INTERNATIONAL

HEALTH AND SAFETY

A course book for the NEBOSH International General Certificate
in Occupational Health and Safety

Series Editor:
Paul Randall
Authors:
Dr Luise Vassie
Tony Morriss
Dr Mark Cooper
Caroline Copson
Dr David Towlson
INTERNATIONAL
HEALTH AND SAFETY
A course book for the NEBOSH International General Certificate
in Occupational Health and Safety

Series Editor:
Paul Randall
Authors:
Dr Luise Vassie
Tony Morriss
Dr Mark Cooper
Caroline Copson
Dr David Towlson
 CONTENTS

Introduction 5

Element 1: Why we should manage workplace health and safety 7

1.1: Morals and money 7
1.2: The force of law – punishment and compensation 12
1.3: The most important legal duties for employers and workers 23

Element 2: How health and safety management systems work

and what they look like 36
2.1: Health and safety management systems and their benefits 36
2.2: What good health and safety management systems look like 49

Element 3: Managing risk – understanding people and processes 61

3.1: Health and safety culture 61
3.2: Improving health and safety culture 69
3.3: How human factors influence behaviour positively or negatively 84
3.4: Assessing risk 96
3.5: Management of change 118
3.6: Safe systems of work for general work activities 125
3.7: Permit-to-work systems 135
3.8: Emergency procedures 144

Element 4: Health and safety monitoring and measuring 152

4.1: Active and reactive monitoring 152
4.2: Investigating incidents 164
4.3: Health and safety auditing 174
4.4: Review of health and safety performance 184

Element 5: Physical and psychological health 190

5.1: Physical and psychological health hazards and risk control 190
5.2: Vibration 202
5.3: Radiation 209
5.4: Mental ill-health 221
5.5: Violence at work 231
5.6: Substance abuse at work 237

International Health and Safety 3

Contents

Element 6: Musculoskeletal health 243

6.1: Work-related upper limb disorders 243
6.2: Manual handling 256
6.3: Load-handling equipment 267

Element 7: Chemical and biological agents 280

7.1: Hazardous substances 280
7.2: Assessment of health risks 291
7.3: Occupational exposure limits 303
7.4: Control measures 307
7.5: Specific agents 322

Element 8: General workplace issues 335

8.1: Health, welfare and work environment 335
8.2: Working at height 346
8.3: Safe working in confined spaces 362
8.4: Lone working 376
8.5: Slips and trips 387
8.6: Safe movement of people and vehicles in the workplace 398
8.7: Work-related driving 411

Element 9: Work equipment 428

9.1: General requirements 428
9.2: Hand-held tools 438
9.3: Machinery hazards 445
9.4: Control measures for machinery 459

Element 10: Fire 468

10.1: Fire principles 468
10.2: Preventing fire and fire spread 478
10.3: Fire alarms and firefighting 492
10.4: Fire evacuation 501

Element 11: Electricity 510

11.1: Hazards and risks 510
11.2: Control measures 518

4 International Health and Safety

ELEMENT 5
PHYSICAL AND PSYCHOLOGICAL HEALTH

5.1: Physical and psychological health

hazards and risk control

Syllabus outline
In this section, you will develop an awareness of the following:
• The physical and psychological effects of exposure to noise
• Assessment of noise exposure
• Methods of noise measurement
• Noise control measures
• The role of health surveillance (as applied to the protection of hearing)

In this section we will examine the ways in which noise can affect physical and
psychological health; that is, we will look at how exposure to noise can cause
harm to hearing (such as hearing loss) and harm to mental health (such as causing
stress).
Noise can be regarded as ‘unwanted sound’.
Certain industry sectors are often associated with hearing damage, especially long
term. Examples of these are:
• manufacturing (from noise sources such as rotating machinery and compressed air
equipment);
• construction (from site equipment such as generators, the process of demolition
and activities such as site transport); and
• entertainment (from frequent exposure to loud music and noise from large
crowds).
Exposure to noise can result in an immediate temporary loss of hearing (an acute
effect) or a gradual long-term effect causing some permanent loss of hearing
(chronic effect).
In this section, you will learn some noise terminology. You will also consider what
you need to take into account when carrying out a noise risk assessment.
Once these assessments have been carried out, you will learn about ways to
minimise harm from noise exposure. Finally, you will consider the role of health
surveillance, which is important in order to identify the extent of damage to hearing
over time.

190 International Health and Safety This preview is taken from Element 5
 5.1 Physical and psychological health hazards and risk control

5.1.1 The physical and psychological effects of

exposure to noise
Structure of the ear 1
In trying to understand hearing damage, you may find it helpful to know about the
structure of the ear (see Figure 1).
Stirrup Semicircular
Canals 2
Anvil
Cochlea
Hammer

Pinna Auditory
Nerve
4
Ear Drum
Auditory
Canal

Outer Ear Middle Ear Inner Ear

5
Figure 1: Structure of the ear
The ear has three basic parts:
• the outer ear where sound waves enter;
• this sound energy proceeds to the middle ear, which contains three small bones 6
called ossicles;
• the movement of the three ossicles causes the eardrum to vibrate, which, in turn,
transmits this energy to the inner ear.
An important term associated with the inner ear is the cochlea, which contains 7
many thousands of tiny cochleal hair cells. These hair cells move when the sound
reaches them, sending a signal via the auditory nerve to the brain, which interprets
the sound. An important feature of the cochlea is that different hair cells respond
to different frequencies. When noise enters the cochlea, it causes the cochleal hairs
that respond to high frequencies to react first. As the noise progresses further into 8
the cochlea, it loses energy and thus has less effect on the hair cells which respond
to lower frequencies. Put simply, high-frequency noise (for example, compressed air)
causes more cochleal hair cell damage than low-frequency noise (for example, noise
from generators). 9
Causes of hearing loss
Many factors can cause hearing loss. Cochleal hair cells become less sensitive as we
get older so we may find it more difficult to understand the speech of people with 10
high-pitched voices. This age-related hearing loss is called presbycusis.
Most relevant to this section is, of course, exposure to noise. It can occur for social
reasons, such as exposure to very loud music but, more significantly, it can occur
due to excessive noise at work. 11
When we talk about ‘excessive noise’, it is not only the intensity of the noise which
is important, but also the amount of time that a person is exposed to the noise. The
combination of the intensity and duration is often referred to as the ‘noise dose’.
Excessive noise can be considered as a large noise dose.

This preview is taken from Element 5 International Health and Safety 191
Physical and psychological health

A further factor that influences the amount of hearing loss is the overall frequency
(pitch) of the noise. In practice, this is likely to result from a mixture of frequencies,
for example, being exposed to noise from different machines.

Types of hearing damage

The loss of hearing as a result of noise is known as noise induced hearing
loss (NIHL).
Two types of damage result in NIHL:
1 Conductive hearing loss, which affects the middle ear, particularly the ear drum.
2 Sensorineural hearing loss, which affects the inner ear, particularly the cochleal
hair cells (as referred to above).
We will now examine the damage to the cochleal hair cells in more detail.
In temporary hearing loss, the cochleal hairs tend to bend over but, if very little
noise exposure follows, the hairs can return to their normal position (so hearing
returns to normal). In permanent hearing loss, the noise dose may be large enough
for the hairs to break off or become permanently flattened. They never grow again,
making the hearing damage permanent. The resulting deafness does not occur over
the whole frequency range; the frequency that is particularly affected is 4kHz.
Tinnitus is another type of hearing damage, often referred to as ‘ringing in
the ears’. It can sometimes be heard as a continuous buzzing sound. It is due
to malfunction of the cochleal hairs. Some studies suggest that if someone has
developed tinnitus at work, they are more likely to go on to develop NIHL.

Social and psychological consequences

People may experience difficulty hearing, particularly in an environment where many
people are talking or there is background noise, such as a TV or music. There can be
a lack of sympathy for people who are hard of hearing so they can become socially
isolated. People may no longer enjoy listening to music because high-frequency
notes can become distorted.
Other consequences relating to mental health include stress, general anxiety, the
loss of ability to concentrate and mental fatigue, which could all lead to impaired
judgement and possibly put workers at risk of accident and disease.

Common noise terms

Sound is a series of pressure waves travelling through a medium such as air. The
sound pressure level (SPL) is the ratio of measured pressure to a reference
standard pressure (the reference used is the threshold of human hearing). In simple
terms, it is a measure of the perception of loudness of a sound, commonly described
as the ‘noise level’. The unit of measurement of SPL is the decibel (dB).
Sound intensity is the amount of power (ie energy per second) being transmitted
by the sound per square metre of surface it is falling on (such as the ear) or
travelling through. It is measured in watts per square metre (W/m2).
The decibel scale used for SPL provides values of sound output from different
sources or situations. It represents the range of sounds to which the ear can
respond, with 0dB being allocated to the softest sound it is possible to hear. Some
examples of noise output in SPL from situations or equipment are shown in Table 1.

192 International Health and Safety This preview is taken from Element 5
 5.1 Physical and psychological health hazards and risk control

Situations or equipment Typical noise level (dB)

Threshold of hearing 0
Quiet bedroom at night 20
1
Normal conversation at 5 metres 60
Underground train 80
Medium-sized printing press 85
Circular saw 90 2
Steel riveter at 5 metres 100
Pneumatic drill 125
Threshold of pain 140
3
Table 1: Examples of noise levels

TIP
You do not need to learn values such as those in Table 1, but you do need to be
able to outline what is meant by the term decibel.
4

Frequency is a measure of the number of pressure waves passing a given point per
second. The higher the frequency, the higher the pitch of the sound. Frequency is
measured in hertz (Hz) or kilohertz (kHz). 1kHz = 1000Hz 5
People with excellent hearing (usually young people who have not been exposed to
high noise doses) can hear from 20Hz up to 20kHz. The ear cannot hear sounds outside
this frequency range. Ears are not very sensitive to hearing low-frequency sounds; this
sensitivity increases with increasing frequency and reaches a maximum between 2 and 6
4kHz before the sensitivity begins to decrease with further increase in frequency.
The A-weighting, whose unit is dB(A), mimics the hearing sensitivity of the human
ear at various frequencies, so that measured sound in dB is filtered to a different
extent at different frequencies. Put simply, dB is the loudness of the sound at source; 7
dB(A) is loudness of the sound as the ear detects it. For example, a noise source of
81dB at 250Hz (for example, from a generator) would result in a value of 72dB(A)
while a noise source of 81dB at 2kHz (for example, from compressed air) would
result in a value of 82dB(A).
8
TIP
Again, you do not need to know how these dB(A) values are calculated, but you
do need to able to outline the meaning of A-weighting. This shows we are less
sensitive to 250Hz (ie the noise sounds ‘quieter’ to us) whereas at 2kHz, it sounds 9
a bit louder. ‘Loudness’ is our perception of SPL but it isn’t the same as SPL
because we have varying sensitivity at different frequencies.

TIP
10
Whereas the term dB(A) is useful for exposure to continuous noise, the term for
very short-duration noise is dB(C).
dB(C) is used to measure a peak value for a high-intensity noise of short duration;
that is, there may be a very high noise level for a very short period of time. An 11
example would be an explosion which might be used in quarrying operations.
The C-weighting scale is much flatter (ie it varies much less with frequency) than
the A-weighting scale, and the weighting is only applied at very low and very
high frequencies.

This preview is taken from Element 5 International Health and Safety 193
General workplace issues

APPLICATION
Test your knowledge by identifying the slip, trip and fall hazards in this diagram.

KEY POINTS
Slip and trips (and falls on the level) are a common cause of accidents in
the workplace.
Broad categories of slip hazards are: wet product or spills on smooth
floors or walking surfaces, dry products or dry product spills making
walking surface slippery, highly polished floors that are slick even when
dry, and moving from one surface to another.
Some of the causes of trips are: uncovered hoses, cables, wires or
extension cords across aisles or walkways; clutter; obstacles in aisles,
walkways and work areas; unmarked steps or ramps; rumpled or rolled-
up carpets/mats or carpets with curled edges; and irregularities in
walking surfaces.
Aggravating issues common to both slips and trips are: carrying or
moving large and heavy objects or simply too many objects at one time,
not paying attention to surroundings or walking while distracted, taking
shortcuts, and being in a hurry and rushing.
Good original design, efficient housekeeping and promptly cleaning up
spills are all effective control measures.

ANSWER TO APPLICATIONS
Identifying slips, trips and falls. Here are some:

• Fall into sewer

• Fall from ladder
• Walk into open window, leading to a fall
• Slip on cables laying on the ground
• Slip on surface due to inappropriate footwear
• Slip on ladder rungs

396 International Health and Safety This preview is taken from Element 8
 8.5 Slips and trips

• Slip on wet surface around maintenance area

• Trip on cables
• Trip on cone
• Trip on sewer cover
1
• Trip on cordless drill
• Trip on box

References 2
ILO. A Guide for Labour Inspectors and other stakeholders – Slips and Trips (www.ilo.org)
1

2
Adapted from Occupational Safety and Health Administration (OSHA), Slips, trips and falls
(www.osha.gov)

Adapted from HSE. Getting to grips with slips and trips (www.hse.gov)
3 3
OSHA (www.osha.gov)
4

HSE. Reducing the risk of falls on stairs (www.hse.gov.uk)

5

Adapted from HSE. Serious burn injuries lead to serious fine for fast food restaurant (www.hse.gov.uk)
6
4

10

11

This preview is taken from Element 8 International Health and Safety 397
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