours. •
■ Hose - simply a clear plastic tube for connecting the air pump to the sampler. •
■ Sampler - a small filter holder that can be attached to the worker close to their breathing zone;
usually clipped to clothing at the collar bone. •
■ Flow meter - used to check the flow rate of the sampler train before and after use.
○ General Method for Sampling and Gravimetric Analysis of Dusts​’
■ The general principle is simple: •
■ Contaminated air is drawn through a filter held inside a sampler (sampling head) for a period of time.
■ The filter is weighed both before and after sampling to give the weight of dust that has collected
(hence gravimetric analysis). •
■ The weight of dust collected is used to calculate the dust concentration in air (mg.m-3). (The dust
collected might also be analysed by other methods to reveal its chemical composition).
■ The type of sampling head used depends on the nature of the particulates being measured (e.g.
inhalable vs. respirable dusts)

24
any micro-organism, cell culture, or human endoparasite, which may cause any infection, allergy, toxicity or otherwise create a
hazard to human health. These include viruses and bacteria which can cause infection and disease, dangerous plants and
animals (for example parasites or insects), biologically contaminated dusts, or wastes from humans and animals.”And a
micro-organism is defined as: “A microbiological entity, cellular or non-cellular, which is capable of replication or of transferring
genetic material

● Types of Biological Agent

○ Fungi
○ Bacteria
○ Viruses
○ Protozoa
● Sources of Biological Agent
○ Human
○ Animal
○ Environment
○ Properties of Biological Agents
○ Rapid mutation
○ Incubation period
○ Infectious –
○ Rapid multiplication
○ Zoonotic/Vector-Borne Disease Zoonoses (singular, ‘zoonosis’), ​or zoonotic diseases, are those that can
be transferred to humans from vertebrate animals. Vector-borne diseases can be transferred to humans by
the bite of an infected arthropod, such as a mosquito. Occupations at risk from zoonoses will vary depending
on the disease in question, but, clearly, people whose work brings them intentionally or incidentally into close
proximity with animals will be at risk from one or several zoonotic diseases, such as: • Farm workers. • Vets. •
Zoo workers. • Pet shop workers. • Sewage workers. • Construction worker
● Diseases Caused by Biological Agents
○ Blood-Borne Viruses There are at least five types of viral hepatitis, all caused by different viruses – types A,
B, C, D and E.
○ Human Immunodeficiency Virus (HIV)
○ Legionella - The bacterium, Legionella pneumophila, is responsible for two important occupational diseases:
Legionnaires’ disease and pontiac fever. Legionella is the generic term used to cover Legionnaires’ disease
and pontiac fever. The first identified outbreak of Legionnaires’ disease occurred among people who had
attended a Pennsylvanian State Convention of the American Legion in 1976. Delegates subsequently
suffered respiratory illness and the bacterium Legionella pneumophila was isolated from lung specimens.
Legionnaires’ disease is a type of pneumonia. As well as affecting the lungs, it may also have serious effects
on other organs of the body. Infection is caused by inhaling airborne droplets or particles containing viable
Legionella, which are small enough to pass deep into the lungs and be deposited in the alveoli. The disease
usually has an incubation period of three to six days. Males are more likely to be affected than females by a
ratio of 3 to 1. Most reported cases occur in the 40-70 year age group. Pontiac fever is a milder, non-fatal
condition with an incubation period between five hours and three days. The illness usually lasts between two
and three days. The symptoms of pontiac fever are similar to those of moderate to severe influenza, with
headache, tiredness, fever and in a small proportion of cases nausea, vomiting and coughing
○ Leptospirosis Leptospirosis (often called Weil’s disease) is caused by bacteria of the genus Leptospira.
Symptoms of the disease can be divided into three stages: The Leptospira bacteria are found in the kidneys
of infected rats (and other mammals, such as cattle) and are urinated out of the host animal; it is from this
source that humans are infected. Infection usually occurs following contact with fresh rat urine or water that
has been urinated into. The bacteria enter the body through damaged skin and through the mucous
membranes of the mouth. Occupational at-risk groups include anyone who is exposed to rats, rat or cattle

25
 urine or to foetal fluids from cattle. Farmers are now the main group at risk for both Weil’s disease and cattle
leptospirosis - the cattle form is a special risk for dairy farmers. Other occupational groups who have
contracted leptospirosis in recent years include vets, meat inspectors, butchers, abattoir and sewer workers.
Workers in contact with canal and river water are also at risk.
○ Norovirus Noroviru​s, sometimes known as the ‘winter vomiting bug’ or ‘Norwalk virus’, is the most common
cause of gastroenteritis in the UK. Each year, it’s estimated that between 600,000 and 1 million people in the
UK catch norovirus. The virus is highly contagious and easily spread. If an infected person doesn’t wash their
hands before handling food, they can pass the virus on to others. It is also possible to catch it by touching
contaminated surfaces or objects. It can affect people of all ages and causes vomiting and diarrhoea. The
incubation period is usually between 12 and 48 hours. Once sickness and diarrhoea start, the symptoms
usually last for one to two days and then resolve naturally as the immune system rids the body of the virus.
Sufferers are infectious to other people during this time. Although having norovirus can be unpleasant, it’s not
usually dangerous and most people make a full recovery within a couple of days.

○
● Intentional Work and Incidental Exposure
○ Exposure resulting from a d​eliberate intention to work with a biological age​nt, i.e. work with biological
agents that involves research, development, teaching or diagnosis. •
○ Exposure that arises out of the work activity, but is incidental to it, i.e. the activity does not involve direct
work with the agent itself, e.g. health care, food production, agriculture, refuse disposal and work in sewage
purification. •
○ Exposure that does not arise out of the work activity itself​, e.g. where one employee catches a
respiratory infection from another. This might be thought of as an exposure resulting from normal life in that it
could and would occur simply as a result of living in the community.
○ If work creates a deliberate or incidental exposure to biological agents then legislation or good
practice will require​: •
■ Assessment of the risk to health created by the work. •
● Prevention or control of exposure. •
● Use of the control measures. •
● Maintenance, examination and testing of control measures. •
● Monitoring of exposure at the workplace.
● Health surveillance. •
● Information, instruction and training for those exposed. •
● Arrangements to deal with accidents, incidents and emergencies.
● Risk Assessment Factors
○ The Risk Group/Category of the Agent
○ Pathogenicity and Infectious Dose
○ Likelihood and Nature of the Resultant Disease
○ Modes of Transmission
○ Stability of the Agent in the Environment
○ Concentration and Amounts
○ Presence of a Suitable Host
○ Available Data
○ Nature of Activity
○ Local Availability of Prophylaxis/Treatment
● General Hierarchy of Control for Biological Agents
○ Biological Safety Cabinets (BSCs)
■ Biological Safety Cabinets (BSCs)
● Class I – these are open-fronted cabinets where air is drawn in, filtered through a HEPA

26
 filter and discharged to the atmosphere. The cabinet protects the operator only from agents
that might infect the operator by airborne routes (see following figure)
● Class II – these are open-fronted cabinets where air is drawn in, exhausted through slits in
the front base of the cabinet then filtered through a HEPA filter. The air drawn down over
the open front forms a curtain to prevent the escape of aerosols back into the laboratory. A
proportion of the air is discharged to atmosphere but the rest is recirculated through the
cabinet.
● Class III – these are totally enclosed, leak-proof cabinets where the operator works through
glove ports. Air is drawn in and extracted through HEPA filters and discharged to
atmosphere. These cabinets protect both the operator and the work from external
contamination. They are suitable for work with Risk Group 3 and 4 organisms.

○ Sharps Control Sharps ​include scalpels, needles, blood lances and any sharp instrument that is capable of
puncturing the skin​.
○ Immunisation/Vaccination ​Vaccines consist of dead or live attenuated organisms that, when administered to
individuals, are able to initiate immunity to the organism (and sometimes similar pathogens)
○ Decontamination and Disinfection
○ Effluent and Waste Disposal
○ Personal Hygiene Measures
○ Personal Protective Equipment (PPE)
■ Absorption Through the Skin
■ Absorption Through the Membranes of the Eye
■ Inhalation Into the Lungs
● Laboratory coats or gowns
● Gloves
● Visors
● Positive pressure particulate response

27
According to the ILO, noise is defined as: “all sound which can result in hearing impairment or be harmful to health or
otherwise dangerous.

● Sound
○ Amplitude - According to the ILO, noise is defined as: “all sound which can result in hearing impairment or be
harmful to health or otherwise dangerous.
○ Intensity ​- The intensity of sound is the power transmitted per unit area (measured in W/m2 ); it is
proportional to the square of the amplitude.
○ Frequency ​This is the number of sound pressure waves generated per second (the unit of frequency is the
hertz (Hz)).
○ The Decibel Scale One consequence of the fact that sound intensity is proportional to the square of the
amplitude is that, as amplitude increases, intensity increases exponentially. To explain; an increase in
amplitude from 2 to 3 and then 4 is matched by an increase in intensity from 22 (4) to 32 (9) and then 42 (16).
The human ear can hear sounds across an enormous range of intensities; from the threshold of hearing up to
the threshold of pain. The intensity of the pressure wave at the threshold of pain is 10,000,000,000,000 times
greater than the intensity of the pressure wave at the threshold of hearing. To allow for easy measurement of
sound intensity across such a huge range, the decibel scale is used, where 0 decibels (dB) is the threshold of
hearing and 130dB is at the threshold of pain. The decibel scale is a logarithmic scale meaning that an
increase in dB value of ten represents a ten-fold increase in intensity. So, 10dB is ten times the intensity of
0dB, 20dB is a hundred times the intensity of 0dB, 30dB is a thousand times the intensity of 0dB, and so on.
See below for some typical decibel levels associated with different noise sources. So, 83dB + 83dB = 86dB
○ A-Weighting and C-Weighting - The human ear is not equally sensitive to sounds across all frequencies.
Humans cannot hear very low- or very high frequency sounds. The human hearing frequency range is from
20Hz to 20,000Hz (20KHz). Even within this frequency range the human ear is more efficient at detecting the
mid-range frequencies. Because the human ear is not equally sensitive to sounds at all frequencies, sound
level meters have weighted scales to account for a variable sensitivity to frequency. The A-weighted scale
(dB(A)) electronically assimilates the sound pressure and mimics the human ear’s response across the range
of frequencies. The measurement of noise in dB(A) is a good indication of the physical harm caused to
hearing.
○ Other weighting scales are also used, such as C-weighting (dB(C)) for peak sound pressure.
● Noise Dose -​The damaging effects of noise are related to the total dose of energy that the ear receives. The dose is
determined by two factors: the level of noise and the duration of exposur​e

28
● Physiology of the Ea​r
○ Outer ear with auditory canal. •
○ Middle ear. •
○ Inner ear.
● Effects of Noise Exposure
○ Hearing Loss
■ Conductive hearing loss ​occurs due to a physical breakdown of the conducting mechanism of the
ear resulting from an acute acoustic trauma, e.g. an explosion or gunfire. The eardrum, ossicles or
the cochlea can be damaged, often beyond repair. There is no cure, although surgery may reduce
the damage to the eardrum. This form of hearing loss is rarely caused by occupational noise
exposures. •
■ Sensorineural hearing loss ​occurs when the hair cells in the cochlea are damaged. Harm may
result from natural causes, such as infection, or by physical injury.
○ Tinnitus Tinnitus is a condition where the sufferer hears “ringing in the ear” or other types of noise in their
head without there being any external noise source. There are no observable external symptoms. Tinnitus
can occur after exposure to excessive noise levels as an acute condition which recedes with time (e.g. after
attending a rock concert). The recovery period could be 12 or more hours where very high exposure levels
occur. People who have chronic noise-induced hearing impairment can suffer from chronic tinnitus. The
symptoms of tinnitus suggest that damage to the nerve structure of the cochlea or the auditory nerve has
occurred, or possibly both.
○ Threshold Shift Threshold shift is a reduction in a person’s ability to hear, i.e. they need more sound intensity
to stimulate their hearing. The condition can be permanent or temporary.
■ Temporary Threshold Shift (TTS)
■ Permanent Threshold Shift (TTS)
○ Noise-Induced Hearing Loss (NIHL​) Noise-Induced Hearing Loss (NIHL) is permanent threshold shift
caused by exposure to excessive noise. NIHL is a condition that results from failure of the hair cells in the
cochlea to respond fully to sound intensities having frequencies within the human speech range. The person
does not necessarily lose the ability to hear all sounds, but is not able to distinguish the spoken word clearly,
even if it is presented with a raised voice.
○ Presbycusis - Presbycusis Presbycusis is the term used to describe a reduction in hearing acuity that occurs
naturally with age. This age-related hearing loss affects the individual’s ability to hear high frequency
(high-pitched) noise most markedly. This type of hearing loss might start at the age of 30 and become more
significant from the age of 60 onwards.
○ Other Effects of Noise on Health In addition to the short​- and long-term effects of exposure to noise on
hearing, there can also be other health effects: •
■ Neuro-psychological disturbances such as headache, fatigue, insomnia (sleeplessness) and
irritability. •
■ Cardiovascular system disturbances such as hypertension and cardiac disease. •
■ Digestive disorders such as peptic ulcers and colitis.

● Planning the Surve​y

○ Who Should Be Assessed
○ Where​? -It is not generally necessary to record exposures below 75dB(A) or so, because it is not significant in
relation to the action value.
○ How​? – Take measurements at the position occupied by the operator’s head and preferably with the person
not present. If the operator needs to be present (e.g. to control the machine), then measure close enough to

29
 the head to get a reliable measurement, but far enough away to avoid sound reflections (>15cm).
○ • ​For ​How ​Long​? Measurements need to be sufficient to account for variations in the day. With integrating
sound level meters, measurements should be long enough to obtain an indication of the average level of
exposure. You may need to measure the A-weighted Leq for the entire exposure period, but you can often do
it for a shorter period if noise is steady or cyclic.
○ Group Sampling If several workers work in the same area, you may be able to assess the exposure for all by
doing measurements in selected locations. Choose the locations and durations so as to determine the highest
exposure someone is likely to receive.
○ Mobile ​Workers and ​Highly Variable ​Daily ​Exposures This includes, for example, maintenance. There is no
typical daily exposure here. Measure a range of different activities likely to be encountered – estimate the
wo​r​st likely exposure from these
○ Very Short Duration Noise​ This includes, for example, gunfire, explosions, cartridge-operated tools.
● Taking Measurements
○ Instrumentation
■ Simple Sound Level Meters (SSLMs)
■ Integrating Sound Level Meters (ISLMs)
■ Personal Sound Exposure Meters (Dosimeters)
○ The Importance of Calibration

● Hierarchy of Noise Control

30
● Hearing Protection
○ Ear muff
■ Disposable
■ Re-usable

31
 ○ Hand-arm vibration is defined as: ​“Mechanical vibration which is transmitted into the hands and arms during
a work activity.” •
■ Whole-body vibration is defined as: ​“Mechanical vibration which is transmitted into the body, when
seated or standing, through the supporting surface, during a work activity

● Workers at Risk
○ Hand-Arm Vibration
○ Workers at Risk Hand-Arm Vibration

32
● Health Effects
○ Whole-Body Vibration
○ Hand-Arm Vibration
○ Hand-Arm Vibration Syndrome (HAVS)
● Standardised Diagnostic Tests for HAVS
○ Standardised Diagnostic Tests for HAVS
○ Sensorineural Tests (for Assessing Nerve Damage)

●
● Planning a Vibration Survey
○ Who Should Be Assessed?
○ Who Should Be Assessed?
○ How?
○ For How Long?
○ Group Sampling
● Taking Measurements
○ Instrumentation
○ The Importance of Calibration

○
● Practical Control Measures
○ Elimination
○ Equipment Selection
○ Care and Maintenance
○ Job Rotation
○ Information, Instruction and Training
○ PPE
○ Elimination
○ Equipment Selection
○ Care and Maintenance
○ Reduced Time Exposure
○ Information, Instruction and Training

○
● Ionisation
○ Non-Ionising Electromagnetic Radiation
○ Non-Ionising Radiation
● Sources of Non-Ionising Radiation
○ Natural Sources
○ Artificial Sources
● Routes of Exposure and Effects of NonIonising Radiation
○ Ultraviolet
■ Eye
● Arch eye
■ Skin

33
 ● Sun burn
■ Chronic effects
● Premature aging of the skin
● Skin cancer
● Cataract
● Photosensitisation – sensitisation of the skin caused by UV exposure of chemicals in, or
on, the skin, such as tar compounds, synthetic dyes, antibiotics and tranquillisers, which
can build up in the skin during medication.
● Formation of toxic contaminants – ultraviolet radiation of wavelengths below 250nm has
the ability to produce ozone and oxides of nitrogen. These gases have an irritant or
corrosive effect on the respiratory system, causing inflammatory conditions similar to
bronchitis.
■ Visible light
● Acute - Nuisance glare – ​being dazzled by intense light that causes the pupil of the eye to
contract, so making less intense areas more difficult to see
● Acute - Disability glare – ​being dazzled by intense light that causes the retina to become
unresponsive to light, resulting in temporary blindness (e.g. staring at a light bulb and then
trying to look at an image).
● Chronic - Blue light hazard – ​retinal damage as a result of exposure to short wavelength
visible light (at the blue end of the spectrum).
● Chronic - Permanent blindness ​– as a result of exposure of the retina to intense light, as
might be encountered when using a laser (especially Class 3B or 4, e.g. for laser surgery or
metal cutting – the classification of lasers will be covered later) or when using optical
instruments such as a telescope and accidentally looking at the sun
■ Infrared Radiation
● Acute effects – ​reddening of the skin (erythema) and surface layers of the eye. •
● Chronic effects – ​cataracts can occur from occupational exposure to white-hot surfaces
over a period of about 15 years through the absorption of infrared radiation in the lens of the
eye.
● Microwaves -Microwaves Microwave radiation covers the wavelength region between
about 1mm and 1m. Biological harm is caused by the process of internal heating, the heat
being generated by the vibration or rotation of water molecules. Eyes affected
● Radio Waves ​Radio Frequency wavelengths cause a similar internal heating effect to
microwaves.
● Control Measures for Non-Ionising Radiation
○ Eliminate as far as possible – explore alternative technologies. •
○ Other working methods may reduce the risk – administrative controls for routine operation and
maintenance, permits, etc. •
○ Choose equipment emitting less radiation. •
○ Technical measures to reduce unwanted emission of radiation – interlocks, shielding, enclosures,
screens, etc. •
○ Maintenance. •
○ Design, siting and layout of workplaces and workstations – control over direction, stray
fields/reflections (e.g. painting surfaces matt black), etc. •
○ Limit the duration and level or intensity of exposure, e.g. time, distance (except in the case of lasers,
where increasing the distance doesn’t work!). •
○ PPE, e.g. eye protection. •
○ Follow manufacturer instructions. •
○ Develop and implement safe systems of work. •

34
 ○ Provide information, instruction and training. •
○ Signs.

●
● Sources of Ionising Radiation
○ Natural Sources A very significant source of most of these forms of ionising radiation is the earth itself. The
rocks that make up planet Earth are radioactive, containing dozens of radionuclides. A typical example is
uranium 238, found at low concentrations in all rocks, soil and water.
○ Artificial Sources Artificial sources of ionising radiation can consist of naturally occurring radionuclides that
have been mined, extracted and concentrated.
■ Alpha particles – emitted by radionuclides and used in smoke detectors, anti-static devices and
certain types of cancer tumour radiotherapy.
■ Beta particles – emitted by radionuclides and used in thickness gauges, medical and science lab
work as tracers and cancer tumour therapy.
■ Neutrons – emitted by fissile material, such as uranium 235 and plutonium 239 inside nuclear power
plants, and generated by high-energy particle beam collisions in nuclear physics research facilities.
■ X-rays – generated by bombarding a metal target with high-energy electrons in a vacuum tube. They
are used for medical radiography, industrial radiography, security scanning of objects and people,
quality control during manufacturing and laboratory analysis, such as x-ray crystallography.
■ Gamma-rays – emitted by radionuclides, such as caesium 137 and used in industrial radiography,
some medical radiography, cancer tumour radiotherapy and in medical and science lab work.
● Quantifying Exposure
○ Radioactivity and the Becquerel (Bq) ​A measure of the rate at which a radionuclide is decaying to produce
ionising radiation. In other words, a measure of how hot a radioactive source is. One Becquerel is one
disintegration per second. This is used to indicate the amount of radiation produced and/or the amount of a
radioactive material present
○ Absorbed Radiation Dose and the Gray (Gy​) This is a measure of the amount of energy deposited into
matter by the radiation. One gray is equivalent to one joule per kilogram
○ Equivalent Dose and the Sievert (Sv​) This is a measure of the likely biological damage resulting from
radiation exposure. The equivalent dose relates to the dose received by a tissue or part of the body, weighted
to take account of the different biological effects of different types of radiati
● Routes of Exposure to Ionising Radiation
● Alpha particles ha​ve little penetrating power, can be stopped by a few centimetres of air, a sheet of paper or the horny
layer of dead cells at the surface of the epidermis. •
● Beta particles have more penetrating power, can move through several tens of centimetres of air and can penetrate
through the horny layer and into living tissue beneath. •
● Neutrons, x-rays and gamma-rays ​are extremely penetrating and can pass through kilometres of air and right through
the human body (longer wavelength x-rays are less penetrating and are absorbed by hard tissue, such as bone and teeth)
● The influence of physical forms are familiar from previous elements: ​•
○ Solids – in their massive form are unlikely to get into the body and therefore may be harmful on contact with
the skin during handling, but otherwise may present little health risk. •
○ Dusts – can become airborne and may be inhaled. Once in the lungs, the dust may be deposited or may
even be absorbed into the bloodstream. •
○ Liquids – can be ingested with relative ease, put into contact with skin or may be able to permeate through
the skin (especially if mixed with solvents). •
○ Mists – can be inhaled into the lungs and absorbed into the bloodstream. • Gas and vapours – can be inhaled
into the lungs and then absorbed into the bloodstream
● Health Effects of Ionising Radiation
○ Acute Effects - ​This damage is either: •

35
 ■ repaired, in which case the cell continues to function, or •
■ cannot be repaired, causing the cell to undergo programmed cell death, or •
■ cannot be repaired, leading to a mutation that may have an influence in the future, but has no
immediate health effect
■ Typical symptoms include​: •
● Nausea and vomiting. •
● Hair loss. •
● Diarrhoea. •
● Headache. •
● Fever. •
● Central nervous system impairment. •
● Skin burns and ulceration. •
● Death.
○ Certain​ cells in the body are more prone to damage by ionising radiation, most especially: •
■ White blood cells – leading to low white blood cell count and a suppressed immune system. •
■ Lining of the intestines – leading to destruction of the gut wall and invasion of the body cavities by
gut bacteria. •
■ Bone marrow cells responsible for red blood cell production – leading to anaemia.
○ Certain​ cells in the body are more prone to damage by ionising radiation, most especially: •
■ White blood cells – leading to low white blood cell count and a suppressed immune system. •
■ Lining of the intestines – leading to destruction of the gut wall and invasion of the body cavities by
gut bacteria. •
■ Bone marrow cells responsible for red blood cell production – leading to anaemia.
● Measurement of Radiation and Exposure
■ Type of radiation present. •
■ Quantity of radioactivity present
■ Type of radiation that a worker has been exposed to. •
■ Dose of radiation that a worker has been exposed to.
○ Passive Dosimeters
○ Thermo-Luminescent Dosimeters (TLDs)
○ Active Dosimeters
○ Personal Alarm Dosimeter
○ Dosimetry Services
○ Control Measure Principles for Ionising Radiation
○ External Radiation
● Control Measure Principles for Ionising Radiation
○ External Radiation External radiation arises from outside the body and may irradiate skin, tissues or internal
organs, depending on the type of radiation and its ability to penetrate the body Protection from external
ionising radiation is based on three principles: •
■ Time – by reducing the time of exposure to the radiation, the accumulated dose is reduced. This
follows the same principles as for toxic chemicals, noise and vibration:
● Dose = Intensity × Time •
■ Distance – by increasing the distance from the source to the person, the dose of radiation is reduced
(or eliminated): –
● Alpha and beta particles do not travel long distances through air (they collide with the air
molecules and lose their energy). Therefore, separation by a few centimetres or metres is
sufficient to eliminate all exposure. –
● Neutrons, x- and gamma-rays travel much greater distances through air (kms), but in doing
so they obey the inverse square law: the dose of radiation decreases as a function of the

36
 square of the distance from source to person. So,
● – if the dose at 1m distance is x,
● – the dose at 2m distance will be ¼ x,
● – and the dose at 4m distance will be 1 /16 x. •
● Shielding – using materials to absorb the radiation so that it cannot pass through. This is the
best method of control, since it applies a safe place approach and relies less on human
behaviour (safe person approach). Different types and thicknesses of shielding material are
used for different radiation sources: –
○ Alpha particles are easily shielded with virtually any material since they have very
low penetration power. –
○ Beta particles can be stopped with a few millimetres of aluminium or thin brass.
○ – X- and gamma-rays require thicker, denser materials, such as lead.
○ – Neutron sources are often enclosed in thick concrete enclosure or hydrogen-rich
materials, such as paraffin wax or water (neutrons are not stopped by dense
materials, such as lead).
○ Practical Control of Internal Radiation Internal radiation stems from radioactive materials that have been
deposited in the body (by inhalation, ingestion, injection or absorption through the skin) and are continually
irradiating internal organs and tissues from within. Once a radionuclide has entered the body, it is difficult, if
not impossible, to limit personal exposure. If the substance is taken up by the body, then it will pass into the
bloodstream and, from there, all parts of the body will receive a dose.
● Radiation Protection Code of Practice
○ Notification, Registration and Licensing of Radiation Work
○ Classification of Workers and Areas
○ Competent Advice
○ Radiation Surveillance
○ Health Surveillance
● Controls
○ Design Features
○ Ventilation and Building Design

● Laser light is electromagnetic radiation that has been produced in such as way that the light waves are all of one
wavelength and all in phase (in step with each other, i.e. the peaks and the troughs are all aligned). Laser light is therefore
very coherent and usually non-divergent (the beam does not spread out as it travels through air or materials).
● Routes and Effects of Exposure to Lasers
○ Eyes
○ Skin
● Control Measures for Lasers
○ Engineered controls:​Screening/enclosures to prevent the escape of hazardous beams. –
■ Interlocks on equipment
■ Non-reflective surfaces. Many high-power laser enclosures and rooms are painted matt black to
prevent reflection. •
○ Administrative​ controls: – Warning lights (to indicate ‘in operation’). –
■ Signs warning of the laser hazard
■ Training for users of Classes 3R, 3B and 4 lasers
■ Safe systems of work and emergency procedures.

37
 ○ PPE​: –
■ Laser safety eyewear. T
■ Skin protection may be necessary for high-power lasers​.

● Anxiety​ can have both psychological and physical symptoms.

○ Psychological symptoms can include: •
■ Feeling worried or uneasy a lot of the time. •
■ Having difficulty sleeping. •
■ Inability to concentrate. •
■ Irritability. •
■ Being extra alert (hypervigilance). •
■ Feeling on edge or not being able to relax.
○ Physical symptoms can include: •
■ Pounding heartbeat. •
■ Breathing faster. •
■ Palpitations (irregular heartbeat). •
■ Nausea. •
■ Chest pain. •
■ Headaches. •
■ Loss of appetite.
● Work-Related
○ Stress ​Stress is not a disease, but a natural reaction to pressure. Unrelieved stress can cause disease. It
certainly contributes to poor work performance and absence.
● Pressure is an inherent part of work, whether it is a deadline that must not be missed, a rate of output that must be
maintained, multiple demands that must all be met simultaneously or simply the risk of massive financial loss if work does
not go well. Pressure does not necessarily lead to stress. In many circumstances, people are able to cope with the
pressure they are under. In fact, in many situations, pressure is a good thing. It results in a positive performance, maintains
motivation and interest and improves health. But if the pressure continues or increases, then the relatively minor symptoms
of stress can escalate into physical and/ or mental ill health.
● Causes of Work-Related Mental Ill Health
○ Demands ​– excessive demands of the job in terms of workload (too much or too little), targets (e.g.
unachievable sales targets for sales staff), speed of work and deadlines, as well as working hours (e.g.
excessively long) and work patterns (e.g. changing shift patterns).
○ Control – lack of control over work, especially where the work is demanding. Control means personal control
by the worker over what work is to be done, how it is to be done, the priorities involved (e.g. realistic
deadlines) and even simple things like control over the working environment (e.g. light levels, temperature,
background noise, etc.). •
○ Support – lack of support in terms of information, instruction and training to do the work and having no-one to
turn to when pressure increases (e.g. no advice/counselling service). •
○ Relationships – poor workplace relationships and, in particular, bullying and harassment whether by
managers, peers or subordinates (e.g. social isolation and exclusion of a worker by their peer group as a

38
 result of prejudice). •
○ Role – lack of clarity about an individual’s role, what responsibilities and authority they have, and how they fit
in to the larger organisational structure (e.g. lack of any form of job description, or role clarity for a worker
used to working in a highly bureaucratic organisation). Conflicting demands can also create stress under this
heading (e.g. having to increase productivity while at the same time decreasing headcount). •
○ Change – the threat of change and the change process itself, whether it is a change that affects just one
worker (e.g. demotion, re-assignment), or the

○
● Identification and Assessment of Risk of Stress and Mental Ill Health - ​A standard five-step approach to risk
assessment can be adapted for both work-related stress and mental ill health: •
○ Identify the risk factors. •
○ Identify the people who might be harmed. •
○ Evaluate the risks: explore problems and identify solutions. •
○ Record findings and implement them. •
○ Monitor and review to assess effectiveness.

In practice, many different tools are used as part of the risk assessment to identify and evaluate risk, at either the individual
and/or organisational level and also develop workable solutions, for example:

○ Discussions and focus groups​. •

○ The use of sickness absence data​. •
○ Interviews.​ •
○ Surveys/questionnaires.
● Practical Control Measures
○ First, take time to fully identify and clarify the problem (try to be as specific as possible). •
○ Ask how this became a problem (for example, was it always a problem? If not, what changed to cause it?).
○ Determine whether this is a one-off problem (so, will it naturally go away in the short-term or is it something
that is likely to be a long-term issue? If it’s very short-term, you may not need to take any action at all).
○ Suggest solutions to identified problems. •
○ Ask how your suggested solutions would actually solve the problems. •
○ How would the solutions be practically implemented? Who would do it and when? How would you check the
solutions are effective? •
○ Prioritise your actions - don’t do too much in one go.
● The Management Standards Approach - ​The HSE’s management standards define the culture of an organisation where
the risks from work-related stress are being effectively managed and controlled.
○ Demands ​– this includes issues such as workload, work patterns and the work environment. •
○ Control​ – how much say the person has in the way they do their work. •
○ Support – this includes the encouragement, sponsorship and resources provided by the organisation, line
management and colleagues. •
○ Relationships – this includes promoting positive working to avoid conflict and dealing with unacceptable
behaviour.
○ ​Role – whether people understand their role within the organisation and whether the organisation ensures
they do not have conflicting roles. •
○ Change​ – how organisational change (large or small) is managed and communicated in the organisation.

39
The ILO Code of Practice – Workplace Violence in Services Sectors and Measures to Combat this Phenomenon defines
workplace violence as: “Any action, incident or behaviour that departs from reasonable conduct in which a person is assaulted,
threatened, harmed, injured in the course of, or as a direct result of, his or her work.”

“Violence can be defined as a form of negative behaviour or action in the relations between two or more people. It is
characterised by aggressiveness which is sometimes repeated and sometimes unexpected. It includes incidents where
employees are abused, threatened, assaulted or subject to other offensive acts or behaviours in circumstances related to their
work. Violence manifests itself both in the form of physical and psychological violence. It ranges from physical attacks to verbal
insults, bullying, mobbing, and harassment, including sexual and racial harassment.”

● Physical and Psychological Effects

Clearly, a very wide range of physical injuries can result from physical assault, from a fatal wound to bruising and grazing (the
most common reported injury). Most incidents, however, do not involve physical assault and so never result in physical injury.
Violent incidents of any type, whether physical or verbal, can be traumatic, may leave the victim suffering from traumatic stress
and can result in Post-Traumatic Stress Disorder (PTSD)

○ Victims of violence can often suffer psychological harm in this way. Typical reactions include: •
■ Withdrawal. •
■ Hyper-vigilance. •
■ Loss of confidence. •
■ Loss of self-esteem. •
■ Mood swings. •
■ Breakdown of working and personal relationships. •
■ Anxiety and depression. •
■ Suicide attempts.
● Risk Factors
○ Workers at Risk The single biggest risk factor for work-related violence is the nature of the job being carried
out by the worker. Workers whose jobs require them to deal with the public are most at risk from violence. In
fact, working with the public might be identified as the single biggest risk factor for work-related violence.
■ Particularly at risk are those who are engaged in: •
■ Giving a service – such as social services, infrastructure maintenance engineers, retail staff, etc.
■ Caring – such as nurses, doctors, care assistants, etc. •
■ Education – teachers and support staff. •
■ Cash transactions – bus drivers, taxi drivers, bank staff, post office staff, etc. •
■ Delivery/collection – postal workers, lorry drivers, security van drivers, etc. •
■ Controlling – stewards, security staff, etc. •
■ Representing authority – police, traffic wardens, bailiffs, various enforcement officers and inspectors,
etc.
■ lone working
■ conducting home visits

● Assessment of Risk of Violence

○ Find out if there is a problem.
■ Staff​ ​surveys​ –
■ Incident​ ​reporting​ –

40
 ○ Decide what action to take.
■ • Identify who might be harmed, and how. •
■ Are the existing arrangements adequate or does more need to be done? •
■ Develop any necessary preventive measures. (Examples of preventive measures are considered
later in this element.) •
■ Record the significant findings of the risk assessment. •
■ Review it regularly
○ Take action. - Involvement of staff in introducing measures to combat violence, and inclusion of the measures
in the safety policy, will ensure that staff are aware of what is going on
○ Check what you have done​. - As with any programme designed to manage an occupational health and
safety risk, it is important to check that control measures are working. Reviews on the effectiveness of
implemented controls can be done by management, or by the health and safety committee.
● Control Measures​ - Control measures will be considered under three headings: organisational, physical and behavioural.
○ Organisational Controls
○ Physical Controls
○ Behavioural Controls
○ Staff Training

● The Human Musculoskeletal System

○ The​ ​skeleton​ – forms the bone frame of the body upon which everything else is supported. •
○ Cartilage – is joined to the bone in certain areas either to support anatomical structures (such as the nose
and ear) or to form articulating surfaces in joints (such as in the spine or knee). •
○ Skeletal​ muscles – are able to contract (shorten) and relax (extend) so as to achieve movement. •
○ Tendon​s – tough connective tissue that joins muscle to bone so that when a muscle contracts, the bone it is
joined to moves. •
○ Ligaments – tough connective tissue that joins bone to bone to form the joints, such as knee, hip, spine and
shoulder joints. •
○ Nerves
● Types of Injury and Ill Health
○ Back Injury and Back Pain
○ Work-Related Upper Limb Disorders (WRULDs)
○ Tendon and Ligament Injuries
○ Muscle Injuries
○ Cuts, Burns and Broken Bones
○ Other Chronic Soft-Tissue Injuries
○ Associated Conditions
■ Eye strain
■ Fatigue and stress
● High-Risk Activities​ - MSD risk is associated with: •
○ Sitting for a long period of time. •
○ Standing for long periods of time, particularly in a static position. •
○ Any repetitive movement of the body. •
○ Any repetitive use of force. •
○ Any form of manual handling, irrespective of the weight being manipulated. •
○ Work in restricted work spaces where body posture is constrained by the available space

41
 ○ Production/Assembly Line Work Assembling small components and/or repetitive handling on a factory
production line will have many of the same health effects listed above: • WRULDs –
■ associated with repetitive handling of parts for long periods of time. •
■ Eye strain – temporary eye fatigue associated with having to focus on small parts. •
■ Back pain – and other MSDs associated with sitting or standing in a fixed position for long periods of
time, perhaps in association with overreaching, twisting and stooping to reach parts. •
■ Fatigue and stress – associated with infrequent rest breaks and a demanding work rate.

● Risk Factors The specifics of manual handling risk assessment and DSE workstation assessment will be discussed in the
next section. There are, however, some general risk factors that contribute to ergonomic risk:
○ Repetition
○ Force
○ Posture
○ Twisting
○ Rest
○ Equipment design
○ Equipment adjustability
○ Lighting
○ Other environment parameters
○ Individual capabilities
○ Other vulnerable groups
● Risk Assessment Methods - ​The ergonomic risk assessment method applied to a work activity will depend, to a large
degree, on the nature of the work activity. In particular, manual handling and the use of DSE each have their own risk
assessment methods.
○ Assessing Manual Handling Risk
■ The Task
■ The Load
■ The Environment
■ Individual Capabilities
○ DSE Workstation Assessment
■ Screen. •
■ Keyboard. •
■ Chair (including foot rest – if required). •
■ Desk. •
■ Other associated equipment such as telephone. •
■ Environment, such as lighting, space, noise and temperature.
○ Use of Assessment Tools
■ Manual Handling Assessment Charts (MAC) Tool
● Single lifting operations. •
● Single carrying operations. •
● Team handling operations.
● Variable Manual Handling Assessment Chart (VMAC) Tool
● Assessment of Repetitive Tasks (ART) Tool
● Risk Assessment of Pushing and Pulling (RAPP)
● Practical Control Measures In general terms​, the control of ergonomic risk can be achieved by introducing changes to

42
 the: •
○ task and the way that it is done, •
○ tools, equipment and machinery, and •
○ workplace environment, so as to suit the individuals carrying out the work
● Display Screen Equipment Control Measures​ The following control measures are appropriate for DSE use include: •
○ Carrying out a workstation assessment to ensure that the equipment and environment meet minimum
standards and that the workstation can be adjusted to suit the user. •
○ Providing basic DSE workstation equipment that meets minimum standards in terms of good ergonomic
design. •
○ Planning the user’s work routine so that they can take short, frequent breaks from screen and keyboard use. •
○ Providing DSE users with a free eye test and, if required, spectacles for screen use. •
○ Providing information and training to users on the potential health risks of DSE use and the preventive
measures; in particular, ergonomic use of the workstation​.
● Factory Assembly Line Control Measures The control measures appropriate for the factory assembly line are very
similar to those applied in the case of DSE use: •
○ Carry out an ergonomic assessment of the workstation to ensure that it is appropriate and can be adjusted to
suit the worker’s needs. •
○ Plan the worker’s work routine so that they can take recovery breaks. •
○ Provide information and training to workers on the potential MSD health risks and the preventive measures; in
particular, ergonomic use of the workstation. Specific controls might include: •
○ Automating the process to eliminate the MSD risk entirely. •
○ Re-layout of the workstation to allow comfortable posture and to minimise overreaching, stooping, twisting,
etc. • Providing seating if not already available. •
○ Providing comfortable shoes and floor mats to relieve foot pressure if sitting is not possible. •
○ Allowing short, frequent breaks from the production line or introduce job rotation to prevent long duration on
one task. •
○ Ensuring lighting is appropriate to the task (brightness or lux levels should be relatively high for fine-detail
work). •
○ Introducing ergonomically-designed hand tools
● Manual Handling Control Measures
○ Eliminate the manual handling. •
○ Assess the manual handling that cannot be eliminated. •
○ Use handling aids. •
○ Modify the task, load or environment. •
■ Task
■ Load
■ Environment
○ Ensure individual capabilities are matched to the activity.
■ Before the lift
■ During the lift
■ Setting down

43
● Health Effects of Working in Extreme Thermal Environments
○ Exposure to Hot Conditions
■ heat stress.
● Inability to concentrate. •
● Muscle cramps
● Heat rash
● Severe thirst
● Late symptom. •
○ Fainting (sometimes called ‘heat syncope’). •
○ Heat exhaustion – fatigue, giddiness, nausea, headache, moist skin. •
○ Heat stroke – hot dry skin, confusion, convulsions, loss of consciousness. This is
the most serious effect as it can lead to coma and death.
○ Exposure to Cold Conditions
■ cold stress.
● Non-freezing injuries, such as chilblains (painful lumps, often on feet) and trench foot
(swollen, infected feet as a result of cold and damp). •
● Freezing injuries, such as frostnip (freezing of the surface layers of skin) and frostbite
(freezing of skin and deeper tissues), usually to the extremities (fingers and toes).
● Symptoms of hypothermia include: •
○ Feeling cold, followed by pain, then numbness. •
○ Shivering (automatic muscle contractions in an attempt to generate metabolic
heat). •
○ Uncharacteristic mood and behaviour changes. •

44
 ○ Confusion. • Muscular weakness. • Drowsiness.
● Environmental Parameters that Affect Comfort
○ Air Temperature (Surrounding Temperature)
○ Radiant Temperature
○ Humidity
○

○
○ Air Velocity or Wind Speed
● Other Parameters that Affect Comfort
○ Metabolic Rate ​The body’s metabolic rate can be expressed in watts (joules of energy per second) or watts
per square metre (of body surface area).
○ Clothing​- as you might expect, has a significant effect on the ability of the body to lose heat to the external
environment. In considering conduction of heat at the body surface through clothing, it is the resistance (or
insulation) to heat flow across a given thickness of material that we are concerned about.
○ Sweat Rate Sweat rate needs to be within certain narrow limits for us to feel comfortable (put simply,
sweating helps us cool down but excessive moisture makes us feel uncomfortable – we like to be largely free
of sweat).
○ Duration of Exposure It may seem an obvious point, but the longer someone is exposed to thermal
discomfort, the more severe the effects are likely to be.
● Measuring Environmental Parameters
○ Thermometers
■ Liquid Thermometers ​The operating mechanism depends on the fact that liquids expand in a
regular manner with temperature change. Liquid expands into a graduated capillary tube.
■ Thermocouples Thermocouples or thermo-electric thermometers depend on the variation of current
with temperature produced by two different metals in contact with each other and incorporated in an
electric circuit. •
■ Resistance Thermometers Resistance thermometers depend on the variation in resistance with
temperature, and hence current flow, within materials when incorporated in an electrical circuit.
■ Hygrometers Hygrometers are used to measure atmospheric humidity. Many different types exist,
such as the whirling hygrometer and electronic versions
■ Anemometer-Anemometers measure wind speed (and usually direction) and come in a range of
types. One type is simply a freely rotating propeller blade.
● Practical Control Measures
○ Hot/Humid Environments
■ Control Heat Sources
■ Circulation of Air and Ventilation
■ Workplace Design
■ Job Design and Job Rotation
○ Personal Protective Equipment
○ Information, Instruction, Training and Supervision
○ Health Surveillance
● Cold Environments •
○ Enclose/Segregate Cold Areas
○ Provide Heating
○ Workplace Design
○ Job Design and Job Rotation

45
 ○ Personal Protective Equipment
○ • Information, Instruction, Training and Supervision
○ Health Surveillance

○
● Health and Safety Aspects of Lighting
○ Incorrect Perception/Failure to Perceive
○ Stroboscopic Effects
○ Colour Assessment
○ Disabling and Discomfort Glare
○ Eye Tissue Damage from Light Exposure
○ Visual Fatigue
○ Effect on Attitudes
● Measurement and Assessment of Light Levels
○ Instrumentation
○ Units
○ Measurement
○ Assessment of Lighting Levels and Standards

○
● Welfare facilities
○ Sanitary Conveniences
○ Washing Facilities
○ Drinking Water
○ Accommodation for Clothing
○ Changing Facilities
○ Rest and Eating Facilities
● Special Circumstances
○ Welfare Facilities for Pregnant Women and Nursing Mothers
○ Smoking at Work
○ Disabled Persons

○
● The regulations require the employer to: •
○ Assess the first-aid need. •
○ Provide first-aid materials, equipment and facilities. •
○ Provide first-aid personnel. •
○ Inform employees of the first-aid arrangements.

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