Practical Implementation of Health Surveillance

Practical implementation of health
surveillance in Germany
Dr. Sven Timm

Head of Section
Central Prevention Division of
German Social Accident Insurance (DGUV)
Strategic Co-operation
Serbia/Belgrade, 29 September 2017

Framework directive 89/391/EEC, Article 14
Preventive medical care (employers‘ duties):

• to survey the health of employees (in accordance with
national rules and regulations),
• to offer preventive medical examinations to all employees,
• (preventive medical surveillance can be embedded into
national health care systems).
Dr. Sven Timm, DGUV, Germany TAIEX, Belgrade , 29 September 2017 Slide 2
German approach on implementation
of health surveillance
Germany: Legislative pyramid concerning OSH
Basic Law
(Constitution) EU Directives
Occupational Health
and Safety Law
OSH statutory ordinances
Accident prevention regulations
OSH legislation and regulation in Germany
EU Legislation
Basic Law
(Constitution)
State OSH legislation Social Security Law

(SGB VII)
Laws
Accident prevention
Ordinances regulations
The different Social Security Schemes
General health care and
occupational medical health care
• General health care guaranteed through public statutory
health care system (>90% of population, mainly
employees);
• Supplemented by private health insurance (<10%, mostly
self-employed and public officers of the state);
• Every German citicen/resident has to have health care
insurance!
• Preventive medical health care within the statutory health
insurance scheme is weak – Preventive medical health
care in professional environment ist strong!
Ordinance on occupational health care (ArbMedVV)
(Verordnung zur arbeitsmedizinischen Vorsorge, ArbMedVV)
• with corresponding 15 Rules for Occupational Health
Care (Arbeitsmedizinische Regeln, AMR);
• description of means of occupational health care;
• occupational medical examinations by an occupational
medical octor including;
• preventive character is predominant – no treatment of
diseases or illness.
Ordinance on occupational health care (ArbMedVV)
Means of occupational health care
• Occupational medical examinations executed by an
occupational medical doctor including
• explanation and guidance of employees about health risks arising
with the occupation as well as
• physical and clinical examinations if necessary and accepted by
the employee,
• assessment, documentation and evaluation of results and
diagnosis of preventive medical health care and
• reasonable recommendations for the employer about measures
of safety and health at work.
Intention of the ordinance ArbMedVV
• ArbMedVV ordinance rules the
• application, kind, amount and rhythm of necessary preventive medical
check up’s.
• In cases where workers are exposed to hazardous and cancerogenic
substances there are strict rules for a mandatory medical monitoring.
• For work places where workers have to operate machinery, to steer
vehicles or to supervise technical installations there are provisions to
have medical check-ups.
• In Annex 1 mandatory and optional occupational health care medical
check-ups in context to different expositions to hazardous substances
and other occasions are listed.
http://www.gesetze-im-internet.de/englisch_arbmedvv/englisch_arbmedvv.pdf
English version of ordinance (free of charge)
15 Occupational Medical Rules AMR (1) – developed by State
Committee on Occupational Health Care
1. AMR 2.1 - periods of inducement / offer for occupational health care
2. AMR 3.1 – necessary information / information search on work place
conditions
3. AMR 3.2 – occupational medical prevention
4. AMR 5.1 – requirements for the offer of occupational healt care
5. AMR 6.1 – periods for the safekeeping of medical documents
6. AMR 6.2 – biomonitoring
7. AMR 6.3 – prevention certificates
8. AMR 6.4 – information for the employer according to § 6 Passage 4
9. AMR 6.5 – vaccination as part of the occupational health care when
working with biological agents
15 Occupational Medical Rules AMR (2)
10. AMR 6.6 – vaccinations, pre-expositional chemo prophylaxis and
emergency prevention as part of the occupational health care in cases
of temporary employment abroad with danger of infection
11. AMR 11.1 – deviations according to Annex Part 1 Passage 4
ArbMedVV in the case of work with cancerogenic or germ cell
mutagenic hazardous substances of Categorie 1A or 1B
12. AMR 13.1 – work with extreme exposition leading to special hazards
13. AMR 13.2 – work with essentially increased physical loads including
risks for the muscolo-skeletal system
14. AMR 14.1 – adequate examination of eyes and ability to see
15. AMR 14.2 – classification groups of respiratory personal protective
equipment
Related regulations in order to guarantee
preventive medical health care in a professional
environment (1)
• Act on occupational physicians, safety engineers and
other occupational safety and health specialists
(Gesetz über Betriebsaerzte, Sicherheitsingenieure und
andere Fachkraefte für Arbeitssicherheit, abbreviated
‘Arbeitssicherheitsgesetz’, ASiG)
• German enterprises are obliged to hire or employ company physicians
• Co-operation obligation with safety professionals (which are obligate too
for German enterprises to have)
• Company physician is a crucial part of the risk assessment team!
Related regulations in order to guarantee
preventive medical health care in a professional
environment (2)
• Accident prevention regulation “Occupational physicians
and OSH professionals – DGUV Regulation 2”
(Unfallverhütungsvorschrift „Betriebsärzte und Fachkräfte für
Arbeitssicherheit“, DGUV Vorschrift 2)
• DGUV V 2 defines in more detail the measures to be taken by employers
in order to fulfil their duties as per AsiG;
• Concept for the provision of standard supervision to enterprises with over
10 employees;
• Qualification, expertise and tasks of the occupational physicians and the
safety professionals are elucidated.
Supporting instruments and institutions
• Guidelines for occupational
medical examinations
• Training courses on various
topics provided by social
accident insurance institutions
and prefessional medical
associations
• Occupational Medical Services
(public (BGs) and private
• Workplace Health Promotion –
networks and support
Monitoring of health status in other EU member
states
● No uniform approach;
● Mostly embedded into national health care approach;
● No real and synoptic overview provided, even by the
EU;
● Responsible in the professional environment is the
employer!
Operational Involvement of Occ. Medical Doctors
Investigation OSH Organisation
duties duties
Information and
Control
Employers` Instruction
duties duties
duties
Co-ordination
Selection
duties
Documentation duties
duties
Risk assessment and documentation of results
Risk assessments and evaluation within the enterprise
can be executed
● by external commercial services/consulters
or
● by internal (or hired) safety and health experts
• Companies have to document the results of risk analysis,

evaluation and occasioned measures.
• Registers for works with cancerogenic, mutagenic and
terratogenic substances.
Thank you for your attention.
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Practical implementation of health

Dr. Sven Timm

Serbia/Belgrade, 29 September 2017

Preventive medical care (employers‘ duties):

OSH statutory ordinances

Accident prevention regulations

State OSH legislation Social Security Law

• Companies have to document the results of risk analysis,

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