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Health Surveillance in The Construction Sector

Posted By Kerry Budworth on 2016-02-22 07:39

Managing construction health risks: Health surveillance

Ongoing health surveillance of your employees is a means of detecting any harmful changes to their health. It also allows you  identify if further corrective action is needed at an early stage. 

What health surveillance do you need?

Health surveillance will allow you to ascertain if the health risk management system you have put in place is correctly working. Health surveillance is a statutory risk based system of ongoing health checks when exposing workers to substances or activities that may cause them harm. It allows you to identify any ill health symptoms early and highlights the controls that you need to improve.

What is the legal position

There can be confusion about what an employer legally has to do. There are a large number of different health checks are available ranging from chest x-rays to measuring blood pressure. Those health checks can be split into those that are:

  • Legally required - the law states that health surveillance is needed for some employees depending upon their risk of exposure to issues like noise, asbestos or silica. 
  • Industry best practice - some employers choose to do more than the law requires because of the benefits they see in doing this. For example, health monitoring for musculoskeletal problems.

What are the legal requirements for health surveillance?

Employers have a legal duty to reduce (so far as reasonably practicable), the risks to the health and safety of employees and others who may be affected by work activity. The starting point for every employer is to assess the risks involved in their work and workplace. A properly undertaken risk assessment will show where there is a significant residual risk to health even after reasonably practicable control measures have been applied. 

It is at this stage that health surveillance should be considered for situations where there is a significant residual health risk to employees. The attendance of Employee’s for health surveillance is mandatory where a risk assessment has established that a genuine need exists. However, and this is important, an employee can not be forced to undertake any tests or answer medical questions. In this case the occupational health provider should inform the employer of this fact and will not be able to make a fitness for work statement for that employee.

Section 2 of the Health and Safety at Work Act 1974 (HSW) states that employers have a general duty of care to ensure (so far as is reasonably practicable) the health, safety and welfare of all their employees. In simple terms, health surveillance is about having procedures in place to detect work-related ill health, catch it at an early stage in order that you can act on the results (HSE 2005). 

What Are The Occupational health risks in construction?

In the construction sector, there are many dangers that can harm workers. By law, you must eliminate, prevent or control the risks. The key risks include:

  • exposure to asbestos, dusts including silica and lead, chemicals, sunlight, diesel engine exhaust emissions
  • frequent loud noise
  • frequent or excessive use of vibrating tools
  • frequent or excessive manual handling of loads
  • stress and fatigue

Let's look at these individually. 

Respiratory disease

There are a host of respiratory diseases that construction workers may be at risk from which include pneumoconiosis arising from silica (silicosis) or asbestos exposure, asthma and other allergic reactions (e.g. due to isocyanate paint or resin exposure) and  COPD (chronic obstructive pulmonary disease). On top of those, some hazards encountered in construction can cause lung cancer. 

Occupational Asthma

Occupational Asthma (OA) is an important occupational health problem with serious implications for both affected employees and their employers. For the affected individual, continued exposure to the causative agent usually leads to deteriorating asthma and the risk of severe (or, on rare occasions fatal) asthma attacks. Even if exposure ceases, the more severely affected individuals may still be left with persistent asthma and chronic disability. Health surveillance in this case would be symptoms enquiries and lung function testing (spirometry).

Respirable crystalline silica (RCS) exposure

Occupational exposure to RCS in construction work occurs when working with concrete. It can occur in concrete removal, demolition work, tunnel construction, concrete or granite cutting, drilling, sanding and grinding. The risk extends beyond the employees undertaking the work, other people in the vicinity of such work may also be exposed. If workers are employed in occupations listed in ‘Health surveillance for those exposed to respirable crystalline silica (RCS)’ (G404, HSE 2006) you should consider health surveillance.

If the risk is low, you may decide (with advice from a health professional) that health surveillance is unnecessary, but where there is a reasonable likelihood of silicosis developing then health surveillance will be appropriate. The decision must be made by the duty-holder, in the light of competent advice, taking account of current (and past) exposure circumstances.

Health surveillance in this case could require chest x-rays (at intervals, in addition to symptoms enquiries) and a baseline assessment would be appropriate. However, the benefits of such health surveillance need to be weighed against the risks associated with serial chest x-rays. It is good practice to monitor workers exposed to respirable crystalline silica for signs of COPD, which could include questionnaire and lung function testing

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a common chronic progressive lung disease which is mainly caused by smoking. It is a lung condition that encompasses chronic bronchitis (regular phlegm production) and emphysema (damage to the air sacs in the lung) Although smoking is the main cause of COPD, exposure at work to dusts, gases, fumes and vapours contribute to about 15 deaths in every 100 from this condition. This causes around 4000 more deaths each year than there would otherwise be. COPD by definition results in slowly progressive irreversible decline in lung function.

The main emphasis of any strategy aimed at the prevention of COPD should be on primary prevention, which is best achieved by smoking cessation, and the elimination or reduction of exposures to causative substances in the workplace. The evidence for a link between exposure to silica and COPD is such that annual spirometry (lung function testing) is recommended to monitor workers for early signs of this disease. 


Asbestos is by known a well known cause of health issues. Where workers are exposed to airborne levels of asbestos above the action levels specified in the Control of Asbestos at Work regulations (2012) then the provisions laid down will apply and a doctor must be appointed for the purposes of the regulations. The requirements for Health surveillance are specified in the regulations.

Noise-induced hearing loss

Health surveillance is a requirement under The Control of Noise at Work Regulations (2005) for those workers regularly exposed to noise over the upper exposure action value of 85 dB(A). That health surveillance involves regular hearing screening. Other workers should have health surveillance provided where their exposure is either:

  • between the lower exposure action value of 80dB(A) and the upper action value of 85dB(A), and the individual may be particularly sensitive to noise
  • or only occasionally exposed above the upper exposure action value, and the individual may be particularly sensitive to noise.

Sensitivity to noise may be indicated by audiometry results from previous jobs, medical history, history of exposure to noise above 85dB(A); or in a very few cases, a family history of hearing loss early on in life.

Suitable health surveillance means regular hearing tests, the maintenance of suitable records, informing workers about the state of their hearing and also the proper fitting, cleaning and maintenance of any hearing protection used. 

Hand-arm vibration

Hand Arm Vibration (HAV) is vibration transmitted from work processes into workers hands and arms. It can be caused by operating hand-held power tools (such as road breakers), hand-guided equipment (such as compactors), or by holding materials being processed by machines.

Regular and frequent exposure to HAV can lead to hand arm vibration syndrome HAVS. HAVS is actually a combination of neurological, vascular and musculoskeletal symptoms. Developing HAVS is most likely when contact with a vibrating tool or work process is a regular part of a person’s job. Occasional exposure is unlikely to cause any issues. Identifying the signs and symptoms at an early stage is crucial to preventing serious long-term health effects.

The Control of Vibration at Work Regulations (COVWR, 2005) has established the necessity for hand arm vibration health surveillance at exposure action value (EAV) over an average eight hour working day, (A8) of 2.5 m/s-2 using triaxial measurements or where deemed necessary by risk assessment. The introduction of the lower EAV together with a reduction in the exposure limit value (ELV) of 5.0 m/s2 means that many more workers will require health surveillance.

Skin disorders

Occupational skin disease may be defined as a disease in which workplace exposure to a physical, chemical, or biological agent or a mechanical force has been the cause of or played a major role in the development of the disease. Work related dermatitis (sometimes called eczema) forms 80% of occupational skin diseases and is caused when someone comes into contact with a hazardous agent(s). 

Irritant dermatitis is caused by a non-infective agent, physical or chemical, capable of causing cell damage if applied to the skin for sufficient time and in sufficient concentration. Dermatology health surveillance is indicated where exposure to irritants is unavoidable even though all reasonable precautions have been undertaken. 

The fine particles of cement, often mixed with sand or other aggregates to make mortar or concrete, can abrade the skin and cause irritation resulting in dermatitis. With treatment, irritant dermatitis will usually clear up. The danger is that if exposure continues over a longer period the condition will get worse and the employee will then be more susceptible to allergic dermatitis.

Allergic dermatitis (in susceptible individuals) is caused by initial contact with a skin sensitiser (such as epoxy resins and their hardening agents, acrylic resins, formaldehyde and hardwoods). Further skin contact with that particular sensitiser can then cause allergic contact dermatitis.


Musculoskeletal disorders (MSD) are problems affecting the muscles, tendons, ligaments, nerves or other soft tissues and joints and can cause conditions such as low back pain, joint injuries and repetitive strain injuries of various sorts. Injury can happen while doing any activity that involves some movement of the body, from heavy lifting to typing. There is no requirement for health surveillance in the case of MSD, however, there is training available to help your employees avoid MSD and the symptoms of MSD can be monitored. There are certain tasks and factors that increase the risk such as:

  • (1) repetitive and heavy lifting
  • (2) bending and twisting
  • (3) repeating an action too frequently
  • (4) uncomfortable working position
  • (5) exerting too much force
  • (6) working too long without breaks
  • (7) adverse working environment (e.g. hot, cold)

The aim of health monitoring for musculoskeletal disorders is to detect symptoms early and ensure the worker gets appropriate advice and treatment and importantly, modifying the work where practicable.

If you have any questions about health surveillance in the construction industry in Leicester or across the UK, don't hesitate to call us on 01455 234 600 or contact us online.