Occupational health

Historically, the emphasis in occupational safety and health (OSH) has been on safety, and the
health aspect hasn’t received the same level of attention, with the exception of some industrial
diseases. A possible explanation for this is that safety is more immediate, ie, an accident occurs
quickly, its effects are usually immediately visible, and it is easier to determine causes and
therefore corrective action. In the case of health effects on workers, many of these develop over
time and it can therefore be more difficult to apportion causes long after the health effect started
developing. Occupational health (OH) issues have historically been under-reported for this
reason.

This situation has been changing in recent years, in recognition of the fact that far more workers
are made ill by their work, or have existing conditions exacerbated, than are injured in workplace
accidents. It has been estimated that in 2017 2.78 million deaths globally were attributed to work
and, within this figure, work-related diseases accounted for 2.4 million (86.3%) of these deaths[1].
OH is a wide field. The WHO definition of services for occupational health, which reiterates the
definition in International Labour Organization (ILO) Convention 1985 (No. 161) is:

‘primary, secondary and tertiary health prevention and promotion services, plus responsibility for
advising the employer and workers on:

 the requirements for establishing and maintaining a safe and healthy working environment which
will facilitate optimal physical and mental health in relation to work
 the adaptation of work to the capabilities of workers in the light of their state of physical and
mental health’.
The ILO defines the range of occupational health as shown in Figure 1. It lists the aspects of
occupational health that will be addressed in the content of this guide. Since OH covers so many
aspects of work which lead to such significant illness absence with associated costs to
organisations, addressing such matters will have many benefits.

The main functions of an occupational health service are to:

 identify and assess the risks from health hazards in the workplace
 watch for factors in the work environment and working practices that may affect workers’ health,
such as sanitary installations, canteens and housing provided by the employer
 advise on work planning and organization, including workplace design and the choice,
maintenance and condition of machinery, and other equipment and substances used in work
 participate in the development of programmes for the improvement of work practices
 collaborate in testing new equipment and evaluating its health aspects
 advise on occupational health, safety and hygiene, and on ergonomics and protective equipment
 monitor workers’ health in relation to work
 try to make sure that work is adapted to the worker
 contribute to vocational rehabilitation
 collaborate in providing training and education in occupational health and hygiene, and
ergonomics
 organize first aid and emergency treatment
 participate in the analysis of occupational accidents and occupational diseases.
Figure 1: ILO definition of OH  [2]
Occupational health provides benefits to workers:
Who What we do Outcome
Workers who can perform their job safely
considering any health issues or disabilities they
Person offered a job Health assessment
may have – eg, drivers, healthcare workers,
pilots
People with a disability or a health condition can
    perform the offered work effectively through
suitable work and/or workplace adjustments
Employees exposed to
Employees who understand health hazards and
hazards at work eg,
Education and training risks and personal measures to protect their
chemicals, noise
health
radiation
Early identification of any health changes to
ensure the cause is investigated and
  Health surveillance improvements made in the workplace to prevent
progression to disease and permanent ill health
in that worker and among co-workers
At-risk groups of employees, eg, business
Employees exposed to Immunisation and
travellers, healthcare workers, are better
infection risks medicines
protected against exposure to infectious diseases
Employees are supported to address work-
Employees with a
related health concerns eg, stress at work or to
work- related health Consultation
cope with work when they have stresses outside
concern
of work
Maintained employment and earnings through
workplace adjustments; or suitable alternate
Employees with a
Health assessment work where a worker cannot perform their
health condition
normal job, either temporarily or on a permanent
basis
Employees on long- Case management Earliest return of functional capacity and return
term sick leave to work by working with the employee’s doctors
 and employers eg, by offering changes to the job
and/or work schedule
Ill health retirement when that is in the
  Health assessment employee’s best interest and if they meet the
medical criteria within the pension fund rules
Employees who are in optimal health through
All employees Health promotion
leading healthier lifestyles
Figure 2: what OH offers to workers 
And it provides benefits to businesses.
What we do Key business partners Outcome
Required statutory and
Health and safety, occupational appropriate employer health
Health risk assessment
hygienists surveillance programmes
implemented properly
Health programmes are
designed and resourced to
Health needs assessment Human resources (HR) address the main lifestyle health
risks; top causes of sickness
absence, etc
Advice and support for matters
Professional advice Managers, HR
relating to health and work
Policies, practices and cultures
that maintain and promote
Policy development HR, Legal employee health and compliance
with relevant health and safety
legislation
Assess significant changes eg, in
shift patterns; the development
Change management Managers, HR, toxicologists
or introduction of a new
chemical
Ensure contingency plans are in
place to deal with health risks
Business continuity planning HR, health and safety
eg, emergency medical response
for disasters, pandemics
Figure 3: what OH offers to businesses
 

Footnotes
1. Hamalainen, Paivi et al, 2017. Workplace Safety and Health Institute: Global Estimates of
Occupational Accidents and Work-related Illnesses, p4.
2. Alli, B: International Labour Organization, 2008. Fundamental Principles of Occupational
Health and Safety. Second edition, p85.

Health risks
Before considering checks and interventions for health effects on workers, the range of possible
effects needs to be considered, alongside injuries caused by safety issues. There are often links
between the health and safety aspects of work. A health effect can have an influence on the
chances of an accident, for instance through physical weaknesses brought on by exposure to
hazardous substances, or fatigue. Conversely a safety concern can have a longer-term effect on
health, such as poor conditions in the workplace or unsuitable equipment.

The key factors in whether something causes harm to health are:

 the duration of exposure

 the level of exposure
 the mode of exposure, eg, contact, inhalation, injection or ingestion
 in the case of chemicals
 individual susceptibility and behaviours, eg, young or old workers, those with disabilities
 the work environment – does the layout make the activity more hazardous, eg, incorrect height,
poor ventilation or lighting?
 variables such as different work rates, and seasonal variations, eg, wind, rain and sunlight.
Effects on health, and their causes, can be divided into acute and chronic, as follows.

Acute causes and effects (immediate factors)

 are instantaneous or develop a few seconds to hours after exposure
 usually have an easily identifiable source (cause)
 can follow repeated or prolonged exposure, eg a worker developing contact dermatitis from oil
 can be recovered from (or the condition is managed), with treatment or by preventing further
exposure
Chronic causes and effects (delayed)
 occur gradually over a long period (years)
 produce no obvious signs of ill health at the time of exposure
 are diagnosed by medical professionals
 are not easily linked to a specific health hazard, exposure or work activity/workplace
 often have no cure, but treatment may alleviate symptoms, eg, cancer or chronic obstructive
pulmonary disease.
The main range of health effects to which workers could be exposed include:

Physical agents
This includes noise, vibration, heat (and lack of it), light levels, radiation and compressed air.
Ergonomic risks will be dealt with in a separate section. The effects of exposure to high noise
levels include hearing loss and tinnitus. Excessive or prolonged exposure to vibration can cause
conditions such as vibration white finger and Raynaud’s syndrome. Excessive heat levels can
result in heat exhaustion and dehydration. Exposure to radiation can cause cancers (not forgetting
skin effects such as melanoma from exposure to the sun). Compressed air can cause blast or
injection injuries.

Chemical risks
Workers could be exposed to toxic, irritant, oxidising, mutagenic or flammable chemicals, or
dusts. This category includes occupational cancers arising from exposure to asbestos,
carcinogenic solvents or welding fumes; respiratory diseases such as silicosis and asthma; skin
diseases such as dermatitis; and infertility or miscarriages due to exposure to chemicals or
biological agents.

Biological risks
Here, the distinction is between naturally occurring biological risks (eg, infections from animals
and plants, viruses) and biological risks created by humans (eg, manufactured pathogens,
pharmaceuticals). Also included would be communicable and non-communicable diseases, the
former including infectious diseases such as HIV and hepatitis.

Psychosocial risks
This category would include mental health issues such as depression and anxiety, and
psychological effects of work and workplace culture, such as lack of control over work and
stress. This also covers lone working, night working, shift working, violence, aggression and
bullying.

Ergonomic risks
Ergonomics can be considered the study of human–machine interfaces, and matching work
equipment to the dimensions and abilities of workers. This includes the design of items such as
control panels to ensure optimum operation by workers, design of workstations to minimise
awkward or repetitive movements or poor postures being adopted, and arguably the use of
display screen equipment. Manual handling could also be included in this category of risks. The
effects of poor ergonomics and manual handling include chronic back pain, upper limb disorders
affecting the arms and hands, and strains and sprains.

A summary of the main types of health hazard are given below:

 Health surveillance
Whereas workplace assessment and monitoring focus on the physical conditions in the place of
work, the aim of health surveillance is to assess the initial and ongoing health of workers, to
provide detection of any health effects on them due to their work. The scope for further work as
a result of such detection varies between the stipulations of professional bodies, or national legal
or good practice requirements.

The ILO set out basic requirements for health surveillance as follows:

Surveillance of the workers’ health should include, in the cases and under the conditions
specified by the competent authority, all assessments necessary to protect the health of the
workers, which may include:
 health assessment of workers before their assignment to specific tasks which may involve a
danger to their health or that of others
 health assessment at periodic intervals during employment which involves exposure to a
particular hazard to health
 health assessment on resumption of work after a prolonged absence for health reasons for the
purpose of determining its possible occupational causes, of recommending appropriate action to
protect the workers
 and of determining the worker’s suitability for the job and needs for reassignment and
rehabilitation
 health assessment on and after the termination of assignments involving hazards which
 might cause or contribute to future health impairment.
Following the above, further detail on these four categories can be provided below.

Pre-placement health checks, which are carried out before starting a job. Caution is needed
here, as in some jurisdictions it is illegal to ask health questions of job candidates or unfairly
discriminate against them as a result. Some general questions can be asked, but the pre-
placement check needs to be carried out once a candidate has been offered a job but before
starting it. This is to protect the worker, rather than discriminate against them in offering them
the job, and should health problems be found, the issue of reasonable adjustments will then need
to be considered. Such checks can also provide a baseline against which future health
surveillance can be assessed.
 Health or medical assessment at intervals is carried out to check for any signs of health effects
on workers caused by their jobs. This should be done periodically as determined by the initial
health risk assessment, or following changes in the job or workplace. While health monitoring is
not an alternative to suitable control measures, it can give information on the effectiveness of
controls or on the need to review them. The range of checks will depend on the types of health
risk to which workers are exposed.
Some of these checks will involve intrusions into the body, eg, taking blood samples, and so
consent will be needed from workers.

The range of checks could include:

 audiometry, to check for any deterioration in a worker’s hearing that could be caused by their
working conditions, and whether hearing protection used by them is adequate
 lung function tests, which are used to check for any effects on a worker’s respiratory system,
such as asthma, that could be caused by exposure to dust or gases, and whether RPE is effective
 blood and biological testing (urine, blood and saliva), which are used to detect whether a
worker’s body has absorbed any harmful substances (eg, lead, cadmium, mercury) and/or
whether any absorption has had an effect on body systems
 skin checks, which are used to detect problems such as dermatitis caused by substances in the
workplace, oils being one example
 checks for damage caused by exposure to high levels of vibration (eg, vibration white finger)
 medical examinations for night shift work.
Fit-for-role surveillance is carried out periodically, often in compliance with legal requirements
(eg, heavy goods vehicle drivers, divers) to determine the ongoing suitability of the worker on
health grounds.
It can also be used when workers have a health issue that could affect their safe performance at
work, or where an incident is suspected to have been caused or contributed to by health issues
such as fatigue, co-ordination problems or drug or alcohol misuse. If a worker is to change to a
different job, such a check may be needed to determine their suitability for the new role.

Health assessment on resumption of work is carried out after a period of absence by the
worker, and may include the consideration of return-to-work arrangements and adjustments to
the worker’s job or workplace. Absence management and rehabilitation are closely linked, as the
aim of any system should be to get the worker back to work as soon as possible, since
statistically the longer time someone is absent due to illness, the lower the chances of them
returning to work. Rehabilitation is concerned with how a worker is returned to work, including
such issues as phased returns and reasonable adjustments in the workplace.
Post-assignment health surveillance, when a worker is to leave a job, can also be carried out to
determine if their employment to that point has caused any ill-health effects. Eyesight tests are
required in some jurisdictions for workers who use display screen equipment, to detect the onset
of the relevant aspect of vision deterioration (and corrective spectacles for DSE work are often
provided by the organisation, where required).

Managing OH
The management of OH is no different than any other aspect of OSH, and therefore involves
many people, principally within the organisation, but possibly including outside specialists. As
with any other aspect of OSH, commitment and leadership from the top of an organisation is a
prime requirement, to demonstrate the importance placed on OH and ensure adequate resources
are applied to it. It should feature alongside safety aspects in any OSH policy, with
responsibilities assigned to relevant people. Managers and supervisors should also address OH
issues as part of their OSH responsibilities, rather than seeing these as separate requirements.

In common with other OSH considerations, organisations should seek to engage workers in the
specification and implementation of OH. Workers can be an invaluable source of information on
health hazards from the roles they carry out, and their input into OH will also encourage
ownership of procedures and processes across the organisation.

The OSH professionals in an organisation have a key role, both in implementing many aspects of
OH within their competence, but also in sourcing and managing other professionals to provide
services outside the remit of the OSH professional. Depending on the size of the organisation,
many aspects of OH can be supplied by in-house people, or occasionally contracted out to
external providers. OSH professionals in an organisation can also play a part in investigating
incidents that caused ill-health to workers, to determine causes and remedial measures. Ill health
found as a result of checks on workers should also be investigated to determine if any corrective
measures are required.

The role of an OSH professional would also include aspects such as advising on welfare
arrangements in an organisation, the design and maintenance of equipment to minimise health
effects on workers, assessing new equipment that may have health implications, and advising on
ergonomic factors in job roles that may have effects on workers.
 As with any aspect of OSH, it is important that OSH professionals recognise the limits of their
competence and should not engage in activities in which they have neither training nor
experience. In such cases, the identification and use of external specialists should be undertaken.

Depending on the size of the organisation and its structure, the provision of first aid is often
included in the range of services for OH. This would be carried out by OH staff, or sometimes by
departments such as facilities management. In other places, first aid services are addressed by
training workers to administer it.

Workplace assessment and action

Having established common health effects from work, the next step is to check and measure the
conditions in the workplace to determine if any of the possible health effects occur. This is a key
activity, should be carried out mainly by an organisation’s OSH professionals but, as with OSH
generally, may need input from external specialists occasionally. It should be carried out
initially, as part of the assessment of any risks to health, to inform recruitment processes, and in
order to stipulate suitable workplace controls and inform the health surveillance process. It
should also be carried out when significant changes are made to the workplace or work
processes, such as new equipment, to check whether health risk assessments are still suitable and
sufficient, and monitoring processes are still relevant. This may indicate the need for additional
or alternative risk controls.

The OSH professional, or specialist, needs to be familiar with the workplace and the work
activities carried out within it, in order to assess possible health effects accurately. A range of
assessment protocols should be used, as below, to determine any possible effects of the
workplace, and the jobs performed by workers, on the health and wellbeing of workers. These
could include:

 evaluation of noise levels in the workplace, to determine the types and level of noise
 measurements of lighting in the workplace, to determine its suitability for the work being done
 temperatures in the workplace, both high and low
 any possible exposure to radiation, both ionising and non-ionising
 measuring levels of dust, and its nature, to which workers could be exposed
 evaluating the presence and levels of gases and vapours that could give risk to health risks
 assessing vibration levels to which workers are exposed
 assessing possible exposure to harmful liquids, such as acids, cutting oils, alkalis and solvents,
some of which may be carcinogenic
 the physical demands of work, which could lead to assessing ergonomic risks and possibly stress.
 Some of these will require specialist measuring equipment, and competence in using it. Such
measuring equipment will include:

 calibrated noise meters

 light meters, usually calibrated in lux units
 accurate temperature monitors
 Geiger counters to measure ionising radiation levels
 dust meters and personal dust samplers for subsequent gravimetric analysis
 gas monitors and detectors for both toxic and flammable gases
 vibration meters which typically record the level and exposure time
 test kits for specific chemicals and monitoring skin condition for signs of adverse reactions
 equipment used in analysis of physical demands of work, including adaptation of work
equipment to workers, and manual handling issues.
The majority of the above measurements could be carried out by an OSH professional, but
specialist help may be needed with issues such as gravimetric analysis of dust content. It is
important that measurements are taken correctly to be valid, including levels in the workplace
generally and the use of personal exposure measuring equipment.

Having assessed the workplace, a number of interventions may be needed to reduce or mitigate
the risks found. These can be summarised as follows:

 enclose equipment/machinery to reduce general noise levels, using noise-reducing mountings for
machinery, or specify equipment with lower emitted noise levels
 shield or relocate lighting to reduce light levels, or conversely increase lighting for low light
levels and introduce more natural light where possible
 increase ventilation or heating as appropriate to cool or heat the workplace, or provide thermal
clothing for workers in refrigerated areas and limit time exposure
 provide lead shielding or relocate radiation sources to protect workers
 provide or enhance dust extraction, using vacuum cleaners rather than brushing to clean
workplace to reduce additional dust generation
 provide or enhance fume extraction for gases, or enclose the process
 specify equipment with lower vibration levels, limit time exposure of workers, provide insulating
gloves where feasible
 re-design process to reduce potential for worker exposure, provide personal protective equipment
(PPE) and respiratory protective equipment (RPE)
 analyse work tasks and re-design to improve adaptation to workers, reducing manual handling by
providing handling aids where possible and providing manual handling training for workers.
Interventions to address psychosocial risks will require a wider consideration of working
methods and culture in the organisation. Aspects of the work that cause stress, for example, will
require investigation to establish the extent of this and what changes could be introduced.
Control over the type and pace of work is another area for investigation.
Menopause in the workplace
IOSH recognises that people have diverse gender and gender non-conforming identities. In this
digital material we are using the word ‘women’ to describe individuals whose sex assigned at
birth was female, whether they identify as female, male, non-binary, or gender non-confirming.
The content is intended to be inclusive and applicable to any person who is experiencing
menopause symptoms.

Global relevance of menopause in the workplace

Worldwide there are an estimated 657 million women aged 45-59, around half of whom work
during their menopausal years 1. The menopause and its transition account for a significant
period of a woman’s working career and at a time when she may be reaching or at her career
peak.
Even though women account for more than 50 per cent of the working population, women’s
health issues are under recognised and often a taboo subject in the workplace. As an under-
recognised health condition in the workplace, the menopause may affect women’s productivity,
damaging their careers and potential to .

Fourteen million lost workdays were reported in the UK in 2018 due to menopause2. And the
number of menopausal working women will escalate. With about a quarter of the world’s female
population experiencing this biological transition, by 2030 menopause-related productivity losses
could cost more than $150 (£110) billion a year. So, it’s imperative for employers to manage the
associated health risks at work.
What is menopause?
Menopause is a natural physiological process defined as the end of the female reproductive
function. It usually occurs between the ages of 44 and 552, with an average age of 511. A woman
is said to be in menopause when she has not had a menstrual period for 12 consecutive months.
Menopause is preceded by the perimenopause or the menopausal transition, which may last two
to 10 years. Women can experience unpleasant symptoms during this time. About one in 100
women experiences menopause earlier in life as early onset menopause. Reasons for this include
chemical exposure, chemotherapy or pharmacological interventions, and surgery.

Symptoms of menopause
Menopause is associated with as many as 34 physical and psychological symptoms, which have
the potential to negatively impact work ability. Not all 34 are experienced by all women and they
are not experienced all the time. Symptoms are transient in nature and each women’s experience
will be individual. The following table depicts some of the more common symptoms.  

 Physical symptoms  Psychological symptoms 

 Hot flushes
 Sleep disorders
 Tiredness
 Night sweats
 Mood disturbances
 Palpitations
 Anxiety
 Increased blood pressure
 Depression
 Osteoporosis
 Difficulties concentrating or decision making
 Cardiovascular disease
 Irritability
 Joint stiffness, aches and  pains
 Loss of confidence
 Headaches
 Reduced ability to learn
 Reduced muscle mass
 Poor memory
 Frequent urinary tract infections
 Reduced sex drive
 

The effects of these symptoms include a reduced ability to learn new tasks, difficulty paying
attention to detail, and poor memory, all of which can negatively impact work productivity and
quality. As many as 88 per cent of women will experience symptoms of varied severity during
their menopause transition and as many as a quarter of these will experience severe symptoms3,4. 
Symptoms bothering women the most include hot flushes, sleep disorders, night sweats and
arthralgia, and those experiencing symptoms are eight times more likely to report low work
ability5.
The experiences of women in the casual or informal economy differ from those of women in
full-time employment. Women in casual employment say musculoskeletal symptoms in the legs,
back, shoulders and neck are the worst, causing them to seek less physically demanding work.
Women in full-time employment reported hot flushes as their main concern6. Those in lower-paid
 and more manual jobs experience significantly more psychological symptoms than women in
higher status ‘white collar’ jobs. Casual work is not detrimental to the health of menopausal
women but rather influences their experience of symptoms and resources available to manage
them.
Menopause and work
Women’s experiences of menopause in the workplace are bi-directional, as menopausal
symptoms can impact a women’s experiences of work and work factors can exacerbate
menopausal symptoms. This causes women to experience negative and varying severity of
symptoms, which can impact industry through decreased productivity, and increased absenteeism
and presenteeism. In addition, 52 per cent of women consider leaving employment because of
the symptoms they experience, threatening a further loss of skill, knowledge and expertise7.
Workplace factors that impact this bi-directional relationship include both the physical and
psychosocial aspects of work. See Table 1 for examples. Employers should promote menopause-
friendly workplaces by addressing these factors.

Table 1: List of physical and psychosocial factors that impact menopause

 Physical aspects  Psychosocial aspects

 Ventilation – lack of fresh air  Lack of management support and understanding
 Temperature – too hot or too  cold  Inadequate autonomy to make decisions
 Ablutions – limited access  Formal meetings and presentations
 Access to cold water  Relationships (co-workers, supervisors, managers)
 Rest areas not available  Role conflict (too many roles, lack of clarity)
 Toxins and chemicals  Work stress/demands (skills do not match demands)
 Ergonomic concerns  Work/life balance (role/responsibility conflicts)
   Organisational culture (trust, discrimination, prejudice)
Women’s experiences and perceptions of menopause and work reflect that they:

 believe management labels them as weak, incompetent, unstable and depressed

 lack support in helping them cope with symptoms
 need to use annual leave or rest days to cope with their symptoms
 are not confident to disclose their status to managers or request accommodations for fear of
embarrassment, stigmatisation and discrimination, and
 reduce their working hours or leave employment to cope with their symptoms.
Positive impacts on work ability are derived from a supportive work culture where women:

 feel they are heard and can express their concerns

 have better supervisor support
 believe management pay attention to women’s health issues through a health-wise culture
 can adopt flexible working hours and hybrid working models.
Women are often unable to address psychosocial factors such as negotiating working hours. But,
where this is possible, and they have control over the physical workplace, there is reduced
reporting of menopausal symptoms and less severity of symptoms when these are experienced.

Managers need to understand the symptoms of menopause and its transient nature and have open
discussions with women. A workplace champion (menopause ambassador) could be identified.
This is a person who is nominated to represent the interests of women experiencing the
menopause transition and who can support all levels of employees in a confidential manner while
providing that link between management and worker where necessary.

How workplaces can enhance women's experiences

Organisations can support women during the menopause and the menopause transition in the
following ways. Please use the below as guidance on what action can be taken in workplaces.

1. Age and gender specific policies and procedures

 Use a gender-based approach when developing and implementing a workplace policy,
programme or practice.
 Firmly integrate menopause management in existing policies instead of producing a separate
menopause policy.
 Incorporate advice from occupational health professionals to strengthen the content of existing
policies and practices.
 Create supportive and inclusive cultures based on effective policies that educate managers,
supervisors, occupational health professionals and the general workforce about the menopause.
 Review and adapt these policies and procedures as the organisation matures to retain relevance to
the scientific evidence of menopause.
2. Management support
 Provide managers with the support and training to have open and honest conversations around
menopause and symptom management.
 Educate managers to improve their knowledge and awareness of the symptoms of menopause
and the possible solutions.
 Empower managers to offer women the flexibility they need to better manage menopausal
symptoms on an individual basis.
 Develop inclusive and supportive workplace cultures and managerial styles that make women
feel comfortable disclosing symptoms or requesting adjustments if required.
3. Age and gender specific health risk assessments
 Ensure risk assessment processes are in place that consider specific risks to peri- and menopausal
women/people (eg endocrine disruptive chemicals) and have arrangements in place to identify
reasonable adjustments for an individual.
 Consider the physical environment as well as psychosocial risks in the risk assessment process.
 Ensure the outcomes and recommendations are implemented to mitigate risk and regularly
review with the employee.
 Engage with competent who can provide guidance on what should be covered in the health risk
assessment, if necessary. Where these services are not available in-house, they can be sourced
externally. Please research and review provider options for where you are based. Within the UK,
information can be sourced from ACAS, and SOM has a list of occupational health providers
that can be used to locate service providers, for example.
4. Training and awareness strategies
 Develop awareness, training and education strategies that raise understanding of the menopause,
associated symptoms, impact on work, potential solutions and communication skills.
 Provide information or sources of information for employees to access self-help solutions and
sources as necessary.
 Cover the bi-directional influence of menopause and work in training, which will provide
managers with the awareness, knowledge and understanding needed to support women during
this phase.
 As an employer, ensure that not only managers and supervisors but also those with a people-
facing function are trained to be aware of this bi-directional influence.
 Improve communication skills to create trusted relationships allowing managers to confidently
have frank discussions with women who, at the same time, feel empowered to disclose their
needs.
 Educate managers about stereotypes to address gender disparities.
5. Health-orientated culture
 Women should be able to access evidence-based advice and healthcare and share their
experiences.
 Health promotion activities should address issues earlier in the life cycle and not only during
middle age (ensuring that promotion activities are inclusive of non-binary, trans and gender non-
conforming people).
 Programmes can be offered that encourage healthy lifestyle activities such as regular exercise,
healthy eating habits, smoking cessation and monitoring and controlling chronic health issues.
 Organisations might also provide financial support for resources that allow menopausal women
to self-monitor symptoms, eg blood pressure monitors.
6. Work attire
 Review the work attire/uniforms and personal protective equipment (PPE) and adapt fabrics as
necessary to prevent unnecessary heat generation and allow for absorption.
 Allow for layering and removal of layers, eg jackets and neck scarves, as needed.
 Be flexible in allowing workers to wear looser clothing for improved comfort.
 Much PPE and clothing is not designed for women. Ensure suitable fits to ensure protection and
comfort.
7. Physical environment
 Hazards within the physical working environment – such as high temperatures, poor ventilation,
working in confined spaces, excessive crowding and insufficient rest areas – can all contribute to
an environment that is problematic for menopausal women.
 Workplace adjustments or modifications can prevent and/or mitigate these factors and are often
cost-effective.
 Ventilation and temperature – allow for the opening of windows, moving a workstation closer to
the window, the use of desk fans to control the individual’s workspace or the introduction of air
conditioning.
 Rest areas, access to cold water and ablution facilities should be available and easily accessible.
8. Psychosocial risks
 Provide workers with opportunities to work flexi hours, where possible, around their symptoms,
with time allowed to attend medical check-ups.
 Allow work from home and hybrid options of work, where possible, while ensuring support
through regular, supportive contact with managers.
 Review employment types and, where possible, provide more secure options of work offering
structure and financial security.
 Assess work demands and increase the control the worker has through job-sharing, paced
working and task scheduling.
 Meeting and presentation rooms should be well ventilated and not overcrowded to prevent
exacerbation or triggering of symptoms.
 Allow breaks to manage fatigue and provide private rest spaces, where possible, for this purpose.
 Improve the culture around managing and reporting psychosocial problems at work.
Significant areas for the OSH professional
 Consider how existing policies and procedures cater for the psychosocial needs of menopause-
related issues – eg sickness absence and medical appointments, flexible working hours, work
patterns and hybrid models of working – and work with your organisations to ensure they are fit
for purpose.
 Governments, trade unions and employers have addressed issues concerning menopause and
work through the adoption of ‘menopause at work’ policies (or within other policies), yet women
employed in precarious settings such as casual work, informal, sessional and the so-called grey
economy may not enjoy these protections. Ensure these issues are addressed within your
operation and across your supply chain.
 Ensure to undertake risk assessments, which may be through managers or others, such as
occupational health and safety and health professionals, depending on the level of support,
advice, guidance or recommendation required. It may be necessary to commission competent and
knowledgeable professionals to conduct health risk assessments designed to identify physical
and psychosocial factors that have the potential to impact women’s work experiences.
 The needs of trans men and women, non-binary, non-gender and gender non-conforming people
need to be considered. They are a group who may also experience a natural or surgical
menopause, depending on ovarian retention and use of hormone therapy, and this can exacerbate
experiences of exclusion or discrimination in a work setting.

Example of an assessment to support adjustments in the office environment 

Do you need to do Action by
What could you be
What are the activities? Potential impact? anything more to whom and
doing?
manage this risk? when?
Risk of road traffic Flexible working
accident where hours
Travelling to, from and fatigue and stress Ability to work from
   
for work from travelling are home
exacerbated by Hybrid models of
insomnia work
Poorly balanced Exacerbation of Air conditioning
   
ventilation and symptoms temperature control
 set and locked to
prevent adjustment
temperature in office
Desk fan for
personal use
Encourage regular
rest breaks away
from computer
Conduct an
ergonomic
Sedentary work at Exacerbate joint
assessment of the    
computer stiffness and pain
worker's working
space
Encourage out-of-
office physical
activity
Monitoring task
allocation
 Stress, anxiety,
Allocate a variety of
frustration,
Occupational psychosocial tasks
demotivation and
stress 1-2-1 meetings to
exacerbation of
Excessive workload discuss workload
symptoms    
demands Provide role clarity
 Boredom, frustration,
Inadequate autonomy and Encourage
demotivated,
job control suggestions from
unproductive,
employee
unengaged
Integrate suggestions
where practical
Access to cold water,  
flexi working hours, Appoint a champion
Experiencing symptoms at Fatigue, hot flushes,
Welfare facilities, as a support  
work anxiety, headaches
including s private Refer to occupational
rest room health for support
 
Have cold water at
hand
Prevent
Separate presentation
Formal presentations and Anxiety, hot flushes, overcrowding in
rooms with  
meetings embarrassment room
microclimate control
Revise uniform
design to
accommodate lighter
fabrics and layering
Chemical exposure Exposure to Conduct COSHH     
endocrine disruptive assessments for all
chemicals such as chemicals on site and
those found in some ensure the health
cleaning products hazards associated
may cause early with that chemical
onset menopause are identified and
controls are in place
Provide access to
occupational health
 services

Resources
 IOSH: Inclusive and supportive workplaces needed to help menopausal women
 NHS: Menopause
 SOM: Guidance on menopause and the workplace
 UNISON: Menopause: the menopause is a workplace issue: guidance and model policy
 ACAS: Menopause at work
 CIPD: Let’s talk menopause
References
1. Rees, M., et al., Global consensus recommendations on menopause in the workplace: A
European Menopause and Andropause Society (EMAS) position statement. Maturitas, 2021. 151:
p. 55-62.
2. Steffan, B., Managing menopause at work: The contradictory nature of identity talk. Gender,
Work & Organization, 2021. 28(1): p. 195-214.
3. Vaccaro, C.M., et al., What women think about menopause: An Italian survey. Maturitas,
2021. 147: p. 47-52.
4. Viotti S, et al., Fostering work ability among menopausal women. Does any work-related
psychosocial factor help? Int J Womens Health, 2020. 12: p. 399-407.
5. Geukes, M., et al., Improvement of menopausal symptoms and the impact on work ability: A
retrospective cohort pilot study. Maturitas, 2019. 120: p. 23-28.
6. Yoeli, H., J. Macnaughton, and S. McLusky, Menopausal symptoms and work: A narrative
review of women's experiences in casual, informal, or precarious jobs. Maturitas, 2021. 150: p.
14-21.
7. Hardy, C., et al., Work outcomes in midlife women: the impact of menopause, work stress and
working environment. Women's Midlife Health, 2018. 4(1): p. 3.
Musculoskeletal disorders
During the 18th Century, it was discovered that certain violent, irregular motions and unnatural
postures can cause the mechanics of the human body to become impaired. From this, serious
illness can develop. It wasn’t until the 20th century that the need to act on reducing these
diseases (now known as musculoskeletal disorders, MSDs) was recognised.

Biomechanics uses the laws of physics and engineering concepts to describe the movement of
body parts and the forces acting on them during normal daily activities.

Although these movements and forces enable workers to be able to perform jobs, when they
over-stress the body they may cause MSDs.

When daily fatigue or micro-trauma to soft tissues overwork a persons recovery system, health
can become affect and over time MSDs will eventually form.
 Fatigue verses recovery curve 
Causes of MSDs
Poor musculoskeletal health can affect all industries, from business to construction. There are
risks to workers who are desk-bound, just as there are to workers in building trades.

MSDs can be made worse or caused by work. Health problems can vary from mild aches and
pains to more serious medical conditions requiring time off work or medical treatment.

It’s important to remember that MSDs are not just caused by or related to work. When managing
and dealing with health issues, do not assume that work is the main contributory factor or is the
root cause. Workers may already be at risk due to their personal lives.

These factors, individually or collectively can cause MSDs or increase the likelihood of them
developing:

 domestic activities or certain hobbies

 certain medical conditions
 previous accidents or incidents
 pregnancy
 age-related degeneration.
In these circumstances, it may be worth accessing help from occupational health (OH)
professionals. They may already work in the organisation, but they will be able to assist with
assessing the individual’s needs by carrying out relevant assessments.
 In the workplace, MSDs are often caused by occupational activities that involve:

 manual handling of heavy loads

 exerting high-intensity forces
 unfavourable postures
 monotonous/repetitive tasks
 application of vibration
 physical environmental conditions
 psychosocial factors.

Types of MSD
General issues
The following may be felt as minor aches or pains. Medical treatment and time off work may be
required where the condition is more serious.

Bone pain: most commonly results from injury and is usually a deep penetrating or dull pain.
Muscle pain: is often a result of an injury but can also be due to an infection or a tumour or from
loss of blood flow to the muscle.
Joint pain: can be worse when moving the joint, and can present as stiffness or an aching,
‘arthritic’ type of pain.
Bursae pain: is worse with movement involving the bursa (a small fluid-filled sac that provides
a protective cushion around a joint). It is often caused by trauma, over-use, gout or an infection.
Tendon and ligament pain: is caused by injuries such as sprains. This type of issue often
becomes worse when the affected area is stretched or moved.
Nerve pain: occurs when pressure is applied to the nerve, which both limits its functioning and
causes damage. Due to repetitive motions and awkward postures, the tissues surrounding nerves
become swollen, and squeeze or compress nerves.8
Soft-tissue damage: is most commonly caused by trauma as a result of sudden impact, force,
vibration or unbalanced positions.
Back pain: can be caused by damage to the muscles or bones of the spine and ribs or to the discs
between the vertebrae. A common factor in back pain is tasks involving repeated exposure to
high- or low-intensity loads over a period, or trauma from an incident.
Common MSDs
Some types of MSDs relate to particular areas of the body.

Upper limb disorders

 Upper limb disorder (ULDs) is a term given to a group of conditions affecting upper limbs – the
hands, arms, shoulders and neck. If they are caused by work, they will be recognised as work-
related upper limb disorders (WRULDs).

Conditions covered by this term are:

 tenosynovitis
 carpal tunnel syndrome
 frozen shoulder
 bursitis of the elbow
 osteoarthritis
 tendonitis
 muscle strain
 tennis or golfer’s elbow
 repetitive strain injury
 vibration syndrome
 vibration white finger
 rheumatoid arthritis
 gout
 fractures
 sprains.
Three factors are known to provoke or cause ULDs:

 posture or the angle at which the arm is held

 force or tension created in the nerves and tendons
 how long a force is applied or how often the task is carried out.
Lower limb disorders
Lower limb disorders (LLDs), specifically affect the hips, back, legs, knees, ankles and feet. If
work has caused the disorders, they will be referred to as work-related lower limb disorders
(WRLLDs). Common disorders include:

 osteoarthritis
 varicose veins
 muscle tear damage
 knee bursitis
 meniscal lesions or tears
 stress fracture or reaction injury
 hernia
 gout
 fractures
 sprains.
Common factors in lower limb disorders occurring in the workplace:

 repetitive kneeling or squatting

 long periods of standing
 frequent jumping from height.
 Managing MSDs
Organisations should already be preventing harm to workers by assessing and controlling risks in
the workplace.

The prevention of MSDs should be carried out in the same way — by assessing and evaluating
the risks to workers and eliminating or controlling those risks.

Putting controls in place doesn’t have to be costly, but making small or big changes to the
workplace will help to prevent workers developing MSDs.

Organisations could think about interventions such as:

 modifying equipment
 making changes in work practices
 purchasing new tools or other devices.
These will help by:

 eliminating unnecessary movements

 lowering injury rates
 reducing worker turnover.
European legislation sets out general principles of prevention. Organisations can use these
methods as part of their strategy to prevent MSDs:

 primary prevention, which includes the risk-assessment process and technical, ergonomic, organisational,
and person-oriented MSDs
 secondary prevention, which involves the identification and health monitoring of workers at risk
 tertiary prevention, which comprises return-to-work activities.
Organisational benefits
Organisations are to ensure their workers are safe and healthy at work. In some countries this is
the law. Managing OSH effectively should be a core value for the business and putting workers
at risk could negatively affect the business.

Preventing MSDs in the workplace will:

 lower costs
 improve productivity
 improve quality
 gain worker engagement
 ensure a better safety and prevention culture
 reduce staff turnover
 improve morale
 prevent worker discomfort
 reduce absence rates.
Identifying the risks
Identifying these risks can be challenging for most organisations, as issues are dealt with in a
reactive way — an issue is investigated when someone reports it.

However, organisations should be thinking proactively about identifying the possible risks.

How would you proactively identify MSD risks in your workplace?

Fishbone diagram – a common tool to capture the root causes by determining causes and effects
 

Risk factors
The work environment is a complex set of systems and so is the human body. There are various
risk factors that can lead to MSDs, which should be considered as part of the risk assessment:

 task
 individual
 load
 work environment
 other factors.
Task
Consideration of the task should cover anything the workers do for their job. Think about factors
such as:

 manual handling activities like lifting of heavy loads or equipment or the type of loads being manoeuvred
 ergonomic risk factors such as high- risk repetition, forceful exertions and repetitive or sustained
awkward postures.
Individual
Consideration should be given to individual factors such as:

 not being aware of good overall health habits

 not enough or no rest and recovery
 poor nutrition, fitness and hydration
 pre-existing conditions or predisposition conditions or injuries
 age
 pregnancy
 body impairments
 obesity
 family health history.
As mentioned previously, it’s important to consider the individual and, if available, provide OH
support to workers.

An additional factor to consider when looking at individual risk factors is whether the person is
right for the job. Some organisations use fit-for-role health checks to assess whether a worker is
suitable to do the job they have been hired for. They are sometimes used at recruitment stage and
then as part of periodic reviews.

Load
No load should be considered universally safe to lift and it should be remembered that workers’
capabilities differ.

A task involving the movement of a load that is too heavy for a worker and is carried out
repeatedly will eventually have a substantial impact on the body, creating a risk of MSDs.

When considering load, the following should be borne in mind:

 shape: if the load is an awkward shape, workers will have to use more effort and so could become tired
more quickly
 size: if the load is lifted in a dragging motion, visibility will be affected, increasing the risk of tripping or
falling
 centre of gravity: often an overlooked factor, but if most of the weight is on one side it can throw the
carrier off balance. The heaviest side should be against the body; this will reduce pressure on the spine
 sudden movements: if the load moves suddenly, workers will be at an increased risk because they will be
unprepared for the additional stress this creates
 grasping and moving the load: the outer condition of the load can make it difficult to pick up, and gloves
can often impair dexterity, making it even harder to feel and lift. If the load can’t be altered, consider
putting it into another container with handles to make it easier to grasp
 labelling: a labelling system to help identify the characteristics of the load will help. Labels should be
easy to read, so different languages or symbols may be useful.
Work environment
The work environment should be suitable for workers to carry out their job without risking an
MSD. Consider the following:

 space constraints
 variation in levels of work surfaces or floors.
Environmental factors such as:

 temperature
 ventilation
 lighting
 excessive noise
 weather
 air quality
 dust.
Other risk factors
These include the organisation of the work and psychosocial factors. Psychosocial factors such
as heavy job demands can lead to stress, which has an effect on musculoskeletal health.
Consideration must be given to ensure workers are not carrying out the same monotonous task
for their entire shift.

Assessment tools
There are many tools available that have been developed by organisations to assess physical
tasks.

Repetitive task assessment tools

Assessment of repetitive tasks (ART) involving the upper limbs, taking into consideration
common risk factors in repetitive work. The process involves completing a form which describes
the tasks, following a flow chart or assessment and completing a score sheet which will be a
guide to making an assessment.

Rapid upper limb assessment (RULA) It was proposed by ergonomics researchers in 1993, this
tool evaluates the exposure of individual workers to risk factors associated with ULDs. A single-
page worksheet is used to evaluate the required body posture, force and repetition. Once all the
data are collated and scored using the worksheet, tables are then used to compile the risk factors,
generating a single score representing a level of risk.

Quick exposure checklist

This provides a weighted score that indicates the comparative risk of a body region, task or risk
factor. This score can then be used to help identify the needs for adapting certain tasks. The
assessment can be used by workers as well as organisations.

Rapid entire body assessment (REBA)

A REBA gives a quick and systematic assessment of the complete body postural risks to a
worker. Like RULA, a single-page worksheet is used to evaluate a score for each of the
following body regions— wrists, forearms, elbows, shoulders, neck, trunk, back, legs and knees.

Job analysis can also be carried out. This is a process that identifies:

 the content of a job in terms of activities involved

 attributes or job requirements needed to perform the activities.
Lifting tools and guidance
The Great Britain (GB) HSE created guidance for the lifting and lowering of loads, which
provides organisations with an indication of how acceptable their own working practices are in
terms of the objects they expect operators to move during normal processing or production.
These are only guidelines – there is no safe lifting limit. The figure below shows a basic guide,
based on assumptions that the worker/operator is using both hands to pick up the load in a safe
and reasonable environment using appropriate lifting techniques.

Lifting and lowering – Health and Safety Executive

 

Organisations should carry out more in-depth assessments depending on the nature of their
industry and work and the tasks workers are involved in.

The National Institute for Occupational Safety and Health’s (NIOSH) lifting guide evaluates
two-handed lifting tasks. The inclusion of an asymmetry multiplier reduces the recommended
weight limit (RWL) by around 10 per cent for each 30 per cent of asymmetry. The RWL is the
 weight of the load that nearly all healthy workers could handle in a specific set of task conditions
over a substantial period (e.g. up to eight hours) without an increased risk of developing lifting-
related lower back pain.

Liberty Mutual material handling tables (Snook tables) were originally produced as a way of
performing ergonomic assessments of lifting, lowering, pushing, pulling and carrying tasks with
the goal of supporting ergonomic design interventions. The tables also provide the proportion of
the female and male population capable of performing certain manual material handling tasks
without over-exertion, rather than giving maximum acceptable weights and forces.

Pushing and pulling guidance

Instead of lifting and carrying, pushing or pulling motions should be used, as they put less strain
on the lower back. When workers use push and pull, less effort is required. However, this still
carries risk.

A risk assessment of pushing and pulling (RAPP) tool has been developed by the HSE. It will
help organisations to identify high-risk pushing and pulling tasks and check the effectiveness of
any risk-reduction procedures. The assessments include a flow chart, assessment guide and score
sheet to help determine the level of risk.

Controlling the risk

Once the risk of MSDs has been assessed, the best solution is to eliminate risks. As this isn’t
always possible, the next option is to control the risk through:

 engineering: this is the most desirable control method to reduce the risks and involves designing or
modifying equipment or machinery to reduce the risk of MSDs at the source of exposure
 administrative and work controls: where engineering controls can’t be implemented or if the risk is still
considered to be too high, these types of controls are implemented, for example developing operating
procedures and training on MSD hazards
 personal protective equipment (PPE): PPE should only be used as a last resort and considered as the
lowest level of protection due to the risks it incurs. Equipment can consist of clothing and other wearable
accessories designed to create a barrier against workplace hazards.
Training
Tackling MSDs in the workplace also includes focusing on the attitudes and behaviours of the
people involved in the work, through training and education.
 Training and education play an important role, but only if they are part of a general prevention
objective of reducing MSD risks in the workplace.

Providing workers with knowledge and skills will result in a positive change. There are different
categories of training on MSDs.

 Awareness training increases workers’ knowledge of safe working methods and the need to adopt healthy
lifestyles. It can include information on ergonomics and biomechanics, which will highlight work-related
risks and how to prevent them. It also includes practical on-the-job training, which includes how to use
equipment correctly.
 Training and exercise therapy can be used to increase physical capacity to cope with the workload or
work environment. This kind of physical training can also help to reduce pain related to an MSD
Following training, monitoring and review of tasks should be carried out. This will help to
ensure the right training has been received and workers can correctly apply the knowledge and
skills at work.

Reporting
The first step is to make sure workers know what to report.

Pain is the most common sign of an MSD, which can persist for some time. In addition to pain,
other signs and symptoms include:

 tingling
 numbness
 burning sensations
 weakness
 swelling
 soreness
 stiffness
 muscle spasms
 reduced range of motion
 aches
 cramping
 restricted mobility.
Once the worker has recognised they have a problem, make sure they can report it and are
encouraged to do so. The earlier the worker reports the problem, the easier it is for their
organisation to prevent the issue from developing into something more serious or happening to
anyone else.

Organisations can document a policy and best practices for early reporting and ensure workers
understand how to report discomfort or other signs and symptoms. Ensure that any reported
 problem is dealt with promptly and assign responsibility to someone in the organisation who can
carry out the role of organising the next steps.

How to report MSD injuries

 Report: in the first instance the worker should know where to report their injury and to whom, and how to
seek medical attention if required. First aid treatment may be enough, but if the injury is more serious,
urgent medical attention will be required.
 Investigate: the organisation must investigate and keep a detailed record of what happened and what the
outcome of the investigation is going to be.
 Legal obligations: check to see if there is a requirement to report illness or injury to a local regulatory
body. If so, the organisation will need to ensure this is carried out.
 Communicate: ensure that the organisation is in regular contact with the worker. If they are off work, it’s
important to keep in touch. This will ensure the worker feels valued and is likely to come back to work.
Body mapping tool
The aim of this is to identify problems that require further investigation when workers are
already hurt or struggling. This is also used to encourage workers to think about solutions to the
problems they report.

The organisation could ask the individual to show on the tool where the discomfort is on their
body and rate it out of 10 (10 being highly discomforting).

Body mapping tool

https://iosh.com/health-and-safety-professionals/improve-your-knowledge/occupational-health-
toolkit/noise/
Noise
Introduction to noise
Sound is the transmission of waves of energy in an elastic medium, such as air. It is a sequence
of small and rapid variations in pressure that causes the molecules to vibrate. The interaction of
the vibrating molecules sets up a wave motion that transmits the pressure variation away from
the vibrating source. When these pressure changes are detected by the ear and transmitted to the
brain they are perceived and then interpreted as sound. This is the process of hearing which is
critical to communication.

Noise is described as unwanted sound either because it is too loud, or its nature is displeasing.
What is considered ‘sound’ to one person can very well be ‘noise’ to somebody else. Anyone
who is exposed to excessive noise is potentially at risk of developing hearing disorders with
associated loss of communication skills, and possibly other health issues. The higher the level of
noise, and the longer individuals are exposed to it, the greater their risk of suffering harm from
the exposure.

Individuals are exposed to noise in their daily lives through environmental noise (alarms, sirens,
traffic noise etc). Noise in the workplace is termed occupational noise. Millions of workers
worldwide are exposed to occupational noise levels that puts their hearing health at risk.
Excessive noise is considered an occupational hazard with many adverse effects, not only to the
workers exposed through noisy operations but also to those around them. The effects of exposure
are dependent on three characteristics of the sound i.e., frequency, loudness, and duration, and
when these are poorly controlled this can lead to temporary or permanent hearing loss and can
 impair worker’s efficiency. It is to be noted that environmental noise contributes significantly to
hearing losses in individuals and therefore not all hearing loss is occupational.

The characteristics of sound

Human awareness of sound is the function of three measurable qualities- decibels (dB),
frequency, and duration. They are important when assessing occupational exposure and in
identifying methods of control to prevent hearing loss.

1. Decibels (dB) refers to the amplitude or the height of the wave and determines the intensity or
loudness of the sound. The amplitude is quantified by measuring the pressure changes as sound
waves are transmitted. Sound is measured from a reference value of 0 dB which is the lowest
level of sound a normal healthy young person can hear.
2. Frequency refers to the number of waves of vibration that can occur in one second and is often
referred to as the pitch- the higher the frequency the higher the pitch- and is measured in units
called Hertz (hz). Hertz is a measure of the number of wave lengths in one second. The range of
frequencies that humans are capable of hearing generally falls within the range of 20-2000Hz.
The human voice can generally produce sounds in the range of 250-8000hZ. The majority of
sounds we can hear are between 20 and 8000Hz. It is interesting to note here that certain sounds
are heard at pre-determined frequencies. Vowels are heard at low frequencies and consonants are
heard at higher frequencies. This becomes relevant when discussing noise induced hearing loss
(NIHL) as the damage associated with this loss will begin at higher frequencies e.g., 4000Hz
which will interfere with speech perception.
3. The third characteristic is duration, or how long an individual is exposed to the sound, which is
an important factor in determining the impact that noise will have on hearing. The longer a
person is exposed to loud noises the greater the risk of hearing damage. For this reason, noise in
the occupational setting is rated as the actual level of the noise over a time interval or time
weighted average (TWA). In industry this time interval is 8 hours (a normal work shift).
Noise is a common hazard and is present to some extent in almost all workplaces. It is the most
prevalent health hazard in industries such as forestry, entertainment, manufacturing, agriculture,
shipbuilding, textiles, mining and quarrying, food and drink, wood working, metal working and
construction.

Even though it is considered the most preventable occupational hazard-significant numbers of

workers still suffer from occupational NIHL.

Noise exposure can also lead to accidents due to loss of concentration, misunderstanding oral
instructions and the masking of sounds of warnings and/or approaching danger.
Mechanisms of hearing
The sound waves as described earlier, travel through the air where they move and collect in the
ear by the outer ear, known as pinna. From here the waves travel down the auditory canal to the
ear drum (tympanic membrane). The movement of the sound waves cause the ear drum to vibrate
which in turn causes the small bones (malleus, incus and stapes, collective name of these bones
is ossicles), in the middle ear to also vibrate. The vibrations transfer mechanical energy through
the middle ear to the cochlea.

The cochlea is a fluid filled tube wound in the shape of a snail shell. It contains the sensory end
organ of hearing- the Organ of Corti. There are 20 to 30 000 thousand sensory hair cells or
Organ of Corti connected to the walls of the cochlea, which then move slowly backward and
forwards in the fluid filled cochlea space.

The organ of Corti is stimulated causing a nerve impulse to be sent to the brain. This is how the
mechanical energy (from the sound waves) is converted to electrical energy which the brain
translates and interprets.

 
Exposure to loud noise over time may damage the hearing capability by continually over
stimulating the hairs so that they cannot return to the upright position. Some extremely loud
noises for example, gun fire will create a sound pressure wave that instantaneously damages
hearing known as acoustic trauma. As the hair cells are essentially nervous tissue once damaged,
they cannot be repaired or recover. It is over stimulating on a persistence basis to loud noises in
the workplace that causes occupational noise induced hearing loss.

Sound levels and their relevance

Decibels are measured on a non-linear or logarithmic scale. This means that instead of sound
intensity increasing in equal increments, each sound interval increases by a factor of the base of
the logarithm.

For noise, this means that a small change in the number of decibels can result in a significant
change in the intensity of noise and hence its potential to damage a person’s hearing.

The 3dB ‘trading effect’ means for every 3 dB the sound level increases the impact on hearing
health which is doubled. For example, 63 dB(A) is twice as noisy as 60 dB(A). The relevance of
 this is apparent when considering exposure to hazardous level of noise. For every 3dB the noise
level increases, the exposure time must be halved to keep the worker safe from harm.

The 3 dB trading effect is accepted in most countries. Some countries like the USA use a 4 dB
and 5dB trading rule.

Examples of sound/noise levels generated in a range of activities:

 normal speech is around 60 dB(A)

 HGV passing close by is around 90 dB(A)
 a gunshot is around 110 dB(A).

Noise exposure limits

Globally occupational safety and health legislation requires organisations to provide workers
with a safe and healthy workplace by controlling exposures to occupational hazards. Noise is a
well-recognised occupational hazard which needs to be controlled.

This is achieved through the implementation of established occupational exposure limits for
noise in the workplace. As countries set their own exposure limits for noise, practitioners will
need to consult local legislation to determine what levels have been set for the country in which
their organisation operates.

Upper limit for peak sound

Country 8-hr average dB(A) exposure
pressure level

China 70-90 115

India 90 140

Netherlands 85 140

Poland 85 135

United Kingdom 85 140

USA 90 140

Although the limits vary from country to country, there is a generally accepted standard of a time
weighted average (TWA) of 85 dB (A). TWA is a method of calculating a workers’ daily
exposure to hazards such as noise, it refers to the average rate at which a worker is exposed to an
adverse condition such as noise without unpleasant or dire effects over a defined period such as
an 8hour day or 40 hour work week.

The A-weighting is applied to instrument-measured sound levels (usually using a sound meter
device) to account for the relative loudness perceived by the human ear, as the ear is less
sensitive to low frequencies. Put simply- A weighting measurements are designed to mimic how
humans intuitively perceive noise that is below 100 decibels in volume.

The loudness of the noise is measured in A-weighted decibels and is abbreviated to dBA. The
dBA scale closely matches the loudness of sounds as perceived by the human ear. What this
means is that when measuring the frequencies and decibels of sound with a sound level meter,
the frequencies in the 500 to 10 000 Hz range are measured filtering the lower frequencies,
which are not usually heard by the human ear. A c-weighted range on the other hand would
measure frequencies 30 to 10 000 Hz.

The importance of the TWA is that the longer the duration of exposure the greater the risk of
harm. When a worker is exposed to noise level below the established exposure limit for a
maximum of 8 hours in a day there should be no negative impact on hearing. When workers are
exposed to noise levels louder than the established exposure limits then the duration of exposure
must be reduced to protect the workers hearing.

Decibel level Maximum daily exposure (hours)

85 8:00

91 6:00

95 4:00

97 3:00

100 2:00

102 1:30

105 1:00

110 0:30

140+ 0:00

 
As well as TWA, many countries also implement an exposure limit value for peak sound
pressure. This peak sound pressure is a limit that workers should not be exposed to and is not
weighted by time.

Directive 2003/10/ECs a legal act provided for in the EU, has set limits for noise exposure at
work. The Directive came into force in 2006 and requires organisations to measure the levels of
noise to which workers are exposed (if necessary). It also states minimum requirements for the
protection of workers from risks to their health and safety which are likely to occur from
exposure to noise.

The Directive recommends three action levels for occupational settings depending on equivalent
noise levels for an average 8 hour working day:

(a) exposure limit values: LEX,8h = 87 dB(A) and ppeak = 200 Pa ( 1 ) respectively

(b) upper exposure action values: LEX,8h 85 dB(A) and ppeak = 140 Pa ( 2 ) respectively
(c) lower exposure action values: LEX,8h = 80 dB(A) and ppeak = 112 Pa ( 3 ) respectively.
What is the difference between exposure, upper exposure,
and lower action values?
The ‘action level’ is a noise exposure level at which if met, the organisation is required to take
action to reduce the level, however, the exposure limit value of 87 dB(A) which no worker can
be exposed to.

The different levels mean different controls, the lower levels may require training and hearing
protection whereas, the upper levels may require additional controls to reduce the level or the
length of exposure time. These will be decided through carrying out a risk assessment, ensuring
the noise limits have been assessed to determine the controls required.

Lower exposure action levels: Upper action levels: Exposure limit values:

Daily or weekly personal Daily or weekly personal

Daily or weekly personal noise exposure of 80 dB(A) noise exposure of 85 noise exposure of 87
A peak sound pressure of 135 dB(A). A peak sound dB(A) A peak sound
pressure of 137 pressure of 140 dB
 Effects of noise
When workers are exposed to high noise levels in the workplace, they can suffer from various
adverse health effects. These can be caused by a single exposure to a very loud noise or by
exposures to raised levels.

The effects of noise on hearing depend on:

 noise intensity or sound pressure (dB)

 frequency or pitch of sound (Hz)
 exposure time
 distance from source
 individual susceptibility (age, disease, genetics etc)
 nature of the sound (reverberation, impact noise etc)
 other factors (lifestyle, hobbies).
The most well-known effect of occupational noise is loss of hearing. However, it can also
aggravate other health conditions. Some individuals are more sensitive to the effects of noise
than others and will suffer harm more readily through noise exposure.

Physiological effects of noise

The effects of noise on the psyche are dependent on the individual and what they consider to be
acceptable. Different sounds affect people differently. Noise may startle, annoy, and disrupt
concentration. Even nuisance noise can lead to issues with concentration, productivity,
irritability, and stress, and must not be confused with excessive or prolonged exposure to noise.
Technically nuisance noise is ambient noise levels between 50dB(A) to 60dB(A), which are
below the levels that could damage a worker hearing but cause annoyance e.g., dripping tap.
They affect individuals in different ways depending on several factors, such as the volume of the
noise, how long it occurs, and how long it occurs (continuous or intermittent). Excessive noise
can influence occupational accidents rates by affecting the accuracy of movements and
perception of auditory signals. For industry loss of attention, work efficiency and productivity
are extremely important outcomes of noise exposure.

Loss of hearing or hearing impairments

Common symptoms of noise induced hearing loss (NIHL)
It’s important to spot hearing loss as early as possible because early symptoms can help to
identify the problem quickly and prevent permanent hearing losses.
 Early warnings can include:

 ringing in the ears (tinnitus)

 inability to hear soft and high-pitched sounds
 muffling of speech and other sounds
 trouble understanding conversation at a distance or in a crowd
 listening to music or watching television with the volume higher than other people need
 difficulty hearing the telephone or doorbell
 finding it difficult to tell which direction noise is coming from
 regularly feeling tired or stressed, from having to concentrate while listening
 answering or responding inappropriately in conversations
 reading lips or more intently watching people’s faces during conversations
 feeling annoyed at other people because of not understanding them
 withdrawal from social interaction and,
 feeling nervous about trying to hear and understand others.
Research suggests it can take 10 years from the time someone notices they have hearing loss
before they do anything about it.

Many of the early warning symptoms of NIHL are subtle often causing a worker to ignore them
until the damage is done. For this reason, it is important to use audiometry testing as a screening
test for hearing losses in the occupational setting. This simple quantitative hearing test can be
used to identify early losses or TTS. Once identified this should prompt improved controls to
prevent any further or permanent hearing losses.

Temporary hearing loss

Known as a temporary threshold sift (TTS) this loss of hearing is due to exposure to noise above
the 85dB level but below approximately 100dB or highly hazardous noise. It is in essence an
intrinsic form of protection as sensitivity of the Organ of Corti is reduced during TTS, providing
a transitory auditory fatigue or temporary hearing loss from which the ear will recover however
long it takes. Originally it was the loss which resulted from a day’s exposure to noise and from
which the ear recovered overnight. In most people recovery occurs in the first hour or two after
exposure depending on the level of noise. The extent of the TTS depends on the type of noise
responsible. Usually with this type of impairment no physical signs appear, the ears appear
normal and there is no pain or dizziness. Early signs and symptoms may be tinnitus or ringing in
the ears and a slight muffling sound.

Permanent hearing loss or noise induced hearing loss

This occurs because excessive and prolonged exposure to noise damages the delicate hearing
mechanism of the inner ear (Organ of Corti). Loss in acuity occurs first in 3000-6000Hz band
but characteristically at 4000Hz, and with time and continued exposure these frequency losses
 increase, and the lower frequencies begin to be affected. The losses are subtle and are often
unnoticed until the damage is severe and impacts the workers communication skills. Generally,
permanent hearing loss tends to be highest after 10 years of exposure and it is known that TTS
and permanent hearing loss run parallel. It is the most common preventable occupational health
condition across the world. The level of noise that is likely to damage hearing varies depending
on the individuals’ characteristics and the duration of exposure to noise. The exposure limits
established by countries is deemed to be that level at which unprotected exposure will not cause
adverse health outcomes.

Noise induced hearing loss does not only occur at work. Environmental exposures through
activities such as carpentry, metal work and attending night clubs are known to expose
individuals to noise levels above 95dB causing hearing loss which may exacerbate any
occupational exposure to noise.

Noise induced hearing loss is caused by chronic exposure to noise above or more than the upper
exposure values. This differs from acoustic trauma which can cause damage from a one-off
exposure.

Acoustic trauma or acoustic shock

This is caused by short bursts of extremely loud noise in a sudden single exposure such as an
explosion or gun shots. It is often associated with a rupture of the ear drum due to the force of
the trauma. The hearing loss experienced can be temporary returning to normal or near normal
within three months.

Other effects of noise

Noise can influence other systems of the body i.e the cardiovascular system, resulting in an
increase in blood pressure and the release of catecholamines in the blood (catecholamines are
hormones which help the body respond to stress or fright and prepare the body for fight-or-flight
reactions8). An increased level of catecholamines in the blood is associated with stress, making
people breath faster, raise blood pressure and send more blood to organs such as brain, heart and
kidneys. It may also cause ear pain, nausea, reduce muscle control and diminished visual fields
both for colour and form. Prolonged exposure over a period may well cause occupational stress
in an individual.

Excessive noise can also increase the likelihood of undesired events or incidents by:

 distracting workers, such as drivers

 making it harder for workers to hear and understand instructions correctly
 masking the sound of approaching danger and warning signals
 contributing to irritation and annoyance that may lead to human error.
Exposure of high noise in pregnant workers can affect an unborn child. Research suggests that
prolonged exposure of the unborn child to high noise levels during pregnancy may influence a
child’s hearing later in life with the low frequencies have a greater potential for harm.

Many chemicals in the workplace are Ototoxic too and exposure to these chemicals even in areas
where noise levels are controlled may cause exacerbated hearing loss in workers.

Managing noise
The effective management of health and safety risks is an essential part of a good health and
safety management system. When risk management is integrated into the core business
functions, real change and improvement can be seen not only by preventing physical harm to the
workers, but also by improving business performance.

Organisations and line managers have a responsibility to protect all workers from the harmful
effects of noise generated in their workplace. This includes all workers whether employed on a
temporary, permanent, or casual basis, as well as all visitors and contractors who may enter a
noise zone in the workplace.

Due to the potentially high-risk nature of noise, organisations are required to control noise at the
source and eliminate or reduce the risks where possible. Using the hierarchy of control is
important to ensure the exposures are reduced to as low a level as possible. Based on the 3dB
trading effect just a 3dB reduction in noise levels will half the impact the noise has on workers.
Personal hearing protection should not be used as the only source of protection as noise can
cause damage through the transfer of noise through vibrations which are transferred via the skull
bone to the cochlear.

To manage health and safety risks effectively, organisations and workers need to fully
understand them. Therefore, having a clear understanding of the noise-related risks and how
these may affect individuals is crucial.

To establish and maintain a safe working environment, organisations need to ensure that:

 noise surveys are conducted to quantify the noise in the workplace and set boundaries for limits
using noise zones
 workers needs are considered during the planning and organising of work
 adequate controls are in place to eliminate or reduce workers exposure
 noisy areas are clearly defined and separated, and enough safety signs are displayed
 hearing protection is provided, maintained, and used correctly
 workers are adequately instructed and trained
 a regular health surveillance programme is in place (audiometry screening tests)
 effective enforcement of controls is applied to mitigate exposure.
Workers need to know how to work safely and without risks to their health. Organisations must
provide them with clear instructions and adequate training. The information must include:

 the nature of risk and where it is located (risk assessment outcomes)

 safe working practice/rules
 the effects of noise on hearing
 the purpose of hearing protection
 instructions on fitting, use and care of hearing protection
 the purpose of health surveillance, including audiometry testing
 reporting problems as soon as they are apparent
 workers within the organisation should be aware of what they are expected to do. When
organisations provide information and training, they should assess the workers knowledge to
ensure that training is relevant and effective. The information and training provided to workers
should be in a form that is easy to understand.
Identifying the risks
Identifying noise as a potential risk can be as challenging as other health related risks, as they are
often dealt with in a reactive way. However, organisations should be thinking proactively about
identifying potential noise risks within the workplace.

The organisation will need to assess the levels of noise to which the workers are exposed.
Results of the risk assessment must be recorded and kept up to date. When carrying out a noise
risk assessment, the organisation must include the level (dB and Hz), type (continuous,
intermittent, impact), and the duration of noise exposure in the various areas of the workplace.
These should then be compared to legally established exposure limits and actions limits. The
assessment will also need to include any interactions with other risks such as chemicals or
vibrations.

The organisation must ensure that noise at work doesn’t exceed the established exposure limits.
Where noise does exceed these limits, the organisation must implement/apply measures to
eliminate or reduce the exposure to acceptable limits using the hierarchy of control.

Individual factors
Exposure to excessive noise is not the only hazard that can result in hearing impairment in the
workplace. Certain chemical agents are ototoxic, for example, trichloroethylene, carbon
monoxide, toluene, and medications such as some antibiotics, aspirin in large doses and loop
 diuretics are known to have a more than synergistic effect on the damage to hearing. Exposure to
such chemicals may increase the impact of noise on hearing loss.

Other risk factors which may affect hearing could include:

 aging, degeneration of inner ear structures over time

 hereditary, the genetic makeup may make people more susceptible to ear damage from sound or
deterioration from ageing
 recreational noise, hobbies, or activities outside of work may also cause hearing problems, for
example motorcycling, carpentry or listening to loud music
 some illnesses, diseases or illnesses that might result in high fever such as meningitis, may
damage the cochlea.
It’s important to take into consideration a worker’s hearing impairment they may already have. If
their ability to undertake a safety critical task is compromised, this could pose a significant risk
to their safety and others around them. The requirement for an assessment of fitness for safety
critical task will only be applied when it is necessary and not used as a form of medical selection
and potential discrimination.

It’s important to remember that the length of time of exposure is also important, noise levels at
85dB(A) may take as long as 8 hours to cause hearing damage whereas 100dB(A) may start
damaging hair cells in the ears much quicker.

Controlling the risks

Once the risk of noise has been assessed, the next step is to control the risks.

The hierarchy of control is used to determine practical and effective risk control methods for the
workplace based on the noise levels reported in the noise survey. The hierarchy of noise control
includes elimination or substitution of noise sources, collective control measures through
engineering and work organisation, and personal protective equipment (PPE).
 There are several ways in which noise can be controlled, which will vary from one workplace to
another. There’s no single technique or solution that is appropriate for every situation. A good
understanding of the nature of the noise, its source, plant operations and work processes, as well
as working hours are necessary to determine the most effective method of eliminating,
minimising, or controlling the noise.

Factors the organisation should consider include:

 the scale of the noise problem and its impact on the business (including workers)
 cost and effectiveness of planned control measures
 the number of individuals who would benefit from proposed control measures.
An essential outcome of noise risk assessment is identifying and prioritising measures to control
the risks. Managers should use the risk assessment findings to formalist an action plan for
controlling noise. The key actions will include:

 prioritising immediate and high-risk areas identified in the noise survey

 identifying possible methods to reduce noise
 assessing the reduction levels that can be achieved by introducing cumulative controls
 assigning responsibilities for implantation of controls
 communicating the plan to all workers
 monitoring controls and performance.
Elimination
Elimination is a process that removes the noise at the source and is the most effective way to
prevent harm to workers. It is not always achievable, but examples would include eliminating
impacts between hard objects or surfaces or moving and isolating the noisy operations away
from other work activities.

Planning and introducing a suitable purchasing or hire policy are essential to reducing the level
of nose at work. Considering at an early stage how the new work process or new machinery
would work without exposing the workers to excessive noise is the most cost effective and long-
term measure business can take to reduce overall noise levels. Before acquiring new machinery,
its noise levels should be considered this can be achieved by liaising with and obtaining
information from the manufacturer or supplier of the plant or machinery. This may include
installation instructions, maintenance arrangements and likely noise levels under the specific
conditions in which the machinery will be operated. Note: the noise levels should always be
considered when introducing a new work process, selecting new work equipment, and designing
the layout of the workstations.

Substitution
Substitution is a process of replacing noisy machinery or equipment with quieter alternatives.
When elimination is not possible, substitution of the noisy machinery or equipment for quieter
ones may be the next- best alternative to control noise.

Organisations should always consider alternative equipment and work processes which would
make the job less noisy.

Performing a task differently can protect the workers as lower noise levels are generated for
example, the use of hydraulic processes to bend material products produces less noise than
hammering.

A risk assessment must be conducted to ensure the substitution of work processes does not
introduce another type of risk, as seen when welding is introduced in place of riveting.

Table 1 shows some examples of substitution methods which can be adopted to reduce the level
of noise in a workplace.

Noise source/process Alternative source/process

fuel engines electrical engines
pneumatic tools electrical tools
 throwing positioning gently
solid wheels rubber tyres
metal gears
plastic gears
metal bearings fibre bearings
metal chutes and containers rubber or plastic chutes and containers
forging pressing
hammering gluing
stapling clipping
chipping grinding
rollers conveyor belts
 

Engineering controls
Engineering controls are all about making changes to processes, machinery, or equipment so that
the workers are exposed to less noise. For example, using screens, barriers, enclosures, and
absorbent materials that help to reduce workers’ noise exposure.

Some engineering measures that may be considered are:

 separating the noisy area from other workspaces (eg sound proof control rooms)
 enclosure of noisy machinery (boxing it in or placing in an enclosed space)
 avoiding metal-to-metal contact by using plastic bumpers
 using absorbent material on surfaces to cushion the fall or impact of objects on walls, ceilings,
and floors to reduce the noise due to reverberation
 using conveyor belts rather than rollers
 using acoustical silencers/mufflers on intake and exhaust systems
 using rubber mounts to isolate vibrating noise source to separate it from the surface its mounted
to
 maintaining optimum speed of machinery or its components
 repairing and replacing loose rotating parts, worn bearings and gears
 undertaking regular maintenance on equipment (very effective in reducing noise emission if
carried out regularly)
 increasing the distance between the source of noise and the workers.

Acoustic insulation material

 
Administrative controls
 Administrative controls are the way work is organised to reduce either the number of workers
who are exposed or the length of time they are exposed to noise. Administrative controls should
be used when it is not possible to reduce noise exposure through elimination, substitution, or
engineering control measures.

Some administration controls include:

 identifying hearing protection zones and clearly sign-posting noisy areas

 increasing the distance between noise sources and workers, the further away the noise source is,
the less harmful its effect on workers will be
 organising schedules so that noisy tasks are performed when as few people as possible are
present
 minimising the number of individuals working in a noisy area keeping individuals out of the area
if their job does not require them to be there
 limiting the time workers spend in a noisy area by job design and job rotation
 providing rest breaks in areas away from a noisy work environment
 providing sufficient information, instructions, and training to the workers for the proper use of
work equipment
 health surveillance to monitor effects of noise on hearing.
Personal protective equipment
Personal protective equipment (PPE) or in this case, hearing protective equipment (HPV)
protects the users from any adverse effects on hearing caused by exposure to high levels of noise
by providing a barrier between the noise and the pathway of hearing. It is the last option in the
hierarchy of control and should be used as a last resort after all the efforts to eliminate or reduced
noise levels have been exhausted through technical and organisational means.

All hearing protection must be capable of reducing the noise exposure to safe exposure levels,
while allowing for communication to be heard without removing the HPE and should be made
available at no charge for workers to use. It is important to ensure that the HPE chosen to protect
the workers is suitable for the individual’s working environment and compatible with other PPE
being used, for example hard hats, dust masks, eye protection etc. It is good practice to offer
different types of protectors so that workers can chose ones which suit them better. This will
improve compliance for the use of HPE.

It is important to consider a worker’s personal preference and health when selecting HPE. For
example, workers who have hearing loss might not like to wear HPE because it makes
communication more difficult. In these cases, meet with the worker and find the best option that
will work for them. These workers need to understand that the continued uncontrolled exposure
to noise they will continue to lose hearing until they are considered deaf.
Hearing protection comes with a single number rating (SNR) in the EU and a noise reduction
rating (NNR) in the USA. This number in decibels provides an estimate of noise reduction
provided to the user when wearing them. A basic earmuff will give the wearer an approximate
protection of 22 to 33 dB reduction and basic foam ear plugs will give approximate protection of
20 to 30 dB reduction.

There will be circumstances where the SNR levels are not enough to reduce the loudness of the
noise to a safe level. In this case, check other control methods to limit the time workers are
exposed. However, this can be difficult for mobile workers or those workers who move around
in the work environment e.g. maintenance crew. For more advice on protecting these workers,
contact industry specific specialist consultants or organisations who will provide further
guidance and information around how to control and manage exposure in the specific
environments.

Hearing protection will only provide protection if worn correctly. Providing training to workers
on how and when to wear HPE should be followed by an assessment of their understanding, to
ensure it is effective.

Psychosocial hazards (including stress)

Various definitions have been given to the term ‘psychosocial hazards’, such as the following:
 “… interactions between and among work environment, job content, organisational conditions
and workers’ capacities, needs, culture, personal extra-job considerations that may, through
perceptions and experience influence health, work performance and job satisfaction”
 “… aspects of the work environment and the way that work is organised that are associated with
a negative impact on mental health and/or physical injury or illness. When psychosocial hazards
are not effectively managed, they can negatively impact on organisational measures including
productivity, absenteeism and turnover.”
More simply, psychosocial hazards are: “those aspects of the design and management of work,
and its social and organisational contexts that have the potential for causing psychological or
physical harm”.

The UK’s Health and Safety Executive explained in 2006 the impact that psychosocial risk
factors have on ‘frame of mind’ and the potentially higher incidences of practising unsafe
behaviours in the workplace.

‘Psychosocial’ refers to the inter-relationships between individuals’ thoughts and behaviours and
their social environment.

This term can be interpreted differently outside of the OSH world and can often refer to social
environments such as family, socio-economic status and level of education. In the OSH field,
psychosocial hazards refer only to hazards created by work and the work environment.

Work-related stress is the most common pathway from poorly managed psychosocial risk to ill-
health.

Emerging psychosocial hazards

An emerging OSH risk is any occupational risk that is both new and increasing.

The European Agency for Safety and Health at Work set up the European Risk Observatory,
which identified and explored emerging OSH risks by carrying out a survey and analysing
scientific literature.

The 10 most important emerging psychosocial risks identified in the survey were divided into
five categories as follows:

 new forms of employment

 contracts and job insecurity
 OSH risks for the ageing workforce
 work intensification
 high emotional demands at work
 poor work–life balance.
What’s the issue?
Psychosocial hazards including work-related stress are referred to indirectly in many national
legal frameworks, but very few countries have specific laws which deal with these hazards in the
workplace.

The concept of ‘psychosocial hazards’ is difficult to understand as they represent workers’

perceptions and experiences, reflecting many considerations in the work environment.

Psychosocial hazards are a major occupational health concern and are associated with serious
economic implications for society and all types of organisations, irrespective of size and sector.
Organisations can manage psychosocial hazards proactively, using the same methods already
used to manage OSH.

There is a wealth of terminology used around psychosocial hazards:

Terminology Translation/meaning Source

A workplace that promotes
workers’ psychological
wellbeing and actively works to National Standard of Canada on
Psychologically healthy and safe
prevent harm to worker Psychological Health and Safety
workplace
psychological health, including in the Workplace
in negligent, reckless or
intentional ways
Relating to the interaction
Psychosocial between social and Dictionary.com
psychological factors
An occupational hazard that
affects the psychosocial
wellbeing of workers, including
Psychosocial hazard Definitions.net
their ability to participate with
other people in a work
environment.
Psychosocial risk The likelihood of factors arising IOSH
from poor work design,
organisation and management,
combined with poor social
context of work, that could
result in a negative effect on
workers’ health including
 psychological, physical or social
issues such as work-related
stress, depression and burnout.
Organisational factors that have
an impact on the psychological
safety and health of workers.
These factors include the way
work is carried out and the Canadian Centre for
Psychosocial risk factors
context in which work occurs. Occupational Health and Safety
Psychosocial risk factors can
affect workers’ mental
responses to work and cause
mental health problems.
An applied method to reduce the
Psychosocial risk management
impacts of risks to psychosocial IOSH
system
hazards in the workplace.
Psychosocial safety climate
(PSC) is defined as shared
perceptions of organisational
policies, practices and
procedures for the protection of
worker psychological health and
safety, that stem largely from
management practices. PSC
Psychosocial safety climate
theory extends the Job National Library of Medicine
Demands-Resources (JD-R)
framework and proposes that
organisation-level PSC
determines work conditions and
subsequently, psychological
health problems and work
engagement
 

When working conditions and human factors are all in balance, work can create a feeling of:

 mastery
 self-confidence
 motivation
 satisfaction or fulfilment
 physically and mentally fitness and health.
Psychosocial hazards or factors are aspects in the design or management of work that increase
the risk of an adverse impact leading to work-related stress, exacerbated non-work-related stress
or affect individual workers’ health and wellbeing.
 A stress response is a physical, mental and emotional reaction that occurs when a worker’s
perceptions of the demands of their work exceed their ability or resources to cope. It’s important
to remember that stress itself does not constitute a physical or psychological injury.

Workers are likely to be exposed to a combination of psychosocial hazards, some of which are
always present, while others only occasionally. The terms ‘psychosocial hazard’ and
‘psychosocial risk’ are sometimes used interchangeably, and stress is often defined as a
psychosocial hazard rather than a consequence of the hazard.

In the OSH profession a hazard is the potential for an agent, process or situation to cause harm or
negative health effects to a person at work. Risk is the likelihood or probability that a person will
be harmed or experience negative health effects if exposed to a hazard.

Psychosocial hazards are aspects of work (eg, lack of autonomy, long working hours) which can
affect workers’ emotions, behaviours, biochemical and neuro-hormonal reactions. The risk is the
likelihood or probability that a person will be harmed or experience negative physical or mental
health effects from being exposed to a psychosocial hazard.

The relationship between hazard and risk is exposure, whether immediate or long-term. In this
context, it includes both physical and psychological outcomes.

Common factors
Common psychosocial factors
Work demands: A work demand may be a positive or negative experience, depending on the
individual’s ability to cope with them, as well as the level of support provided by the
organisation to help them manage the demands.
The ability to cope with demands can be affected by external factors such as bereavement,
relationship breakdown or illness. If work demands are imagined as being liquid in a bottle, the
work demands may fill the bottle. If nothing else is added, the worker can cope. However, if
something is added, then the bottle overflows. Work demands should always allow room for
other demands without causing the bottle to overflow.

Work demands that could result in a negative experience can be categorised into several
categories:

 quantitative demands – time pressure or the amount of work

 cognitive demands – affect primarily the brain processes involved in processing information; the demands
can be made more difficult by work equipment, workload, pace and inadequate work resources to carry
out the work
 emotional demands – primarily associated with the effort needed to deal with organisationally desired
emotions during interpersonal
 transactions (for example, the pressure to respond in a particular way when smiled at by a stranger in the
street)
 physical demands – primarily associated with the musculoskeletal system
 organisational demands – culture, structure of communication, organisational principles and priorities,
and leadership style.
Organisations should liaise with workers and listen to any of their concerns regarding work
pressures to reduce negative feelings and experiences. By listening to workers, this will also have
a positive impact on them as they will feel valued within the organisation, especially if they feel
the organisation is making improvements following their concerns.

Organisational improvement of negative job demands

 improve time management and work flow
 ensure adequate breaks and recreation time
 avoid unrealistic deadlines
 substitute heavy manual tasks with machinery to reduce physical workload
 avoid encouraging workers to work regularly for long hours
 monitor shift patterns and working overtime.
Job insecurity, organisational change and restructuring: All organisations at some point
undergo change. Whether change is positive or negative, it may increase pressure and instability
on workers, creating anxiety and concern over job security. Job insecurity can:
 have a negative impact on job satisfaction
 increase the likelihood of reporting negative mental ill health
 lower the likelihood of reporting absenteeism
 increase levels of presenteeism.
Factors which can affect workers include:

 a lack of permanent contracts

 a lack of guaranteed hours
 high unemployment rates
 an economic downturn
 the introduction of new technologies
 a lack of career prospects
 poorly managed change
 poorly communicated change
 a lack of prospects for promotion or career development.
Organisational initiatives for managing change:
 focus on clarity and objectives around work expectations
 provide feedback on development to workers be transparent and fair regarding organisational processes
and procedures
 Relationships at work: The sense of belonging and social cohesion that is created by work
relationships is an important aspect of psychological health. Where this breaks down or is not
present, it can lead to negative health outcomes.
Relationships at work are affected by:

 social or physical isolation

 poor relationships with superiors, colleagues and staff members
 interpersonal conflict
 lack of social support
 bullying
 harassment
 Role-related factors affecting health include:
 role ambiguity
 role conflict
 responsibility for people
 low participation in decision-making
 lack of control over workload
 perceived lack of work–life balance.
Work–life balance is about individuals feeling they have a good balance between the demands of
work and time to spend on other, non-work-related activities that they wish to pursue. It is not a
static thing and will change for individuals over time and will mean different things to different
people. What might have been relevant for a worker aged 25 might not necessarily meet their
needs when they are 35 or 55 years old.

Anyone in an organisation can become bullied or harassed. It might be difficult to identify if

someone is being treated in this way. People who are the targets of bullying may experience a
range of effects such as:

 shock
 anger
 feelings of frustration and/or helplessness
 increased sense of vulnerability
 loss of confidence
 physical symptoms such as inability to sleep and loss of appetite
 psychosomatic symptoms such as stomach pains and headaches
 panic or anxiety, especially about going to work
 family tension and stress
 inability to concentrate
 low morale and productivity.
Initiatives for managing relationships at work
At an individual level:

 encourage workers to report incidents such as inappropriate comments and behaviours to their line
manager or human resources department.
At an organisational level:
 investigate any complaints concerning harassment at work and take appropriate measures
 establish a policy of zero tolerance of bullying
 carry out a risk assessment
 establish a reporting system and procedure and ensure workers are aware of the process
 train managers in conflict management
 provide managers with advice and assistance in handling difficult absence issues.
Work-related violence and trauma: Work-related violence is a workplace incident involving
exposure to abuse, the threat of, or actual, harm that causes fear and distress and can lead to
stress, anxiety, post-traumatic stress disorder (PTSD) and/or physical injury. This includes
adverse social behaviours (workplace bullying and harassment) and third party violence such as
patients or customers attacking workers.
It is common among groups that are public- or customer-facing, as well as first responders,
disaster and emergency services and defence personnel. Violence can include:

 robbery
 physical or verbal assault
 being bitten, spat at or scratched or kicked
 being threatened with a weapon
 being followed
 threatened
 damage to vehicles
 sexual assault
 witnessing abuse or violence
 witnessing traumatic scenes – for example, accidents and suicide.
Those who work with people who may have mental ill health disorders or are under the influence
of drugs or alcohol can be at increased risk of violence.

The work environment can trigger negative behaviour which can contribute to the development
of bullying, harassment and violence. This can be due to any of the hazards mentioned or
circumstances such as a poor social environment or competition between workers in the
workplace.

Organisations can adopt initiatives to manage work-related violence.

Initiatives on work-related violence: 

 a response system to address immediate safety issues
 arrangements for medical treatment such as a first aider or information on how to contact the emergency
services
 ensure workers know how to report and notify external agencies such as the police
 put incident management policies and procedures in place and ensure they are implemented
 consult with other teams in the organisation such as human resources, facilities, security and any workers
who are likely to be directly affected by work-related violence on policies and procedures regarding
incident management
 prepare and communicate emergency and evacuation plans, providing training in the form of
 practice drills to ensure workers are aware of the procedures.
IOSH has funded research into the impact of unacceptable behaviour on health and wellbeing at
work and the workplace behaviour study.  

Work related stress

The World Health Organization describes work-related stress as the response people may have
when presented with work demands and pressures that are not matched to their knowledge and
abilities and which challenge their ability to cope.

Work-related stress is considered a global concern. However, not all manifestations of stress at
work are categorised as work-related stress. Stress can also stem from outside the working
environment, leading to changes in behaviour and reduced effectiveness at work. Stress can also
occur as a combination of work and non-work factors.

Unhealthy lifestyles can also affect workers health and performance at work. The impact of this
on workers varies between individuals.

If a worker is suffering from high stress levels, this can develop into a mental ill health disorder,
behavioural disorder or a physical impairment.

Health effects from the impact of stress can be exhaustion, burnout, anxiety and depression.
Physical impairments can include cardiovascular disease (CVD) and musculoskeletal disorders
(MSDs).

Signs of stress can be noticeable by colleagues and managers. They include deteriorating
relationships with colleagues, irritability, indecisiveness and reduced performance. Stressed
workers may also engage in unhealthy activities such as increased smoking, alcohol
consumption, drug use and misuse and increased risk-taking.

A certain amount of pressure is healthy and can improve performance and motivation. However,
when that pressure exceeds the individual’s ability to cope and turns into stress it starts to have a
negative impact on their mental health. Prolonged exposure to work stressors can leave workers
vulnerable to have negative effects on health and wellbeing and cause illnesses, from headaches
and gastrointestinal disorders through to depression and anxiety disorders, heart attacks and
diabetes.
 The symptoms of work-related stress not only affect individual workers but can also negatively
affect an organisation, resulting in an increase in:

 absenteeism
 presenteeism
 higher accident and injury rates
 higher rates of early retirement
 reduced productivity
 reduced engagement.
The cost of these can run to billions for businesses and society globally.

Work-related stress can be preventable by taking appropriate action.

Work-related stress and the link with musculoskeletal

disorders (MSDs)
The role of psychosocial factors and work-related stress in the development of MSDs has
received increased attention. Several epidemiological studies have been conducted in various
sectors (from office to manual work), repeatedly showing linkages between work-related
psychosocial factors and MSDs. Overall it is clear that the incidence of MSDs is associated with
high perceived work-related stress levels, high workload and demands, low social support, low
job control and low job satisfaction and monotonous work.

Effective measures
Senior management engagement
It’s important when tackling this subject to ensure that senior management is committed to
tackling the issues and providing resources.

Collating evidence of the problem and risk by using data such as absence reports, complaints,
staff survey and quantifying this in financial terms (how much is it costing the organisation) is
helpful in gaining senior management support.

Other ways to secure commitment would be through explaining the positive business benefits to
tackling psychosocial hazards, such as:

 maintaining business output and performance

 high staff performance and productivity
 low staff turnover and less intention to leave
 high attendance levels
 high staff recruitment and retention
 good level of customer satisfaction
 strong organisational image and reputation
 lower levels in potential litigations
 legal compliance (where this is applicable).
It’s important to highlight the effectiveness of internal collaboration as there’s a need for more
preventative strategies and better coordination between an organisation’s human resources and
occupational safety and health teams, as well as occupational health services (which may be
provided externally).

Consultation and participation

Engaging with workers at all levels will make them feel more valued. Setting up working groups
or steering groups up with a representative from various departments will help to gather
information as well as update workers. The organisation may already have a health and safety
committee in place but a separate sub-group may be appropriate to help to steer the process.

Research has proven that self-reporting questionnaires can be a good way to measure
psychosocial risks by asking workers how they feel about certain potential hazards.
Organisations potentially have access to a wealth of information, such as:

 sickness absences data

 presenteeism data
 number and type of grievances
 staff attitude survey results and
 exit interviews
 one-to-one meetings between managers and workers.
Organisations can use this information to gain an insight into what the psychosocial issues are.

Consultation with workers is key to a healthy and safe workforce. Consulting on psychosocial
hazards matters involves:

 sharing information on hazards and risks

 giving workers an opportunity to express their views
 raising issues
 contributing to the decision-making process
 advising workers on outcomes
 protecting workers from reprisals when reporting incidents, hazards, risks and opportunities for
improvement
 removing barriers that may limit workers’ participation
 encouraging proactive dialogue on all aspects of psychosocial risk management.
Some organisations may already have successful communication channels, in the form of:

 toolbox talks
 discussions
 focus groups
 surveys
 committee meetings
 team meetings and individual discussions.
Organisations are recommended to develop their own measures which can be specific to them,
based on local knowledge and information and incorporated into a risk management framework
if possible.

Organisations can develop ways of assessing hazards through questionnaires focussing on:

 observations
 task analysis
 job descriptions
 reports of harm and what they may highlight about the hazards.
This information can be used in determining the need for a separate psychological health and
safety policy, which is tailored to the organisation.

Psychosocial hazards and risks can be tackled in the same way as any physical hazard or risk –
the elements are the same. Using the plan, do, check, act method is essential in tackling the issue:

 identify the hazards – what are they?

 hazards that may affect the workers
 decide who might be harmed and how – consider all workers but specifically any vulnerable
people
 assess the risks – including their frequency and severity
 record the findings – document any finding so that the organisation can carry out any necessary
work and benchmark figures once a review has been carried out, remembering to communicate
findings with workers
 review assessments and controls – if any controls have been identified, ensure they are working,
carry out a review of the risk assessment and see if any of the risks have been reduced following
the implementation of the control measures.
Take time to review current risk assessments and make sure the controls are still working. If any
changes need to be made, these will need to be communicated to the workforce.

Line managers
 Line managers can proactively address potential consequences from psychosocial hazards
including work-related stress issues, which will reduce the likelihood of workers suffering from
physical and mental ill-health.

Line managers can be the first port of call for workers to turn to when they have an issue, putting
them the ideal position to identify and manage issues such as work-related stress.

Line managers can also notice a change in workers’ behaviour, giving a reason to investigate and
find out what is causing the unusual change in behaviour.

Line manager responsibilities

1. Be aware of the potential hazards (and the psychosocial risk factors) and how they can be
mitigated.
2. Engage and communicate with workers about these potential hazards and raise awareness.
3. Be aware of the organisation’s commitment, policies and procedures on these issues.
4. Provide support and get involved in organisational initiatives to tackle issues such as stress, by
encouraging staff to complete questionnaires, attend focus groups or suggest solutions. This will
help workers to feel able to talk openly about any issues to the line manager.
5. Be aware of and undertake training to improve competencies needed to manage issues and
prevent them from developing.
6. Identify work-related stress early and work with the individual and human resources team to
resolve the problem, providing access to relevant support services if required.
7. Help staff return successfully to work after work-related stress.
Emotional intelligence
A manager should have a high level of emotional intelligence – the ability to perceive,
understand and manage their own feelings and emotions. This quality gives individuals a variety
of skills such as the ability to manage relationships, navigate social networks, influence and
inspire others. This is an important factor for success, influencing productivity, efficient and
team collaboration.

Why managers should cultivate their emotional intelligence

 Self-awareness – being self-aware is a vital skill for managers and gives them the ability to
recognise emotions and how they affect others. This enables them to address problems and
handle any future complications.
 Emotional management – this skill gives managers the ability to remain aware of their feelings,
regulate themselves and stay in control. It is important for managers to keep their emotions in
check as it will help them stay in a position which is respected by workers.
 Effective communication – managers with a high emotional intelligence are often listened to and
can communicate effectively in a way that will motivate and inspire others. This is essential for
building and leading successful teams.
 Social awareness – this is a skill that enables managers to put themselves in the position of the
worker, giving them the ability to provide feedback, which is not only helpful to the worker but
 will also motivate and inspire a team. This also enables them to manage relationships and build
networks.
 Conflict resolution – managers can use this skill end disputes quickly between workers,
customers or third parties and provide a resolution if required. Situations like these can affect the
efficiency, effectiveness and productivity of an organisation.
Health and safety managers
By proactively addressing work-related issues such as stress, health and safety managers reduce
the likelihood of workers developing physical and mental ill health issues.

Health and safety manager responsibilities

1. Understand psychosocial hazards and risks, including the causes, management and prevention of
work-related stress.
2. Keep up to date with good practice relating to the topic by looking at other organisations and
case studies to see how others have reduced work-related stress.
3. Conduct a review of the organisation on the subject, including any existing policies, procedures
and risk assessments.
4. Use the HSE management standards or equivalent to identify the hazards and extent of issues in
the workplace. Explain to the organisation what changes need to be made to improve the
workplace. Remember to monitor and review any changes being put into place.
5. Look for potential triggers which could harm workers’ physical and mental health, for example
changes to senior management in the organisation. Workers may require support to help them
through the process. It’s good to start by reviewing any current risk assessments on this – if there
isn’t one, prepare one for the organisation, using the HSE management standards as a guide.
6. Communicate and engage with workers by providing information on mental and physical health
risks from psychosocial hazards such as work-related stress awareness, and encourage workers to
inform their line managers.
7. Give feedback on any concerns about potential risks from psychosocial hazards in the workplace
to board level – remember that it’s important to maintain confidentiality of the worker or
workers involved if reporting to senior personnel.
8. Examine any risks from psychosocial hazards and factors in frequent sickness absence, or
workers’ presenteeism or absenteeism.
9. Work with the human resources team, occupational health, facilities team and any other team or
department, if you have them, to support individuals and implement solutions identified by staff
to enable a successful return to work if required.
In the UK, the Health and Safety Executive (HSE) developed six areas of work design that can
help manage the psychosocial hazards. Although originally used to manage stress, they can also
work with psychosocial hazards.

 Demands – this includes issues such as workload, work patterns and the work environment.
 Control – how much say the person has in the way they do their work.
 Support – this includes the encouragement, sponsorship and resources provided by the
organisation, line management and colleagues.
 Relationships – this includes promoting positive working to avoid conflict and dealing with
unacceptable behaviour.
 Role – whether people understand their role within the organisation and whether the organisation
ensures that they do not have conflicting roles.
 Change – how organisational change, large or small, is managed and communicated in the
organisation.

Mental health
We each have our own distinct perception of life through experiences with different thoughts,
emotions physical processes and interactions. Everybody has mental health and physical health,
and one can influence the other. These states can shift across a spectrum, and a mental state can
 change at any time, sometimes in response to recognisable factors and sometimes as a result of
those which are harder to identify. These changes can lead to mental ill-health complications.

Most people will spend an average of 90,000 hours in work over a lifetime but a worker’s mental
health does not start and end in the workplace. Mental health can be affected by factors both
inside and outside of the workplace, which organisations should recognise.

By learning more about mental health and potential causes of mental ill-health, organisations
become better able to implement effective management methods. These can prevent or limit
work impacts on mental ill-health. Organisations may also develop a deeper understanding of
what is happening to a worker with mental ill-health and be more empathetic to what they may
be experiencing.

Workers with mental ill-health require:

 support in gaining self-awareness and insight into their personal need to prevent the negative
impacts of mental ill-health and to regain control
 personalised return-to-work support where the focus is on values, views and needs
 effective collaboration between various professionals.
Organisations who provide appropriate support for workers’ mental health are likely to
experience:

 improved productivity, innovation, efficiency and morale

 reduced sickness absence and presenteeism, plus worker retention, leading to financial and
resource savings
 enhanced organisational reputation in the marketplace
 satisfaction in honouring its duty of care towards its workers
 savings in legal and regulatory.
Mental health, mental ill-health and stigma
A person’s mental health is the state of their psychological, emotional, cognitive and social
wellness. It can affect decisions, reactions, attitude, behavioural and social characteristics and
general mood. There can be a lot of stigma and misconception associated with mental health and
what it means.

When talking about someone’s mental health, the perception is that it is a negative state of mind,
emotions, behaviour or wellbeing. It is automatically associated with adverse effects, but this
should not be the case.

Mental health
 The World Health Organisation defines mental health as: “A state of wellbeing in which every
individual realizes his or her own potential, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to her or his community.”

Mental health can describe both positive and negative mental states. These can be of a short
(acute) or long-term (chronic) duration. States can change suddenly or progressively over a
lifetime and can be unpredictable.

Positively, a person’s mental health can be healthy, stable, adaptable, strong and resilient.
Therefore, organisations and occupational safety and health (OSH) professionals should take
care when using the phrase ‘mental health’ and use it in the appropriate context.

Mental health can be negatively affected by:

 past or present traumatic events

 physical and mental abuse
 environmental factors
 significant events
 specific tasks
 fears or threats
 other illnesses (including pain and chronic pain)
 biological factors (eg, genes)
 no obvious recognisable.
A persons mental health may change across a spectrum of states over time.  The mental state for
some can change in a short period of time and fluctuate rapidly (eg day to day), and for some it
can be more long-standing and have an effect over a longer period.

Movement from a positive to a negative mental health state caused by a negative event or factor
 

Mental ill-health
Mental ill-health can be described as:

 “When one’s mental health has reached a point where they cannot cope with stress, thoughts,
emotions, or previously diagnosed disorders; and symptoms cannot be managed without the need
for some sort of intervention.” – As defined by IOSH.

This means that someone may experience  symptoms of mental ill-health, and may require some
sort of support, treatment or recovery time. However, this will not necessarily mean that they
have a (diagnosed) mental disorder.

A mental disorder or condition or diagnosed mental illness can be described as:

“A state of mental ill health that can develop into known diagnosed mental illnesses or disorders
that adversely affect the way one thinks, feels, behaves, interacts, and functions, and where
medical intervention may be required.” As defined by IOSH.
Mental ill-health can also be referred to as a ‘mental health problem’.

When talking about diagnosed mental disorders, organisations must consider the  terminology
they use that best suits their workplace. For example, a worker may be diagnosed with  a ‘mental
disorder’. This terminology could be perceived negatively in the workplace. It could impede
ambitions to reduce organisational stigma. Referring to ‘mental disorders’ as ‘mental ill-health
conditions’ may be more beneficial for workers and the organisation. It may allow workers to be
more honest and  open about mental ill-health.

It is true that once diagnosed, mental disorders can usually be treated with self-help, medication,
psychological therapies and with the intervention of medical professionals. However,
organisations should be implementing preventative controls in the workplace before negative
mental health states are reached.

Stigma
Mental ill-health can have associated stigma in the workplace and society. A stigma can be
defined as a personal belief, mark of disgrace or negative attitude that is associated with an
individual, group of people, circumstance or quality. Those who have mental ill-health can
experience discrimination and exclusion. It is important that workers are encouraged to seek help
for mental ill-health, both in and out of the workplace, and that organisations support this.
 Workers may be embarrassed afraid or confused about what they are experiencing or feeling.
This can make it difficult for workers to approach their organisation regarding their mental
health and to seek support.

To help eradicate or alleviate concerns, managers and workers need to be educated  about mental
health (and wellbeing) and adopt a ‘top–down’ approach to encourage and demonstrate
workplace culture change. This approach will help to cascade values, attitudes and behaviours
towards wellbeing in the workplace.

Removing stigma and already embedded perceptions about mental health through cultural
change can take time and patience. It involves commitment, good leadership, effective
communications (including training), the development of suitable preventative methods and
supportive intervention when required.

What causes mental ill health

Scientific and psychological research is taking place to try and determine what causes mental ill-
health. Causes can be complex and a combination of variable factors such as genetics, brain and
bodily function, occupational factors and life experiences.

 
Common factors that can affect mental health
 
states
 

Occupation-related factors
There are many areas or factors in the workplace that can cause or exacerbate mental ill-health.
Work-related stress is one of those factors that can both lead to mental ill-health and be
exacerbated by it.

Work-related stress can be caused by single events, a combination of events or a combination of

other factors such as:

 undue pressures (job demand)

 poorly defined job roles
 lack of control over work
 unhealthy work–life balance
 poor working relationships
 organisational change
 lack of variety in work
 limited career.
Consequences of stress
The consequences of such causes can include:

 poorer work performance

o reduction in productivity and outputs
o increase in human error rates
o increases in the number of incidents and injuries
o poor decisions
o deterioration in planning and control of work
 changes in workers’ values, attitudes and behaviours
o lack of motivation
o fatigue or mental burnout
o poor timekeeping
o worker changes to working relationships
o hostility and conflicts between workers
o poor relationships with clients
o increases in disciplinary
  absenteeism
o increases in sickness absence
o general poor health and hygiene
o increases in physiological conditions (eg sleeping issues, high blood pressure, body aches, heart
disease).
o presenteeism and leavism
o psychological urge to attend work when not in a fit state to do so
o financial and resource cost implications
o reduction in productivity
o lower morale.
Data on sickness absence, performance or worker retention rates can help to indicate possible
causes, as can speaking with workers either face-to-face (one-to-one or in a group) or via
surveys.

Biological agents
Microbial pathogens (such as viruses or bacteria) can influence the brain’s structure and function
and be a causal factor during the development of mental ill-health. They can also exacerbate
mental ill-health symptoms.
Pathogens can be contracted via the workplace. If a worker is experiencing mental ill-health
symptoms, a pathogen (such as influenza) from another worker may be enough to alter their
mental state and trigger more prolonged symptoms. This can lead to further mental ill-health
symptoms and potentially a mental disorder. For example, bacteria such as Streptococcus can be
causal factors in the development of obsessive-compulsive disorder (OCD).  A parasite infection
known as Toxoplasma gondii  may be connected to the development of schizophrenia.
Ionising radiation
Genetic mutations or cell destruction caused by radiation exposure can affect the structure,
function and biological chemistry of the brain which can lead to mental ill-health.

For example, while radiation does not necessarily affect workers in all industries, air crews and
astronauts are subjected to higher amounts of radiation via cosmic rays. These workers spend
more time higher up in the Earth’s atmosphere where the radiation is greater. Organisations and
OSH professionals operating in these industries must consider the possible mental ill-health
consequences from radiation exposure.

Toxins
Exposures to toxins can lead to acute or chronic mental ill-health. Different toxins may require
different exposure levels before they have an effect (guidance should be sought, depending on
the legislation of the country in which the organisation is located).

Metals – lead, aluminium, mercury, arsenic, thallium, manganese and tin are metals commonly
associated with mental ill-health. Exposures can lead to depression, anxiety, memory loss,
dementia, attention deficit hyperactivity disorder (ADHD) and insomnia. A well-known example
of mental ill-health associated with a metal is mercury fumes which were inhaled in the tanning
and hatting industry in the 18th and 19th centuries.

Mercury was used to process felt hats. Erratic behaviour, drooling, mood swings, erethism and
dementia were experienced after the inhalation of mercury. This is where the phrase ‘as mad as a
hatter’ derives from.

Gases – the brain can be deprived of oxygen when carbon monoxide, carbon dioxide or hydrogen
sulphide are inhaled. The gases are known to cause mental ill-health symptoms. For example,
survivors of carbon monoxide poisoning can experience developmental neurological or mental
deterioration that can eventually lead to mental disorders such as depression or personality
 disorders. Inhaling carbon dioxide (CO2) can enhance  anxiety in those with panic disorder (PD)
more than those with most other mental disorders.
Solvents – exposure to solvents such as ketones, glycols, aldehydes, alcohols and aromatic
hydrocarbons can cause a range of mental ill-health symptoms. Solvent exposures can come
from work activities or personal solvent use (via glues and aerosols).

Others – many other toxins have been shown to cause or exacerbate mental ill-health.

Traumatic events
Traumatic events are those that are significant enough to cause a heightened emotional and/ or
physical response (stress processes) in the body. They are usually associated with loss, abuse,
threats, isolation, injury and disaster and can have a negative impact on someone’s mental health.
Traumatic events can also be experienced by observing, or learning about, an event (for example,
listening to another’s experience and being affected by it).

Traumatic events can affect the brain by causing emotional injuries. Emotional memories are
created deep in the brain and are stored (potentially indefinitely). Some memories do not
dissipate easily (or at all) and can be recalled at any time. This triggers repeated stress responses
in the body which can lead to continuous damaging effects (eg post-traumatic stress disorder,
PTSD).

Experiencing a traumatic event can often cause shock which can eventually lead to denial,
sadness, guilt or anger. If these feelings are continuous, they can lead to mental ill-health and
symptoms such as:

 flashbacks (reliving the traumatic experience in the mind)

 emotional responses such as nightmares, sleep disturbances and numbing
 addictive behaviour such as substance abuse
 withdrawal from social interactions, work or generally becoming isolated
 development of anti-social behaviour
 confusion and/or impaired cognitive abilities
 depression, anxiety or PTSD (developing into other mental disorders)
 challenging thoughts of the person’s own mortality (which can lead to suicidal thoughts or
behaviours).
Personal factors and lifestyle choices
 Mental health can be affected by personal factors – either from a single factor (originating from
one source) or a combination of different factors (from one or multiple sources). Wherever the
source originates, symptoms may still be present or worsened while working.

Some examples of how a worker’s personal life can affect their occupational environment are:

 financial hardship or debt

 poverty or housing and transport issues
 relationship issues (including caring responsibilities)
 medical complications or illnesses
 traumatic events (loss, grief, accidents, illnesses)
 cultural, religious or spiritual beliefs
 addictive behaviour (substance abuse, gambling, extensive social life)
 life fulfilment
 gender
Organisations should try to help workers to find a balance between their personal life and
occupational responsibilities. Offering support or signposting workers to appropriate supportive
mechanisms can help to prevent the development of mental ill-health.

Nutritional intake
As with all organs in the body, to remain healthy the brain requires different levels of amino
acids, complex carbohydrates, essential fatty acids, minerals, vitamins and water. Although the
link between nutrition and mental health is complex, it may also be an important factor regarding
fuelling the brain with good nutrition can develop and support healthy neurotransmitter activity
and protect the brain from oxidants that can have a negative  effect on mental ill-health
symptoms.

Organisations and OSH professionals should recognise that there is a relationship between
nutrition and mental health. This will help them to make informed decisions regarding the
promotion of healthy eating and positive mental health.

Physical activity
The brain and body function collaboratively and have an effect on each other if there is damage
or disease. Therefore, a lack of physical activity (ie, not increasing the heart rate above its resting
state) can have negative consequences on mental health.
 Organisations could encourage a culture that promotes physical activity. It is something that
could be completed by workers on a regular basis (if possible) to help prevent, maintain or
improve mental and physical health. Those who do usually feel more positive, alert, motivated
and may be able to cope more positively with stressors than those who are less active.

Such activities could include:

 walking, running or cycling

 fitness classes or resistance training
 sports (tennis, football, netball, swimming, basketball, martial arts, korfball and many others).
Sleep
Poor sleep can negatively affect mental health. Conversely, mental ill-health can affect
someone’s sleep.

Poor sleep or sleep disturbances can lead to:

 depression, anxiety, general negative emotions, confusion, reduced motivation and irrational
thought processes
 feelings of isolation, loneliness, and social withdrawal
 deficiencies with mental repair and recovery
 episodes of mania, paranoia, psychosis and enhancement of any existing mental ill-health
symptoms.
Mental ill-health can also affect sleep in a number of ways:

 anxiety can enhance thought processes (that overtake lateral thinking and constructive thinking
processes) and make it difficult to sleep
 depression and seasonal affective disorder (SAD) can lead to oversleeping
 severe depression with adverse associated thoughts that can lead to insomnia
 post-traumatic stress disorder (PTSD) can lead to nightmares and night terror sleep disturbances
(can also discourage someone from sleeping and lead to insomnia)
 psychosis and paranoia-based thoughts, hallucinations and delusions can lead to someone feeling
fearful to sleep due to disturbing thought processes
 mania episodes can cause energetic thought processes and lead to someone feeling not tired (not
wanting to sleep when their body requires it)
 psychiatric medication can have side-effects such as insomnia, oversleeping or disturbed.
Female reproductive system
During the female menstrual cycle hormone levels can change quite dramatically. The change in
hormones can cause one to experience different types of mild mental ill-health symptoms such
as:
 mood changes
 sympathy
 loneliness
 anger
 irritability
 hopelessness and feeling overwhelmed
 stress
 anxiety
 depression
 fatigue or a lack of energy
 concentration issues.
Symptoms may be experienced one or two weeks before the menstrual period begins or at some
point every month. These can disappear after the menstrual period is completed. This is known
as premenstrual syndrome (PMS).

Some can experience a more severe type of PMS called premenstrual dysphoric disorder
(PMDD) where the symptoms are more intense or amplified and potentially devastating. Those
with PMDD can experience severe depression and suicidal thoughts or tendencies which can be
distressing.

The menopause is another stage of the female reproductive system development which occurs
later in life. The body undergoes psychological and physical changes predominantly through a
decrease in the hormone levels of oestrogen and progesterone. This can also lead to mental ill-
health symptoms such as:

 anxiety (through fear, isolation, frustration and irritability)

 lower self-esteem
 poor concentration levels
 poorer judgement.
In some cases, the mental ill-health symptoms can lead to depression and suicidal thoughts or
tendencies.

Types of mental ill health and mental

disorders
Some mental ill-health symptoms can develop and be diagnosed as mental disorders. By
understanding some of the consequences of mental ill-health, organisations and OSH
professionals can better understand how to support and help workers to reach a more positive
mental state. Supplementary to this, the information can help when implementing prevention
strategies. If this is ignored, organisations potentially risk contributing to some workers
developing mental ill-health and mental disorders.

Anxiety
It is natural for people to feel emotionally strained, worried, nervous or fearful at times. These
emotions stimulate the body’s survival mechanisms to prepare us for action against anticipated
danger and misfortune. These mental stimuli are collectively known as ‘anxiety’ and can modify
brain processes and behaviour.

Anxiety can become a mental disorder when it becomes uncontrollable, unexpected and
unhelpful. It can seriously affect someone’s life, work and health.

Anxiety disorders  

Depression
Depression can be described as a ‘lowering of feelings’ that affects emotional states, thoughts,
self-esteem, happiness and self-worth. It can last for short or prolonged periods. When
depression becomes more developed, it can be described as feeling like a physical disease that
has overwhelmed the body and the brain. This gives the conception that the psychological
condition can feel like it has become a physical condition.

It is normal to feel ‘down’ or ‘low’ at times in response to traumatic, difficult or emotionally

demanding ordeals. However, if someone is unable to make a transition from this temporary
negative state to a more positive coping state, they may have depression.
  

Depressive disorders  

Post-traumatic stress disorder

Those who are exposed to traumatic events such as workplace incidents, accidents, bullying,
harassment, violence or abuse, or other stress-inducing events may develop post-traumatic stress
disorder (PTSD). Those with PTSD are unable to eliminate thoughts and emotions associated
with injury, loss, danger, anger or grief that then influence their behaviour.

Many associate PTSD with military combat experiences, but PTSD extends much further than
this and can be caused by varying traumatic experiences – for example, events    that include a
threat to life such as the death of a relative or witnessing a severe injury in a workplace.

Symptoms can develop within three months (approximately) of a traumatic (trigger) event, or
they can develop many years later. The symptoms interfere with the individual’s work, everyday
life and social relationships.
 Most people can recover from PTSD naturally, or by communicating with others, or with
professional therapy.

Vicarious trauma / secondary traumatic stress

This type of mental ill-health can occur in individuals due to indirect exposure to emotional
trauma that somebody else has experienced. It can also occur when someone is exposed to
graphic media or information such as disturbing news accounts and traumatic stories (audio or
visual).

Those who work in high-stress or traumatically exposed sectors of work such as child abuse
investigators, judges and public services could be more likely to experience the disorder.

Trigger experiences could be related to abuse, violence, workplace incidents and natural
disasters.

Organisations and OSH professionals should consider the potential for vicarious trauma/
secondary traumatic stress (VT/STS) if a worker or group of workers is exposed to a traumatic
workplace event (such as a fatal incident or serious injury). The event may affect more workers
indirectly than those directly exposed to the event.

VT/STS can occur due to a one-time exposure event or after repeated exposures.

Managing Mental Health

The World Health Organisation predicts that depression will become the world’s most common
illness by 2030. Their evidence suggests that depression is the leading cause of disability
worldwide and is a major contributor to the overall global burden of disease. These facts
highlight the need for organisations to manage and invest in preventative and supportive methods
where work is a contributory factor in mental ill-health.

Work is changing rapidly across the world and certain global factors can have a negative impact
on mental health, such as:

 the globalisation of markets

 migration and urbanisation
 technological advances.
However, some changes such as wage increases, access to training and education and improved
working conditions can create positive mental health impacts.
 Organisations must make physical, environmental or working practice changes, and/or engage in
recognition and supportive approaches. Rewards for such changes and approaches are highly
beneficial and invaluable for the workplace and its workers.

With more understanding and knowledge of mental health, organisations will be able to
implement more effective methods of mental ill-health control. They will also have a deeper
understanding and be better able to rehabilitate workers with mental ill-health returning to the
workplace.

Organisational benefits of managing health

Improving workers’ mental health can lead to benefits for organisations.

 An increased potential for financial gains, as workers are less dissatisfied, unhappy or disengaged and
may:
o take less time off work for sickness absence
o be less late for work and more productive
o incur fewer injuries and illnesses (due to bodily factors)
o decide not to leave an organisation.
 A reduction in compensation claims due to early intervention or action and lower insurance costs for an
organisation.
 Reduced absenteeism, resulting in:
o less frequent sickness absence
o shorter sickness absence periods
o lower potential for recurrence of sickness absence.
 Reduced presenteeism and increases in productivity due to:
o improved resilience
o a potential reduction in early retirement
o an increase in worker objective attainment.
 A positive organisational culture with:
o higher productivity
o better morale
o loyalty
o improved worker retention
o improved social
o A decrease in mental ill-health such as depression, which is as serious a condition as heart disease and
one of the main factors for worker absence through disability and early death.
 An increase in job satisfaction, which can lead to higher levels of:
o positivity
o creativity
o productivity.
 More efficiently functioning brain processes and a more positive emotional state that will help to
promote:
o innovation
o better problem-solving skills
o improved cognitive function
o a physically healthier.
 Individuals will be happier and more productive at This can enable positive benefits in their personal lives
too, such as:
o Healthier lifestyles
o Improved social relationships
o An overall satisfied way of life.
Remember that most workers will have the desire to work for those who create rewarding social,
cultural and financial values that can collectively improve workers’ mental health and wellbeing.

Using an occupational safety and health management system

to manage mental health
Policy – organisations will usually have a general OSH policy that covers all OSH risks,
including mental health. If the general OSH policy covers mental health, it may need to be
supplemented with a proactive mental health-based strategy.
Strategy – a strategy is required to help plan and implement mental health objectives. A set of
specific objectives translates policy into statements regarding what is to be achieved. For
example:
 promoting mental ill-health awareness throughout the organisation
 providing support and treatment methods (including signposting) for those at risk
 making organisational changes where and when required
 welcoming and re-integrating those with mental ill-health back into the workplace.
Once a strategy has been created, a mental health action plan (MHAP) is required. The MHAP
will detail any short-term objectives, initiatives and/or required actions in line with policies and
the strategy.

IOSH has produced a tool that assists organisations when benchmarking the design of their
mental health objectives. By evaluating the design and identifying areas for further development,
organisations can devise a MHAP for improvement. Mental health in the workplace:
benchmarking questions
Organisational – leadership, accountability and responsibility should be delegated to enable
implementation of a mental health strategy and embedded objectives.
Risk analysis – risk assessments are used to identify safety and health hazards involved with
work. They can be used to identify mental health hazards in the same way that one would for
physical hazards.
Risk management – once risk assessments have been completed and analysed, identified
controls will need to be implemented to mitigate the risks of mental ill-health in the workplace.
Merely putting in place reactive control measures to respond to workers with mental ill-health is
insufficient. One of the key principles of OSH is to put in place preventative controls to avoid harm being
 caused. Preventative controls need to be introduced at the stage where a worker’s mental health is
‘healthy’. Such controls can be identified by measuring potential mental ill-health stressors in the
workplace through risk assessment or other means. All  controls implemented after this stage (eg at a
‘struggling’ and ‘unwell’ stage) will be reactive as an individual has already begun to experience mental
ill-health symptoms. Some prime examples of reactive controls are worker/employee assistance
programmes (EAPs) and mental health first aid (MHFA).
Progression through a mental health continuum with proactive and reactive controls 

Monitoring and measuring – one  aspects of a MHAP and strategy are implemented, it is
important to measure and monitor them, to:
 ensure that all agreed actions have been implemented
 ensure that everything is working correctly and is effective
 help identify potential modifications - such as data gathering or further controls.
Gathering data is important for measuring and monitoring levels of mental health in an
organisation. It enables evidence-based decisions that can help to improve mental health
management arrangements. Methods to measure and monitor mental health could include
gathering information and data on:
 individual return-to-work plans
 regular discussions with the workforce to find out whether implemented controls are effective
 follow-up surveys (effective for gathering information on worker’s current states of mental health)
 relapses in mental ill-health
 illness absence rates.
Investigating mental ill-health should be approached in the same way  as anything else OSH
related. Close attention should be given to mental ill-health stressors – factors that can cause or
exacerbate mental ill-health.

Key performance indicators (KPIs) can help an organisation to know ‘how they are doing’
internally, but also externally when benchmarked against other similar organisations or
national/global standards.

Mental health management audits should be completed against a benchmark, eg legal

requirements, organisational standards, international standards or good practice guidance.
Findings will help to identify corrective actions required.

Reporting – it is important to report on mental health both internally and externally to the board,
managers, workers and other stakeholders. Reporting also gives organisations the opportunity to
celebrate and promote their successes.
Mental health training
Training managers and workers with a focus on mental health can help to promote a more
positive wellbeing culture in the workplace.

Managers should be trained in mental health awareness and on the important role that they play
in the organisation’s strategy/ MHAP. They should be trained with the skills that enable them to
support workers who may be experiencing mental ill-health and to signpost them to appropriate
care and healing methods. Early intervention with formal and informal conversations can help
workers to build good rapport with managers and address potential issues.

Maintaining good, open and effective communication is crucial. For other workers, the training
should be focussed on mental health awareness.

Mental health first aid

Many organisations see mental health first aid (MHFA) as an important aspect of their
arrangements for managing and promoting positive mental health, as with physical first aid in the
workplace.

Training aims to equip mental health first aiders with skills that enable them to offer help and
signpost workers to further support as a reactive or recovery control.

Training does not enable mental health first aiders to become therapists or specialists.

Instead, training is focused on reacting to workers with mental ill-health. The worker must have
developed and be experiencing symptoms such as anxiety or depression before seeking help.

IOSH has conducted research on MHFA MENtal health first aid in The wORkplace (MENTOR):
A feasibility study
Returning to work following mental ill-health
IOSH has undertaken research in this area Return to work after common mental disorders. The
research identified barriers and facilitators across the different stakeholder parties in the process
– mental health professionals, occupational health professionals, general practitioners and
managers.
 Controlling occupational related factors
Risk assessments will identify possible factors in the workplace that may cause or exacerbate
mental ill-health. Mechanisms for identifying other sources of intelligence may include collated
data on sickness absence, performance or worker retention rates and from speaking with
workers, either face-to-face (one-to-one or in a group) or via worker surveys.

Some of the most common factors found in the workplace that can lead to mental ill-health and
some preventative and adjustment examples are detailed below.

Causes and controls  

Cause Control suggestions
make environments more friendly if possible, by
encouraging face-to-face interaction and
approachable workspaces
consider offering a temporary reserved parking
bay to make it easier for workers with mental ill-
health to attend work
offer flexible working where possible
Occupational environments
consider increasing workers’ work space
locate workers away from noisy practices (eg
machinery) that may aggravate mental ill-health
symptoms
introduce and provide a private space where
workers can retreat to rest, talk in private,
concentrate or consolidate thoughts and emotions
extend paid or unpaid leave during a medical or
related absence-
allow additional time to encourage workers to
Other policies, eg bullying and harassment,
meet performance targets or objectives
equality and diversity, violence and aggression
allow workers to take or make reasonable
personal phone calls throughout the day if
required
assign workers mentors, managers, mental health
first aiders (MHFAs) or mental health champions
(MHCs) to provide help and support when
required
ensure senior management arrange regular one-
Support and assistance
to-one meetings with managers to discuss worker
progress and to help prioritise tasks
offer additional training and information based
on workers’ duties and tasks if required
offer to signpost workers to supportive services
 Chemical hazards
Hazardous substances present one of the major hazards that Occupational Safety and Health
(OSH) professionals need to consider regarding health at work.

Hazardous substances are used for a variety of tasks, from simple cleaning operations to complex
chemical processes. Hazardous substances have the potential to harm human health. They may
be solids, liquids or gases; they may be naturally occurring, manufactured as a single substance
or mixture, or can be a by-product of an industrial process. When  used in the workplace, these
substances often generate vapours, fumes, dusts and mists. A wide range of industrial, laboratory
and agricultural chemicals are classified as hazardous, as are many biological agents and
nanoparticles.

Hazardous substances can cause a wide range of health effects, from localised (skin irritation or
burns from irritating or corrosive substances) to systemic (such as occupational cancers and lung
disease).

Although hazardous substances can also lead to fire, explosion and environmental risks, this
guidance will only focus on  the health risks arising from occupational exposure to hazardous
chemicals.

The physical state of chemicals

Chemicals can exist in many physical states. They can be:

 solids
 liquids
 gases
 dusts (inhalable and respirable), fumes, vapours, and mists.
The physical state of chemicals may change, depending on the environmental factors and / or
processes. They are important to consider when assessing the routes of exposure.

The classification of chemical hazards

 Substances hazardous to health are  classified as:

 corrosive – for example, oven cleaners and caustic soda.

 hazardous to the environment - for example, pesticides and mercury
 explosive – for example, fireworks.
 acute toxicity - such as lead or sodium cyanide
 health hazard - such as chemical irritants like adhesives
 sensitiser – substances (for example, isocyanate paints) that can cause an allergic reaction or effect,
usually affecting the skin or respiratory system.
 oxidising – for example, hair dyes and bleaches.
 flammable – for example, liquefied petroleum gas (LPG) or methylated spirits.
 serious health hazard (which includes carcinogens, mutagens and reproductive toxins) - for example,
asbestos, silica dust and diesel fumes.
Routes of exposure
There are many ways that a chemical can either enter or come into contact with the human body.
To understand how chemicals can affect the human body, an OSH professional must understand
the mechanics    of normal operation of the various organs and processes in a healthy individual.

Through the lungs

The respiratory system is made up of tissues and organs that allow a person to  breathe. It
consists of the airways (which are made up of nasal cavities, mouth, larynx or voice box and
trachea or windpipe), the lungs (bronchioles and alveoli) and the linked blood vessels. Through
breathing (inhalation and exhalation), the respiratory   system facilitates the exchange of gases
between the air and the blood and between the blood and the body’s cells.

Diagram of the lungs

The physical state and size of the particles will determine how far chemical substances can
penetrate the respiratory system and beyond.

 An inhalable substance can only penetrate as far as the bronchioles and can be deposited along the
respiratory system to this It can therefore affect the mouth, nose, larynx, trachea and bronchioles.
 A respirable substance can penetrate through to the alveoli and can interfere with the gas exchange Some
respirable substances can also be respired themselves and can enter the bloodstream.
 Gases that are inhaled can cause acute (sudden or brief) effects on the airways and lungs. Examples
include chemicals such as chlorine and ammonia. These gases react with the water content in tissues
(especially in the mouth, nose and throat) to produce hydrochloric acid and ammonium hydroxide
respectively. The concentration of these reacted substances will determine how severe the irritation or
corrosion will be to these organs.
 Gases can also create chronic (long-term or prolonged) effects when inhaled or respired. These effects
can be toxic, sensitisation, carcinogenic or mutagenic effects.
Through the skin
Skin is comprised three primary regions – the outer layer (epidermis), the middle layer (dermis)
and the inner layer (hypodermis or subcutaneous tissue).

Diagram of the skin

Chemicals can enter the skin by:

 penetration
 permeation
 absorption.
As well as being absorbed through the skin, chemicals can be transported into the body via
mucous members – the ears, eyes, nose and mouth.

Chemicals such as corrosives can almost immediately affect living tissue by damage or
destruction of the proteins (called amide hydrolysis). There are three levels of burn category.

 Injury to the top layer of skin, or the epidermis, is called a superficial burn. This was formerly called a
first-degree burn.
 Injury to the second layer of skin, or the dermis, is called a partial thickness injury or dermal injury. This
was formerly called a second-degree burn.
 Injury to the third layer of skin, or subcutaneous tissue, is referred to as a full thickness injury. This was
formerly called a third-degree burn.
Hydrochloric acid and sodium hydroxide are, respectively, common examples of acid and alkali
corrosives.
Irritants affect the skin and mucous membranes by causing inflammation. Irritants work in the
same way as corrosives but produce less acute effects. Common irritants to the skin include
liquids such as oils, lubricants and solvents. These cause reddening, dryness and cracking of the
skin on contact.

Skin sensitisers usually affect the hands and forearms, as these are the parts of the body that are
most likely to be exposed to these substances. The sensitisation can also spread to other parts of
the body. Common chemical skin sensitisers include chromium in cements, some textile dyes
and pigments and isocyanates and epoxy resins in paints and varnishes.

Irritant contact dermatitis The most common form of occupational dermatitis is irritant contact
dermatitis. This is caused when a specific irritant in a high enough concentration comes into
contact with the skin for a sufficiently long time to damage the skin cells. If a mild irritant is in
contact with the skin it will wash away the stratum corneum lipids and prevent the skin’s natural
barrier from protecting and regenerating. If the exposure takes place over time the lipids will fail
to regenerate and, as a consequence, dermatitis will often occur in the area of exposure on the
skin. This type of dermatitis, which occurs over time, is sometimes referred to as chronic irritant
contact dermatitis.

Through the digestive system

The digestive system is a group of organs working together to convert food into energy and basic
nutrients to feed the entire body. It is primarily made up of the mouth, oesophagus, stomach,
small intestines and large intestines.   
The oesophagus is a muscular tube connecting the mouth to the stomach. It is around 25 cm long
in adults. When food is swallowed, the walls of the oesophagus contract to move the food down
to the stomach.  The stomach breaks down much of the food chemically and mechanically, using
powerful stomach acids and stomach muscle movement. The food is then transferred into the
small intestine.

Effects of absorption of chemicals through the digestive system or by direct contact

Chemicals that are ingested often affect the throat or stomach lining first and, if absorbed, then
affect the liver. The chemicals can either be broken down or transported to other parts of the
body where they can accumulate. As with inhalation, chemicals can also react more directly with
linings of the mouth, throat, stomach or bowel. Corrosives and irritants have an acute effect on
the digestive system. They react chemically with the linings of the oesophagus and stomach and
either inflame the tissues (in the case of irritants) or destroy them (corrosives). Corrosives can
also cause ulcerations to occur in the stomach.
 Other chemicals that are ingested have more chronic effects. Toxins, carcinogens and mutagens
may be absorbed through the intestines and are transported to other organs via the circulatory
system. Accumulation of these chemicals can either poison the organs or potentially cause the
uncontrolled growth of abnormal cells or change of normal cells.

Managing the risks of hazardous chemicals

As part of undertaking a hazardous chemicals assessment and implementing control measures,
you must identify what the hazards are from the chemical(s). The most straightforward way to
identify these is to obtain a safety data sheet (SDS) from the chemical manufacturer.  
A SDS contains information on the hazardous chemical relating to: 

Elements within a SDS

 
Manufactured chemicals will follow the UN Global Harmonised System of Classification and
Labelling of Chemicals (GHS). It is not a formal treaty or a legally binding international
agreement, so countries will create local or national legislation to implement the GHS.  
Reading a SDS 
The GHS contains a specification for SDS to follow a 16-section format: 
Section 1: identification of the chemical / mixture and of the organisation. An important
consideration in this section is making sure that the name of the chemical matches up with the
label on the chemical container. Many chemicals have similar names but have different
properties. This section will also identify relevant uses of the chemical. Section 1 of the SDS
must include manufacturer/supplier contact information and an emergency contact number. 
Section 2: hazard identification. This is one of the most important sections of the SDS for
writing a hazardous chemical assessment. This section outlines the physical and health effects of
the chemical. It will include any relevant hazard warning labels.  

Globally Harmonized System Classification Labelling and Packing symbols 

Section 3: composition / information in ingredients. This section provides information on the

composition of the substance, including the percentages if its hazardous constituents. It does not
give a full breakdown of all substances, but will include those that: 
 contribute to the overall hazard classification 
 are present at concentrations above certain levels of concern 
 have indicative occupational exposure limit values (IOELVs). 
Section 4: first aid measures. This section is useful to identify initial first aid treatment if a
worker is exposed to a chemical. First aiders also need to be made aware of the information
contained in an SDS to allow them to respond in the correct way in the case of an emergency. 
Section 5: firefighting measures. Although not relevant to identifying the health hazards in a
chemical, it is helpful in considering fire risk assessments, the storage of chemicals identified as
flammable or explosive, and to identify any specific firefighting measures that may be required.  
Section 6: accidental release measures. This section is helpful for identifying different work
activities with chemicals, this may include cleaning activities for spillages for example.  
Section 7: handling and storage. This section expands on previous information. 
Section 8: exposure controls / personal protection. This section identifies if there are exposure
standards, such as indicative occupational exposure limit values or biological limit values set for
the chemical. In relation to personal protection, it may include detail on the types of personal
protection that may be required.  
Section  9: physical and chemical properties. Included for completeness. 
Section 10: stability and reactivity. Included for completeness. 
Section 11: toxicological information. This section is useful when determining the detailed
potential health effects of the chemical. 
Section 12: ecological information. Included for completeness.
Section 13: disposal considerations. Included for completeness. 
Section 14: transport information. Included for completeness. 
Section 15: regulatory information. This section outlines the OSH (and environmental)
legislation specific to the chemical that may not have been included in other sections. 
Section 16: other information. This section is used to provide any additional information the
manufacturer considers important for the user to know. It may include information on revisions
from earlier versions, relevant risk or hazard phrases, precautionary statements, or advice on
training workers.  
Where hazardous chemicals are produced as part of a process or are naturally occurring, then
advice should be sought from process engineers, industrial chemists or other guidance sources.  
Another way of identifying chemical hazards present in the workplace is by ensuring that
occupational hygiene monitoring is undertaken, such as air sampling and personal dosimetry.
Occupational hygienists can measure build-up of hazardous chemicals in the work atmosphere
and worker exposure. Biological monitoring of workers can also identify chemical build-up in
the body, by the use of blood and urine testing. 
Other sources of information 
It is critical to gather information about: 
 how is the chemical used (or produced)? 
 how much is used? 
 for how long? 
 Who is at risk? Particular groups of workers may be at higher risk from working with some chemicals.  
Together the information will enable appropriate controls or a combination of controls to be put
in place.  
Assessment of chemical hazards and their use 
Assessing exposure to a hazardous chemical involves looking at the type, intensity,
concentration, length, frequency and occurrence of exposure to workers, including the combined
effects of hazardous chemicals used together and the related risk. This includes the amount of the
chemical being used and any indicative occupational exposure limit values (IOELVs) associated
with it.  
Assessment of a chemical is a subjective (or qualitative) process and is based on the assessor’s
knowledge and experience of not only the chemical in question but also the activity and
environment that it is being used in. Existing controls in place will influence how an assessor
will decide on the level of risk.  
Methods for recording this decision-making process vary, but can be numerical, using a high,
medium or low scale or using a red/ amber/green rating. 
Unlike most risk assessments, it is worth assessing the uncontrolled risk, as it helps to identify
what exposure controls are needed for different routes and different groups of people. 
Workers at higher risk from working with chemicals 
As well as reviewing the chemical being used, it is important to consider any workers who may
be particularly at risk and specify the measures to be taken to protect them, including any
additional training and information they require. It is also important to consider workers who
may not be routinely exposed to chemicals but who could be at risk during maintenance or repair
work or accidentally exposed, for example to intermediary products in a chemical production
process that is usually closed. Workers should know who to contact if things go wrong and how
to protect themselves in the event of an incident. Certain groups of workers may be at increased
risk when working with hazardous chemicals. This can be due to: 
 susceptibility to certain chemicals-communication difficulties  
 inexperience-workers undertaking nonroutine, high-risk duties.  
Workers at higher risk include: 
 new and expectant mothers 
 workers of reproductive capacity 
 migrant workers 
 shift workers 
 young people 
 older workers 
 workers with medical conditions. 
Implementing controls  
 This involves drawing up an action plan. It should list the steps to be taken, in order of priority,
to reduce the risks to workers   and should specify how, by whom and by what date each step
should be taken. In some countries, for standard working operations such as filling, pumping,
drilling, grinding and welding, practical information on tested control techniques is available
(direct advice or control guidance sheets).  
Control measures for hazardous chemicals (using the
hierarchy of control) 
There are many measures that are used to control exposure from chemicals. Certain controls are
more effective than others. This order of effectiveness is known as the hierarchy of control. 
Eliminating the risk 
 Change the activity so that a hazardous chemical is not used.
 Use a non-harmful substance instead of a hazardous one (known as elimination through substitution). 
Substituting the system of work, substance or plant 
 Change the type of hazardous chemicals kept on site. 
 Use a pelletised form of the hazardous chemical, rather than a powdered form.
 Replace the chemical with a safer substitute. 
 Vacuum or use an industrial sweeper to clean up concentrated dusts, rather than sweep them up
manually. 
 Apply the substance using a brush or roller instead of by spray gun application. 
 Select a product with less volatile ingredients.
Engineering controls 
 Use Local Exhaust Ventilation (LEV) to remove fumes. 
 Increase ventilation.
 Use spill containment. 
 Use safety relief valves.
 Use overfill protection. 
 Automate processes to remove / reduce the worker interface. 
Administrative controls 
 Introduce a restricted work area. 
 Locate potentially hazardous materials or processes away from frequently-used thoroughfares and
buildings. 
 Separate goods from other hazards. 
 Segregate incompatible substances. 
 Use placards or hazard warning signs. 
 Enhance housekeeping / cleaning.  
 Provide specific training and work instructions. 
 Provide spill clean-up equipment. 
Example of a hazardous chemical control measure 

The most common engineering control to prevent worker exposure to inhalable and respirable
chemicals is local exhaust ventilation (LEV). Workplace New Zealand defines LEV as:  
 “…an engineering system that captures dusts, vapours, and fumes at their source and transports
them away from the worker’s breathing zone. This prevents workers from inhaling these
substances and reduces contamination of the general workplace air.” 
 There are several designs of LEV that are used in the workplace: 
 glove boxes-spray booths 
 on-tool extraction 
 flexible capturing hoods 
 extracted workbenches.  
These generally consist of: 
 an inlet/enclosure/hood to capture the contaminated air 
 ducting to carry the air away from the point of extraction 
 filters to clean the contaminated air  
 a fan to draw the contaminated air from the hood to the filter via the ducting to an exhaust stack 
 an exhaust stack that discharges filtered air outside the building.  
LEVs are only effective if they are well designed, maintained and used properly. 
Revising and updating  
The last part of a hazardous substance assessment is reviewing the risk assessment. This
document should be regularly revised and updated. Effective risk assessment and prevention
require organisations to keep themselves and their workers well informed and trained. Workers
also need to be consulted on the risk assessment and any changes to the chemicals, products and
work processes involved in their jobs. 
Vibration
Introduction to vibration
Vibration, usually found in machines, are oscillations - repetitive or periodic movements -
around an equilibrium point, where opposing forces or influences are balanced. These can be like
a pendulum or random, such as a tire on a gravel road. Vibration motions of engines, electric
motors or mechanical devices are often unwanted and undesired.

A handheld drill, for example, creates regular mechanical vibrations as the oscillations are
constant. The oscillations may change in speed or intensity depending on how the drill is used
but are always there.

Vibration exposure occurs when contact with a vibrating machine transfers vibration energy to
parts of the body, such as hands. Anyone exposed to vibration is potentially at risk from
developing loss of feeling and sensations in their fingers, hands and arms.

The higher the level of vibration and longer someone is exposed to it, the greater there is of risk
of suffering harm from the exposures.

Workers worldwide are exposed to excessive occupational vibrations that puts their health at
risk. It can also affect those around them. The effects of exposure depend upon characteristics of
the vibration, including frequency, duration and amplitude. When these characteristics are poorly
controlled, this can lead to issues such as hand-arm vibration (HAV) or whole-body vibration
(WBV), which can both impair the worker's ability to do work tasks.

Exposure levels
Vibration is like any other form of risk exposure, for example, dust, gas, noise and radiation.
Organisations should aim to reduce vibration exposure to as low a risk as possible. Some
countries will have exposure action levels (EAV) and exposure limit values (ELV), such as
Australia, Canada and the United Kingdom (UK). This is where organisations are required to
take specific action when the daily vibration exposure limit reaches a certain value. More
information can be found in country specific regulation and standards documents such as.
 European Union: EU directive 2002/44/EC - vibration
 United Kingdom: The Control of Vibration at Work Regulations 2005
Different types of equipment and machinery can produce different levels of vibration. The levels
of vibration can increase due to environmental factors, such as damaged flooring or roadways,
lack of maintenance or incorrect use.

Examples of equipment and their typical

measured vibration emission levels
Equipment Type of equipment and use Vibration emission level 

Typical use
12 m/s2

Modern and well-maintained

equipment design, good
Road breakers operating conditions and 5 m/s2
competent operators

Poor equipment and operating

conditions 20 m/s2

Typical use
15 m/s2

Modern and well-maintained

equipment design, good
Demolition hammers operating conditions and 8 m/s2
competent operators

Poor equipment and operating

conditions 25 m/s2

Hammer drills/combination Typical use

9 m/s2
hammers
Modern and well-maintained 6 m/s2
equipment design, good
operating conditions and
 competent operators

Poor equipment and operating

conditions 25 m/s2

Modern designs
5-7 m/s2
Needle scalers
Older designs
10-25 m/s2

Modern - vibration-reduced -
designs 4 m/s2
Large angle grinders

Other designs
8 m/s2

Chainsaws Typical design and use

6 m/s2

Sanders (random orbital) Typical design and use

7-10 m/s2

Exposure action levels (EAV)

An exposure action level (EAV) is a daily amount of vibration exposure above which
organisations are required to take action to control exposure. The greater the exposure level, the
higher the risk and the more action organisations need to take to reduce the risk. For example, in
relation to hand-arm vibration (HAV), the UK's EAV is a daily exposure of 2.5m/s2 A (8). In the
UK, this is based on an 8-hour period where the (8) represents the 8-hour period.

Exposure limit values (ELV)

This level of exposure must not be exceeded. It is the maximum amount of vibration a worker
may be exposed to on any single day. For example, in relation to HAV, the UK exposure limit
value (ELV) is a daily exposure of 5m/s2 A(8). It represents a high risk which workers should not
be exposed to.

Vibration levels and effect of exposure

Hand-arm vibration (HAV) exposure limits by
country
Daily vibration exposure values for hand-arm vibration (HAV)
Country Vibration exposure action value Vibration exposure limit value
(EAV) (ELV)

Australia
2.5 m/s2 5.0 m/s2

Canada
2.5 m/s2 5.0 m/s2

EU Directive 2002/44/EC
2.5 m/s2 5.0 m/s2

New Zealand
2.5 m/s2 5.0 m/s2

United Arab Emirates

2.5 m/s2 5.0 m/s2

United Kingdom
2.5 m/s2 5.0 m/s2

Whole-body vibration (WBV) exposure limits by

country
Daily vibration exposure values for whole-body vibration (WBV)
Country Vibration exposure action value Vibration exposure limit value
(EAV) (ELV)

Australia
0.5 m/s2 1.15 m/s2

Canada
0.5 m/s2 1.15 m/s2

EU Directive 2002/44/EC
0.5 m/s2 1.15 m/s2
 New Zealand
0.5 m/s2 1.15 m/s2

United Arab Emirates

0.5 m/s2 1.15 m/s2

United Kingdom
0.5 m/s2 1.15 m/s2

The common daily vibration exposure levels for HAV and WBV are similar worldwide. OSH
professionals should check their own counties values to ensure compliancy.

Measuring vibration
Workers may find it difficult to determine if the vibrations are a risk to them. It is important that
vibrations are measured to determine what exposures could be harmful. Vibrations are
determined by measuring 'pressure waves' of vibration energy created by the mechanical
oscillations from equipment or machines.

Measuring vibration can be carried out collecting data from manufacturers of the tool or
equipment. But it also can be due to the age and how the tool or machine has been maintained.

For more accurate measurements, portable devices can be attached to the tool or machine.

One way this can be measured is by using an accelerometer, which is a small device installed
directly on the surface or within the vibrating object. They are very sensitive to frequencies,
making them good for detection on larger objects which are vibrating at a higher frequency but
limiting their use on smaller objects with lower frequencies.

Vibration meters or accelerometer should only be operated by competent people. This is because
the results can be variable depending on different influential factors. These factors include:

 the operator's measuring technique

 the condition of the equipment or machinery
 the material being processed
 how the equipment or machine is being used. For example, the hand grip force
 the measuring method.
A competent assessor will consider these factors when taking vibration measurements and
producing representative data.
 Vibration is measured via 'vibration acceleration' in units of meters per second squared (m/s2).
Measurements take into consideration defined vibration directions. Vibration frequencies and
duration of exposure are also determined.

Effects of vibration
There are two types of vibration which can cause injuries and ill health to workers. These are
hand-arm vibration (HAV) and whole-body vibration (WBV).

Hand-arm vibration (HAV)

This is when vibration is transmitted to a person's hand and arm when using power tools,
equipment, and machinery. If exposed to high levels or long periods of vibration, it can cause
moderate to severe ill-health effects. These can be painful and disabling conditions involving the
nerves, joints, tendons, muscles and blood vessels.

Causes
Any piece of equipment or machinery that vibrates can be a cause if it's used incorrectly, is
poorly maintained or is used for long periods of time. HAV is typically experienced when using:

 angle grinders
 concrete breakers, jackhammers and road breakers
 chainsaws
 demolition hammers
 drills
 grinders
 impact wrenches
 needle scalers
 polishers
 powered mowers
 power tools
 riveters
 sanders
 strimmers and bush cutters.
Industries
These types of equipment are most often used in:

 construction
 estate management
 fabrication
 forestry
 foundries
 heavy engineering
 motor manufacturing and repair
 public utility services
 shipyards and ship building.

Health conditions
HAV can cause health conditions such as:

 hand-arm vibration syndrome, formally known as vibration white finger: a vascular hand and arm
disorder from restricted blood flow. This causes whitening (blanching) of the hands. Symptoms include
tingling, numbness and pain.
 carpal tunnel syndrome (neurological vibration): hand and arm disorder causing tingling, numbness and
pain sensations. It can also cause weakness of the hand and arm.
 Dupuytrens contracture: fingers can become permanently curled towards the palm of the hand resulting in
reduced hand and grip strength.
 muscles and soft tissue damage: conditions such as arthritis, changes to muscles and tendonitis. All can
result in a loss of hand and grip strength
 musculoskeletal disorders: vascular and muscular conditions such as stiffness, weakness and pain in the
hands, arms and associated joints.
Symptoms caused by HAV can include:

 tingling and loss of sensation (numbness) in the fingers

 general pain and distress
 lack of dexterity and ability to complete task work such as assembling, handling small components or
everyday tasks
 sleep disturbances
 reduced ability to work in damp or cold conditions such as outdoor working
 loss of touch in the hands making it difficult to feel things properly
 whitening (blanching) of one or more fingers (white finger) when exposed to cold and wet conditions
 fingers becoming red and painful on the recover of blanching in the fingers
 pain and cold sensations between white finger occurrences
 loss of strength in the hand such as a weaker grip strengthen
 bone cysts in fingers and wrists.

Whole body vibration (WBV)

This is when vibration is transmitted to a person's body through sitting, standing or lying on a
vibrating surface. It can also be transmitted through the feet of workers who operate and drive
mobile machines and vehicles. This is particularly the case when they are used over rough and
uneven surfaces, or if there is a vibrating function. Vibration can also be shocks and jolts to the
body.
 Causes
WBV can be caused by:

 excessive vibration exposure through intensity or exposure duration

 incorrect, poorly designed or damaged cabs or seating
 operator competency
 operator health and medical condition
 poor posture including incorrect seating heights or positions
 poor conditions, poor maintenance and incorrect use
 repeated movements such as bending, leaning, twisting, or stretching when operating a vibrating
mechanism or machine
 sitting for long periods
 the type of tyres being used or tyre pressures
Equipment and machinery
Any piece of equipment or machinery that vibrates can be a cause. WBV is typically experienced
when using:

 construction vehicles and plant

 forklift trucks (FLT)
 off-road vehicles
 maritime vessels
 quarrying and earth-moving machinery
 stationary plant and platforms, such as gantry crane platforms or vehicle platforms
 tractors and other agricultural machinery
 trains.

Health conditions
WBV can cause health problems, such as:

 back, neck or shoulder pain and conditions

 circulation issues
 fatigue
 head aches
 loss of balance
 motion sickness
 muscular conditions
 respiratory conditions
 sleep and visual disturbances
 stomach and bowel issues and conditions.
Managing vibration risks
Organisations and line managers have a responsibility to protect all workers from the harmful
effects of vibration generated in their workplace. This includes all workers whether employed on
a temporary, permanent or casual basis, as well as all visitors and contractors.

Due to the potential risks of vibrations, organisations are required to control it at the source and
to eliminate or reduce where possible.

To manage health and safety risks effectively, organisations and workers need to fully
understand vibration-related risks and how to control them.

Considering vibration risks in the

workplace
Create an equipment and machinery register.

 ↓

Identify equipment and machinery that may create vibrations that could be exposed to workers.

Collate manufacturer instructions for identified equipment and machinery, and find out vibration
levels.

Ensure the vibration risks associated with the identified equipment and machinery - and activities
- is included in risk assessments and method statements (RAMS). Check your country's
regulations regarding vibration levels. Think about how long workers may be using vibration
equipment and machinery.

Identify suitable control measures following the hierarchy of control and implement. Tackle
higher risks first.
 ↓

Implement health monitoring/surveillance program (ensure vibration exposure is included in

health checks if a program is already in place).

Review risk assessments regularly, maintain equipment, and apply the process to new
equipment/machinery.

Identifying risks
A risk assessment will help to identify vibration risks and possible controls. A vibration risk
assessment should consider:

 who is at risk and to what level?

 which activities may need to be controlled due to vibration exposure?
 what equipment/machinery may cause vibration risks (consider what they are used for and consult with
workers to discover which equipment/machinery seems to have high vibration, poor handling, difficulty
in operating, if they are well-maintained and in a good condition, etc.)
 what information is known about the equipment/machinery from manufacturer instructions, supplier
information and vibration measurements
 how long equipment/machinery with vibration risks are used for.

Controlling risks
Using the hierarchy of control is important to ensure the exposures are reduced to as low a level
as possible.

The hierarchy of control is a method of prioritising controls to reduce risks, from most effective
at the beginning.

Controls that protect multiple workers should be used in preference to those that protect an
individual and rely on human intervention. There will inevitably be some level of risk remaining
that the organisation is content with once suitable controls have been implemented.

All organisations should focus on eliminating the risk as a priority. If this is not possible, they
should reduce the risks to as low as possible.
 Examples of how to reduce risks
Examples of how to reduce risks include:

 provide suitable equipment

 check manufacturer instructions for equipment and machinery vibration levels. This allows for more
efficient controls.
 consider workers' needs during the planning and organising of work
 provide workers with sufficient and relevant instruction, information and training
 provide, maintain and correctly use vibration-related personal protective equipment (PPE)
 a regular health surveillance programme is in place, with regular health checks
 apply effective enforcement of controls to reduce exposure.

Instruction and training

Workers need to know how to work safely and without risks to their health. Organisations must
provide them with clear instructions and adequate training. The information must include:

 the nature of risk and where it is located, including risk assessment and RAMS outcomes
 safe working practices and rules
 the health and safety effects of vibration exposure - both short and long term - and how to recognise
symptoms of vibration-related ill-health effects
 the purpose of vibration control
 instructions on fitting, use and care of vibration-related PPE
 the purpose of health surveillance, including regular health checks
 reporting problems and symptoms as soon as they are apparent
 attend further training on how to reduce vibration exposure on specific equipment or machinery, for
example, how to reduce grip force.
Workers within the organisation should be aware of what they are expected to do. When
organisations provide information, instruction and training, they should assess the worker's
knowledge to ensure that training is relevant and effective. The information and training
provided to workers should be in a format that is easy to understand and should also consider the
language of workers.

Elimination
The most effective way of ensuring that workers are not exposed to the risks is by removing
them. Removing the need to use vibrating equipment and machinery. For example, tasks could
be completed with new technology which remove the need for any vibrating equipment and
machinery.
 Substitution
This control reduces the risks by replacing processes or a material with a version that has less
risks associated with it. Using correct types of equipment and machines that are suitable for the
tasks and not using equipment that is not designed for the type of work that is being carried out.
Think about if the equipment or machinery can operate safely in the conditions. For example,
ground or rugged terrain.

Engineering
These controls are designed to remove a risk at source or isolate people from risks.

Most manufacturers are required to design equipment and machinery so vibration risks are
reduced as low as possible using the latest technological advancements. Health and safety
information should also be provided. This will usually include:

 warnings about vibration-related risks

 information on how to maintain the equipment and machinery
 information on safe use and training requirements
 vibration emission information
 the test method used - usually internationally agreed test methods - to determine the vibration emission
information.
This information allows users to compare vibration performance of different equipment and
machinery. Consideration should be given to how the equipment and machinery are used as
vibration levels can vary depending on this. The initial manufacturer tests are performed in a
laboratory type test and not during work activities.

Some manufacturers may use a colour coding system to help identify high, medium or low
vibration risk equipment and machinery.
 Biological hazards
Biological hazards include bacteria, viruses, fungi, toxins and others such as protozoa. These can
all cause harm to human health. Although rarely visible, biological hazards are not always
understood. Exposure can lead to sudden and long-term health issues, and sometimes life-
threatening diseases.

Biological hazards are widely found in the natural environment and as a result are present in
many work sectors and industries. Most biological hazards are harmless but due to the health
effects and problems, they can be a hazard and risk in all workplaces. Health issues can be a
result of either direct exposure or related allergens and toxins.

Although biological hazards are found in all work environments, some sectors are at a higher risk
such as:

 healthcare
 veterinary services
 agriculture
 sewage management
 laboratories.

How the body is affected

Most biological hazards can cause disease in humans, from the common cold to life-threatening
diseases. They can also cause other effects, such as poisonings, or provoke an allergic response.

 Chronic health conditions are long-term conditions and diseases lasting 3 months or longer. They may not
have a cure.
 Acute conditions - sometimes called poisonings - are adverse effects from either a single dose of a
substance, multiple doses given within 24 hours or an inhalation exposure of 4 hours.

Bacteria
This is a common microscopic organism, which can multiply rapidly and build-up, causing
infection. Most bacteria are harmless. Many types grow naturally on the human body and mucus
membranes.

Bacteria Name of infection or illness

Salmonella enterica Diarrheal illness

Vibrio cholerae Cholera

 Shigella dysenteriae Dysentery

Mycobacterium tuberculosis Tuberculosis (TB)

Pseudomonas aeruginosa and burkholderia cepacia Pneumonia

Legionella pneumophila Legionnaire’s disease

Chlamydia psittaci Psittacosis

Staphylococcus aureus Skin infections, endocarditis and osteomyelitis

Leptospira Leptospirosis, also called Weil's disease 

Bacteria can be found on all workplace surfaces, in the soil and growing in various substances
used by workers.

Bacteria needs certain conditions to replicate, such as:

 warmth - usually bacteria thrive between 5 to 60C

 moisture - some form of water is needed for bacteria to replicate
 food - nutrients, including foodstuffs, biological metalworking fluids and more
 pH - most bacteria reproduce best at a neutral pH level of 7
 time - if provided with the optimum conditions for growth, bacteria can multiply to millions of duplicate
cells over a short time through binary fission vision. This is when bacteria divide in two every 20
minutes.

Viruses
Viruses are different to bacteria as they are the smallest microbes. A virus is a core genetic
material, either Deoxyribonucleic acid (DNA) or Ribonucleic acid (RNA), covered by a
protective coat of protein. Viruses replicate inside other living cells, they can latch on to host
cells, taking over their functions. The infected cell can infect new cells when stimulated.

Viruses can cause several diseases in more advanced cell structures. Examples include:

 chicken pox
 cold
 COVID 19
 ebola
 flu
 hepatitis
 herpes simplex virus (HSV)
 measles
 mumps
 polio
 rabies
 rubella
 smallpox.

Fungi
Fungi are more complex organisms than bacteria or viruses, they have a cell structure like plants
and animals. Fungi can reproduce generating spores. Most spores are dispersed by the air,
traveling to a suitable location to develop. Spores then make pathogenic fungi a particular risk as
they can be inhaled or respired.

Pathogenic fungi Illness they cause

Aspergillus, a common mould Aspergillosis - a respiratory condition

Blastomyces Blastomycosis - a lung infection

Candida Candidiasis in the ear, mouth and oesophagus

Coccidiodes Coccidioidomycosis - also called valley fever

Paracoccidioidomycosis, disease affecting the

Paracoccidioides, a fungus
lungs and cause lesions in the mouth and throat

Multiple fungi Fungal nail and eye infections

Histoplasma Histoplasmosis

As well as causing infections directly through inhalation, ingestion or direct contact, fungi can
also produce toxins, which can affect human health.

Fungi can be found in damp soil and buildings; they can enter the body either directly or through
spores being carried there through the air. Fungi need moisture to grow and reproduce, therefore
they are generally be found in damp areas, like kitchens, bathrooms, and basements of buildings.
 Toxins from biological sources
Toxins are a subset of poison produced by living organisms. Poisons are any substance that can
cause harm to an organism if enough has been absorbed, this can be either through ingestion,
inhalation, or direct contact.

Many organisms produce toxins either as a defence mechanism or for predation, they tend to be
produced by bacteria, fungi, plants, insect, and animals.

The five most deadly toxins are:

 botulinum toxin A, from the bacteria clostridium botulinum

 tetanus toxin A, from the bacteria clostrifium tetani
 diphtheria toxin, from the bacteria corynebacterium diphtheriae
 muscarine, from the mushroom amanita muscaria
 bufotoxin, from the common toad genus bufo.
Toxins can present in a variety of workplace settings. Venomous insects such as bees and wasps
can nest in any number of workplace buildings and can potentially sting workers. In many
countries, snakes and spiders are highly venomous, so can be a threat to workers.

Protozoa
Other types of biological hazards are protozoa. These are single-celled and extremely small cells.
Most people have protozoa living in or on their body at some time, and many are infected with
one or more species throughout their life. Some protozoa are harmless, but many other are
parasitic and produce disease. Infections range from asymptomatic to life threatening, depending
on the species and strain of the parasite.

Protozoa can be found in many sources of water, such as fresh and marine environments and in
soil. Therefore, they can be found in untreated water systems, wastewater and in agricultural
settings such as fields and foodstuffs. Some are parasitic, which means they live in other plants
and animals including humans.

The most widely known protozoa is malaria, which is found in tropical and sub-tropical regions
of the world.
 Health effects 
Poisonings and toxins
The damage caused by poisoning and toxins can be minimal to deadly.

Anaphylaxis
A severe allergic reaction which can be fatal. This usually occurs in response to almost any
foreign substance. Common triggers include:

 toxins from insect bites

 stings
 food
 medicines.

Long-term diseases, also called chronic diseases

Local
Local diseases target one part or organ of the body, such as the lungs. An example of a local
disease is hepatitis B (HBV). This can be transmitted into the body through contact with
infectious body fluids such as blood, vaginal secretions or semen.

Systemic
Systemic diseases affect many parts of the body, or the whole body. They can start as a local
disease and progress to systemic disease. For example, pneumonia may begin in one lung or both
lungs but then spread throughout the body into a potentially life-threatening condition.

Parasitic
Parasitic diseases are infectious diseases caused or transmitted by a parasite. A common example
of parasitic disease is toxoplasmosis. Infection usually occurs from:

 eating undercooked contaminated meat

 exposure to infected cat poo, or
 mother-to-child transmission in pregnancy.

Cancer
Carcinogens are substances that can cause cancer. Cancer is an uncontrolled growth of abnormal
cells in the body. Some new cases of cancer could be attributed to agents such as human
papillomavirus (HPV), helicobacter pylori, hepatitis B and C viruses.

For more information on occupational cancers, please see our No Time to Lose website.

Psychological conditions
There is a possible connection between infections and the development of disorders such as
schizophrenia, depression and bipolar disorder. A theory is that infection may influence the brain
with infective agents, altering the central nervous system.

Toxins (long-term)
Some toxins can have long-term effects. They affect people in different ways, from mild illness
to death. For example, there are several types of toxins produced by harmful algae, which in
large quantities can form toxic blooms. These can be responsible for causing:

 respiratory irritation and distress

 diarrhoea
 vomiting
 numbness
 dizziness
 paralysis
 death.

Allergies
Allergies are long-term conditions that are not life threatening but cause localised tissue
inflammation. Some biological hazards can cause hypersensitivity, which is an over reaction by
the immune system to an allergen. Examples include:

 pollens from plants

 viruses
 bacteria
 animals and birds.
 Workplace risks
Most workers are at some risk from biological hazards. There is more of a risk in jobs that
involve direct work with biological hazards, such as blood, tissues and fluids.

Find out more about the risks in each of these job sectors.

Retail, food and drink

Catering facilities, like kitchens or canteens, can be the source of several biological hazards. This
can be from raw food or poor preparation, cooking and storage. Food groups such as nuts, fruit,
shellfish, eggs and cows' milk can also be allergens and should be listed on product labels and
menus. Water can also be the source of biological hazards. Drinking water dispensers can pick
up contaminants, so need to be carefully managed.

Retail workers may find themselves working with deliveries of food from tropical countries and
these may have spiders or venomous creatures in the boxes.

Health, social care and emergency services

The main concerns when carrying out first aid is blood and other bodily fluids. Cleaning
procedures should be considered where blood or contaminated fluids have contaminated the
workplace. The first aid kit should include gloves for hygiene purposes.

Health care workers - including doctors, nurses, healthcare assistants, midwives and dentists - are
at risk from:

 direct contact of contaminated work equipment, such as needles and infectious pathogens
 potential transfer between workers.

Construction and facilities management

Biological hazards are located in buildings. Legionella is an example of one that can contaminate
a building's water systems and services.
 Other areas and job sectors
Other areas of work and risks to consider include:

 animal industries, such as veterinary services and agricultural work with animals like cows and sheep
carrying infectious diseases, for example zoonoses (diseases that can transmitted from animals to
humans)
 sewage management workers who may come into contact with faeces from humans and animals
 public service workers such as police officers and paramedics exposed to infectious pathogens. This can
be either from contact with infectious members of the public or deliberate acts such as needle stick attacks
and injuries
 engineering, due to machine work using bacterially contaminated metal-working fluids
 office, shops and factories due to exposure to bacteria from the contamination of untreated water systems.
Unhygienic work surfaces and poor housekeeping also potentially expose workers to disease-causing
bacteria
 leisure centres with swimming pools or water systems because of untreated water systems that are
potentially a risk for legionella bacteria.

Standards and benchmarks

Biological hazards are classed in different ways. In the UK, the Health and Safety Executive
(HSE) produces an approved list of biological agents. This provides classification of biological
agents as referred to in COSHH, The Control of Substances Hazardous to Health Regulations
2002.  
Biological safety levels are used to standardise precautions required when working with
biological agents in a laboratory facility. There are four levels, ranging from one, which is a low
level for low level hazards, to four, which is the highest level and the greatest risk to humans,
likely to be life threatening.  
Other UK health safety legislation covering specific micro-organisms:
 The Genetically Modified Organisms (Contained Use) Regulations 2000
 The Notification of Cooling Towers and Evaporative Condensers Regulations 1992  - the control of
legionella bacteria 
 The Carriage of Dangerous Goods and Use of Transportable Pressure Equipment Regulations 2004  - the
protection of everyone involved in transporting dangerous goods, including micro-organisms.

Managing biological hazards

To manage health and safety risks effectively, organisations and workers need to fully
understand them. Having a clear understanding of the biological hazards and how these effects
individuals is crucial.
Because you cannot see these hazards with the naked eye, it can be very difficult to identify
biological hazards in the workplace. 
 Identifying biological hazards
Ways to identify biological hazards in the workplace are:
 biological hazards occurring as a by-product or a contaminant of work processes
 environmental biological hazards, including animal and insect transmission (zoonoses)
 communicable diseases, brought in from outside the organisation, transmitted from person to person
 deliberate working with biological hazards. 

Finding further information

Under certain circumstances biological hazards can survive and often breed in equipment or on
surfaces as part of work activities and processes. If a biological hazard is known or suspected in
this way, it's important to find information on:
 the specific characteristics
 the hazards it poses
 routes of transmission
 control, and
 if any emergency arrangement are required. 
You can find most of this information in maintained databases of biological hazards on the:
 Government of Canada website, or
 Germany's federal ministry of Labour and Social Affairs .  

Risk assessment and controls

Biological hazards should be treated as any other hazard in the workplace. They need to be
assessed to determine how they should be controlled. A conventional, task-based risk assessment
is a valid way of assessing the risks.

Hierarchy of control
When controlling the risks, a hierarchy of control approach is just as effective for biological
hazards as other hazards and risks in the workplace.
 Elimination
 Substitution
 Engineering controls
 Administrative controls
 Personal Protective Equipment (PPE)
By implementing controls in the workplace, the risk of biological hazards can be greatly reduced
and, in some cases, they can be eliminated. The main controls used to address biological hazards
are engineering, administrative controls and PPE.  

Engineering controls
Where risks cannot be eliminated or substituted, this level of controls can be designed to lower
the risk. In the case of biological hazards, this can be for example removing the risk of infections
at source or isolating people from the hazards, or both.
 Engineering controls include:

 enclosure, such as access-controlled rooms and biohazardous safety cabinets

 local exhaust ventilation (LEV) systems, including high efficiency particulate air (HEPA) filters and fume
hoods
 mechanical ventilation, where air is exchanged and filtered through ducting systems
 natural ventilation, resulting in a number of air changes per hour.

Administrative controls
These alter the way work is done, including the timing of work, and can be policies and other
rules and work practices, such as:

 standards and operating procedures

 training
 housekeeping
 infection control
 personal hygiene practices.
Examples of administrative controls include:

 vaccination policies for specific biological hazards

 treatment of water systems
 health surveillance and health risk assessments
 safe systems of work for working with biological hazards
 awareness training on routes of transmission and appropriate precautions.

Personal protective equipment (PPE)

Where controls higher up in the hierarchy of control are considered but a risk remains, PPE can
be used.

PPE only provides protection to those who wear it, but not others nearby who are not directly
involved in the activity. It also only provides protection when worn correctly without damage or
hinderance to the person wearing it.

Examples of PPE to protect from biological hazards include:

 body protection-aprons, coveralls, gowns and scrubs.

 eye, face, and head protection, such as protective glasses, goggles, face shields, caps, hoods and hair
covers
 foot protection, such as overshoes and protective boots
 respiratory protection, such as powered and non-powered respirators and breathing apparatus.
 Return to work
Work related ill health results in millions of lost working days. Organisations can support
workers early in their absence to help them to return to work as soon as is  practicable.

Return to work is a concept encompassing all procedures and initiatives that facilitate the
rehabilitation of workers who are absent  from work for various reasons or have a reduction in
their work capacity or capability.

As work is generally good for one’s health and wellbeing, it is important for a worker  to return
to work as quickly as possible. Research by the United Kingdom (UK) Health and Safety
Executive (HSE) shows that after just six weeks’ sickness absence a person’s ability to return to
work falls away rapidly.

Getting workers back to work as soon as practicable will ensure they are staying on a regular
work schedule and maintaining a productive mindset. It will also prevent interruption of salary
and/or benefits.

Supporting workers to return to work is a team approach. It could include the following people:

 manager
 supervisor
 human resource (HR) workers
 OSH professional
 representatives (OSH, labour, union).
Other services may also be involved if required, such as OH professionals, medical professionals
or a case management worker. In some cases, a claims manager from an insurance company may
be involved.

During the return-to-work process, workers  may require additional training or updating on any
changes relevant to their role or within the organisation while they have been on leave. This may
be decided by the OH professional and their manager and arranged during the return-to-work
interview. Without an OH professional, this  can be arranged by the manager and the worker.
 Developing a return-to-work plan for workers will help to reflect an organisation’s  commitment
to provide a safe and healthy workplace. This will benefit the organisation  financially by
minimising the costs of recruiting and hiring new workers. This will also reduce downtime and
the need to train replacement workers. It will also benefit the organisation’s culture as it will
increase morale and improve operations by ensuring workers are trained and skilled.

In the return-to-work plan it is good practice for the organisation to:

 keep in regular contact with the worker

 identify and provide suitable duties for the worker
 monitor the workers
 provide a supportive environment and be understanding.
Rehabilitation:
Rehabilitation is one component of the return-to-work process. The aim of rehabilitation is to
help a worker back to suitable or alternative work after long-term sickness, disability or
unemployment.

Getting back to work as quickly as possible  enables workers to regain confidence and
motivation, and to maintain good relationships with their managers and co-workers. The worker
could also avoid financial hardship due to missing work and possible early retirement due to ill
health.

A cost effective way an OSH professional can support rehabilitation is by setting up a formal
Occupational Health (OH) and rehabilitation programme. A well-managed programme can help:

 keep workers in work

 reduce workers’ short-term pain and suffering
 minimise or eliminate long- term disabilities
 get workers back to work quickly and safely.
Providing rehabilitation in the return-to- work process will also support a worker’s wellbeing by:

 ensuring faster recovery

 reducing suffering
 reducing disruption to family, social and working life
 improving physical and mental health
 improving financial security.
Returning to work after a work-related incident or ill-health
If a worker is absent because of a work- related incident or illness, they might be reluctant to
agree to reintegrate back into work. This could be because they are:
 concerned that the source of harm hasn’t been removed or aren’t confident  that what has been done to
remove
 or control it has been successful
 thinking about claiming compensation and feel it may have a negative impact on their claim
 not aware of the organisation’s ability and willingness to be sufficiently flexible to meet their needs.
Part of an OSH professional’s role is to provide the organisation with the confidence to carry out
a successful return-to-work programme. This can be done by making sure that a proper
investigation has been carried out and measures have been put in place to prevent recurrence.

Returning to work following a bereavement

As well as returning to work following an incident or illness, organisations should consider
having arrangements in place including policies and procedures for workers who return to work
following a bereavement.

It’s important to remember that grief can affect people in many ways, such as their mental health.
Life events such as returning  to work, can also have an effect on their health. OSH professionals
can provide managers with information and support, including guidance on the worker’s ability
and advice on work adjustments. Each case will need to be assessed on its individual merits.

Return to work plan

A return to work plan should be tailored to the needs of the worker and the business. It doesn’t
have to be complicated.

Six steps to returning to work

These six steps are widely used by organisations and are an element of IOSH’s Managing
occupational health and wellbeing course, which provides practical advice and tools for
managers to create a healthy and productive place of work.

Step 1 recording sickness absence

 

The first step of a return-to-work plan is to create a policy for recording sickness absence. This
will help the organisation to identify why the worker is off sick and if it is a work-related illness.
Doing this will identify if the worker has a high rate of sickness and help to benchmark the
organisation’s performance.

There are many tools and template systems available for tracking and recording sickness absence
in the workplace, but many organisations can set up their own. This doesn’t need to be
complicated and can be done on a spreadsheet or word processor.

Sickness absence information is sensitive data and must be kept private. The organisation needs
to be clear to their workers on what the information is used for and ensure it isn’t passed on
inappropriately to anyone internally or externally.

Generally, sickness absence can be recorded by line managers and HR departments, but an OH
professional can help by ensuring records are being kept up to date and monitoring them. This
will result in workers being offered support when they are off sick, and issues being highlighted
if they need to be investigated.

Step 2 keep in contact

 

As part of the return-to-work plan it is important for the organisation and the worker to keep in
contact. This is to ensure the worker doesn’t feel out of touch or undervalued. The organisation
should keep in regular contact with them but without making them feel pressurised to come back.

Regular contact will demonstrate that the organisation is committed to supporting the individual
and plays an important role in ensuring a successful return to work.

Initial contact should always be personalised, either meeting in person or via a phone call.
Sending a positive letter that assures the worker they are being supported by the organisation is a
very good way to initiate a return-to-work process.

Documenting organisational support also strengthens their legal position with regards to intent to
support the worker.
Tips for planning a conversation with a worker
remain positive – if work is the cause of the absence, any negative points in the conversation will affect the
worker’s motivation to return to work
focus on tasks the worker can do, rather than can’t do, following their illness or accident
reassure the worker their job is safe and encourage them to focus on their recovery
listen to any concerns the worker may raise and address these promptly ask your worker when they feel they
could return to work and discuss suitable duties available

Who contacts the worker?

The worker’s manager is the most appropriate person to contact the absent worker, as they know
the worker best. If the worker doesn’t feel comfortable talking to their manager, they could be
contacted by an HR/workplace representative or someone the worker feels comfortable talking
to.

The communication needs to be reasonable and timed correctly. Too much initial contact with
someone with mental ill-health could be detrimental. For example, if a worker is stressed from
work and has recently stopped work, it is recommended that careful consideration be given to
when first contact is made.

Consulting the workplace occupational health services (OHS) team or injury management
specialist is encouraged in these cases.

Information about a worker’s medical condition should be kept confidential, unless the worker
has consented (with a signature) to the information being passed to others. The manager and
workers should agree what can be communicated.

Step 3 plan and implement workplace controls or adjustments

Return to work risk assessments
When a worker is returning to work, controls and procedures that had been considered safe in the
past may not be suitable now. Risks will need to be identified so that the worker can return to a
safe working environment. To identify any risks to the worker, the organisation should undertake
a return-to- work risk assessment.
 The risk assessment should consider:

 the impact of the workplace on the worker’s ability to complete tasks without causing harm to themselves
or others
 the work tasks of the individual
 if existing controls are sufficient or if additional controls will need to be considered by the organisation
The risk assessment should be checked by the worker to ensure they are satisfied with the
controls being put in place.

Additional considerations when carrying out the risk assessments could be:

 medication that may prohibit the worker from working on machinery or driving
 first aid requirements – additional provision may be required due to the nature of the illness or medication
 adjustments to the environment or workplace arrangements.
Workplace adjustments
Adjustments to workplace arrangements and/or environments should be considered

to aid a worker’s return to work. The adjustments don’t have to be difficult, and there are many
solutions that can be achieved by working with the individual and their supporting medical
professional.

The benefits of workplace adjustments are to:

 return the worker to their job with any modifications needed, or to an alternative job if no adjustments are
possible
 retain valuable skills
 remove any obstacles and barriers to return to work
Always seek assistance and advice from other professions when required.

IOSH’s research return to work after cancer has two example risk assessments that could be used
for anyone returning to work.
Step 4 specialist advice and treatment
 

In some circumstances further assistance may be required, including OH advice from in-house
professionals (if applicable) or external consultants. Some workers may require rehabilitation in
the form of specialist treatment and support from other services before they return to work.

OH professionals such as occupational therapists can advise on good practice on return to work
and help to determine what work is appropriate for the worker. They can also provide advice on
 whether rehabilitation is an option and, if so, the adjustments to the workplace that may be
needed.

Rehabilitation, sometimes referred to as workplace or vocational rehabilitation, means helping a

worker who has been injured or ill to go back to a safe and suitable workplace at the earliest time
possible using medical interventions and treatments. It is often carried out by specialist OH or
medical professionals.

Having OH support can:

 help to develop a workplace culture

 contribute to an organisation’s success
 help to ensure compliance with the law
Organisational methods of helping to treat a worker who is returning to work can be as follows.

 create an inclusive, open and valuable culture by encouraging workers to be open and by demonstrating
that worker wellbeing is important to the organisation.
 good communication – using various methods of communication to raise awareness of illnesses, for
example mental ill-health. These methods will enable the organisation to receive valuable feedback
regarding potential health issues.
 working methods – allow those who may be experiencing ill health such as stress to take regular breaks,
adjust working environments and adopt flexible working methods. Set clear and realistic targets for
workers and consider ways in which to measure ill health effects.
 internal support – provide workers with adequate support, education and guidance on how to manage
some ill health conditions or negative perceptions of illnesses such as mental ill-health.
 external support – offer worker assistance programmes to provide support externally through counselling,
therapies or legal advice. Give support to workers who may require other treatments and make regular
contact with them to provide additional support and to mitigate organisational disengagement.
 technology, such as apps on mobile phones or tablets, can also help to treat some health conditions. These
apps can help workers to self-manage their condition; improve cognitive skills; receive training and
development; and track symptoms. Such apps may be able to analyse data and recognise changes in
behavioural patterns.
Step 5 agree a return to work plan
 

To help the worker return to work, it is a good idea to prepare a formal plan that acknowledges
the individual’s circumstances. It doesn’t have to be complicated, but it is a useful tool to address
actions or issues that could prevent the individual from returning to work. The plan can be in
template form to prompt the manager or OSH professional – but it’s important to remember that
everyone will be different and some of the circumstances will vary dramatically.
The plan should include details about workplace adjustments, working environment and working
arrangements, checks that need to be made to ensure the plan is put into practice and dates when
the plan will be reviewed.

If any medical or occupational professionals are involved, make sure they are included and have
seen and agreed the plan too.

By having a return-to- work system in place, the organisation will benefit from keeping valued
staff, avoiding unnecessary recruitment and training costs and keeping the organisation
productive.

Return to work interview

A return-to-work interview is crucial to any successful return-to-work process. To ensure the
interview is successful it should be carried out face-to- face and in a relaxing, private
environment.

The interview should be well planned beforehand to ensure that it is appropriate for the
individual – someone with cancer will have different needs to someone returning to work
following an accident. Templates do help, but ensure it is personal to them and considers their
individual needs following any treatment they have been going through. The worker may find
them difficult, particularly if their absence involved distressing situations. Focusing on what the
injured person can do at work – their ‘functional capacity’ – is key.

Step 6 co-ordinate the return to work

 

When the worker returns to work, no matter how long they have been absent, they should be
welcomed back to ensure that they feel supported. It is possible that other advisers will be
involved, so it might be useful to appoint a co-ordinator to facilitate the return to

work. This ensures the correct arrangements are in place, eases communications and ensures that
the worker receives the correct information. A co-ordinator will also ensure the worker has one
point of contact instead of having to liaise with different departments.
 The role and responsibilities of an OSH
professional in return to work
Before OSH professionals give advice on return-to-work cases, they should ensure that they are
acting within their competence. Where clinical judgments are needed, for example diagnosis or
treatment, they should always get advice from a medical expert. An OSH professional can
support good return-to-work practice by giving advice on risk assessments for workers.

10 point action plan for OSH professionals

1. Don’t forget that prevention is best – include rehabilitation as part of a wider strategy on workers’ health
and wellbeing. The aims of the strategy should be to tackle the causes of work-related ill health and
injury, address problems before absence occurs and – through health promotion – encourage workers to
take responsibility for their own health.
2. Promote the benefits of work (in a safe and healthy environment) to the wellbeing of workers, including
those with health problems.
3. Promote early contact with workers who are absent for a long period and maintain regular return-to- work
meetings/interviews.
4. Put forward a cost–benefit–based argument for buying in OH advice, especially medical professionals or
organisations that specialise in a certain area. They will have a better understanding of the individual’s
condition and can advise on aids that may support their return to work.
5. Suggest that workers with musculoskeletal disorders and  mental ill- health are referred early for
rehabilitation or help them to get medical treatment such as physiotherapy or cognitive behavioural
therapy to aid fast recovery.
6. Tackle myths around return to work and rehabilitation – in particular, challenge people who use OSH as
an excuse for not considering rehabilitation.
7. Support managers by helping or training them to undertake assessments of workers who come back to
work.
8. Ensure that the assessments assess the individual, not the illness: don’t make assumptions about a
worker’s capabilities based on perceptions of their health. In other words, take a holistic view and don’t
focus on medical conditions. 
9. Focus on what the worker can do and how barriers to their return to work can be removed.
10. Assess whether measures put in place to help a worker return to work would also benefit other workers
exposed to the same hazards.

https://iosh.com/health-and-safety-professionals/improve-your-knowledge/occupational-health-
toolkit/return-to-work/osh-professional-role/