Contact address (internal or home address): HEALTH DECLARATION Please tick this box if you have any of the following health disorders: Diabetes \200 Heart or circulatory disorders \200 Depression/anxiety \200 Stomach or intestinal disorders \200 Chronic chest conditions \200 Any condition that causes diffi culty with sleeping \200 Any medical condition for which you are taking medicines accordi ng to a strict timetable NEXT STEPS If you have declared a health problem, you may be referred to a doctor or nurse for further assessment. This will be done in confidence, and no medical details will be pas sed to your employer without your consent. The medical adviser will make a simple declarati on of your fitness for night work, and the need for any adjustment to working hours on heal th grounds. SIGNATURE : DATE : Fig 37.1 Example of night worker health assessment questionnaire. 37_Smedley_Chap37.indd 757 1/2/2013 1:35:09 PM CHAPTER 37 Clinical tasks and procedures 758 Methods for alcohol and drug screening Managers are responsible for the health, safety, and welfare of those work- ing under their supervision. This responsibility includes ensuring employee \201 tness for work. Managers must be alert to intoxication from alcohol or drug misuse. This can be established by simple observations and assessment of cog- nition, speech, posture, and movements witho ut recourse to screening tests. Screening tests (cid:8)(cid:8)2 Testing for drugs and alcohol should not be undertaken ligh tly, and must be part of a substance abuse policy (see b p. 378, Substance abuse policies). \200 There are many different forms of screening tests for alcohol and drugs of misuse that may be conducted (see Table 37.1); \200 directly at the \200\230poi nt of contact \200\231 \200 indirectly using specialist laboratory services Alcohol may be measured by breath, saliva or urine testing \200 Drug testing may use bloo d, saliva, hair or urine with differing considerations as shown in Table 37.1. 1 All test subjects must be invited to pre-declare any prescribed or over- the-counter medi cines and any special foods or supplements that they have taken, to enable accurate test in terpretation. Table 37.1 Summary of screening methods Breath Saliva Urine Blood Hair Advantages Easy to collect + + + + Observable test + + + + Minimal training + + + Equipment readily available + + + + + Low cost + + + Long-term detection + Disadvantages Dif \201 cult to collect + Potential for deliberate interference by subject + Limited application (substances that can be tested) + + + 37_Smedley_Chap37.indd 758 1/2/2013 1:35:10 PM METHODS FOR ALCOHOL AND DRUG SCREENING 759 For-Cause Random Pre-employment Urine Sample Chain of Custody ensures integrity of sample Sample A Sample B Near Person Testing Appeal Process Independent Lab Test Lab Test Review Medical Officer RMO interprets test result Result communicated as \200\230+ or \200\223 \200\231 to manag er Employee opportunity to question Manager Occupational Health provide case management support Employee Fig. 37.2 Alcohol and drug screening process. Chain of custody \200 This is the process for managing the collection, handling, storage, and testing of biological samples to prevent any possible contamination or interference (s ee Fig. 37.2) Normally, the sample is divided at collection into samples A and B and sealed, with a tampe r evident seal, in the presence of the test subject. In the event of a positive sample A te st result, the test subject has the opportunity to arrange an independent test of sample B. Who should be tested? \200 The selection of test subjects must be clearly de \201 ned in the policy and selection procedures should avoid any possible discrimination Possible options may include: announced or unannounced testing of all employees \200 only those in de \201 ned safety critical roles \200 those involved in accidents ( \200\230for cause \200\231). Positive test results \200 Alcohol testing often uses the Road Traf \201 c Act standards to de \201 ne \201 tness for work Drug testing reports only the presence of an illicit drug as a marker for drug-taking behavior The Review Medical Of \201 cer (RMO) will interpret and report test results, but managers are responsible for deciding possible employment implications. Further information Faculty of Occupational Medicine (2006). Guidance on Alcohol and Drug M isuse in the Workplace . FOM, London. 37_Smedley_Chap37.indd 759 1/2/2013 1:35:10 PM CHAPTER 37 Clinical tasks and procedures 760 Lung function testing In occupational medicine lung function is most commonly measured: \200 During the assessment of \201 tness for work in individuals with respiratory disorders As part of respiratory health surveillance and subsequent investigation ( b p. 428, Respiratory health surveillance). Common measurements and de \201 nitions \200 FVC is the maximum volume of gas that can b e expired from the lungs during a forced expiration from a position of full inspiration Forced expiratory volume in 1s (FEV 1 ) is the maximum volume of gas that can be expired from the lungs in the \201 rst second of a forced expiration from a position of full inspiration FEV 1 /FVC gives an indication of airways obstruction. A ratio below 70 \200\22375% indicates signi \201 cant obstruction PEF is the maximum \202 ow achievable from a forced expiration starting at full inspirati on with an open glottis. It occurs early in the expiratory maneuver when the lungs are expa nded and the airway diameter is large Simple self-paced tests of walking distance (e.g. the 6-min walk test) can be used in the o bjective assessment of functional disability. However, such tests depend on motivation. In the shuttle walk test the subject increases his/her walking speed each minute. This test is more reproducible than simple paced walk tests. The gold standard test uses a bicycle ergo meter to measure VO 2 max and other physiological parameters. However, this requires standa rdized testing in a laboratory and is not usually practicable for routine clinical OH work. Nomograms FEV 1 , FVC, and PEF vary with height, age, and sex, and with ambient tem- peratu re and pressure. Conversely, FEV 1 /FVC is useful because it is self- normalizing (unaffect ed by height, age, and sex). Individual recordings of lung volumes should be compared with nomograms (reference graphs of the normal readings in healthy adults for a given age, heigh t, and sex). This can be done manually using standard graphs (given in Appendix 6: Lung vol - umes). However, most modern automated spirometers provide a print-out that includes a com parison with normal \200\230expected \200\231 values. Quality control in lung function testing It is important that measurements are reproducible . This is particularly important for health surveillance, where serial measurements are use d to identify temporal changes in function. Therefore, lung function testing should be gove rned by a written protocol. The British Thoracic Society recommends the following. \200 S tandard training and procedures for staff who carry out testing: record patient \200\231s height, weight, age \200 record medication including timing of l atest dose of bronchodilators 37_Smedley_Chap37.indd 760 1/2/2013 1:35:10 PM LUNG FUNCTION TESTING 761 record temperature and barometric pressure for BTPS standard 1 corrections patient should be seated for 5 \200\22310min prior to testing, and sit upright in a chair for the test standard set of instructions for the patient, including standardized encouragement for maxi mum inspiration and to maintain effort throughout expiration Spirometers and peak \202 ow meters must be maintained according to the manufacturer \200\231s instructions Spirometers must be calibrated regularly according to the manufacturer \200\231s instructions 2 Quality check on the \202 ow volume print-out and guidelines for rejection, and repeat if unsatisfactory Record the greatest FEV 1 , FVC, and PEF from at least three technically acceptable maneuvers. The variability between readings should be (cid:3) 5%. Rejection criteria for lung function measurements \200 Leak at the mouthpiece \200 Poor ly co-ordinated start to the maneuver \200 Cough during the maneuver \200 Early termina tion of the expiration \200 Submaximal effort Further information and guidance British Thoracic Society and the Association of Respirator y Technicians and Physiologists (1994). Guidelines for the measurement of respiratory funct ion , Recommendations of the British Thoracic Society and the Association of Respiratory Te chnicians and Physiologists. Resp Med , 38 , 165 \200\22394. American Thoracic Society (2002). Guidelines for the six-minute walk test. Am. J Resp Crit Care Med , 166 , 111 \200\22317. Available at: M http://ajrccm.atsjournals.org/cgi/content/full/ 166/1/111 1 Body temperature and pressure standard. 2 Since 2004, new peak \202 ow meters have a corrected scale (EU scale). Old mini-Wright peak \202 ow readings must be converted using a standard scale. 37_Smedley_Chap37.indd 761 1/2/2013 1:35:10 PM CHAPTER 37 Clinical tasks and procedures 762 Serial peak \202 ow testing Method of choice for suspected cases of occupational asthma. Protocol Initial training It is important that readings are as reproducible as possible. Th erefore, the patient should \201 rst be instructed in basic PEF technique. This should be taught by an OH professional, or a technician who has been trained in standard procedures. The patient should be observed, and corrected on poor technique. Readings taken at the sam e time should be within 5% before the technique is deemed satisfactory. Recording regime \200 The best of three PEF readings should be recorded every 2h during waking time. Measurements should be continued at home and at work \200 Reading should con tinue for a period of at least 4wks: including at least a 1-wk period away from work A standardized sheet should be used by the patient to record the timing of: \200 symptoms \200 medication, in particular bronchodilators \200 signi \201 cant exposures, e.g. work activity (noting that co-exposure to more than one allergen can occur), leisure time exposure to smoky rooms, cold air, exercise Patients should be instructed not to enter missing or very late readings, but to leave blan ks in the event that readings are inconvenient or inadvertently forgotten. Tampering Although rare in practice, it is theoretically possible for patients to tamper wi th or fabricate serial peak \202 ow readings. Moreover, non-compliance is not uncommon. I t is more dif \201 cult to tamper and to disguise non - compliance if digital data-logging peak \202 ow meters are used. Recording and interpreting results \200 Serial PEF charts are usually plotted graphically to show the minimum, maximum, and mean peak \202 ow readings each day. Treatments and ex posures, and presence at work or home can be noted on the graph (see Fig. 37.3) Research evidence suggests that the consistency of diagnostic interpretation of serial PEF records by physicians using basic visual examination of graphi cal plots is poor; so physicians have tried to standardize interpretation using criterion-b ased computer software. Various computer programs are used by specialist centers. Some are freely available for use by OH practitioners, including the OASYS software. OASYS uses a sc oring system to assess serial PEF records, and preset cut-off scores to determine occupatio nal asthma cases (94% speci \201 city and 75% sensitivity). 37_Smedley_Chap37.indd 762 1/2/2013 1:35:10 PM SERIAL PEAK FLOW TESTING 763 700 675 ) n M / L ( 650 i 625 w o F l 600 P 575 550 1 11 21 31 41 51 61 71 81 Days At Work Fig. 37.3 Example of a serial peak \202 ow record from a trout processing worker showing occupational asthma. (Reproduced by kind permission of Dr Keith Palmer.) The diagnostic features of occupational asthma on a serial PEF record are: \200 variable air \202 ow obstruction, with >20% variation in PEF values \200 con sistent falls in peak \202 ow on work days compared with non-work days. Further information and guidance OASYS. Oasys and occupational asthma. Available at: M http ://www.occupationalasthma.com/ default.aspx 37_Smedley_Chap37.indd 763 1/2/2013 1:35:11 PM CHAPTER 37 Clinical tasks and procedures 764 Screening audiometry Purpose Hearing conservation programs employ industrial audiometry to con- \201 rm the effectiveness of existing noise control measures. Health surveil- lance is required for all employees exposed at the upper action value and those workers at i risk between the lower and upper action values (see b p. 548, Control of Noise at Work Regulati ons 2005). Most OH serv- ices offer screening, rather than diagnostic audiometry. The latte r involves tests of both air conduction (AC) and bone conduction (BC), whereas the former o nly tests air conduction and cannot be used for diagnosis. By measuring hearing thresholds (the faintest sound perceived at that fre- quency) the aim is to detect deterioration befor e the individual is aware of any de \201 cit. 2 The test \200\223retest reliability of ind ustrial audiometry is limited. There are many causes of hearing loss other than noise-induc ed hearing loss (NIHL) (see b p. 302, Noise-induced hearing loss). Do not assume that hear- ing loss in a noise-exposed worker is necessarily NIHL (see b p. 430, Classi \201 cation of hearing loss, and b p. 432, Patterns of hearing loss). How to perform screening audiometry Tools required \200 Pure tone audiometer: a number of audiometers are available for industrial audiometry including the Bekesy self-recording audiometer and computer-based aut omatic systems. Frequencies tested are 500Hz and 1, 2, 3, 4, 6, and 8kHz, and intensity of tone ranges from 0 to 120dB HL Matched earphones with insulating ear muffs. 2 Ideally audiometry tests are carried out in a soundproof booth or room to d ambient noise. Background noise should not exceed that stat ed in EN 26189. Screening questionnaire \200 The employee should complete a short questionnaire to record : \200 occupational and hobby noise exposure (e.g. music, shooting, motor sport) and use of hearing protection risk factors for hearing loss (use of ototoxic drugs, head injury, meningitis, ear disease, ear surgery, family history of deafness) symptoms, such as dizziness, tinnitus, ear discharge, or communication dif \201 culties du e to hearing impairment. Clinical examination \200 The external ears should be examined for evidence of previous surgery, followed by otoscopy looking for impacted cerumen and to inspect the tympanic memb rane Record evidence of otitis externa, tympanic perforations, etc. \200 Tuning fork testing ( Rinne and Weber tests) may assist in the interpretation of any hearing loss identi \201 ed on a pure-tone screening audiogram (See b p. 302, Noise-induced hearing loss). 37_Smedley_Chap37.indd 764 1/2/2013 1:35:11 PM SCREENING AUDIOMETRY 765 Exposure enquiry 2 Employees should not be noise exposed in the 16h prior to test to reduce the risk of temporary threshold shift (TTS). Alternatively, wear PPE if noise exposed prio r to testing. \200 Record noise exposure in the 16h before testing \200 Where there is doubt as to the presence of TTS, repeat audiometry at a later date when not noise exposed. Procedure Detailed information on audiometry methods is available in EN 26189. \200 Expla in the procedure to the employee and give clear instructions: \200\230We are going to test your hearing. You will hear a series of tones of varying loud ness and pitch. Each time you hear a tone, please press the button once and once only. Plea se listen carefully \200\231 The tester should check to con \201 rm that the employee has understood \200 The employe e should don the earphones and the tester should check that the earphones are well \201 tted Once test commences, observe the employee \200\231s performance to con \201 rm that he/she is correctly responding to the screening audiometry Problems may arise where people are not motivated (poor attention) or have not grasped what is required of them If audiogram is at odds with speech communication, repeat the test \200 Once the test is complete it should be reviewed with the employee. Checks and calibrations \200 Test ambie nt noise level with a noise meter to con \201 rm that background noise is within recommended limits \200 A three-stage approach to calibration is advised: Stage A \200\224daily inspection (e.g. loose/damaged headphone wires); self-test audiogram identi \201 es gross changes in performance. Stage B \200\2243-monthly on-site objective test of calibration \200 Stage C \200\224an nual workshop calibration check/recalibration if required. If daily/quarterly checks raise doubts, recalibration is indicated. Retention of audiometry records Records of health surveillance should be retained for as lo ng as the employee remains in employment. As claims for NIHL may arise many years after emp loyment ends, it is prudent to retain records for longer. Relevant standards and guidance \200 EN 26189: 1991 Speci \201 cation for pure tone air conduction threshold audiometry for hearing conservation purposes BS EN 60645 \200\2231: 2001 Audiometers. Pure-tone audiometers \200 HSE (2005). Controlli ng noise at work. The Control of Noise at Work Regulations 2005 , L108. HSE Books, Sudbury. The British Society of Audiology. Available at: M http://www.thebsa. org.uk/ 37_Smedley_Chap37.indd 765 1/2/2013 1:35:11 PM CHAPTER 37 Clinical tasks and procedures 766 Color vision testing Pre-employment or pre-placement testing for color vision de \201 cits may be required in safety critical jobs (aviation, \201 re- \201 ghting, railways) or i n jobs requiring good color matching (printing, textiles). One example of a safety critical job is seafaring, where deck crew must distinguish other ships \200\231 red and green navi gation lights at night to avoid collisions. Congenital red \200\223green color vision de \201 cits occur in 8% of men and 0.4% of wome n, re \202 ecting the X-linked inheritance of this condition. Although such people are oft en termed \200\230color blind \200\231 this is a misnomer as most show altered color recog nition. Procedure The accuracy of color vision testing is in \202 uenced by the test employed, the individual \200\231s visual acuity, and the adequacy of lighting. There are many color vis ion tests, but few are widely used in occupational health practice. 2 What matters is wheth er an employee \200\231s color perception is adequate, in terms of safety and performance, for the proposed role. In recent years some industry bodies have reviewed color vision dema nds in their indus- try and revised guidance on color vision standards and testing for spec i \201 c occupations; notably the UK \200\231s Maritime and Coastguard Agency for seafar- ers, the Civil Aviation Authority for \202 ight crew and the Fire Services for \201 re \201 ghters. These revised standards should avoid unnecessarily excluding some individuals with color vision de \201 cits who are, in fact, \201 t for that work. Ishihara test \200 Ishihara plates were designed as a screening test for congenital red \200\223green color vision de \201 cits. This test is the one most commonly employed i n the occupational setting A number of different versions of this test exist, including the full 38 plate, an abbreviated 24 plate, and a concise 14 plate edition The 38 plate edition consists of an introductory plate, transformation plates (2 \200\2239) , vanishing plates (10 \200\22317), hidden digit plates (18 \200\22321) and classi \201 ca tion plates (22 \200\22325). The numbers on transformation plates are read as different num bers by those with color vision de \201 cits when compared with those with normal color vi sion. Vanishing plate numbers are invisible to those with red \200\223green de \201 cits. Classi \201 cation plates are used to classify those screening positive on plates 2 \200 \22317. Birch recommends that the hidden digit plates are unhelpful and should be omitted The 24 plate edition has an introductory plate, transformation plates (2 \200\2238), and vanishing plates (9 \200\22313) The Ishihara test should be viewed at arm \200\231s length. Although the recommended lighting is a MacBeth easel lamp, this is now dif \201 cult to obtain. Dayligh t is a reasonable substitute Many with normal color vision will misinterpret some plates, and these misinterpretations s hould be distinguished from true errors 37_Smedley_Chap37.indd 766 1/2/2013 1:35:11 PM color VISION TESTING 767 The individual should be asked to read and identify the number on each plate Undue delay (>4s) in identifying a number suggests a mild de \201 cit. Three or more error s on plates 2 \200\22317 of the 38 plate edition or two errors on plates 2 \200\22313 of th e abbreviated 24 plate test indicate red \200\223green color de \201 cit. City University test \200 The City University test (3rd edn) is a two-part test. Part 1 i s a sensitive screening test of four pages, with four lines of colored dots arranged in columns of three. The individual is asked to identify differences in color (where they exist) in e ach column. It may be used to identify tritan de \201 cits based on speci \201 c errors m ade on the lower half of pages 2, 3, and 4 Part 2 is a series of six plates, each of which has a central colored dot and four colored dots arranged around the central dot. The individual has to identify which of the four surr ounding dots is the closest color match to the central dot Part 2 will classify subjects as protan, deutan, tritan, or normal color perception Those with mild de \201 cits score normally or make few errors in Part 2. Lantern tests The Maritime and Coastguard Agency vision standards indicate that those deck of \201 cers and ratings failing the Ishihara test may undergo a lantern test. This must b e done at one of the three MCA marine of \201 ces, using a Holmes Wright B lantern. Relevant standards and guidance HSE (1987). Color vision examination: a guide for occupatio nal health pro- viders , MS7. HSE Books, Sudbury. Available at: M http://www.hse.gov.uk/ pu bns/ms7.pdf Further information Birch J (2001). Diagnosis of defective color vision , 2nd edn. Butterwo rth Heinemann, Oxford. 37_Smedley_Chap37.indd 767 1/2/2013 1:35:11 PM CHAPTER 37 Clinical tasks and procedures 768 Clinical assessment of hand \200\223arm vibration syndrome Clinical grading The vascular an d neurological components of HAVS are graded accord- ing to 2 scales developed by a worksho p in Stockholm (see Tables 37.2 and 37.3). These scales are used internationally and by the HSE and UK Faculty of Occupational Medicin e to frame advice on avoidance and career counsel- ling. (Some assessors now combine these clinical features with the output from objective tests \200\224see HAVS clinical assessment and diagnosis ). Table 37.2 Stockholm workshop scale for classifying VWF Stage* Grade Description 0 No attacks 1 Mild Occasional attacks affecting only the tips of one or more \201 ngers 2 Moderate Occasional attacks affecting distal and middle (rarely also proximal) phalanges of 1/more \201 ngers 3 Severe Frequent attacks affecting all phalanges of most \201 ngers 4 Very severe As in stage 3, with trophic skin changes in the \201 nger tips Table 37.3 Stockholm workshop scale for classifying sensorineural HAVS Stage* Symptoms 0SN Exposed to vibration but no symptoms 1SN Intermittent numbness, with or without tingling 2SN Intermittent or persistent numbness, reduced sensory perception 3SN Intermittent or persistent numbness, reduced tactile discrimination and/or manipulative dex terity The sensorineural stage is established separately for each hand. 37_Smedley_Chap37.indd 768 1/2/2013 1:35:11 PM CLINICAL ASSESSMENT OF HAND \200\223ARM VIBRATION SYNDROME 769 Additionally, the vascular effects are sometimes allotted a score, based on the phalanges i n which blanching symptoms are reported (see Fig. 37.4). 1 1 1 2 1 2 1 2 1 2 2 2 1 1 2 2 3 3 3 3 3 3 4 3 4 3 5 5 Left Hand Right Hand Score: Th 1 Total: Score: Th 1 Total: 2 3 4 2 3 4 Fig. 37.4 Grif \201 n blanching score. 37_Smedley_Chap37.indd 769 1/2/2013 1:35:11 PM This page intentionally left blank 771 Chapter 38 Non-clinical tasks and procedures Document a workplace inspection 772 Assess an occupational hygiene report 774 Carry out an ergonomics assessment 776 Carry out a noise assessment 778 Carry out a display screen equip ment assessment 780 Assess and interpret a research paper 782 Writing a press release 784 C onduct a media interview 786 38_Smedley_Chap38.indd 771 1/2/2013 1:04:36 PM CHAPTER 38 Non-clinical tasks and procedures 772 Document a workplace inspection Part A. Background information \200 Name of factory \200 Department(s) inspected \200 Purpose of inspection \200 Name and quali \201 cations of inspector \200 Date of insp ection. Part B. Inspection checklist 1. Plant, process, materials \200 Site plan \200 Processes and tasks conducted (routine and non-routine) \200 Hazard types identi \201 ed (includi ng methodology). ( Hazard types: physical, chemical, biological, psychosocial, ergonomic/mechanical) Materials handled (raw materials, products, by-products, waste products) Control measures available and their use, e.g. personal protective equipment, engineering c ontrols, and administrative controls. 2. Personnel \200 Workforce: number, job titles, gender \200 Working hours, shift patte rns \200 Sickness absence, risk assessment, RIDDOR reports, health surveillance data. 3. Services and records \200 Welfare facilities (canteen, changing rooms, showers, etc.) \200 Occupational health staff and clinical facilities \200 Occupational health service s provided \200 Record: types, safe keeping, and access. Part C. Findings \200 Activities conducted on site \200 Hazards: type, location, number exposed and timing of exposure \200 Signi \201 cant hazards identi \201 ed \200 Rank ing/prioritization of risks \200 Agreed list of actions, responsibilities, and timescale. Signature Review data 38_Smedley_Chap38.indd 772 1/2/2013 1:04:37 PM This page intentionally left blank CHAPTER 38 Non-clinical tasks and procedures 774 Assess an occupational hygiene report OH professionals must be able to assess the quality a nd relevance of occupational hygiene reports, interpret them, and advise the employer on fu rther action. This checklist summarizes the items that should be included in a good-quality (and fairly detailed) hygiene report. Title page \200 Name and address of client \200 Consultant: name (printed legibly) \200 quali \201 cations \200 signature \200 Date of issue \200 Report reference number. Introduction \200 Background to the investigation \200 Who requested the survey \200 Purpose of survey \200 Information provided by client \200 Date on which the work was c onducted \200 Description of plant, layout, and main processes. Shift patterns. Information on processes assessed \200 Types of processes and/or tasks assessed \200 Eq uipment/tools/chemical substances used by workforce \200 Patterns of work \200 Control measure available and whether they are used \200 Relevant health and safety legislation \200 Occupational exposure limits \200 Summary of potential health effects, e.g. acute a nd chronic. Assessment methodology \200 Techniques used to evaluate exposure; both sampling and analy sis, and reference to standard validated methods, e.g. MDHS published by the HSE Limitations of the technique methods used (if appropriate) \200 Sampling strategy, includ ing selection of individuals for sampling and sampling periods Techniques used for evaluating control measures \200 Instrument type used and their calib ration. Discussion \200 Interpretation of results with reference to objectives and relevant legislation and exposure standards Explanation for the following: variations in measured exposure levels \200 exposure patterns/trends \200 outliers 38_Smedley_Chap38.indd 774 1/2/2013 1:04:37 PM ASSESS AN OCCUPATIONAL HYGIENE REPORT 775 Sources of error in data collection and uncertainties in estimating exposure levels. Recommendations \200 Key points for action, including reasons and implications of taking no action Prioritization of action including resources, expertise, and timescale \200 Address any s peci \201 c concerns expressed by the client and mentioned in the Introduction. (cid:2) Remember that if you are not an occupational hygienist, you should only interpret h ygiene data to the extent of your competence. Most OH professionals have general training i n the principles of occupational hygiene. However, always ask for clari \201 cation or exp lanation of results from the occupational hygienist who produced the report if the conclu- sions are not clear and/or well justi \201 ed. 38_Smedley_Chap38.indd 775 1/2/2013 1:04:37 PM CHAPTER 38 Non-clinical tasks and procedures 776 Carry out an ergonomics assessment A comprehensive ergonomics assessment covers the range o f ergonomics hazards, including physical (posture, loading, repetition), psychosocial, and organizational factors. Monitoring and analysis techniques There are numerous methods for assessing ergonomics risk s (Table 38.1). The simplest combinations for most basic assessments are a self-admin- iste red questionnaire to a population of exposed workers (or a sample thereof) plus direct obse rvation of work tasks. Further information about speci \201 c aspects of risk assessment i s given on b p. 120, Lifting and han- dling; b p. 124, Posture; b p. 128, Repetitive work; b p. 780, Carry out a display screen equipment assessment; b p. 134, Organizational psycho- social factors; b p. 308, Stress 1: recognition and assessment; b p. 311, Stress 2: interv entions/risk controls. Ergonomics assessment tools A number of generic ergonomics assessment tools are available f or use in workplace and task assessment. As with most practical methods of risk assessment, there is a compromise between scienti \201 c validity and usability. The tools listed her e have been developed by ergonomics experts and are widely used. HSE tools \200 Manual Handling Assessment Chart (MAC). Available at: M http:// www.hse.gov.uk/msd/mac/index.htm Are you making the best use of lifting and handling aids? Available at: M http://www.hse.gov.uk/pubns/indg398.pdf Pushing and pulling of loads: assessment and example checklists. Available at: M http://www.hse.gov.uk/msd/pushpull/ppchecklists.pdf; and M http://www.hse.g ov.uk/msd/pushpull/ppexample.pdf Tools linked to HSG (60) Upper limb disorders in the workplace. Available at: M http://www. hse.gov.uk/msd/pdfs/risk \201 lter.pdf; and M http://www.hse.gov.uk/msd/pdfs/worksheets.pd f Other ergonomics assessment tools \200 The Assessment of repetitive tasks (ART) tool. Ava ilable at: M http:// www.hse.gov.uk/msd/uld/art/index.htm The Rapid Upper Limb Assessment (RULA) tool: original reference \200\224McAtamney L, Corlett EN (1993). RULA: a survey method for the investigation of work-related upper limb disorders, Appl Ergon , 24 , 91 \200\2239. download form \200\224M http://ergo.human.cornell.edu/ahRULA.html 38_Smedley_Chap38.indd 776 1/2/2013 1:04:37 PM CARRY OUT AN ERGONOMICS ASSESSMENT 777 Table 38.1 Monitoring and analysis techniques Method Advantages Disadvantages Quick to complete and inexpensive Subjective Con \201 ned to the items in the questionnaire; therefore d scope for recognizi ng new or unexpected risks Self-administered questionnaire or checklist about speci \201 c exposures or risk factors Interviewer administered questionnaire or checklist Opportunity for standardized explanation from interviewer Subjective Direct observation in the workplace, recording the exposures in real time. Computer technol ogy can be used to facilitate recording Objective Intrusive Dif \201 cult to check that all risks have been captured, as there is no permane nt record of the actual activity Video recording in the workplace, with later indirect observation and recording of exposure s Objective Repeatable measurements from a permanent record of the actual activity Intrusive Ethical issues around recording if sensitive subjects are inadvertently included on the video, e.g. when videoing a health care worker lifting and handling patients Observing experimental reconstructions of tasks under laboratory conditions Objective Allows closer measurements that might be too intrusive to be used in an actual wo rkplace (e.g. attachment of a spinal motion monitor, or use of an inclinometer) Always a \200\230proxy \200\231 for workplace exposures, so may not recreate the task or w orking environment accurately 38_Smedley_Chap38.indd 777 1/2/2013 1:04:37 PM CHAPTER 38 Non-clinical tasks and procedures 778 Carry out a noise assessment The noise assessment can be divided into three stages. Background information \200 De \201 ne purpose of the survey, e.g. collection of noise e xposure data for compliance with the Control of Noise at Work Regulations 2005 Gather background information: plan of work/layout to be assessed \200 tasks performed and patterns of work \200 time spent on speci \201 c tasks and variability in exposure time \200 previous records of no ise surveys/assessments \200 control measures available, e.g. ear muffs, noise refuge and control rooms, acoustic screens any recent relevant health concerns/reported symptoms. Preliminary site visit and static noise measurements \200 Systematically identify all noi se sources \200 Collect exposure information: who is exposed, when, for how long, and how often Identify control measures used and their effectiveness \200 Take measurements with a hand -held sound-level meter at workers \200\231 position(s) relative to a noise source Plot noise levels on a site map (noise mapping) showing position of machines and workers. T his helps to understand the distribution of noise levels for the area being assessed Estimate the LAeq for the job/task levels from information on tasks performed by workers and exposure time The LAeq for each job/task is then combined with its duration during the working day to determine the L EP , d . The calculation can be performed using t he electronic spreadsheet available on the HSE website M www.hse.gov.uk/noise Detailed noise survey: personal dosemetry \200 In certain situations the L EP , d and pea k sound pressure level are best determined by personal dosemetry: \200 \202 uctuating noise exposure levels \200 high exposure variability \200 sources of impulse noise Where L EP , d is likely to exceed the noise exposure limits, carry out octave band analysi s (noise frequency pattern) for tasks performed by the workers. These data will assist with the selection and design of control measures Identify steps needed to reduce noise exposure as far as reasonably practicable by examining in turn the noise source, the transmission of noise from the sourc e, and the individual exposed Keep records of assessment (see Table 38.2) and review. 38_Smedley_Chap38.indd 778 1/2/2013 1:04:37 PM CARRY OUT A NOISE ASSESSMENT 779 Table 38.2 Noise monitoring survey data form a. Premises \200\224name, address b. Survey \200\224conducted by, date of survey c. Survey equipment \200\224type, model, calibration, sound level meter settings e.g. weigh ting, response time d. Workplace \200\224layout, processes, noise sources e. Individuals exposed \200\224number, shift pattern, tasks conducted f. Ear defenders \200\224type available, actual use time, protection afforded by ear defend er Estimate of personal exposure levels Tasks and location Individual (name) Noise level LAeq Exposure duration L EP,d dB(A) Peak pressure (L Cpeak ) Octave band analysis \200\224dB levels at different frequencies Frequency 63Hz 125Hz 500Hz 1KHz 2KHz 4KHz 8KHz dB level 2 dB values, e.g. for a noise source (machine) need to measure using an octave band analyze r as part of the survey, and record on the form for each frequency. 38_Smedley_Chap38.indd 779 1/2/2013 1:04:37 PM CHAPTER 38 Non-clinical tasks and procedures 780 Carry out a display screen equipment assessment All organizations are likely to possess at least some equipment that falls under the terms of the Health and Safety (DSE) Regulations 1992 as amended (see b p. 528, Health and Safety (DSE) Regulations 1992). These regulations require that every employer shall perform an assess- ment of workstations to assess and re duce risk for DSE users. Procedure \200 The assessor should be trained regarding the requirements of the DSE regulations and how to undertake a DSE assessment Use a checklist or on-line questionnaire to gather operator feedback \200 Record the key \201 ndings for retention until the next DSE assessment. 2 A home worker \200\231s workst ation should be assessed even if the employer did not provide the workstation. Elements to be considered in a DSE assessment Equipment \200 Workstation should be of suf \201 cient size to permit adjustment of the equipment and should be non-re \202 ective Chair should be height adjustable with an adjustable backrest that offers good lumbar support A footrest should be provided if the user so desires \200 Display screen/monitor should g ive a clear image with adjustable contrast and brightness Keyboard should be adjustable, with suf \201 cient space in front of the keyboard to support wrists/arms Keys should be legible and the keyboard layout should facilitate use \200 Document holder should be provided where required \200 Keyboard and mouse should be regularly cleaned as a build-up of dirt i risk of work-related upper limb disorder Non-keyboard input devices (mouse/tracker ball, etc.) should be suitable for the task and the user. Environment \200 Adequate space \200 Keep workstation tidy and free from clutter \200 Adequate room/task lighting \200 No direct glare or re \202 ections on screen \200 Ad justable window blinds \200 Comfortable humidity levels \200 Low noise levels from equi pment \200 Avoid trailing cables. Equipment/user interface \200 Software should be \201 t for purpose \200 \200\230Help \200\231 functions should be provided \200 User m ust be adequately trained in: \200 use of equipment/software \200 setting up the workst ation correctly 38_Smedley_Chap38.indd 780 1/2/2013 1:04:37 PM CARRY OUT A DISPLAY SCREEN EQUIPMENT ASSESSMENT 781