How to build a health surveillance programme

Start from your risk assessment - it identifies who is exposed to a risk that triggers health surveillance (under COSHH: a substance linked to an identifiable disease, a real chance of harm, and a valid detection technique), so those workers are who to include; the assessment defines the coverage, not guesswork. You know who to include in health surveillance by starting from your risk assessment. Health surveillance is required where specific criteria are met - under COSHH, exposure to a substance linked to an identifiable disease or health effect, a reasonable likelihood of harm under the work conditions, and a valid technique to detect it (with similar requirements under other regimes like noise, vibration and asbestos). So your risk assessment tells you which exposures trigger health surveillance. From that, you identify the population: the workers exposed to those triggering risks are the ones who need to be in the programme. This might be everyone doing a particular process (all the sprayers exposed to isocyanates, all those exposed to a hazardous dust), scoped by who actually has the exposure. So the coverage is defined by the risk assessment, not guessed at - you surveil those whose exposure warrants it, which ensures the programme covers the right people and doesn't waste effort on those who don't need it. Competent occupational health advice helps confirm who needs what. So the risk assessment defines who to include. So your risk assessment identifies the exposed workers to include. This is general information, not competent occupational health advice. This is general information.

Checks matched to each risk - skin checks for dermatitis risks, respiratory questionnaires and lung-function tests (spirometry) for respiratory risks, and other targeted checks appropriate to the hazard - each a valid technique for detecting early signs of that specific harm, chosen with competent occupational health advice. Health surveillance involves checks matched to each specific risk - targeted at the harm the exposure could cause, not a general health check. So a dermatitis risk calls for skin checks; a respiratory risk (from a sensitiser like isocyanates or flour dust, or a hazardous dust) calls for respiratory questionnaires and lung-function tests (spirometry); and other risks have their own appropriate checks. The key requirement is that each check is a valid technique for detecting early signs of that specific harm - so it can catch the effect early, when action can still help. The checks range from relatively simple (skin checks, questionnaires) to more formal (lung-function testing), and they're carried out at appropriate intervals (typically a baseline plus periodic checks). Choosing the right checks for your risks is where competent occupational health advice is essential - a professional advises on what's appropriate and how it should be done, rather than you guessing. So the checks are risk-specific, valid detection techniques, chosen with occupational health advice. So targeted checks matched to each risk, chosen with advice. This is general information, not competent occupational health advice. This is general information.

People competent for the check - some checks (like interpreting lung-function tests or clinical judgements) need an occupational health professional, while simpler ones (some skin checks, questionnaires) can be done by a suitably trained responsible person under occupational health guidance; match the person to the check. Health surveillance should be carried out by people competent to do the specific check - and the level of competence needed varies. Some checks need an occupational health professional (a doctor or occupational health nurse): for example, interpreting lung-function tests, making clinical judgements, or assessing a worker showing signs of harm. Others - simpler checks like some skin checks or standard questionnaires - can be carried out by a suitably trained 'responsible person' under occupational health guidance. So the principle is to match the person to the check: don't have complex clinical checks done by someone untrained, but you don't necessarily need a doctor for the simplest routine checks (a trained responsible person, overseen by occupational health, can do those). Underpinning the whole programme is competent occupational health support - advising on the checks, doing or overseeing the clinical parts, and interpreting results. So a well-run programme has the right competence at each level, with occupational health professionals involved for the parts that genuinely need them. So it's people competent for each check, backed by occupational health. So competent people, matched to each check's demands. This is general information, not competent occupational health advice. This is general information.

Because surveillance is pointless if results just sit in a file - its value is in acting: protecting a worker who shows early signs (reviewing their exposure, medical follow-up) before harm becomes serious, and using results across the workforce to check whether the controls (including LEV) are working. Acting on the results is the most important part because health surveillance is pointless if the results just sit in a file - the whole value is in what you do with what it finds. Acting means two things. First, respond to individual results: if a worker shows early signs of harm, take action to protect them - review and reduce their exposure, arrange medical follow-up, and address why it happened. Catching an early effect and acting on it is the entire point, because it can prevent the harm becoming serious or permanent (sometimes the difference between a reversible early sign and an established, irreversible disease). Second, use the results across the workforce to check the controls: if surveillance is picking up health effects among workers, that's a signal the exposure controls may not be adequate - people are being harmed despite them - so review the controls, including whether the LEV is capturing the contaminant and still working. So the results protect individuals and verify the control regime. Without acting, you've detected harm but done nothing about it, defeating the purpose. So acting is where surveillance delivers its protection - which is why it's the crucial step. So because the value of surveillance is only realised by acting on it. So because detecting harm only helps if you act on it. This is general information, not competent occupational health advice. This is general information.

They work together - health surveillance results picking up harm signal that controls may be failing, prompting a check of the LEV; but controlling exposure (with tested LEV) is the primary protection and surveillance the safety net, so a good programme is built alongside good, tested controls, not instead of them. Health surveillance and LEV testing work together as complementary parts of protecting workers' health. Controlling the exposure at source is the primary protection - and LEV (capturing the contaminant before it's breathed) is a key control, kept effective by regular thorough examination and testing. Health surveillance sits alongside this as a check and safety net: it catches anything the controls miss, and it provides feedback on whether the controls are working. If surveillance starts picking up health effects among workers, that's a signal the exposure controls may not be adequate - a prompt to review them, including whether the LEV is still capturing the contaminant (which its testing confirms). So surveillance can flag a failing LEV, and LEV testing then verifies and fixes it. But surveillance detects harm rather than preventing exposure, so it doesn't replace controlling the exposure - a good programme is built to work with well-maintained, tested LEV and the other controls, not instead of them. So the two reinforce each other: tested LEV prevents harm, surveillance catches and flags anything that gets through. So they're complementary - surveillance flags control failures, LEV testing proves the control. So they work together, control first and surveillance as backup. This is general information. This is general information.

No - controlling the exposure at source (reducing it, capturing it with LEV, RPE where needed) is the primary protection; health surveillance detects harm rather than preventing it, so it's a check and safety net alongside control, not a substitute - a worker whose surveillance detects early disease has still been exposed. No - health surveillance does not replace controlling the exposure, and a programme should never be built as if it did. The primary protection is controlling the exposure at source: through the hierarchy of control (reducing the hazard, capturing it with LEV, using RPE where needed), so that harm doesn't occur in the first place. Health surveillance works differently - it detects harm, or its early signs, rather than preventing exposure. So it's a check and a safety net that sits alongside the controls, not a substitute for them. Relying on surveillance instead of proper control would be backwards: it would mean waiting to detect harm rather than stopping it happening, and a worker whose surveillance detects early disease has still been exposed and harmed. So a health surveillance programme should be built alongside good exposure control (including well-maintained, tested LEV), as the backstop that catches anything the controls miss and flags if the controls are failing - not as the main line of defence. The right order is: control the exposure to prevent harm, and use surveillance to catch and flag anything that gets through. So no - it supports control, it doesn't replace it. So no; control prevents harm, surveillance only detects it. This is general information, not competent occupational health advice. This is general information.