3.
10
OCCUPATIONAL HEALTH PROGRAM
3B Group 5
Department of Family and Community Medicine
TOPIC OUTLINE
I. Introduction
II. Occupational Statistics and Diseases
III. Agents of Diseases in the Occupational Environment
IV. Causes of Accidents in the Industry
V. Strategies for Prevention and Control of Occupational
Diseases
VI. Fundamental Principles of Occupational Health and Safety
VII. Occupational Health Services
VIII. Occupational Health Program
IX. National Objectives for Health (2011-2016)
X. Partner Institutions
XI. The World Health Organization Healthy Workplace Model
INTRODUCTION
 Occupational Health and Safety
o Aim at:
 Promotion and maintenance of the highest degree of
physical, mental, and social well-being of workers in all
occupations
 Prevention among workers of adverse effects on health
caused by their working conditions
 Protection of workers in their employment from risks
resulting from factors adverse to health
 Placing and maintenance of workers in an occupational
environment adapted to physical and mental needs
 Adaptation of work to humans
o Encompasses the social, mental and physical well-being of
workers, i.e. the “whole person”
o Requires the collaboration and participation of both employers
and workers in health and safety programs
o Involves consideration of issues relating to occupational
medicine, industrial hygiene, toxicology, education,
engineering safety, ergonomics, psychology, etc.
Issues on Occupational Health and Safety
 The human, social and economic costs of occupational accidents,
injuries and diseases and major industrial disasters have long been
cause for concern at all levels from the individual workplace to the
national and international
 Despite continuous if slow improvements, occupational accidents
and diseases are still too frequent and their cost in terms of human
suffering and economic burden continues to be significant
 Overall occupational accident and disease rates are slowly declining
in most industrialized countries but are level or increasing in
developing and industrializing countries
 Variations in performance:
o Difference between developed and developing countries
o Difference between economic sectors
 highest rates of occupational deaths occur in agriculture,
forestry, mining and construction
o sizes of enterprise
 rate of fatal and serious injuries in small workplaces
(defined as those with fewer than 50 employees) is twice
that in large workplaces (defined as those with more than
200 employees)
1 of 16 [Caryl, Fritz & Ena A.]
January 31, 2018
OCCUPATIONAL STATISTICS AND DISEASES
Definitions
 Working-age population
o number of people who meet the criteria of specific minimum
age and who are asked about their economic activity (ILO)
 Labor force
o 15 years old and above who are economically active
(contribute in the production of goods and services in the
country), at a specific time period (DOLE, PSA)
o Consists of the members of population who are 15 – 64 years
old
o Conditions accdg to Article 139 of PD 442 Labor Code of the
Philippines:
1. No child below fifteen (15) years of age shall be
employed, except when he works directly under the sole
responsibility of his parents or guardian, and his
employment does not in any way interfere with his
schooling
2. Any person between fifteen (15) and eighteen (18) years
of age may be employed for such number of hours and
such periods of the day as determined by the Secretary of
Labor and Employment in appropriate regulations
3. The foregoing provisions shall in no case allow the
employment of a person below eighteen (18) years of age
in an undertaking which is hazardous or deleterious in
nature as determined by the Secretary of Labor and
Employment
o Article 287 of PD 442 stated that the mandatory retirement age
is 65 years old
 Labor force survey
o Nationwide quarterly survey of households to gather data
about the demographic and socio-economic characteristics of
the population
o Objective: to provide a quantitative framework for the
preparation of plans and formulation of policies affecting the
labor market
 Labor Force Participation Rate (LFPR) - proportion of total labor
force to the total household population 15 years old and over
 Employment Rate - proportion of employed persons to the total
labor force
 Unemployment Rate - proportion of unemployed persons to the
total labor force
 Underemployment Rate – proportion of underemployed persons
to total employed persons
Occupational Statistics (2017)
 LFPR of 61.2% out of 69.9 million population 15 years old and over
 About 42.8 million economically active population comprising of
either employed or unemployed persons
 Annual employment rate estimated at 94.3%; annual unemployment
rate 5.7%; and annual underemployment rate 16.1%
 Approximately 42.1 million are in the labor force
 Negros Island Region recorded the highest LFPR at 66.1 percent,
while Autonomous Region in Muslim Mindanao (ARMM) had the
lowest LFPR at 44.3 percent
 four regions with the lowest employment rates include: Ilocos
Region (91.3%), National Capital Region (NCR) (91.5%), Caraga
(91.5%), and CALABARZON (91.8%)

 Highest employment rate in Caraga (95.7%) and Region XII
(95.7%)
 According to the modeled ISO estimate on employment distribution,
16.3%, 27.7%, 56.1%, and 35.8% of the total employment in the
Philippines were under industry, agriculture, services, and
vulnerable employment, respectively
Occupational Diseases
 More than 2.78 million deaths occur per year as a result of
occupational accidents or work-related diseases
 374 million non -fatal work-related injuries and illnesses occur each
year
 main causes of death from all work-related diseases were
circulatory diseases (31%), work-related cancers (26%), respiratory
diseases (17%) and occupational injuries (14%)
Figure 1. Breakdown of the estimated Fatal Work-Related Mortality by
Cause in 2015
 Proportion of the cause of fatal work-related diseases had remained
almost the same except for an increased proportion of respiratory
diseases occurring in all the regions
 Circulatory diseases had increased in all regions except for HIGH
and EURO
 Proportion of work-related cancer (malignant neoplasm) dominated
the fatal work-related diseases in high income countries
Figure 2. Fatal Work-Related Mortality by WHO regions and cause in
2015.
 Asia had the highest number of work-related mortality among the
five regions
 Asia had the highest number of work-related deaths in each disease
category
 Locally, the number of occupational diseases doubled from 2011 to
2013; administrative and support service activities recorded the
largest share of occupational diseases in 2013 (32.7%), taking the
spot of manufacturing, which was the top in 2011
 Top 5 industries causing occupational diseases locally (2013):
administrative and support service activities (33%), Manufacturing
(30%), Wholesale and Retail Trade, Repair of Motor Vehicles and
Motorcycles (6%), Mining and Quarrying (5%), and Informations
and Communications (4%)
2 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 Back pain (32%) was set as the most common occupational disease
affecting workers in establishments employing 20 or more workers,
for both 2011 and 2013. This was followed by peptic ulcer (11%),
essential hypertension (11%), neck-shoulder pain (11%),
occupational dermatitis (5%), and occupational asthma (5%)
AGENTS OF DISEASES IN THE OCCUPATIONAL ENVIRONMENT
Physical Agents
 Physical factors, hazards, or agents refer to noise, illumination,
ventilation, temperature and humidity, ionizing radiation, abnormal
pressure (due to altitude), and the like which may place added
stress on the body.
Noise
 Considered as any unwanted sound that may adversely affect the
health and well-being of individuals or populations.
 Excessive exposure to noise might result in different acute
conditions such as communication problems, decreased
concentration, sleepiness and eventually can interfere with job
performance
 Characteristics of Noise:
o Number of pressure variations per second
o Hertz (Hz)- cycles per seconds
o Human ear has an audible range of 20-20,000 Hz while for
speech; it is at 500-2000 Hz
o Expressed in decibel (dB)
o Threshold for audibility is at 0 dB while for pain is at120 dB
 Noise-induced hearing loss can occur if the sound is 85 decibels or
higher.
o Continuous exposure to noise of > 90 DB leads to sensorineural
type of hearing loss. Workplaces with this kind of noise include
printing press, construction sites and metal castings.
o Rupture of the tympanic membrane leads to conductive hearing
loss.
o Continuous exposure to sounds of 80-90 decibels of higher in 8
hours for 20 years may lead to sensorineural hearing loss.
 If you cannot properly hear each other at a distance of 3 feet, it is
already considered as a high-risk place.
 The threshold limit values refer to sound pressure that represents
conditions under which it is believed that nearly all workers may be
repeatedly exposed without adverse effect on their ability to hear
and understand normal speech.
 For occupational noise, the best characterized health outcome is
hearing impairment.
 Exposure to excess noise - as assessed by audiometry; defined as a
change in hearing thresholds of an average 10 dB or more at 2000,
3000 and 4000 Hz in either ear (poorer hearing)
 Noise-induced Hearing Loss (NIHL) is measured by comparing the
threshold of hearing at a specified frequency with a specified
standard of normal hearing, and is reported in units of decibel
hearing loss (dBHL).
 Threshold shift is the precursor of NIHL, the main outcome of
occupational noise.
 Because hearing impairment is usually gradual, the affected worker
will not notice changes in hearing ability until a large threshold shift
has occurred.
 Noise-induced hearing impairment occurs predominantly at higher
frequencies (3000−6000 Hz), with the largest effect at 4000 Hz.
 It is irreversible and increases in severity with continued exposure.
Table 1. Permissible noise exposure limit (PEL) criteria as per OSHA
Duration per day, hours Sound levels, dBA, slow
response

8 90
6 92
4 95
3 97
2 100
1-1/2 102
1 105
1/2 110
1/4 115
 The Occupational Safety & Health Administration (OSHA)
recommends that noise should be controlled below a level
equivalent to 85 dB for eight hours to minimize occupational noise-
induced hearing loss; and has set the permissible exposure limit to
90dB for all workers for an 8-hour workday.
 Workers in noisy surroundings should be tested periodically for
hearing loss.
Figure 3. Distribution and number of permanent hearing loss cases
reported by clinicians in Michigan, by industry, 2000 (NIOSH, 2004)
 Feasible administrative or engineering controls shall be utilized
when workers are exposed to sound levels exceeding those specified
thereof when measured on a scale of a standard sound level meter at
slow response.
 If such controls fail to reduce sound within the specified levels, ear
protective devices capable of bringing the sound level to permissible
noise exposure shall be provided by the employer and used by the
worker.
 Exposures to impulsive or impact noise shall not exceed 140
decibels peak sound pressures level (ceiling value).
Illumination
 Lighting is an essential provision for any workplace. Improper or
poor lighting can cause eye strain, headaches and discomfort.
 In addition, it can be a safety hazard such as misjudgment of the
position, shape or speed of an object can lead to accidents and
injury.
 Occupational effect of visual fatigue includes loss of productivity,
increased accident rate, more mistakes, lowering of quality, and
visual complaints
3 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 As per Rule 1070: Occupational Health and Environmental
Control, the following are the general guidelines regarding
illumination:
General Provisions
 All places where persons work or pass or may have to work or pass
in emergencies, shall be provided during time of use with adequate
natural lighting or artificial lighting or both, suitable for the
operation and the special type of work performed.
Natural Lighting
 Skylights and windows should be located and spaced so that
daylight conditions are fairly uniform over the working area.
 Where necessary, skylights and windows should be provided with
means to avoid glare.
 A regular system of cleaning skylights and windows should be
established to ensure that they are kept clean at all times.
Artificial Quality
 Artificial lighting shall be provided when daylight fails or for area
where the daylight illumination is insufficient.
 The general lighting should be of uniform level, widely distributed to
avoid harsh shadows or strong contrast and free from direct or
reflected glare.
 Where intense local lighting is necessary, a combination of general
and supplementary lighting at the point of work may be provided.
 Supplementary lighting shall be specially designed for the particular
visual task and arranged or provided with shading or diffusing
devices to prevent glare.
Intensity
 Artificial lighting shall be adequate at the place of work for the
operation or work performed.
 A minimum of 20 lux (2 foot candles) shall be provided for yards,
roadways and outside thoroughfares.
 A minimum of 50 lux (5-foot candles) shall be provided:
o where discrimination of detail is not essential, such as handling
coarse materials, coal or ashes, rough sorting or grinding of clay
products;
o for passageways, corridors, stairways, warehouses, storerooms
for rough and bulky materials.
 A minimum of 100 lux (10 foot candles) shall be provided:
o where slight discrimination of detail is essential such as for the
production of semi-finished iron and steel products, rough
assembling, milling of grains, opening, picking and carding of
cotton, or other primary operation in most of the industrial
processes; and
o for engine and boiler rooms, passenger and freight elevators,
crating and boxing departments, receiving and shipping rooms,
storerooms, and stockrooms for medium and fine materials,
locker rooms, toilets, and washrooms.
 A minimum of 200 lux (20 foot candles) shall be provided where
moderate discrimination of details is essential, such as for medium
assembling, rough bench and machine work, rough inspection of
testing of products, sewing light-colored textile or leather products,
canning and preserving, meat packing, planing of lumber and
veneering.
 A minimum of 300 lux (30 foot candles) shall be provided where
close discrimination of details is essential such as for medium bench
and machine work, medium inspection, fine testing, flour grading,
leather finishing and weaving cotton goods or light colored

cloth/goods or for office desk work with intermittent reading and
writing for filing and mail sorting.
 A minimum of 500 to 1,000 lux (50 to 100 foot candles) shall be
provided where discrimination of fine details is involved under
conditions of a fair degree of contrasts for long assembling, fine
bench and machine work, fine inspection, fine polishing and
beveling of glass, fine wood-working and weaving dark colored
cloth/goods, or for accounting, bookkeeping, drafting, stenographic
work, typing or other prolonged close office desk work.
 A minimum of I 000 lux (1 00 foot candles) shall be provided where
discrimination of extremely fine detail is involved under conditions
of poor contrast for long periods of time, such as for extra fine
assembling instrument, jewellery, and watch manufacturing,
grading and sorting tobacco products, make-up and proof-reading in
printing plants, and inspection of sewing dark-colored cloth
products.
 The provisions of paragraphs 2 to 8 apply to lighting equipment
under average operating conditions. Where conditions allow, it may
be necessary to provide initially an illumination of at least 25%
more. In locations where dirt will collect rapidly, the initial level
should be at least 50% above the recommended standards.
 Any windowless room shall be provided with general lighting
sufficient in intensity for the most exacting operations carried
therein.
Note: I foot candle = 10.75 lux
For purpose of computation use I foot candle = 10 lux
Emergency Lighting
 Where large numbers of persons are employed in buildings more
than one story in height, emergency lighting system shall be
provided in all important stairways, exits, workplaces and passages.
 Emergency systems shall be capable of producing and maintaining
for at least one (1) hour, a minimum intensity of 5 lux (0.5 ft. candle)
and shall have an energy source independent of the general lighting
system installation.
 Provisions shall be made for the automatic lighting of the emergency
system immediately upon failure of the general lighting system.
Ventilation
Atmospheric Conditions
 Suitable atmospheric conditions shall be maintained in workrooms
by natural or artificial means to avoid insufficient air supply,
stagnant or vitiated air, harmful drafts, excessive heat or cold,
sudden variations in temperature, and where practicable, excessive
humidity or dryness and objectionable odors.
Air Supply
 Clean fresh air shall be supplied to enclosed workplaces at an
average rate of not less than 20 to 40 cubic meters (700 to 1400 cu.
ft.) an hour per worker, or at such a rate as to effect a complete
change of air a number of times per hour varying from four (4) for
sedentary workers to eight (8) for active workers.
 Where an adequate supply of fresh air cannot be obtained by natural
ventilation or where it is difficult to get the desired amount of air at
the center of the workrooms without creating uncomfortable drafts
near the inlets, mechanical ventilation shall be provided.
Cleanliness
 Dusts, gases, vapors, or mists generated and released in work
processes shall be removed at the points of origin and not permitted
to permeate the atmosphere of the workrooms.
4 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 Internal combustion engines fuelled by gasoline, diesel or liquefied
petroleum gas (LPG). Installed in workrooms shall be located such
that exhaust gases are prevented from permeating the atmosphere
of the workrooms.
Air Movements
 The air movement in enclosed workplaces shall be arranged such
that the workers are not subjected to objectionable drafts.
 The air velocity shall not exceed 15 meters (50 ft.) per minute
during the rainy season and 45 meters (150 ft.) per minute during
the summer season.
Temperature Humidity
 A temperature suitable for the type of work performed shall be
maintained in enclosed workplaces and such temperature shall be
increased or decreased and the degree of humidity varied in
accordance with the kind of work.
 All employees shall be protected either by insulation of the
equipment or by other suitable means against radiation and
excessive temperature due to steam and hot water pipes or other
heated machinery or equipment.
 In workplaces involving exposure of workers to unduly high or low
temperatures, passage rooms shall be provided so that the workers
can gradually adjust themselves to the prevailing temperature.
Radiation
Non-ionizing Radiation
 Non-ionizing radiation is described as a series of energy waves
composed of oscillating electric and magnetic fields traveling at the
speed of light. Non-ionizing radiation includes the spectrum of
ultraviolet (UV), visible light, infrared (IR), microwave (MW), radio
frequency (RF), and extremely low frequency (ELF) (OSHA). The
skin and the eyes are most sensitive to damage.
A. Ultraviolet Radiation (UV)
 Ultraviolet radiation (UV) has a high photon energy range and is
particularly hazardous because there are usually no immediate
symptoms of excessive exposure.
o UVA operates in the 400-315nm range
o UVB is present as 315-280nm.
o UVC is at 280-100nm
 Sources of UV radiation include the sun, black lights, welding arcs,
and UV lasers. Prolonged human exposure to solar UV radiation may
result in acute and chronic health effects on the skin, eye and
immune system.
 Sunburn is the most common acute effect of excessive UV radiation
exposure. In long term exposure, UV radiation also causes a number
of degenerative changes in the cells, fibrous tissue and blood vessels
of the skin. These include freckles, nevi and lentigines, which are
pigmented areas of the skin, and diffuse brown pigmentation. UV
radiation accelerates skin aging, and the gradual loss of the skin’s
elasticity results in wrinkles and dry, coarse skin.
B. Visible Light Radiation
 The different visible frequencies of the electromagnetic (EM)
spectrum are "seen" by our eyes as different colors. Good lighting is
conducive to increased production, and may help prevent incidents
related to poor lighting conditions. Excessive visible radiation can
damage the eyes and skin.
C. Infrared Radiation (IR)
 The skin and eyes absorb infrared radiation (IR) as heat. Workers
normally notice excessive exposure through heat sensation and
pain. Sources of IR radiation include furnaces, heat lamps, and IR
lasers.
 Occupational Health Program

D. Radiofrequency and Microwave Radiation Table 3 . Projected threshold estimates of the acute absorbed doses for
 Microwave radiation (MW) is absorbed near the skin, while 1% incidences of morbidity and mortality involving adult human organs
Radiofrequency (RF) radiation may be absorbed throughout the and tissues after whole body gamma ray exposures (ICRP Publication No.
body. At high enough intensities both will damage tissue through 103).
heating. Sources of RF and MW radiation include radio emitters and Time to develop Absorbed dose
cell phones. Effect Organ/Tissue effect (Gy)
E. Extremely Low Frequency Radiation (ELF)
Morbidity 1% incidence
 Extremely Low Frequency (ELF) radiation at 60 HZ is produced by
power lines, electrical wiring, and electrical equipment. Common Temporary
sources of intense exposure include ELF induction furnaces and sterility Testes 3-9 weeks ~0.1
high-voltage power lines. Permanent
F. Laser Hazards sterility Testes 3 weeks ~6
 Lasers typically emit optical (UV, visible light, IR) radiations and are Ovaries <1 week ~3
primarily an eye and skin hazard. Common lasers include CO2 IR
Depression of
laser; helium - neon, neodymium YAG, and ruby visible lasers, and
blood- Bone Marrow 3-7 days ~0.5
the Nitrogen UV laser.
forming process
Ionizing Radiation Main phase of skin Skin (large areas) 1-4 weeks <3-6
 Ionizing radiation is a type of energy released by atoms that travels reddening
in the form of electromagnetic waves (gamma or X-rays) or particles Skin burns Skin (large areas) 2-3 weeks 5-10
(neutrons, beta or alpha). The spontaneous disintegration of atoms
Temporary hair
is called radioactivity, and the excess energy emitted is a form of
loss Skin 2-3 weeks ~4
ionizing radiation
 Natural radiation Cataract Eye Several years ~1.5
o Natural radiation comes from many sources including more Morbidity
than 60 naturally-occurring radioactive materials found in soil, Bone marrow
water and air. Radon, a naturally-occurring gas, emanates from
rock and soil and is the main source of natural radiation. Every syndrome
day, people inhale and ingest radionuclides from air, food and Without medical
water. care Bone marrow 30-60 days ~1
o People are also exposed to natural radiation from cosmic rays, With good
particularly at high altitude medical care Bone marrow 30-60 days 2-3
 Human-made source Gastro-intestinal
o Human exposure to radiation also comes from human-made
sources ranging from nuclear power generation to medical syndrome
uses of radiation diagnosis or treatment. Today, the most -Without medical
common human-made sources of ionizing radiation are X-ray care Small intestine 6-9 days ~6
machines and other medical devices -With good
 The following are from the recommendations of the International medical Small intestine 6-9 days >6
Commission on Radiological Protection which includes 1990
care
recommendation and the updated and summarized threshold
estimates of the acute absorbed doses for 1% incidences of Pneumonitis Lung 1-7 months 6
morbidity and mortality involving adult human organs and tissues
after whole body gamma ray exposures  In cases of a pregnant worker, she can continue working in an X-ray
department as long as there is reasonable assurance that the fetal
Table 2. 1990 Recommendations of the International Commission on dose can be kept below 1 mGy during the pregnancy.
Radiological Protection (ICRP Publication No. 60)  In addition, prenatal exposure to ionizing radiation may induce
Effects One single Prolong brain damage in fetuses following an acute dose exceeding 100 mSv
absorption absorption between weeks 8-15 of pregnancy and 200 mSv between weeks 16-
(Sv- 25 of pregnancy. Before week 8 or after week 25 of pregnancy
(Sv) year) human studies have not shown radiation risk to fetal brain
development
Testis permanent 3.5 - 6.0 2
infertility
Chemical Agents
Ovary permanent 2.5 - 6.0 > 0.2
 Harmful chemical agents include naturally occurring and synthetic
infertility
organic and inorganic chemicals.
Lens of eyes milky of lens 0.5 - 2.0 > 0.1  They exist in the form of solids, liquids, gases, mists, dusts, fumes
cataract 5.0 > 0.15 and vapors, may enter the body through absorption (e.g. direct
Bone marrow Blood forming 0.5 > 0.4 contact through the skin), inhalation, or ingestion.
deficiency  The degree of worker risk from exposure to any chemical hazard
depends on the nature and potency of the toxic effects and the
magnitude and duration of exposure.

5 of 16 [Caryl, Fritz & Ena A.]

 Occupational Health Program

 Route of chemical hazards may either be through inhalation, may cause reactions like eczema or dermatitis. Skin irritants include
ingestion or through skin contact. acids, alkalis, solvents and oils.
 These involve the concepts of acute and chronic toxicity as well as  Respiratory irritants may cause dyspnea, edema or other
local and systemic toxicity. manifestations of inflammation. Some of these are aldehydes,
ammonia, nitrogen dioxide, chlorine and ozone.
Table 4. Difference between acute and chronic chemical toxicity.
Sensitizers/allergens
Acute Chronic
 These substances cause skin or respiratory allergic reactions after
Occurs almost immediately Represents cumulative damage to
repeated exposures.
(hours/days) after an specific organ
 Some common allergens are wood dust, formaldehyde, organic dyes.
exposure systems
Many months or years to have Poisons
recognizable
 Poisons are chemicals that cause life-threatening damage to tissues
clinical disease or internal organs in very small amounts.
Skin Absorption Inhalation  The best-known poison is lead.
Absorption of phenol through the Consumption of lead causing
skin creating a damage to the Lead Poisoning
chemical burn kidneys  Workers can be exposed to lead through inhalation of fumes and
dusts, as well as through ingestion as a result of lead- contaminated
Inhalation Inhalation
hands, food, drinks, cosmetics, tobacco products, and clothing.
Inhalation of formaldehyde Inhalation of asbestos causing  The major occupations and industries associated with lead
causing irritation to cancer to the lungs overexposure include battery manufacturing, pigment
mucus membranes manufacturing, chemical industry, rubber industry, plastics
industry, construction workers, gas station attendants, lead miners,
radiator repairs, welders and many more.
Asphyxiant
 Lead has potential for causing irreversible health effects, including
 An asphyxiant is a substance that can cause unconsciousness or hypotension, CNS problems, anemia and diminished hearing acuity
death by suffocation. Asphyxiants are extreme hazards when before it is clinically recognized.
working in enclosed spaces
 Staudinger and Roth (1998) recommend the following actions to be
 Chemical asphyxiants, which interfere with the transportation or taken upon determining the blood levels of lead of workers:
absorption of oxygen in the body, include carbon monoxide, o Blood lead level > 40ug/dL requires medical intervention
nitrobenzene, hydrogen cyanide, and hydrogen sulphide. o Blood lead level > 60ug/dL or three consecutive measurements
averaging > 50ug/dL indicates the necessity for removal of the
Combustible and Flammables employee from the site.
 Flammable and combustible liquids are liquids that can burn. They
are classified, or grouped, as either flammable or combustible by Carcinogens
their flashpoints.  Carcinogens are identified by their ability to cause cancer in exposed
 In general, flammable liquids will ignite (catch on fire) and burn workers, other human populations, or in test animals. Known
easily at normal working temperatures. Combustible liquids can human carcinogens are substances that have been clearly
burn at temperatures that are usually above working temperatures demonstrated in studies to cause cancer in humans.
 The flashpoint of a liquid is the lowest temperature at which the  Examples include benzene (leukemia), asbestos (lung cancer), 2-
liquid gives off enough vapor in sufficient concentration to form an naphthylamine (bladder cancer) and vinyl-chloride (liver
ignitable mixture with air near the surface of the liquid. As a result, angiosarcoma).
they can be serious fire hazards. Both chemicals burn very fast and  Probable human carcinogens are those whose cause-and-effect
give off heat and thick clouds of black, toxic smoke relationships with cancer are not yet well-established; examples of
 Combustibles are chemicals that will ignite and burn easily when probable human carcinogens are formaldehyde (leukemia) and
subjected to temperature greater than 37.8ºC (100F) and below carbon tetrachloride (liver cancer).
93.3ºC (200F); some of these are acetic acid, kerosene, naphthalene  Many occupational cancers have a long latency period, meaning that
and phenol. Flammables are those that burn when subject to a cancer may develop 10 -20 years or longer after exposure to the
temperature less than 37.8ºC (100F) (OSHA); flammable chemicals carcinogen.
include acetaldehyde, ethyl chloride and petroleum ether.
Teratogens
Corrosives
 Teratogens can cause birth defects, abnormalities, developmental
 Such substances chemically burn tissue and can cause tissue delays, or death in animal offspring in the absence of significant
destruction on site of contact. Skin, eyes and digestive system are harmful effect on the mother.
the most commonly affected parts of the body.
 These materials are usually identified using test animals and may
 Examples include concentrated acids and alkalis, phosphorus. cause similar effects in humans. Lead, xylene and toluene are
teratogens.
Irritants
 A non-corrosive material that causes itching, soreness or
inflammation of exposed skin, eyes or mucous membranes. They

6 of 16 [Caryl, Fritz & Ena A.]

 Occupational Health Program

Reproductive Toxins o Human bodily matter such as blood, tissues, vomit, urine,
 Reproductive toxins can cause sterility, reduced fertility, or other faeces, saliva and breast milk etc., that may contain viral or
adverse reproductive effects (e.g. a mother's ability to produce milk) bacterial diseases
in animal studies or in people exposed in the workplace. o Living animals such as cattle, sheep, poultry, fish and
 Examples include ethylene oxide and glycol ethers. invertebrates, and their urine and faeces
o Animal products such as raw and cooked meat, offal, skins,
blood, milk and eggs
Biological Agents o Laboratory cultures such as animal and human tissue cultures,
 Biological hazards, also known as biohazards, are organic bacterial and cell cultures, and
substances that pose a threat to the health of humans and other o Biohazard waste, sewerage and rubbish
living organisms. In general, biological hazards include pathogenic  The exposure of these biological hazards occurs among health care
micro-organisms, viruses, toxins (from biological sources), spores, workers in fever hospitals, laboratories and general hospitals;
fungi and bioactive substances. among veterinarians and agricultural workers in animal husbandry
 Biological hazards can also be considered to include biological and dairy farms and pet shops; and among sewerage workers, wool
vectors or transmitters of disease. sorters and workers in the leather industry
 Outside the health arena, biological hazards include substances that
cause social and economic disruption, property damage and Table 6. Diseases that can be obtained and the occupation which are
environmental degradation, such as insect plagues or infestations. most likely to be exposed (WHO, 2001)
 Worldwide, it is estimated that around 320 000 workers die each
year from communicable diseases caused by work-related Occupation at risk
exposures to biological hazards Disease Contact Source for
 COSHH classifies biological agents into one of four Hazard Groups exposure
(HG) based on ability to infect healthy humans: (Occupational) Droplet infection, HCW in TB
o pathogenicity to humans Pulmonary contact with treatment centers,
o hazard to employees Tuberculosis infected material from in
o severity of the disease that may result humans labs, and in
o transmissibility to community (sputum) or animals veterinary clinics
o availability of prophylaxis & or effective treatment
 Allocation to a (COSHH) Hazard Group coincides with the minimum
Brucellosis Contact with infected Veterinarians,
containment level required for handling it, but circumstances may
require higher level (but never lower unless a specific derogation is animals or workers in
requested and granted by the HSE). their secretions and agriculture and
products animal
husbandry,
Table 5. The four hazard groups (HSE, 2013).
shepherds, and
Hazard  Unlikely to cause human disease laboratory, and
Group 1 slaughterhouse
Hazard  Can cause human disease and may be hazard to Anthrax Anthrax bacillus Workers in
Group 2 employees; survives, can agriculture and
 it is unlikely to spread to the community and infect skin, lungs, or animal husbandry,
there is usually effective intestine slaughter
 prophylaxis or treatment available houses, tanneries,
and working
Hazard  Can cause severe human disease and may be a in the manufacture
Group 3 serious hazard to of goods
 employees; from wool, hair,
 it may spread to the community, but there is bones, and
usually effective prophylaxis or leather
 treatment available Viral hepatitis B and C Body fluids, Workers who are
Hazard  Causes severe human disease and is a serious contaminated likely to come
glassware and in contact with
Group 4 hazard to employees;
equipments blood and body
 it is likely to spread to the community and
fluids of infected
there is usually no effective
person
 prophylaxis or treatment available
Acquired Sexual contact, Blood bank
Immunodeficiency perinatally, technologies,
 According to HSE (2005), the categorization gives an indication of Syndrome (AIDS) contaminated blood or dialysis,
the inherent hazard of the agents listed, but it does not take into
account the work that you carry out using the agent, (e.g. amount, blood technicians,
titre used or procedures undertaken) nor does it indicate whether products emergency
there may be any additional risks to those who, for example, have room personnel,
reduced or compromised immunity or are pregnant. morticians,
 The main types of biological materials that are potential hazards dentists, medical
found in workplaces are the following (Safe Work Australia, 2011): technicians,

7 of 16 [Caryl, Fritz & Ena A.]


surgeons,
laboratory workers,
prostitutes
Ergonomics
 Ergonomics is the science of designing the workplace, keeping in
mind the capabilities and limitations of the worker.
 Referred to as “human factors”, ergonomics is the scientific
discipline concerned with the understanding of the interactions
among human and other elements of a system, and the profession
that applies theory, principles, data and methods to design in order
to optimize human well.
 It aims to learn about human abilities and limitations, and then
apply this learning to improve people’s interaction with products,
systems and environments, and to improve workspaces and
environments to minimize the risk of injury or harm.
 Poor worksite design leads to fatigued, frustrated and hurting
workers. This rarely leads to the most productive worker. More
likely, it leads to a painful and costly injury, lower productivity and
poor product quality.
 A systematic ergonomics improvement process removes risk factors
that lead to musculoskeletal injuries and allows for improved
human performance and productivity.
Table 7. Benefits of Ergonomics
Ergonomics reduces costs
 By systematically reducing
ergonomic risk factors, you
can prevent costly
musculoskeletal diseases.
Ergonomics improves
 By designing a job to allow
productivity for good posture, less
exertion, fewer motions and
better heights and reaches,
the workstation becomes
more efficient.
Ergonomics improves quality  Poor ergonomics leads to
frustrated and fatigued
workers that don’t do their
best work.
 When the job task is too
physically taxing on the
worker, they may not
perform their job like they
were trained.
Ergonomics improves  Employees notice when the
employee engagement company is putting forth
their best efforts to ensure
their health and safety.
 If an employee does not
experience fatigue and
discomfort during their
workday, it can reduce
turnover, decrease
absenteeism, improve
morale and increase
employee involvement
Ergonomics creates a better  Ergonomics shows your
safety culture company’s commitment to
safety and health as a core
value.
8 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 The cumulative effect of the
previous four benefits of
ergonomics is a stronger
safety culture for your
company.
 Healthy employees are your
most valuable asset; creating
and fostering the safety &
health culture at your
company will lead to better
human performance for
your organization.
Table 8. Primary workplace ergonomic risk factors
High Task Repetition  Many work tasks and cycles
are repetitive in nature, and
are frequently controlled by
hourly or daily production
targets and work processes.
 High task repetition, when
combined with other risks
factors such high force
and/or awkward postures,
can contribute to the
formation of
musculoskeletal diseases
(MSD).
 A job is considered highly
repetitive if the cycle time is
30 seconds or less
Forceful Exertions  Many work tasks require
high force loads on the
human body.
 Muscle effort increases in
response to high force
requirements, increasing
associated fatigue which can
lead to MSD.
Repetitive/Sustained  Awkward postures place
Awkward Postures excessive force on joints and
overload the muscles and
tendons around the effected
joint. Joints of the body are
most efficient when they
operate closest to the mid-
range motion of the joint.
 Risk of MSD is increased
when joints are worked
outside of this mid-range
repetitively or for sustained
periods of time without
adequate recovery time.
CAUSES OF ACCIDENTS
 The ever increasing mechanisation, electrification, chemicalization
and sophistication have made industrial jobs more and more
complex and intricate.
 This has led to increased dangers to human life in industries
through accidents and injuries. In fact, the same underlines the need
for and importance of industrial safety.
 An accident, also known as an unintentional injury, is an
undesirable, incidental, and unplanned event which interrupts the
orderly progress of the work.

 According to the Factories Act, 1948: “It is an occurrence in an
industrial establishment causing bodily injury to a person who
makes him unfit to resume his duties in the next 48 hours”
 An industrial injury is defined as “a personal injury to an employee
which has been caused by an accident or an occupational disease
and which arises out of or in the course of employment
Types of accidents
 Accidents may be of different types depending upon the severity,
durability and degree of the injury.
 Major Accident - an accident causing death or permanent or
prolonged disability to the injured employee
 Minor Accident - a cut that does not render the employee disabled
 External Injury - when an employee gets injury with external signs
 Internal Injury - injury without showing external signs such as a
fractured bone
 Temporary Accident - when an injury renders an injured employee
disabled for a short period, say, a day or a week,
 Permanent Accident - making injured employee disabled forever
 Disability caused by accident may be partial or total, fatal or non-
fatal.
 No accident occurs automatically. Instead, certain factors cause
accidents. It has been noticed that an accident does not have a single
cause but a multiplicity of causes, which are often closely related
Causes of accidents
Unsafe conditions
 Unsafe working conditions are the biggest cause of accidents.
 These are associated with detective plants, tools, equipment’s,
machines, and materials. Such causes are known as ‘technical
causes’.
 They arise when there are improper guarded equipment’s, defective
equipment’s, faulty layout and location of plant, inadequate lighting
arrangements and ventilation, unsafe storage, inadequate safety
devices, etc.
 The psychological reasons such as working overtime, monotony,
fatigue, tiredness, frustration and anxiety are also some other causes
that cause accidents.
 Safety experts identify that there are some high danger zones in an
industry.
 These are, for example, hand lift trucks, wheel-barrows, gears and
pulleys, saws and hand rails, chisels and screw drivers, electric drop
lights, etc., where about one-third of industrial accidents occur.
Unsafe acts
 Industrial accidents occur due to certain acts on the part of workers.
These acts may be the result of lack of knowledge or skill on the part
of the worker, certain bodily defects and wrong attitude. ‘
 Examples are:
o Operating without authority.
o Failure to use safe attire or personal protective equipment’s,
o Careless throwing of material at the work place.
o Working at unsafe speed, i.e., too fast or too low.
o Using unsafe equipment, or using equipment’s unsafely.
o Removing safety devices.
o Taking unsafe position under suspended loads.
o Distracting, teasing, abusing, quarrelling, day-dreaming,
horseplay
o One’s own accident prone personality and behavior.
9 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
Other causes
 These causes arise out of unsafe situational and climatic conditions
and variations.
 These may include excessive noise, very high temperature, humid
conditions, bad working conditions, unhealthy environment,
slippery floors, excessive glare, dust and fume, arrogant behaviour
of domineering supervisors, etc.
STRATEGIES FOR PREVENTION AND CONTROL OF OCCUPATIONAL
DISEASES
 Controlling exposures to occupational hazards is the fundamental
method of protecting workers. Traditionally, a hierarchy of controls
has been used as a means of determining how to implement feasible
and effective control solutions.
Figure 4. Hierarchy of Control of Occupational Diseases
Elimination and Substitution
 Elimination and substitution, while most effective at reducing
hazards, also tend to be the most difficult to implement in an
existing process.
 If the process is still at the design or development stage, elimination
and substitution of hazards may be inexpensive and simple to
implement.
 For an existing process, major changes in equipment and
procedures may be required to eliminate or substitute for a hazard.
Where necessary for the protection of workers, the competent
authority should require the replacement of hazardous substances
by substitute materials, in so far as this is possible.
Engineering Control
 Engineering controls are favored over administrative and personal
protective equipment (PPE) for controlling existing worker
exposures in the workplace because they are designed to remove the
hazard at the source, before it comes in contact with the worker.
 Well-designed engineering controls can be highly effective in
protecting workers and will typically be independent of worker
interactions to provide this high level of protection.
 The initial cost of engineering controls can be higher than the cost of
administrative controls or PPE, but over the longer term, operating
costs are frequently lower, and in some instances, can provide a cost
savings in other areas of the process.
 One type of engineering control involves built-in protection as part
of the work process concerned. These engineering controls should
be built in during the design phase; they may be implemented later,
but this tends to be more costly.

 Engineering controls may be more expensive to implement than
methods which depend on continual vigilance or intervention by the
worker, but they are safer.
 Another form of engineering control is the mechanization process.
This involves the use of a machine to do dangerous work rather than
exposing a worker to the hazard.
 Where the elimination of hazardous substances is not practicable in
existing plants and processes, employers or managers should apply
technical measures to control the hazard or risk by changing the
process, so that the job is done in a completely different and safer
way, or by enclosing the process completely to keep the hazard from
reaching the worker.
 Good work practices and working methods can ensure that
hazardous materials are contained before they become a problem.
Where complete containment has not been achieved, strict
housekeeping and personal hygiene are absolutely essential to
ensure workplace and personal safety.
Administrative Control and Personal Protective Equipment
 Administrative controls and Personal Protective Equipment are
frequently used with existing processes where hazards are not
particularly well controlled.
 Administrative controls and PPE programs may be relatively
inexpensive to establish but, over the long term, can be very costly
to sustain.
 These methods for protecting workers have also proven to be less
effective than other measures, requiring significant effort by the
affected workers
 When none of the above approaches is feasible, or when the degree
of safety achieved by them is considered inadequate, the only
solution is to provide exposed persons with suitable personal
protective equipment and protective clothing.
 This is the final line of defense and should be used only as a last
resort, since it entails reliance on active cooperation and compliance
by the workers.
 Moreover, such equipment may be heavy, cumbersome and
uncomfortable, and may restrict movement. Employers should
consult workers or their representatives on suitable personal
protective equipment and clothing, having regard to the type of
work and the type and level of risks.
 Furthermore, when hazards cannot be otherwise prevented or
controlled, employers should provide and maintain such equipment
and clothing as are reasonably necessary, without cost to the
workers.
 The employer should provide the workers with the appropriate
means to enable them to use the individual protective equipment.
Indeed, the employer has a duty to ensure its proper use.
 Protective equipment and clothing should comply with the
standards set by the competent authority and take ergonomic
principles into account. Workers have the obligation to make proper
use of and take good care of the personal protective equipment and
protective clothing provided for their use.
FUNDAMENTAL PRINCIPLES OF OCCUPATIONAL HEALTH AND
SAFETY
 According to the Fundamental Principles of Occupational Health and
Safety (2008), occupational safety and health is an extensive
multidisciplinary filed, that involves on issues related to scientific
areas such as medicine- including physiology and toxicology –
ergonomics, physics and chemistry, as well as technology,
economics, law and other areas specific to various industries and
activities.
10 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 The following are the basic principles of Occupational Health and
Safety:
o All workers have rights.
o Occupational safety and health policies must be established.
o A national programme on occupational safety and health must
be formulated.
o Social partners (that is, employers and workers) and other
stakeholders must be consulted.
o Occupational safety and health programmes and policies must
o aim at both prevention and protection.
o Continuous improvement of occupational safety and health
must be promoted.
o Information is vital for the development and implementation of
effective programmes and policies.
o Health promotion is a central element of occupational health
practice.
o Occupational health services covering all workers should be
established.
Rights and Duties
 The general principles are essential in for the creation of effective
policies and to ensure that they are enforces. Moreover, these
principles provide ethical considerations regarding matters that
involve the rights of the people involved in the concept of
occupational health and safety.
 The responsibilities of governments, employers and workers should
be complementary and mutually reinforcing in the common task of
promoting occupational safety and health to the greatest extent
possible within the constraints of national conditions and practice.
Workers’ Right
 It is increasingly recognized that the protection of life and health at
work is a fundamental workers’ right; in other words, decent work
implies safe work.
 Furthermore, workers have a duty to take care of their own safety,
as well as the safety of anyone who might be affected by what they
do or fail to do. This implies a right to adequate knowledge, and a
right to stop work in the case of imminent danger to safety or
health. In order to take care of their own safety and health, workers
need to understand occupational risks and dangers.
 They should therefore be properly informed of hazards and
adequately trained to carry out their tasks safely. To make progress
in occupational safety and health within enterprises, workers and
their representatives have to cooperate with employers, for
example by participating in elaborating and implementing
preventive programmes.
Employers’ Responsibilities
 Because occupational hazards arise at the workplace, it is the
responsibility of employers to ensure that the working environment
is safe and healthy. This means that they must prevent, and protect
workers from, occupational risks. But employers’ responsibility
goes further, entailing knowledge of occupational hazards and a
commitment to ensure that management processes promote safety
and health at work.
 Training is one of the most important tasks to be carried out by
employers. Workers need to know not only how to do their jobs, but
also how to protect their lives and health and those of their co-
workers while working. Within enterprises, managers and
supervisors are responsible for ensuring that workers are
adequately trained for the work that they are expected to
undertake. Such training should include information on the safety
 Occupational Health Program

and health aspects of the work, and on ways to prevent or minimize the workers, and their representatives, in the
exposure to hazards. establishment/undertaking of the following:
 On a larger scale, employers’ organizations should instigate training o The requirements for establishing and maintaining a safe and
and information programmes on the prevention and control of healthy working environment which will facilitate optimal
hazards, and protection against risks. Where necessary, employers physical and mental health in relation to work, and
must be in a position to deal with accidents and emergencies, o The adaptation of work to the capabilities of workers in the
including providing first-aid facilities. light of their state of physical and mental health.
 Adequate arrangements should also be made for compensation of  In order to provide occupational health services in establishments,
work-related injuries and diseases, as well as for rehabilitation and there has to be occupational health personnel who are qualified
to facilitate a prompt return to work. In short, the objective of first-aider, nurse, dentist, or physician.
preventive programmes should be to provide a safe and healthy  On the other hand, an occupational health practitioner refers to a
environment that protects and promotes workers’ health and their physician, nurse, engineer, dentist, or chemist duly licensed to
working capacity. practice his or her profession in the Philippines.
 Occupational health services in the workplace with the help of
Government’s Duties occupational health personnel are expected to fulfill the following
 Governments are responsible for drawing up occupational safety functions:
and health policies and making sure that they are implemented. o Identification and assessment of the risks from health hazards
Policies will be reflected in legislation, and legislation must be in the workplace
enforced. But legislation cannot cover all workplace risks, and it may o Surveillance of the factors in the working environment and
also be advisable to address occupational safety and health issues by working practices which may affect the worker’s health,
means of collective agreements reached between the social including sanitary installations, canteens, and housing where
partners. these facilities are provided by the employer
 Policies are more likely to be supported and implemented if o Advice on planning and organization of work, including the
employers and workers, through their respective organizations, design of the workplace, on the choice, maintenance, and
have had a hand in drawing them up. This is regardless of whether condition of machinery and other equipment, and on
they are in the form of laws, regulations, codes or collective substances used in work
agreements. o Participation in the development of programs for the
 The competent authority should issue and periodically review improvement of working practices as well as testing and
regulations or codes of practice; instigate research to identify evaluation of health aspects of new equipment
hazards and to find ways of overcoming them; provide information o Advice on occupational health, safety and hygiene, and on
and advice to employers and workers; and take specific measures to ergonomics and individual and collective protective equipment
avoid catastrophes where potential risks are high. The occupational o Surveillance of worker’s health in relation to work
safety and health policy should include provisions for the o Promoting the adaptation of work to the workers
establishment, operation and progressive extension of occupational o Collaboration in providing information, training and education
health services. in the fields of occupational health and hygiene and
 The competent authority should supervise and advise on the ergonomics
implementation of a workers’ health surveillance system, which o Organizing of first-aid and emergency treatment;
should be linked with programmes to prevent accident and disease o Participation in analysis of occupational accidents and
and to protect and promote workers’ health at both enterprise and occupational diseases
national levels. The information provided by surveillance will show  In addition to these functions, there are different specifications per
whether occupational safety and health standards are being type of establishments (i.e. single, non-hazardous establishments
implemented, and where more needs to be done to safeguard and single, hazardous medium scale establishments) and number of
workers. workers
 As the definition indicates, the main focus in occupational health is
on three different objectives: Table 9. Required Occupational Health Personnel per type of
o The maintenance and promotion of workers’ health and establishment and number of employees
working capacity; Number
Type of Required Occupational Health
o The improvement of work and working conditions so that they of
establishment Personnel
are conducive to safety and health; and workers
o The development of work organizations and preventive safety Single, non- 100-199 Occupational health practitioner
and health cultures in a direction that supports safety and hazardous shall conduct inspection of the
health at work. Such development also promotes a positive medium scale workplace at least once every three
social climate and enhances the smooth operation and possibly establishment (3) months
also the productivity of working enterprises. The term 100-199 shall have a part-time occupational
“culture” in this context means an environment reflecting the single, hazardous health physician as one of its
value systems adopted by the undertaking concerned. Such a medium scale personnel, who shall perform the
culture is reflected in practice in the managerial systems, establishment duties of an occupational health
personnel policy, principles for participation, training policies physician
and quality management of the undertaking. hazardous and 200 and shall have a part-time or full-time
non-hazardous more occupational health physician as
OCCUPATIONAL HEALTH SERVICES large scale one of its personnel
 Occupational Health Services are services entrusted with essentially establishments
preventive functions and responsible for advising the employers,

11 of 16 [Caryl, Fritz & Ena A.]

 Occupational Health Program

 All companies in the Philippines are under the Rule 1960 of the  Act as adviser to
Department of Labor and Employment which seeks to establish management and labor on
occupational health services in accordance with the guidelines and all health matters;
regulations provided for under the said rule.  And report directly to top
 The general provisions of this said rule are as follows: management in order to be
o Every employer shall establish in his place of employment effective.
occupational health services in accordance with the regulation
and guidelines provided for under this rule.  In accordance to rule 1960, every employer shall organize and
o The employer, the workers, and their representatives, where maintain an occupational health program to achieve the following
they exist shall cooperate and participate in the objective:
implementation of the organizational and other measures o Assess the worker’s physical, emotional and psychological
relating to occupational health services. assets as well as his liabilities in order to facilitate his proper
 This Rule shall apply to all establishments whether for profit or not, placement and ensure the suitability of individuals according
including the Government and any of its political subdivisions and to their physical capacities, mental abilities and emotional
government-owned or controlled corporations. make-up in work which they can perform with an acceptable
 The Bureau of Dental Health Services of the Department of Health degree of efficiency without endangering their own health and
shall be responsible for the development and enforcement of dental safety and that of their co-workers;
standards. o Protect employees against health hazards in their working
 Since occupational health services require physicians and nurses, it environment in order to prevent occupational as well as non-
is also imperative to discuss their duties and responsibilities in the occupational diseases;
workplace. o Provision for first-aid, emergency services and treatment
 These duties of promoting and maintaining the health and well- depending on the nature of the industry;
being of the workers remain the same even if the practitioners are o Assure adequate medical care of ill and injured workers;
working part-time or full-time. o Encourage personal health maintenance and physical fitness
and proper nutrition practices; and
Table 10. Duties and responsibilities of Occupational Health Physicians o Provide guidance, information and services for family planning
and Nurses programs.
Physician Nurse  With these objectives, the health program shall activities that are
 Organize, administer and  In the absence of a physician, essential in maintaining and monitoring the health and well-being of
maintain an occupational to organize and administer a every employee. These activities may be done annually or as the
health service program health service program need arises. The following activities include:
integrating therein an integrating occupational o Maintenance of a healthful work environment by requiring
occupational safety safety, otherwise, these occupational health personnel to conduct regular appraisal of
program. activities of the nurse shall sanitation conditions, periodic inspection of premises,
 Continually monitor the be in accordance with the including all facilities therein, and evaluate the working
work environment for physician environment in order to detect and appraise occupational
health hazards through  Provide nursing care to health hazards and environmental conditions affecting comfort
periodic inspection of the injured or ill workers; and job efficiency
workplace;  Participate in health o Health Examinations (entrance, periodic, special, transfer,
 Prevent diseases or injury maintenance examination. If separation)
in the workplace by a physician is not available, o Diagnosis and treatment of all injuries and occupational and
establishing proper medical to perform work activities non-occupational diseases
supervision over which are within the scope o Immunization programs
substances used, processes, allowed by the nursing o Accurate and complete medical records of each worker
and work environment; profession, and if more starting from his first examination or treatment, which must be
 Conserve the health of the extensive examinations are under the exclusive custody and control of the occupational
workers through physical needed, to refer the same to a health personnel. Such records shall be made available to the
examinations, proper physician; worker or his duly authorized representative and ~ not be
advice for placement and  Participate in the used for discriminatory purpose or in any other manner
health education; maintenance of occupational prejudicial to his interest
 Provide medical and health and safety by giving o Health Education and Counseling in which the occupational
surgical care to restore suggestions in the health and safety personnel shall cooperate with the
health and earning capacity improvement of working supervisors in imparting appropriate health and safety
of injured workers; environment affecting the information to employees, such as health hazards and proper
 Maintain and analyze health and wellbeing of the precautions, habits of cleanliness, orderliness, safe work
records of all medical cases workers; practices, use and maintenance of available personal protective
and to prepare and submit  Maintain a reporting and clothing and devices, and the use of available health services
to the employer annual records system, and, if a. and facilities
medical reports, using form physician is not available, o Nutrition program which shall be under the dietician and
DOLE/BWC/OH-47, as prepare and submit an supervised by a physician if the latter is present.
required by this Standards; annual medical report, using
form DOLE/BWC/HSD/OH- Physical Examination
 Conduct studies on
occupational health within 47, to the employer, as  Health examinations are required in every establishment who hires
his means and resources; required by this Standards workers as mentioned above. These physical examinations are

12 of 16 [Caryl, Fritz & Ena A.]


essential as it provides baseline knowledge on the state of health of
an employee who will start his/ her job in a specific company.
 This will also determine special needs of the employee if there is
any. This will also determine if a person is fit for the job that he/she
is applying for.
 Moreover, physical examination must also be done when an
employee is about to be transferred of separated from the employer
and when the employee became sick or injured.
 All physical examinations must be complete and thorough, free of
charge, and include X-ray or special laboratory examinations when
necessary due to the peculiar nature of the employment. The results
of these physical examinations shall be recorded carefully and
legibly on appropriate forms by the health service personnel
charged with such responsibility.
 Records of physical examinations and all information obtained by
the health personnel shall be considered strictly confidential.
Pre- Employment Physical Examination
 Shall be conducted to determine the physical condition of the
prospective employee at the time of hiring and to prevent the
placement of a worker on a job where, through some physical or
mental defects, he may be dangerous to his fellow workers or to
property.
 These examinations should be a general clinical examination
including special laboratory examinations when necessary due to
the peculiar nature of the workers’ prospective employment and
include chest x-ray examinations.
 Under the following circumstances, x-ray examinations be rendered
free of charge. If the establishment does not have x-ray facilities, the
x-ray examinations must be done by government clinics or hospitals
Table 11. Classifications of applicants after the pre-employment physical
examinations
Classification Description
Class A Physically fit for any work
Physically under-developed or with correctible
defects, (error of refraction dental caries, defective
Class B
hearing, and other similar defects) but otherwise fit
to work
Employable but owing to certain impairments or
conditions, (heart disease, hypertension, anatomical
Class C defects) requires special placement or limited duty
in a specified or selected assignment requiring
follow-up treatment/periodic evaluation
Unfit or unsafe for any type of employment (active
Class D PTB, advanced heart disease with threatened failure,
malignant hypertension, and other similar illnesses).
Periodic Annual Mediacal Examination
 Periodic annual medical examinations shall be conducted in order to
follow-up previous findings, to allow early detection of occupational
and non-occupational diseases, and determine the effect of exposure
of employees to health hazards. These examinations:
o Shall be as complete and as thorough as the pre-employment
examinations and include general clinical examinations
o Shall include all special examinations and/or investigations
deemed necessary for the diagnosis of these diseases which
will be free of charge in case the workers are exposed to
occupational health hazards
o Shall include, whenever feasible, a chest x-ray examination at
least once a year which shall be rendered free of charge to the
workers
13 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
o Shall be as frequent as the nature of employment may warrant
taking into consideration the special hazards involved and
their relative importance
o Shall include regular biochemical monitoring which shall be
conducted free of charge for workers exposed to toxic
substances/pesticides classified under toxicity categories I and
II of the World
o Health Organization (WHO) toxicity classification standards
o Shall have an interval of no longer than one year between two
(2) consecutive periodic physical examinations
 In occupations where there is a risk to the health of the worker
either due to toxic substances they handle or of the environment in
which they work, only persons who are pronounced medically fit
shall be employed.
 When occupational diseases have been detected in workers and
continued employment might jeopardize their health, their
employment shall be discontinued until after their complete or
satisfactory recovery.
 If circumstances permit, such workers shall meanwhile be given
some other job consistent with their state of health and which shall
not impede or retard their recovery.
Other Special Examinations
 These may be required where there is undue exposure to health
hazards, such as lead, mercury, hydrogen sulfide, sulfur dioxide,
nitro glycol and other similar substances.
Return to Work Examination
 These are conducted to detect if the illness of the worker is still
contagious. This will also check if the worker is fit to return to work.
Separation from Employment Examination
 These are necessary to determine if the employee is suffering from
an occupational disease or injury that has not healed yet.
OCCUPATIONAL HEALTH PROGRAM
World Health Organization Global Plan Of Action On Workers’
Health 2008-2017
 The plan of action deals with all aspects of workers' health,
including primary prevention of occupational hazards, protection
and promotion of health at work, employment conditions, and a
better response from health systems to workers' health.
Objective 1: To devise and implement policy instruments on
workers’ health
 Countries and member states should formulate their national policy
frameworks to promote workers' health, strengthening their
ministries of health, and integrating workers' health concerns into
national health strategies.
 They also need to minimize the gaps between different groups of
workers in terms of levels of risk and health status. High-risk
economic sectors and vulnerable working populations, such as
younger and older workers, need special consideration and
protection.
Objective 2: To protect and promote health at the workplace
 Member states should improve their health risk management.
 They must adopt basic occupational health standards and make
certain that all workplaces comply with minimum requirements.
 They must work to promote health and prevent non-communicable
diseases in the workplace, in particular by advocating healthy diet
and physical activity among workers, and promoting mental and
family health at work.

 Additionally, the plan suggests that global health threats, such as
tuberculosis, HIV/AIDS, malaria, and avian influenza, can also be
prevented and controlled at the workplace
Objective 3: To improve the performance of and access to
occupational health services
 Member states can improve their coverage and quality of
occupational health services by integrating their development into
national health strategies, health-sector reforms and plans for
improving health systems performance; determining standards for
organization and coverage of occupational health services; setting
targets for increasing the coverage of the working population with
occupational health services; creating mechanisms for pooling
resources and for financing the delivery of occupational health
services; ensuring sufficient and competent human resources; and
establishing quality assurance systems.
Objective 4: To provide and communicate evidence for action and
practice
 Member states must design systems for surveillance of workers'
health. This includes establishing national information systems,
building capability to estimate the occupational burden of diseases
and injuries, creating registries of exposure to major risks,
occupational accidents and occupational diseases, and improving
reporting and early detection of such accidents and diseases.
 Also strategies and tools need to be elaborated for improving
communication and raising awareness about workers' health. They
should target workers, employers and their organizations, policy-
makers, the general public, and the media.
Objective 5: To incorporate workers’ health into other policies
 Measures to protect workers' health should be incorporated in
economic development policies and poverty reduction strategies.
Employment policies should be designed to influence worker health
PHILIPPINE OCCUPATIONAL HEALTH PROGRAM
 The program addresses the incidence of occupational diseases and
work-related diseases and injuries among workers through health
promotion and protection in all workplaces.
 It initially focuses on public health workers and informal sector
workers including, but not limited to those in agriculture, transport,
and small-scale mining.
 It aims to improve workers’ access to basic occupational health
services at the local level.
 Vision: “Healthy Filipino Workforce”
 Mission:
o Direct, harmonize and converge all efforts in occupational
disease prevention and control
o Ensure equitable, accessible and efficient health services to
workers
o Establish dynamic partnership, shared advocacy, responsibility
and accountability
 Objective: By 2022, the number of occupational diseases and
injuries by 30% from the 2015 baseline as identified in the
Occupational Health and Safety Profile of the Philippines is reduced.
 Program Components
o Policies/Guidelines/ Standards Development
o Capacity Building
o Technical Assistance
o Research
o Communication and Promotion
o Advocacy and Lobbying
o Monitoring and Evaluation
14 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
o Human Resource Development
o Information Management
National Occupational Health and Safety Policy Framework (A.O. No.
2017-0001)
General Objective
 This National Occupational Health and Safety Policy Framework
shall guide the key stakeholders in the development,
implementation, monitoring, and evaluation of Occupational Health
and Safety for both the public and private sector workers.
Specific Objectives
 Institutionalize occupational health and safety system in both the
public and private sectors
 Identify and delineate the mandates of different government
agencies within the policy framework.
 Prioritize areas of intervention for strategic convergence.
 Establish collaborative mechanism for monitoring and evaluation.
Guidelines
 With a vision for a responsible health system where participating
agencies collaborate towards attaining the health, safety and well-
being of workers, the National Occupational Health and Safety Policy
Framework shall be based on the following strategic thrusts:
o Quality occupational health services which shall be
delivered to those who need them, where and when needed in
the most efficient way. It shall be a comprehensive and
integrated package of occupational service provisions in all
levels of the health care delivery system, with emphasis on
promotive, preventive, treatment, and rehabilitative care.
o Human Resources for OHS which shall be in optimum
balance of sufficiency and competency. It shall include
developing mechanisms to guarantee availability and
accessibility of accredited training institutions and service
providers adept in rendering comprehensive OH service
interventions for both the public and private sectors.
o An occupational health and safety information system shall
be established and maintained. It shall serve as a database for
policy and program development and support for immediate
and efficient provision of occupational health and management
systems at the local level.
o Health financing shall ensure that the budget is adequate to
cater to the needs of workers for occupational health services.
In addition to PhilHealth benefit packages, other benefit
packages shall be addressed through existing Health
Maintenance Organization programs for clients in the private
sector in consonance with the guidelines developed by the
Department of Health.
o Good leadership and governance, which shall be responsible
for developing evidence-based policies and strategic
frameworks to enable the health system to respond to the
worker’s needs. This includes maintaining transparency
through consultations and cooperation among the industry,
labor and government. This also involves building stronger ties
between health regulatory agencies and institutions concerned
with OHS.
o Occupational health and safety devices and technologies of
assured quality, safety, efficacy and cost-effectiveness shall be
made available and accessible.
 To synchronize and coordinate occupational health interventions of
participating agencies to ensure that the vision will be achieved,
areas of convergence shall focus on the following:
o Generation and management of OHS-related data in terms of
programs and services, occupational diseases and injuries;
 Occupational Health Program

o Planning, implementation, monitoring, and evaluation of OHS
policies and legislations;
o Provision of efficient and responsive OHS programs, services,
and research;
o Advocacy and awareness campaigns, resource sharing and
regulatory enforcements.
NATIONAL OBJECTIVES FOR HEALTH (2011-2016)
 Overall Goal: Reduce the health burden from occupational diseases,
injuries and accidents
 Establish coordinative linkages and meetings with partners that
target DOH and other government agencies, academe, industry,
Philippines National Poison Management and Control Center, non-
governmental organizations and professional organization
PARTNER INSTITUTIONS
 According to the joint DOH-DOLE-CSC Administrative Order No.
2017-0001 entitled "National Occupational Health and Safety
(NOHS) Policy Framework" of 2017 the following department and
agencies have the following roles and responsibilities:

Table 12. Strategic Objectives, Indicators, and Targets for Occupational Department of Health and Attached Agencies
Diseases, Injuries, and Accidents  Strengthen creation of standards and policies for occupational
Strategic Latest 2016 health;
Indicator
Objective Baseline Targets  Develop advocacy packages on OHS, and recommend mechanisms to
Morbidity, % Workers who harmonize different occupational health and safety promotion
disability and become campaigns with partner agencies;
mortality from disabled as a result of  Ensure that the necessary infrastructure, human resource
To be To be
adverse occupational hazards complement, and logistics for occupational health services are
determined determined
occupational % Workers died due available at all DOH-retained hospitals;
conditions are to  Develop occupational health service and benefit packages for the
reduced occupational hazards informal sector, public health and other public-sector workers;
An  Establish standard specifications of health devices as applied in
% Cities and
occupational occupational health;
municipalities
health To be  Capacitate the local government units in implementing and
with occupational 40 percent
information determined sustaining the NOHS Policy Framework; and
health information
system is  Establish surveillance of occupational injuries, diseases" and deaths
systems
established in the DOH Health Information System.
% Health facilities The following are the attached agencies of DOH in the implementation of
Occupational providing special Occupational Health Program:
8.51
health clinical assessment  Inter-Agency Committee on Environmental Health (IACEH)
(2000)
programs at and treatment o Occupational Health Sector
40 percent
the local services to workers o Toxic and Hazardous Substances Sector
level % Health centers with  Department of Labor and Employment (DOLE)
19.15
established stress management o Occupational Safety and Health Center (OSHC)
(2000)
services o Bureau of Working Conditions (BWC)
 Department of Environment and Natural Resources (DENR)
STRATEGIES FOR 2011 TO 2016 o Environmental Management Bureau (EMB)
 Protect individuals, families, workers and communities from o Mines and Geoscience Bureau (MGB)
exposure to occupational and environmental hazards, disease  Department of Transportation and Communications (DOTC)
agents or stressors that could affect their health, through public  Department of Energy (DOE)
health and environmental interventions.  Energy Utilization Management Bureau(EUMB)
 Set up healthy and safe workplaces in national agencies and LGUs.  Civil Service Commission (CSC)
Key local health workers (provincial health officers, city health  UP College of Public Health
officers, municipal health officers, rural health physicians and public  UP-PGH National Poison Management Control Center
health nurses) will be trained on the prevention, recognition and  Philippine College of Occupational Medicine
management of occupational health-related diseases in coordination
 Occupational Health Nurses Association of the Phils.
with the DOH.
 Strengthen infrastructure, human resource capabilities and systems Department of Labor and Employment and Attached Agencies
for the registration of occupational diseases and injuries.
 Ensure OSH standards as well as policies, programs and devices on
 Generate baseline health assessment information on workers in
its administration and enforcement conforms to the NOHS Policy
high-risk industries or hazardous workplaces.
Framework;
 Review, update and strengthen laws, standards and regulations
 Provide knowledge and information services on OSH standards data,
related to occupational health to make them relevant and practical
programs and enforcement activities, and recommend mechanisms
for more decisive enforcement by LGUs and the labor sector.
to harmonize different OSH promotion campaigns with partner
 Conduct health promotion activities for the workers in industrial
agencies;
establishments.
 Implement the Inter-Agency Committee on Environmental Health-
 Develop policies on integrating basic occupational health services
Occupational Health (IACEH-OH) sector-approved training,
into the National Health Insurance Program. This is to target the
research, and development program;
workers in the informal sector in high risk industries (e.g. transport,
 Establish standard specifications of Personal Protective Equipment
mining and agriculture)
and other safety devices, and,
 Upgrade the capacity of personnel in the Department of Health and
 Formulate employees' compensation guidelines in support to the
Local Government Units in responding to occupational health and its
National Occupational Health and Safety (NOHS) Policy Framework.
related concerns
15 of 16 [Caryl, Fritz & Ena A.]

Civil Service Commission
 Ensure that occupational health and safety standards and
regulations are integrated, enforced and implemented in the public
sector;
 Monitor and evaluate compliance of public sector on occupational
health and safety standard and regulations;
 Ensure access to occupational health and safety services in the
public sector; and
 Coordinate with the TACEH-OH Sector implementation issues
affecting the public sector
WHO FIVE KEYS TO HEALTHY WORKPLACES
 The model presented by the World Health Organization is intended
to provide guidance for what a workplace can do, when workers and
their representatives and the employer work together in a
collaborative manner.
 It has three components:
o Avenues of influence for a healthy workplace
o Process for Implementing a Healthy Workplace Program
o Key Underlying Principles of a Healthy Workplace Initiative
Avenues of Influence for a Healthy Workplace
 A healthy workplace is “one in which workers and managers
collaborate to use a continual improvement process to protect and
promote the health, safety and well-being of all workers and the
sustainability of the workplace by considering the following, based
on identified needs:
o Health and safety concerns in the physical work
environment;
o Health, safety and well-being concerns in the psychosocial
work environment including organization of work and
workplace culture;
o Personal health resources in the workplace (support and
encouragement of healthy lifestyles by the employer)
o Ways of participating in the community to improve the
health of workers, their families and members of the
community.
Process for Implementing a Healthy Workplace Program
 The process of developing a healthy workplace is in many ways as
critical to its success as its content. The WHO model is anchored in a
well-recognized organizational process of "continual improvement"
which ensures that a health, safety and well-being program meets
the needs of all concerned and is sustainable over time. The steps in
the process include the following:
o To mobilize workers and employers to invest in change
o To assemble a "healthy workplace team"
o To assess baseline data, workers’ health and the desired future
o To prioritize factors directly essential to health
o To plan initiatives for health
o To do the planned action
o To evaluate the implementation process
o To improve the program based on evaluation reports
Key Underlying Principles of a Healthy Workplace Initiative
 While all enterprises have different needs and situations, there are
some key underlying principles of a healthy workplace initiative
that will raise its likelihood of success.
Key 1: Leadership commitment and engagement
 Mobilize and gain commitment from major stakeholders (e.g. senior
leadership, union leadership) to integrate healthy workplaces into
the enterprise's business goals and values.
16 of 16 [Caryl, Fritz & Ena A.]
Occupational Health Program
 Get necessary permissions, resources and support.
 Provide key evidence of this commitment by developing and
adopting a comprehensive policy that is signed by the enterprise's
highest authority which clearly indicates that healthy workplace
initiatives are part of the organization's business strategy.
Key 2: Involve workers and their representatives
 Workers and their representatives must not simply be “consulted”
or “informed” but must be actively involved in every step of the risk
assessment and management process from planning to evaluation
considering their opinions and ideas.
 It is critical that workers have some collective means of expression.
Key 3: Business ethics and legality
 One of the most basic of universally accepted ethical principles is to
“do no harm” to others and to ensure employees' health and safety.
 Adhere to workers' social and ethical codes as part of their role in
the broader community.
 Enforce occupational health codes and laws.
 Take responsibility for workers, their families and the public and
avoid undue risks and human suffering.
Key 4: Use a systematic, comprehensive process to ensure
effectiveness and continual improvement
 Mobilize strategic commitment to a healthy workplace.
 Assemble the resources required.
 Assess the current situation and the desired future.
 Develop priorities.
 Develop a comprehensive overall plan and specific project action
plans by learning from others, for example, consult experts from a
local university or ask experienced union leaders to act as mentors,
visit other enterprises, and consult the virtual world.
 Implement the plan.
 Evaluate the acceptance and effectiveness of the plan.
 Improve when circumstances indicate it is needed.
Key 5: Sustainability and integration
 Gain senior management commitment to use a health, safety and
well-being “filter” for all decisions.
 Integrate the healthy workplace initiatives into the enterprise's
overall strategic business plan.
 Use cross-functional teams or matrices to reduce isolation of work
groups and establish a health and safety committee and a workplace
wellness committee.
 Evaluate and continuously improve.
 Measure not only financial performance but also customer
knowledge, internal business processes and employees' learning
and growth to develop long-term business success.
 Maintain a comprehensive view to workplace health and safety and
examine all aspects to identify a wider range of effective solutions
 Consider external influences such as lack of primary health care
resources in the community.
 Reinforce and recognize desired behavior through performance
REFERENCES
 3B Group 5 report
LET’S GO BATCH 2019! 100% PROMOTION!
#2019KAKAYANIN #ROADTOCLERKSHIP