Health & Safety Management Lecturing Resource

for

Quarrying Related Degree Courses

LECTURE NOTES:

HEALTH ASSESSMENT & SURVIELLANCE

Objectives of this Section

 To outline the difference between safety and health hazards.

 To demonstrate a practical methodology for undertaking health risk assessments

 Understand the reasons for undertaking health surveillance.

 To identify some common health hazards present in the quarrying industry. 1.0 Introduction

Health and safety law places a duty on employers to ensure the health as well as the safety of their employees. Yet across industry, each year many more people become ill as a result of their work than are killed or injured in industrial accidents. Most diseases caused by work do not kill, but can involve years of pain, suffering and discomfort for those affected. It has long been recognised that health risks have not received the same attention as safety risks. Cole (1996) 1gives several reasons for this. These are:

 the health risk may not be understood or well defined and the cause/effect relationship not established.

 Health risks tend not to attract widespread publicity or demand the same urgent attention as safety risks.

 Health risks appear to have little, if any, short term effect and it may be that ill-health does not occur for many years after exposure.

 Health risks may be more difficult to address, resulting in attention being directed to risks where control is more visible and likely to attract tangible benefits

 Comprehensive data on the occupational ill-health may simply not exist in many cases and in practice, the true extent of occupationally related ill-health may be unknown.

Health problems may not be as obvious as a safety failure such as a structural collapse, machinery accident or a fire & explosion. Most people may never see cases of occupational ill health whilst at work. They may miss the connection between the effect and its causes, so it is even more important to adopt a proactive approach to managing health risks.

1 Cole RJ (1996) HSE Strategy for Improved Health in the Mining Industry. In proceedings of the IMM Conference on Health & Safety in Mining & Metallurgy. London: Institute of Mining & Metallurgy. Lecture Notes: Topic 6 2 Health Assessment & Surveillance Typical Health Risks

Risks to health from work activities include:

 Skin contact with irritant substances, leading to dermatitis etc;

 Inhalation of respiratory sensitisers, triggering immune responses such as asthma

 Badly designed workstations requiring awkward body postures or repetitive movements result in upper limb disorders, repetitive strain injury and other musculoskeletal conditions;

 Noise levels which are too high, causing deafness and conditions such as tinnitus;

 Too much vibration, eg from hand-held tools leading to hand arm vibration syndrome and circulatory problems;

 Exposure to ionising and non-ionising radiation including ultraviolet in the sun’s rays causing burns, sickness and skin cancer

There are a number of specific health and safety Regulations that deal with specific health hazards. These all require a risk based approach and include:

 Chemicals & hazardous substances: The Control of Substances Hazardous to Health Regulations , 1999

 Noise: Noise at Work Regulations, 1989

 Manual Handling: Manual Handling Operations Regulations, 1992

 Ionising radiation: Ionising Radiation (Protection) Regulations, 1985

Occupational Health Occupational health is about protecting the physical and mental health of workers and ensuring their continual welfare in their working environment. In addition to preventing ill health, other important aspects of occupational health include:

 Ensuring fitness and physical capability to perform a job safely;

 Health education and promotion;

 Providing medical services including health surveillance;

 Rehabilitation after illness or injury.

Lecture Notes: Topic 6 3 Health Assessment & Surveillance 2.0 Health Risk Management

The principals for the management of health risks are the same as described in the last topic, although there are some specific differences. A typical health risk management process is described below, based on the diagram shown below (Bailey, 19962)

START

Workplace risk assessment

No Risk uncertain risk Measure Exposure: STOP  airborne -OEL’s known risk

Select control measures for:  exposure, and  spread of contamination

elimination engineering administration

Review if: personal protective equipment  significant changes  new information  every 2-5 years

Ensure Ensure use of controls: Monitoring Programme continuing  information, instruction, training  design effectiveness  rules and procedures  implement of controls  supervision

The workplace risk assessment covers the elements of hazard identification and risk assessment.

Hazard Identification

For each work activity all the heath hazards need to be identified. Most hazards can be identified based on knowledge and observation of the work activity, though specialist advice

2 Bailey SR (1995), The Management of Occupational Hygiene, Occupational Health & Safety Training Unit, University of Portsmouth. Lecture Notes: Topic 6 4 Health Assessment & Surveillance or assistance may be necessary. Useful advice is also available from other sources such as data sheets supplied with equipment or chemicals.

The most common agents likely to present health hazards at quarries are listed below 3according to work activity (This list is not exhaustive).

Dust Noise Vibration Oil, Skin Manual Eyesight Welding Asbestos DSE Fuel, respirator handling fume Grease y senisiters Weighbridg    e Office Staff    Loading     ?  Shovel Dumper     ?  Plant    ? ?  ? Operator Crusher    ? ?  ? Operator Foreman   ? ? ?  Driller   ? ?   Shotfirer   ? ?   Fitter   ?      ? ? Electrician   ?     ? Manager   ? ?   ?

Risk Assessment

In order to be able to make an assessment of the risk of health hazards, the two major elements that need to be considered are:

 The potential consequences of exposure to the hazard;

 The potential exposure to the hazard.

3 From QPA Health Surveillance Guide. Published by the Quarry Products Association Lecture Notes: Topic 6 5 Health Assessment & Surveillance

 Physical  Hazardous form; properties  Quantity  Activities

Potential Potential of severity Exposure

Risk of Harm

Potential Severity The potential severity of exposure to the hazard is related to the properties of the hazard. For example:

 The toxicity of a chemical;

 The sound pressure level at the operators ear and the frequency of a noise source;

 The intensity and penetrability of ionising radiation;

Potential Exposure Potential for exposure means the opportunity to do harm. In assessing the potential exposure to the hazard, it is necessary to consider:

 The proportion of the work force who are or will be exposed to the hazard (in particular the frequency of exposure and length of time of exposure).

 Any risk reducing control measures that are in place and their effectiveness in reducing the risk.

Lecture Notes: Topic 6 6 Health Assessment & Surveillance Again a subjective scale can be used to estimate the level of risk (e.g. HSE, 19974)

4 HSE (1997), Successful Health & Safety Management, HS(G)65, HSE Books. Lecture Notes: Topic 6 7 Health Assessment & Surveillance Estimating Risk

Risk = Severity of Harm x Likelihood of occurrence

Where Severity is rated according to:

(3) Major

Death or major injury or illness causing long term disability

(2) Serious

Injuries or illness causing short-term disability

(1) Slight

All other injuries or illnesses

The likelihood of harm may be rated according to:

(3) High

Where it is certain that harm will occur

(2) Medium

Where harm will often occur

(1) Low

Where harm will seldom occur

Where necessary some form of sampling and exposure measurements should be undertaken to determine the extent of the hazard at the time of the assessment. These can then be compared with any occupational exposure limits (such as TLV’s and OEL’s) that have been set for the industry, as well as any in-house standards. Such exposure measurements may also assist in determining any remedial action that is necessary.

Lecture Notes: Topic 6 8 Health Assessment & Surveillance Controlling the Risk

If the assessment of risk shows that further action is necessary, then control measures should be selected according to the hierarchy of risk control, namely

Hierarchy of Risk Control

 Elimination of the risk. This can be achieved through redesigning the activity or equipment to eliminate the release of the hazard;

 Reduction of the risk at source through engineering controls. This can be achieved by enclosing the activity or equipment to capture and/or absorb the hazard, dilute the hazard or release it into a safer place;

 Minimising the risk through procedural controls. This involves implementing systems and procedures so that work is carried out in a particular way that limits exposure to the hazard.

 Use of appropriate personal protective equipment (PPE).

The use of PPE is the last resort for the control of the exposure of employees to hazards. This is because PPE only protects the wearer and then only if worn properly. Situations where the use of PPE may be necessary are:

 Where adequate control of exposure cannot be achieved by elimination, reduction at source or minimisation through administrative controls.

 As a ‘stop-gap; measure, where a risk assessment indicates that further control measures are necessary and until those further measures have been introduced and are deemed effective.

Lecture Notes: Topic 6 9 Health Assessment & Surveillance Examples of Hierarchy of Risk Control: Noise5

 Sound absorbent material around noisy machinery;

 Use of sound absorbing wall and floor materials;

 Cover the source of the noise (e.g. using hoods);

 Arranging plant and equipment to create screens and reduce the level of reflected sound;

 Isolating workers from the noise source;

 As a last resort provide comfortable PPE

Ensuring the use of Control Measures

Having introduced new control measures it is essential that they are adequately used by employees, and so systems should be put in place to ensure that such measures are used effectively. This is a responsibility of both the employer and employee and can be achieved by ensuring that the workforce receive adequate instruction and training through:

 Working procedures, codes of practice or other procedural controls;

 Educating the workforce on the hazards and risks involved in their work and how control measures will protect their health.

 Effective supervision.

Employees must use these control measures in compliance with any such instruction and training.

Systems should be put in place to ensure that the effectiveness of all the risk reducing control measures does not decrease over time. Any engineering controls should be subject to regular checking and maintenance. The frequency of this should be determined by the risk assessment and based on the engineering reliability of the control measures and the consequences of their failure with respect to exposure.

Proactive monitoring: Sampling & Exposure monitoring

Active monitoring is achieved through sampling and exposure monitoring in order to:

5 Glendon AI & McKenna EF (1995), Human Safety & Risk Management, Chapman & Hall, UK Lecture Notes: Topic 6 10 Health Assessment & Surveillance  Check the effectiveness of risk reducing control measures, as a failure in these measures results in an increased risk of harm occurring;

 Confirm that Occupational Exposure Limits are not exceeded;

 Tie in with the medical surveillance programme.

Lecture Notes: Topic 6 11 Health Assessment & Surveillance 3.0 Health Surveillance

Health surveillance means having a system to look for early signs of ill-health caused by work in order to:

 Detect adverse effects early;

 Prevent further harm being caused.

Health surveillance is mandatory in some cases, such as work with certain chemicals or with ionising radiation. It may also be appropriate where the risk assessment has identified a high level of exposure to other hazards. The criteria for carrying out occupational health surveillance are:

 There is an identifiable disease or condition associated with the work;

 There are valid techniques to detect the condition at an early stage;

 There is reasonable likelihood that the disease or condition will occur in the particular circumstances of the exposure;

 That health surveillance will be of benefit to individuals or groups of workers.

Elements of a health surveillance programme (from QPA Health Surveillance Guide) It is becoming increasingly common to carry out new employee health assessments to ensure that the person is fit for the duties that they are required to perform. This may take the form of health questionnaires together with medical examinations where appropriate.

Health questionnaires can also be administered as part of the surveillance programme, along with the appropriate testing techniques (such as audiograms, lung function tests). These techniques, along with the frequency at which the assessments take place depend on the hazard and associated risk.

Health surveillance can be carried out at several levels depending upon the complexity of the health effect being monitored.

 Supervisors, with some training, can recognise the onset of many conditions and have the advantage of being in daily contact with the workforce;

 An occupational health nurse can administer standardised tests, such as audiometric testing, lung function tests etc.

Lecture Notes: Topic 6 12 Health Assessment & Surveillance  A doctor with appropriate qualifications and experience would be required to carry out more detailed clinical examinations such as assessments of hand arm vibration syndrome.

Suggestions for health surveillance for health hazards common to quarries are given in the Quarry Product Association’s Health Surveillance Guide. Examples from the Guide are given in the appendix to this section.

Lecture Notes: Topic 6 13 Health Assessment & Surveillance Appendix: Hazard information from QPA Guide

Dust Noise Substance/ Whilst dust is present in all quarries, the nature Quarrying is a noisy industry, typical levels Hazard of the dust presents differing levels of risk. In being: general the highest risk is presented by dusts Primary Crusher: 89-108 dB(A) containing high levels of respirable crystalline Hand Drill: 106 - 110 dB(A) silica. Limestone may have no free silica. Flint may be in excess of 90%. Possible Ill Exposure to dust can affect chest health and Long term irreversible hearing loss. Health can result in pneumoconiosis or silicosis. Effects Control Routine atmospheric dust monitoring is The Noise at Work Regulations 1989 set out Level required. EH40 “Occupational Exposure Limits” three action levels:

st lists standards for various dusts. E.g. 1 Action Level – 85 dB(A) L EP,d Occupational Exposure Standards -assessment must be carried out Limestone 10mg/m3 total inhalable dust/4 -ear protectors on request

nd mg/m3 respirable dust. 2 Action Level – 90 dB(A) L EP,d Coal: 2 mg/m3 respirable dust - reduction of exposure required Kaolin: 2 mg/m3 respirable dust - ear protectors to be provided Maximum Exposure Limit - ear protection zones required

Crystalline Silica: 0.3mg/m3 respirable dust Peak Action Level – 140 dB(A) L EP,d - as 2nd Action Level Health For new employees where a medical For new employees where a medical Surveillance assessment is considered appropriate medical assessment is considered appropriate may include a respiratory questionnaire, lung audiometer should be carried out. function test and possibly x-ray if exposure to It is good practice to carry out regular hearing silica is likely. checks on all employees whose daily personal Where operatives are exposed to levels of noise exposures equal or exceed 90 dB(A); respirable crystalline silica greater than 0.1 many employers already do this. 90 dB(A) is the mg/m3, the Guidance in EH59 (latest revision) same as the ‘second action level’ in NaW Regs should be followed. – the level at which protection must be worn. The risk of hearing damage rises significantly at exposures above this level. Therefore, even when hearing protection is used, hearing checks (audiometry) should normally be provided when noise levels reach or exceed 95 dB(A), except where that exposure is likely to be only temporary, for example for a few weeks in a year. Table (Cont’d)

Dust Noise Precautions Avoid generation of dust in the first instance. Purchase less noisy equipment and keep it Avoid exposure to dust. Maintain seals/filters maintained. etc for control rooms, vehicle cabs and other Reduce exposure below peak and second ‘dust refuges’. action level. Where exposure cannot be adequately control Provide quiet refuges. by other means appropriate respiratory Educate the workforce. protective equipment should be used. Only approved PPE giving adequate attenuation should be used. All PPE must be properly maintained. Additional “Respirable Crystalline Silica: exposure “Control of Noise in Quarries” HS(G)109 ISBN Information assessment document” HSE EH74/2 ISBN 0 0 7176 0648 1 7176 1659 2 “Health Surveillance in Noisy Industries” “Control of respirable crystalline silica in IND(G)193L quarries” HS(G)73 ISBN 0 11 88 5680 4 “A guide to audiometric testing programmes” “Occupational Exposure Limits” HSE EH40 – HSE Guidance Note MS26 ISBN 0 7176 0942 1 consult current edition “Keep the Noise down: advice for purchasers of EH59 Respirable Crystalline Silica (1997 workplace machinery” HSE IND(G)263. Revision) ISBN 0 7176 1432 8 “Managing asbestos in workplace buildings” HSE IND(G)223 “The Control of Asbestos at Work” HSE L27 (1999 Revision) ISBN 0 7176 1673 8

Lecture Notes: Topic 6 15 Health Assessment & Surveillance