NATIONAL HEALTH STRATEGY

HEALTHY AND
SAFE EMPLOYEES

NATIONAL GUIDELINES
FOR OCCUPATIONAL HEALTH ASSESSMENT

2020
CONTENTS PAGES

Abbreviation and Acronyms...................................................................................................................2

Foreword..................................................................................................................................................3
1.Introduction....................................................................................................................................4
2.Aim.................................................................................................................................................4
3.Purpose...........................................................................................................................................5
4.Scope..............................................................................................................................................5
5. Intended Audience........................................................................................................................5
6.Considerations...............................................................................................................................6
7. Activities of Occupational Health Services..................................................................................6
7.1 Surveillance of Workers’ Health............................................................................................... 6
7.2 Surveillance of Work Environment........................................................................................... 6
7.3 Risk Assessment........................................................................................................................ 7
8. Occupational Health Screening.................................................................................................. 11
8.1 Fitness to Work Assessment................................................................................................... 11
9.Principles......................................................................................................................................12
10. Generic Process...........................................................................................................................12
10.1 Health Questionnaire.............................................................................................................. 13
10.2 Nursed Based Assessment..................................................................................................... 13
10.3 Physician Based Assessment.................................................................................................. 14
10.4 Work-Related Tests and Investigations.................................................................................. 14
10.5 Consultation and Research..................................................................................................... 15
10.6 Declaration of Fitness to Work............................................................................................... 15
10.7 Occupational Factors to Be Considered............................................................................... 15
11. Implementing OH Assessment Program...................................................................................16
12. Assessor Selection.......................................................................................................................17
12.1 Health, Safety, and Environment............................................................................................ 17
12.2 Occupational Physician........................................................................................................... 18
12.3 General Practitioner................................................................................................................. 18
12.4 Occupational Health Nurse.................................................................................................... 18
13. Occupational Health Surveillance Program...............................................................................19
13.1 General Objectives.................................................................................................................. 19
13.2 Types of Health Surveillance................................................................................................... 19
13.3 Frequency of Health Surveillance........................................................................................... 20
13.4 Special Groups......................................................................................................................... 20
13.5 Management Review............................................................................................................... 20
13.6 Records..................................................................................................................................... 20
13.7 Confidentiality.......................................................................................................................... 21
13.8 Health Hazards......................................................................................................................... 21
14. Outcome of OH Assessment......................................................................................................21
14.1 Fit for Current Position............................................................................................................ 21
14.2 Fit with Restriction................................................................................................................... 21
14.3 Temporary Unfit for Current Position..................................................................................... 21
14.4 Permanently Unfit for Current Position................................................................................... 21
 14.5 Consequences......................................................................................................................... 22
15. OH Assessment Records............................................................................................................23
15.1 Security of OH Records........................................................................................................... 23
15.2 Transfer of OH Records........................................................................................................... 23
15.3 Archiving................................................................................................................................... 23
16.References....................................................................................................................................24
17.Appendices..................................................................................................................................25
17.1 Appendix 1 – Hazardous Materials or Exposures Requiring Medical Surveillance............ 25
17.2 Appendix 2 – Risk Assessment Matrix: Guidance on likelihood scoring........................... 37
17.3 Appendix 3 – Generic Health Questionnaire........................................................................ 39
17.4 Appendix 4 – Generic Medical Examination Form............................................................... 45
17.5 Appendix 5 – Some Occupations Requiring Medical Screening......................................... 47
17.6 Appendix 6 – Generic Fitness to Work Certificate............................................................... 66
17.7 Appendix 7 - Audiometry Questionnaire.............................................................................. 67
17.8 Appendix 8 - Job Safety Analysis Form................................................................................. 69
17.9 Appendix 9 - Risk Assessment Form...................................................................................... 70
Acknowledgment
The National Health Strategy 2018-2022 is a crucial step in the right direction, focusing on human
development as one of the major criteria towards achieving the Qatar National Vision 2030.

“Healthy and safe Employees,” led by the National Lead Dr. Asma Ali Al Nuaimi, has been identified
as one of the seven priority populations within the National Health Strategy 2018-2022, which reflects
a population health approach.

The Strategy plans for this population aim to develop a better understanding of occupational health
in Qatar but also to promote and enhance healthier lifestyles and wellbeing of employees. The
subtask group HE 02 which focusses on Occupational Health assessment is chaired by

Dr. Maryam Al Muslemani, Subtaskforce Lead from PHCC and the Core Members are:
Dr. Abdelrahman Mohgoub Ibrahim Dagig, Qatar Energy
Dr. Abid Sulaiman Akhter, Qatar Energy
Dr. Zaineb Nory Ahmed, HMC
Eng. Badr Al Saadi, MME
Mrs. Nida Mohammad Mansour, PHCC
Dr. Imran Habeebur Rehman, PHCC
Dr. Rafa Mohamed Saeed Omer, MoPH
Mr. Abdullah Al Dosari, Ministry of Labour

Subtask Group 2 is focusing on establishing an effective Occupational Health Assessment (OHA)

program. This document aims to advise employers on the employees’ health and makes
recommendations on what adjustments could be considered to ensure a safe and healthy working
environment for that employee. It will also provide fitness to work guidelines.

By implementing these guidelines, It is hoped that these initiative both employers and employees
in Qatar will detect the benefits of applying OHA and recognize that paying on occupational health
assessment is long term investment, it will have the potential to benefit both employees and the
organizations they are working for

National target by 2022:

%55 of government and semi-government employees will have access to an
occupational health-based workplace wellness program

NATIONAL GUIDELINES
OCCUPATIONAL HEALTH ASSESSMENTS
 Abbreviation and Acronyms
GCC Gulf Cooperation Council

ILO International Labor Organization

MoPH Ministry of Public Health

NHS National Health Strategy

OH Occupational Health

OHA Occupational Health Assessment

QNV Qatar’s National Vision

WHO World Health Organization

HE2 Healthy and Safe Employees subtaskforce 2

JHA Job Hazard Analysis

PPE Personal Protective Equipment

PTP Assessment, Pre-task planning

HR Human Resources

HSE Health and Safety Executive

PFT Pulmonary function test

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Foreword
Qatar’s National Vision (QNV) 2030 provided the foundation for the formulation of the first National
Health Strategy 2011-2016 (NHS-1), which built a solid foundation for the second National Health
Strategy 2018-2022 (NHS-2). NHS-1 categorically emphasized that Qatar must improve health and
safety conditions across all sectors, with particular focus on the population of workers, given that
workplace injuries are the third highest cause of accidental deaths. It also highlighted that National
occupational health standards must be developed, and occupational health policies and regulations
must be enforced.
NHS-2, Healthy, and safe employees’ initiative, focuses on the physical and mental health of workers
to improve population health, increase efficiency and economic productivity, and reduce the burden
on healthcare services. To achieve good results, establishing a continuous and regular occupational
health assessment system and developing a unified system to assess occupational hazards in all
professions and situations on a case-by-case basis. This effort will culminate in the development of
occupational safety promotion programs under an integrated national policy based on reviewing all
labor laws at both corporate and state levels.
In order to optimize Qatar’s continued and sustained economic growth and to successfully achieve
the QNV 2030, we must value the health and wellness of our employees. The employer is responsible
for protecting the health and safety of the workforce, and employees must take reasonable care to
look after their health and safety. Occupational Health assessment is an integral part of health risk
management, which in itself is an essential tool in meeting these responsibilities. Although
occupational health legislation exists in Qatar to safeguard the health of workers, many employers
do not seem to be in full understanding of its provisions.
HE2 subtask force is dedicated to the development and implementation of the National Guidelines
on Occupational Health Assessment. This document is designed to assist employers and OHS
professionals in establishing various types of OH assessment programs to ensure that each worker
is medically fit to perform the required duties of a job effectively and without any risk to self or
others› health and safety.
In closing this foreword, I must thank and congratulate all HE2 subtask force members for their
enormous undertaking and producing this guideline document of such comprehensive coverage
and impeccable quality.
Healthy and safe Employee Taskforce

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 1. Introduction
The Qatar National Vision 2030 (QNV 2030) is a development plan launched in 2008 aiming to
“transform Qatar into an advanced society, capable of achieving sustainable development” by 2030.
It has four central pillars: economic, social, human, and environmental development. The ‘Human
Development’ pillar expresses Qatar’s ambition to develop a healthy population, which, amongst
many other target areas, includes the development of strategies aimed at improving national OSH
performance. This was implemented in its first phase via the National Development Strategy (NDS)
2011-2016 and its health component, the National Health Strategy (NHS-1) 2011-2016.
This work is currently being achieved through the NDS 2018-2022, supported by the (NHS-2) 2018-
2022. Led by the MoPH, the NHS-2 is an all-encompassing vision for Qatar’s health sector, which sits
above all other health strategies to guide the development of the Qatar healthcare system. It has
‘Healthy & Safe Employees’ as one of its 7 ‘priority populations’ with the following objectives:
• Minimize the rate of occupational diseases, injuries, and deaths at all workplaces,
• Implement an occupational health capability that contributes to the development, implementation,
and enforcement of occupational health standards,
• Establish data collection, monitoring, and reporting of occupational health status across the
healthcare system.
This work is currently being undertaken by seven sub-taskforces, membership of each taskforce
comprises key parties from the relevant Government ministries and the wider OSH community in
Qatar. The role of the HE2 subtask force is to ‘Develop and implement national guidelines on
occupational health assessments.’
The ILO Occupational Health Services Convention (No. 161) defines «occupational health services»
as services entrusted with essentially preventive functions and responsible for advising the employer,
the workers, and their representatives in the undertaking on the requirements for establishing and
maintaining a safe and healthy working environment which will facilitate optimal physical and mental
health in relation to work and the adaptation of work to the capabilities of workers in the light of
their state of physical and mental health.
Occupational health assessment is an integral part of OH services. Various types of OH assessment
should contribute to the aims of occupational health defined by the Joint ILO/WHO Committee.
Work health assessments must be carried out fairly, objectively, and in accordance with equal
opportunities legislation and good occupational health practice. OH assessment should be
appropriate to the occupational risks in the enterprise and should be accompanied by a number of
safeguards concerning its purpose, its quality, the protection of workers› interests, and the collection,
transmission, and use of health and medical data.

2. Aim
Occupational assessment is important to ensure the compatibility of the workers to their assigned
job and that their occupational exposure to hazards does not have any detrimental effect on their
health. The scope of occupational health is expanding to cover not only health and safety but also
psychological and social well-being and the ability to conduct socially and economically productive
life.
As for health examinations, they are crucial in identifying any conditions to prevent and control
effects adverse to the health and safety of workers and prevent the occurrence of work-related
injuries and diseases.

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3. Purpose
Workplaces demands on our physical and emotional capabilities and subjects people to a wide
variety of substances and conditions. Work itself may lead to ill health or injury, just as some health
conditions may be worsened by work factors.
Some of those conditions may be acute, chronic, or relapsing in nature. Impairments and disabilities
may also be temporary or permanent. These may or may not affect a person›s capacity to do his or
her normal job.
Health assessment for work involves matching the person›s physical capabilities to the requirements
of the task. The principles are the same whether the health assessment is to determine existing
conditions, capabilities, or other factors predisposing to ill-health, is carried out before employment,
before placement in a new job or work environment, or periodically during employment.
The purpose of these guidelines is to assist all those who have responsibilities to design, establish,
implement and manage workers› health assessment programs that will facilitate preventive action
towards ensuring a healthy and safe working environment for all.
The aim of OH assessment is to evaluate a person›s physical and mental capacity to carry out the
tasks inherent in a job and in the environment in which they are to work. The subject›s fitness should
be interpreted in functional terms and the context of the job requirements.
The assessment helps to ensure that the job does not cause or aggravate any existing disease or
injury and that the characteristics of any disease or disability will not cause harm to others, including
fellow employees and members of the public, through inappropriate actions by the employee.
Employers have a duty to ensure, so far as is reasonably practicable, the health, safety, and welfare
of all their employees. Good employment practice involves due consideration of the needs of all job
applicants and employees with special needs or medical conditions to ensure the legal duties of
reasonable adjustment and nondiscrimination in employment,
It is ultimately the employer›s responsibility to set the objectives for attendance and performance
and to ensure compliance with the law on health and safety and employment, to provide a baseline
health profile for statutory health surveillance to measure and detect any changes in health during
employment, and to make sure that job applicants are free from any contagious disease as per GCC
rules and regulations for expatriate medical examination.

4. Scope
This guideline applies to all employers and places of business covered under the Qatar Labor law of
2004. If the requirements of this document conflict with requirements set by another regulatory
authority, employers are required to follow the more stringent requirement.

5. Intended Audience
• Policy- and decision-makers in health, social and environmental issues
• Purchasers and providers of occupational health services
• Workers’ representatives
• Organizations, employers and representatives of employers
• Professional associations in all occupational health disciplines
• Academic entities involved in research, education, and training in occupational health

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 • Clinical affairs and medical scientists and researchers
• Health, safety and environment agencies responsible for inspection and enforcement of
legislation and regulations
• Insurance companies
• Auditing and certifying bodies

6. Considerations
These guidelines constitute practical recommendations and do not replace national laws, regulations,
international labor standards, or other accepted standards. Local circumstances and the availability
of financial and technical resources will determine how far it is practicable to follow the provisions of
the guidelines. These provisions are considered to be the basic requirements for workers› health
assessment and are not intended to discourage competent authorities from adopting higher
standards.
Surveillance should be carried out in consultation with the workers or their representatives, and
(Article 9 of the ministerial Decree No. 19 of 2005) and should not result in any loss of earnings for
them - free of charge (Article 100 of the Labour Law; Article 1 of the Decree No. 19 of 2005).
Furthermore, the medical examination should take place during working hours.

7. Activities of Occupational Health Services

7.1 Surveillance of Workers’ Health

Surveillance of workers’ health is one of the key activities of Occupational Health Services. It is
composed of a systematic set of procedures that will detect the early signs of work-related health
changes that could indicate permanent damage to the individual’s wellbeing.
Health Surveillance may include specific medical surveillance by health professionals, which in itself
may include clinical examinations or biological monitoring to measure and assess both uptake and/
or the effects of exposure to certain environments; examples of hazardous materials are listed in
Appendix 1. This is the reason that health surveillance may feature both primary and secondary
prevention characteristics in occupational health and safety.

7.2 Surveillance of Work Environment

The quality of the working environment through compliance with safety and health standards has to
be ensured by surveillance at the workplace. According to ILO Convention No. 161, surveillance of
the working environment is one of the main tasks of the occupational health services.
It is carried out for the identification of hazardous exposures and other conditions of work,
identification of exposed workers, and assessment of the levels of exposures for various groups of
workers.
Most of the instruments guiding occupational health services emphasize the need to carry out the
surveillance before initiating services, periodically during the course of the activities, and always
when substantial changes in work or the working environment have taken place.
The results obtained provide the necessary data to estimate whether preventive actions taken
against health hazards are effective, as well as whether workers are placed in jobs adequate to their
capacities.

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These data are also used by the occupational health service to ensure that reliable protection against
exposures is maintained and to formulate advice on how to implement controls in order to improve
the working environment. In addition, the accumulated information is used for epidemiological
surveys, for the revision of permissible exposure levels, as well as for the evaluation of the effectiveness
of control measures and other methods of various preventive programs.

7.3 Risk Assessment

Findings of surveillance of health and working environment are used as a source of information for
primary prevention measures to provide identification and evaluation of the environmental factors
which may affect the workers’ health.
Risk assessment can be defined as «the process of evaluating the risk to health and safety of workers
while at work arising from the circumstances of the occurrence of a hazard at the workplace.” The
purpose is to propose controls to reduce the level of risk. The process can be described as a
continuous improvement cycle that can be implemented in the management processes. Risk
assessment is a five-step process. In order to carry out risk with the active involvement of the entire
workforce, is to follow these five steps provided below:
Step 1: Identifying hazards and those at risk
Step 2: Evaluating risks
Step 3: Deciding on the safety and health risk control measures
Step 4: Implementing Corrective Actions and Record responsibility
Step 5: Monitoring and reviewing

7.3.1 Step 1: Identification of Hazard

Hazard Identification is the foundation of a safe workplace. At its most basic level, hazard identification
is simply looking at a job, task, or situation and asking, “Is there anything here that could hurt
someone or damage something?”
There are many standard hazard identification tools that can help to document the hazard
identification, such as Inspection Checklists, Personal Protective Equipment (PPE) Assessment, Pre-
task planning (PTP) and Job Hazard Analysis (JHA).
Job Hazard Analysis
Job hazard analysis considers as one of the best ways to determine proper work procedures. It is a
procedure that integrate accepted safety and health principles and practices into specific task or job
operation. In a JHA, each basic step of the job is to identify the potential hazards and to recommend
the safest way to do the job. JHA is simply:
1. Breaking down the steps of performing a job.
2. Identifying hazards at each step
3. Creating controls to keep workers safe while performing that task.
The key difference between JHA and risk assessment is the scope. JHA is of a narrow scope and
involves only job-specific risks. Whereas risk assessment involves operational risk such as
environmental hazards, waste management, equipment maintenance, etc.

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 Instructions for Conducting a Job Hazard Analysis
1. Break job into steps
A job step is defined as a segment of the operation necessary to advance the work. These steps are
not only specific to the job but also specific to the work area. If the work area changes, the steps may
need to change as well.
2. Job-related hazard
Hazard is a source or a situation with a potential for harm in terms of human injury or ill-health,
damage to property, damage to the environment, or a combination of these. Hazards related to a
job task can be classified as:
Table 1. Occupational Health Hazards as per ILO guidelines.

CATEGORY EXAMPLE

Accident hazards Falls, slips and trips on wet and slippery floors, Entanglement of
clothes, hair, fingers, arms in rotating and other moving
equipment, in particular centrifuges, mixers, blenders, fires and
explosions, electrical shocks, etc.

Physical hazards Radiation, Ionizing radiation (Alpha particles, beta particles,

gamma rays, x-rays, neutrons), Non-ionizing radiation (Infrared
radiation, visible light, ultraviolet light, laser radiation, microwave
and radiofrequency radiation; very- and extremely-low frequency
electromagnetic fields). High amplitude whole-body vibration
and noise in subsonic

Chemical hazards Exposure to an extremely wide variety of chemical substances

Biological hazard Exposure to an extremely wide variety of biological agents

Ergonomic Musculoskeletal effects from routine work in a fixed position,

repetitive movements, improper set up of workstation. Eye strain
from work with optical and electron microscopes, etc.

Psychosocial and Stress and violence

organizational factors

For each hazard identified, it is needed to be clear about who might be harmed and how; this will
help ascertain the best way of managing the risk. In each case, identify how they might be harmed,
i.e., what type of injury or ill health might occur.
3. Hazard Control
Each hazard identified in the previous step needs control. The control explains how you will eliminate
the hazard or how you will significantly reduce the risk of injury. A hazard control consists of all steps
necessary to protect workers from exposure to a substance or system, the training, and the procedures
required to monitor worker exposure and their health to hazards.
For selecting an appropriate control often involves prioritizing the hazards and risks. Hazard can be
classified as follows:

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• Class ‘A’ Hazard: A major condition or practice that is likely to cause serious, permanent disability,
loss of a body part, death or an extensive loss of building assets, equipment or materials within
the workplace
• Class ‘B’ Hazard: A serious condition or practice that is likely to cause a serious injury resulting in
temporary disability of a worker, or major damage to the building, equipment or materials
however is non-disruptive and not quite considered a Class ‘A’ Hazard
• Class ‘C’ Hazard: A minor condition or practice likely to cause a non-disruptive, non-disabling
injury or illness, or non-disruptive property damage.

7.3.2 Step 2: Evaluating Risks

Risk expresses the likelihood that harm from a potential hazard will be realized and taking into
account the likely severity of harm. Risk evaluation allows you to determine the significance of risks
and then to decide whether to accept a specific risk or take action to prevent or minimize it. To
evaluate risks, it is worthwhile ranking them once identified. This can be done by considering the
consequence and likelihood of each risk. The likelihood of a hazard and its severity of consequences
are compared to determine the overall risk (See Appendix 2).

7.3.3. Step 3: Deciding on the Safety and Health Risk Control Measures
For each hazard identified, the core activity in risk assessment is to identify, decide on, and implement
the safety and health risk controls following the order in which they are listed in what is termed the
“hierarchy of risk control measures.” Example of the hierarchy of risk control measures as per ILO:
• Risk Control Measure 1: Elimination or substitution of hazards
• Risk Control Measure 2: Tools, equipment, technology, and engineering
• Risk Control Measure 3: Safe work methods, practices, education, and training
• Risk Control Measure 4: Personal protective equipment (PPE)
• Risk Control Measure 5: Health/medical surveillance

Elimination or Substitution

Engineering controls

Safe work methods

PPE

surveillance

Figure 1. Hierarchy of risk control measures

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 Risk Control measure1: Elimination or substitution of hazards
Start by considering Risk Control Measure 1, which is the best means of protection because
eliminating or substituting the hazard means you have effectively reduced the risk of exposure of
anyone to the hazard, and thus of being seriously harmful, to zero or as near to zero as possible.
Risk Control measure 2: Tools, equipment, technology, and engineering
Where elimination or substitution is not possible, the next best solution is to consider which tools,
equipment, technology, and engineering measures can help reduce the risk from the hazard
identified. Risk Control 2 measures are good because they provide collective protection of the work
area rather than just protection for the individual.
Risk Control measure 3: Education, Training, and Communication of Results
Occupational health services should play an active role in providing relevant information and
organizing education and training in relation to work. Education and training consider as risk control
measures. Information on identified workplace health hazards and risks must be communicated to
the managers responsible for implementing prevention and control measures.
To ensure proper understanding and use of information, the employer is responsible for the
education of workers on risks and hazards at work and on their avoidance, prevention, and protection,
as well as on safe working practices.
Risk Control measure 4: Personal protective equipment
Apart from standard items like boots and overalls, personal protective equipment (PPE) is one of the
last safety and health risk control measures for workers to consider and exists only to augment the
other risk controls measures you have already put in place.
Risk Control measure 5: Surveillance of Workers’ Health
Risk assessment findings should be used to identify any future need for health surveillance. The
exposures to hazards identified during risk assessment should guide the scope and measures of
health surveillance and OH assessment. If the results of the risk assessment suggest that despite all
protective measures, a significant risk for the health of an employee remains, OH assessment carried
out. For this purpose, OH assessment is implemented to assess (before a person starts work and at
certain intervals afterward) whether and to what extent health and safety hazards for the employee
are associated with the work.

7.3.4 Step 4: Implementing Corrective Actions and Record Responsibility

If it is decided on additional control measures, action has to be taken to ensure they are implemented.
It is good practice to allocate the responsibility of this to named individuals, as well as assigning a
time frame for implementation. The date of implementation should also be recorded.

7.3.5 Step 5: Monitoring and Reviewing

After the implementation of the control measures, it is important to monitor its effectiveness by
inspections, testing, or consultation with employees. Additionally, as a recommendation by ILO, a
review every year or so formally when the employer is informed that the risk assessment is no longer
valid or when there has been a significant change in matters to which it relates.

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8. Occupational Health Screening
For occupations listed in Appendix 4, or any risky occupations and activities as determined by the
risk assessment (refer to section 5.3), occupational health screening and medical examinations shall
be conducted to determine:
I. If employees are medically and physically able to perform the assigned duties without substantial
risk of harm to themselves, others, or the job to be performed (fitness for duty examinations);
and
II. To identify pre-existing medical conditions which may be aggravated by workplace hazards or
exposures

8.1 Fitness for Work Assessment

8.1.1 Pre- Employment Medical

This is a medical examination conducted prior to commencing work with a new employer. In the
instance prior to employment, the employer has no experience of the person›s physical ability to
carry out the work and seeks the pre-employment medical examination, to be given adequate
information on those matters.
Conducting pre-employment examinations is to determine whether the applicant is able, with or
without any adjustment, to perform the inherent requirements of the job; or checking whether the
applicant has any infectious disease so that the employer may act reasonably in order to protect
public health.

8.1.2 Periodic Medical

Based on risk assessment findings, some occupations or occupational groups shall undergo fitness
to work medical at regular intervals with appropriate tests and follow up (Article 105 of the Labour
Law; Article 2 of the Ministerial Decree No. 19 of 2005).
It is necessary that any health professional undertaking these types of examinations is aware of the
characteristics of the hazard, as well as the characteristics of the workplace, including monitoring
and normal work procedures, as well as breakdown and maintenance conditions.
Any pre-employment or periodic examination is an opportunity to inform the worker of any abnormal
findings, which may require follow up and referral to a personal medical practitioner. This should be
by letter setting out the specific abnormalities. Information about unhealthy lifestyles provides an
opportunity for counseling on the ill effects of the lifestyle, and what is of benefit for good health.

8.1.3 Episodic-follow up screening (Long absence, Retirements, and After changing jobs)
Episodic/ follow up screening is a short and focused examinations on a pervious identified issue.
The need for medical assessment after changing jobs involves significant change of their duties for
a clear health conditions of the employee when appointed into a new position. Long absence is
defined by long-term sick – four weeks or longer – with health problem or significant or prolonged
illness or injury. This medical examination will help remove any barriers to ease the return of the
employee safely to work. Furthermore, this examination is conducted after retirement and benefits
has been perceived to the employee to enable them to be aware of their health problems or discuss
ant ongoing medical surveillance. In case of early retirement due to illness or injury must require
medical examination to determine whether the employee should cease work permanently or
maintain the employee at the workforce after a rehabilitation program enrollment.

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 8.1.4 End of service (legal protection for the employer)
This medical examination is conducted after the termination of an assignment involving a hazard
that could lead to future health problems or impairment. This examination is intended to make a
final assessment and evaluation of the employees’ health. This is done by comparing the results with
previous medical examinations and assess the effect of the job assignment on the worker’s health.

9. Principles
A well-designed OH assessment process will reduce risk and liability and will determine whether
employees are capable of conducting their assigned tasks. At the same time, however, a well-
designed process will avoid waste, discrimination, and unnecessary and inappropriate exclusion of
individuals from work that they could carry out safely and productively.
The principles of OH assessment may be summarized as follows:
• OH assessment program should be based on an assessment of the risk.
• The program should aim to match the requirements of a position with the reasonable (and
foreseeable) health and capacity requirements for an employee in that position.
• Any tests of functional capacity or medical examinations should relate to an assessment of fitness
for the assignment of tasks.
• Tests and examinations should produce repeatable and consistent results.
• Tests or examinations should apply equally to all who are required to do the work.
• Tests and examinations must be legal in the country in which they are applied.
• All work capacity tests or medical examinations must be safe.

10. Generic Process

The process of the health assessment involves the referral of the individual by the employer to a
health professional who carries out the assessment. The interpretation of the result of the assessment
is then referred back to the employer. The employer determines the employment or placement of
the person.
The extent and purpose of the assessment should be outlined by the employer. However, the
assessor should ensure the nature and purpose of the assessment is understood both by the
employer, in general terms, and by the employee, or potential employee, at the commencement of
the assessment. Some assessors provide written information to the person prior to attendance for
assessment and obtain signed consent from the person to undertake the assessment.
The individual›s privacy must be respected. Provision should be made for the person›s privacy while
dressing and during the examination, as well as for the collection of specimens for testing, such as
urine.
The information gained should be kept confidential, but the individual must be made aware of any
abnormality that is detected and referred appropriately for consultation or treatment to their
personal medical practitioner. With regard to the work proposed, the person should be advised
when a recommendation for modification or alteration in work practices will be made to the employer.
Medical records generated for the purpose of health assessment for work must be kept confidential
and clearly identified separately from the person’s medical record obtained for any other purpose.
The records are the property of the health professional who generated the record. Only results

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relevant to the performance of the job are conveyed to the employer.
In the case of health surveillance for exposure to particular substances, there may be legislative
requirements to inform the appropriate public authority of the results and to keep the records for a
prescribed period of time.

10.1 Health Questionnaire

Each assessment shall begin with the completion of a health questionnaire- for data collection. The
health questionnaire shall include:
Administrative information

• Full Name • Gender

• Address • Current occupation

• Date of Birth • Company name

Health information

• Past medical and surgical history • Known allergies

• Family history • Current medications are taken

• Occupational history • Immunizations received

• Current medical complaints • Lifestyle (smoking, alcohol, exercise)

All questionnaires must conclude with a declaration statement where an applicant declares by
signing that they have provided all medical conditions as best as possible to the best of their
knowledge. This is both a cover for litigation and measures the company›s reputation.
The employer may utilize functionally specific questionnaires for the different risk groups or hazards
(e.g., respiratory questionnaire or food handler’s questionnaire), but each of these must have a
minimum of the above requirements. Additional assessment questions that are specific to work may
supplement the «core» questions. Standardization of questionnaire provides better data for
epidemiological research. A sample health questionnaire is in Appendix 2.

10.2 Nurse Based Assessment

OH nursing staff shall carry out and record the following data in medical examination form.

• Height • Blood Pressure

• Weight • Pulse
• BMI • Visual Acuity

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 10.3 Physician Based Assessment
Physician assessment includes a detailed review of a health questionnaire, review of nursing
assessment, an interview, systemic physical examination as appropriate. This health assessment is
directed by the following:
• Findings of the health questionnaire and nursing assessment
• Occupation / job designation
• Hazard exposure
• Living and working environment
• Legal requirements
• Industry standards for the occupation
The physician shall complete the respective sections of the medical examination form legibly with
signature, stamp, and date. The sample medical examination form is included in Appendix 3.
The physical examination results and its consequences should be discussed with the individual. To
assist the physician’s recommendation and decision, as an adjunct to the physical assessment, a
physician might need to order additional investigations and or seek specialist opinion.

10.4 Work-Related Tests and Investigations

Generally, work-related tests and investigations are based on the following:
• Clinical findings during physical examination
• Occupational health hazards
• Safety-critical jobs
• Living and working environment
• Statutory requirements
• Industry standards

Table 2. Medical assessments examples

CATEGORY EXAMPLE

Perceptual Snellen›s, Ishihara›s, City University, Voice tests, Audiometry

Functional Spirometry, Peak flow, Strength tests, Trade test

Aerobic capacity Step test, Bicycle ergometer

Physical endurance Stair climb, Hose drag, Equipment carry, Ladder raise

)Diagnostic (health on work Exercise electrocardiography, Drug and alcohol tests, Psychological
assessment

)Diagnostic (work on health Hematology, Biochemistry, Urine and Stool analysis, Radiographs

14
10.5 Consultation and Research
• Details from other specialists-such as psychologist, audiologist
• Advice or a second opinion from a specialist occupational physician
• Advice or second opinion from independent specialist-such as cardiologist, neurologist
• Review of the job description, job hazards, journals, and research

10.6 Declaration of Fitness for Work

Some occupations have statutory standards, and appraisals must include measuring necessary
factors. Others have standards set by authoritative recommendations or guidance. If no guidance
exists, physicians must judge how extensive the assessment should be by taking account of the
nature of any medical conditions identified, the type of work, and the reasons for management›s
request for medical advice. Workers medically fit: Article 23 of the Labour Law; Article 88 of the
Labour Law (for young workers);
Assessing physician should always have a basic knowledge of the job demands and working
environment before undertaking a medical-functional appraisal so that the extent and emphasis of
the appraisal may be tailored accordingly. Any medical conditions that could pose a risk to the
subject›s or others› health and safety or that could affect attendance and performance should be
identified and evaluated.
The evaluating physician shall use a comprehensive approach and take into consideration workers›
health, functional capacity, experience, type of work, risks involved, etc. and relate how these
collectively would affect fitness to work.
When making a decision on fitness, the medical conditions must be expressed in functional terms
and in the context of job requirements, as some disabilities /impairments may be irrelevant to the
job where there is no health and safety risk. Thus, a person can be fit for his job.
When fitness criteria are defined, and the assessment clearly satisfies or fails to satisfy the employer›s
requirements and responsibilities, a «medical recommendation» of fitness shall be made without
delay.
When fitness criteria are uncertain when the employer›s requirements and responsibilities cannot
be predetermined or presumed, the «medical conclusions» of the assessment should be made clear
to the employer. In addition, a medical view on the potential for enabling options or on the
appropriateness of employment or continued employment may be given as «medical advice.»
In straightforward cases, a medical-functional appraisal and assessing physician existing knowledge
of the job demands and working environment may be sufficient for a recommendation of fitness.
However, a closer look at occupational factors is often needed to determine the precise requirements
of the job, the subject›s real abilities in a working environment, the nature of any hazards, and the
probability of harm occurring (the actual risk in the workplace).

10.7 Occupational Factors to Be Considered

Ability in the workplace: consider the actual effect of a physical or medical condition on performance:
• Confirm job requirements - perception, mobility, strength endurance
• Ask the employee what the work entails
• Review job description or inspect the worksite

15
 • Field tests of specific abilities or structured job simulation exercises
• Trial of employment with feedback from management

Nature of hazards: consider the interaction of occupational factors and medical condition
• Harm from demands - heart attack, back strain, prolapsed disc
• Harm from exposures - asthma, dermatitis, hearing loss
• Harm from situations - seizure-trauma, accidents
• Harm from infections - food handling, surgical procedures
• How much harm likely - temporary, permanent, minor, major, fatal
• Who may be affected - self, colleagues, clients, public

The extent of risk: focus on facts and avoid presumption

• Question employee on relevant details
• Obtain management report on material facts
• Examine documentation - exposure records, accident reports, etc.
• Observe work, workplace, and working practices
• Identify the frequencies and duration of hazardous exposures or situations
• Request technical data if required - from the hygienist, ergonomist, etc.
• Review relevant literature, journals, and research

11. Implementing OH Assessment Program

Implementing the OH assessment program requires the coordinated input of a number of different
stakeholders. Successful implementation will require strong and visible leadership from senior
management, Figure 2 outlines those steps which should be followed to ensure the successful
implementation of the program.

IDENTIFY NEEDED
CONDUCT A JOB CONDUCT A RISK MEDICAL CONSULT
HAZARD ALALYSIS ASSESSMENT ASSESSMENT

OBTAIN COMPETENT DEFINE A DETAILED

DEVELOP
RESOURCES TO DELIVER TIMELINE FOR
IMPLEMENTATION PLAN
TESTS IMPLEMENTATION

CONDUCT MEDICAL REVIEW COMPLIANCE RUN PERIODIC

ASSESSMENT AND PROCESS QUALITY CHECK

Figure 2. Implementing the OH assessment program steps

16
• Conduct a risk assessment: Decide which workgroups require OH assessment. This should
involve HSE professionals who have a detailed understanding of risk assessment and the
operational requirements of the task to be completed.
• Identify which medical assessments, functional capacity evaluations, and/or trade tests are to be
used for each workgroup: Ensure all tests are valid for their intended use. Specialist help will be
required from occupational physicians, ergonomists, safety professionals, etc.
• Conduct a legal review to confirm that the intended approach is permissible within the context
of the local legislative framework.
• Consult with human resources as necessary. It will be necessary to address specifically the
consequences of being unfit for duty and refusal to attend an assessment.
• Agree to a detailed timeline for implementation.
• Obtain competent resources to deliver tests, paying particular attention to the competence of
those engaged for this purpose. Specific challenges arise when a network of different health
providers is engaged in providing a service at different locations. All will require specific guidance
on what is required with respect to medical examinations and tests, investigations, and non-
medical evaluations.
• Develop an implementation plan with line management and HR teams, specifically addressing
notification procedures.
• Conduct medical assessments on the population identified by the risk assessment. Notify line
management and HR teams of the outcome maintaining medical confidentiality. Set a recall date
for periodic review.
• Review the compliance and implementation process. It is particularly important to monitor
compliance. If a risk assessment identifies a particular test or examination as necessary, but it is
not carried out, the net result may be an increased liability.
• Run periodic quality checks on tests conducted to ensure ongoing validity.
For most contractors, the required OH assessments are often conducted by another organization.
In this case, the parent company should specify the requirements for fitness for duty, which the
contractor must. Contract HSE clauses can be an effective means of capturing and enforcing this
requirement. This is particularly important for joint venture partners and for their contractors.
Agreement early on in the contracting and procurement process can specify who is responsible for
what in respect of the contracted workforce.

12. Assessor Selection

12.1 Health, Safety, and Environment

All necessary health, safety, and environmental procedures shall be employed to protect medical
personnel and the surrounding environment while conducting OH and risk assessments. All
equipment’s calibration and necessary maintenance of medical equipment shall be adhered to
ensure the accuracy of results and the safety of the operators and clients.
An OHA and risk assessment is necessary when any form of hazard is identified and impacts a
worker’s health. The nature of the hazard and the clinical expertise required should determine the
necessary clinician undertaking the assessment. As a result, businesses and organizations should
have a clear understanding of the tasks that need addressing and their expectations of the clinicians.

17
 12.2 Occupational Physician
Suitably qualified and experienced occupational physicians can bring a wealth of practical knowledge
of the broader context in which such medical assessments take place, as well as the experience to
assess fitness for work. They will be familiar with a risk assessment for health risks in the workplace
and with the introduction of necessary controls. They will be especially experienced in such things
as health and medical surveillance of workers and maintaining health and surveillance records.
Some organizations acquire the service of an occupational physician on a sessional basis, utilizing
the physician for many purposes, such as rehabilitation, injury prevention, advice on product safety.
The occupational physician will be able to consider the accident experience of the organization, the
hazards involved and the risks, the sensitivity of various examination procedures or tests to detect
problems, and then the appropriate referral resources for the more complex medical cases.
It may also be worthwhile for an organization to consider a one-off expenditure by utilizing the
services of an occupational physician to establish OH assessment protocol. General Practitioners
with a specialist interest in occupational medicine are also trained in the principles of occupational
medicine and risk assessment and are thus able to offer occupational health services to local
businesses and organizations.

12.3 General Practitioner

An examination of the physical capabilities required in a workplace utilizes the hazards of the
workplace as the starting point for examination, and thus clinicians familiar with the workplace can
competently carry out such a focused examination.
General practitioners may also not be aware of the significance of incapacity or medical condition
in a workplace setting, even if they have visited the workplace, or have communicated with the
management. Many incapacities become problematic at times of breakdown or maintenance
situations, which is not usually obvious at the time of a visit. Occupational physicians, and occupational
health nurses, through years of experience and knowledge, are aware of, or will consider, all probable
circumstances of a workplace.
General practitioners, who are sent their own patients to examine for suitability to work, are in an
unpleasant position. Already a doctor/patient relationship exists. There are constraints of
confidentiality and trust, which are unlikely to be contravened at a time of OH assessment. The
general practitioner in that situation is usually under pressure to accommodate the patient, rather
than the employer, and hopes that non- disclosure of incapacity, or other medical condition, will not
eventuate in injury or illness for the patient or any other person in the workplace.
An employer who wishes to utilize the services of a general practitioner should ensure the physician
is willing to visit the work site; there can never be sufficient understanding of physical and other
requirements, such as work organization, without such direct contact.

12.4 Occupational Health Nurse

A general nurse with postgraduate qualifications in occupational health is accepted as an occupational
health nurse, is considered to be a capable professional at a cost that is accessible to many employers.
However, it is strongly recommended that access to the advice and consultation service of a medical
practitioner is necessary for any OH nurse. Therefore, the utilization of a physician should be part of
OH assessment or other examination procedures, when necessary.
There are certain types of examinations that nurses have not been trained to carry out, and therefore
they cannot be recognized as having the skill to do so, no matter what experience they may have

18
attained over time. Examination of the respiratory system (such as lungs and upper airways), of the
abdomen, much of the cardiovascular system, the neurological system and others, have not been
part of the training of either general or occupational health nurses.
If OH assessment requires any such testing, a physician must carry it out. Specific health surveillance
activities, in accordance with the hazardous substance legislation, where it exists, should be carried
out under the supervision of a physician adequately trained in the requirements of health surveillance.
However, some aspects of the OH assessment can be performed by the occupational health nurse.
The primary role of the occupational health nurse is to coordinate the delivery of comprehensive,
equitable, quality occupational health services for workers with providing ethical, and confidential
nursing care within legal and professional parameters. Further, occupational health nurse is
responsible for conducting health examinations, assessing the work environment, providing primary,
secondary, and tertiary prevention strategies, providing health education programs, providing
health promotion programs, providing counseling interventions and programs, managing the
information system; conducting health surveillance programs, and monitoring injury/illness trends.

13. Occupational Health Surveillance Program

Occupational health surveillance is appropriate where potential exposure to a workplace hazard has
a known health effect, and there is a validated, reproducible and measurable impact. Surveillance
will be conducted when exposure is identified or can be reasonably expected or is required under
legislation. These include a wide spectrum of chemical, physical and biological hazards which can
be divided into general industry-related hazards such as noise, radiation, benzene and also location-
specific exposures such as process-related chemicals. Health surveillance will not be conducted
when there is no exposure or reason to expect an exposure unless specifically required by legislation.

13.1 General Objectives

Any health surveillance program must be underpinned by a set of clear objectives:
• Establish health parameters for all employees during pre-employment and periodic screening.
• Identify early health effects in an exposed population.
• Provide an ongoing program to monitor for any deterioration in any employees who may have
established health effects due to damaging exposures.
• Increase awareness amongst employees of the risks of exposure and provide information on
appropriate protection/ risk prevention.
• Provide feedback to the employer on the effectiveness of the health risk management program.
• Provide a system to ensure effective feedback and the management of control measures to
ensure that the health of the workforce is not further affected by workplace exposures.

13.2 Types of Health Surveillance

Health surveillance may take one or more of the following forms:
• Review of records and occupational history during and after exposure.
• Simple questionnaire – e.g., asking about symptoms of vibration white finger in users of vibrating
tools.
• Simple examination – e.g., visual examination of the hands for dermatitis.

19
 • Physiological tests – e.g., hearing tests to identify noise-induced hearing loss, lung function tests
to look for damage to lungs from dust or chemicals.
• Biological monitoring – e.g., measuring mercury in urine to assess exposure; benzene metabolites
in the urine.
• Biological effect monitoring – e.g., analysis of red blood cells for the effects of lead exposure.
• Clinical examination – clinician performing a physical examination.

13.3 Frequency of Health Surveillance

Health surveillance shall be performed at appropriate intervals as defined by the exposure, or as
indicated in the relevant procedure, or as defined by legislation.
• Evidence of harm may require the frequency to be increased.
• Change in work materials or processes may require a change in frequency.
• Evidence that harm is not occurring may allow a reduction in frequency or removal from the
surveillance program if risk control effective.
• Change of materials or processes may remove the risk factors thereby allowing the worker to be
removed from health surveillance.

13.4 Special Groups

Special consideration needs to be given to those groups of employees whose risks may be
significantly higher than others, such as pregnant workers, and employees with chronic illness.

13.5 Management Review

Occupational health specialists shall carry out regular reviews of all health surveillance program with
communication to management to ensure that:
• Health surveillance is being carried out in accordance with legislative and company requirements.
• Results are analyzed to ensure control measures are working.
• Any new risks have been recognized and dealt with appropriately.
• Areas for improvement are identified and implemented.

13.6 Records
Health surveillance records shall be kept for an appropriate period, which may be determined by
legislation, established practice, or following specialist advice. Where there is no existing requirement,
it would be recommended that health surveillance records are held for as a minimum at least as long
as the individual remains in employment, with consideration of longer as inquiries may arise
sometime after exposure and hence subsequent to employment. It is suggested that all records be
kept for 40 years ( Article 91 of the Labor Law (for young workers); Article 105 of the Labor Law (it
does not specify for how long the records should be kept)).

20
13.7 Confidentiality
Medical information cannot be released to the employer unless the employee has given explicit
consent. Confidentiality of the medical examinations: Article 8 of the ministerial Decree No. 19 of
2005.

13.8 Health Hazards

Health surveillance programs shall be established to detect early signs of work-related ill health
among employees exposed to certain hazards with established high health risks. These are described
in the previous sections.

14. Outcome of OH Assessment

OH assessment should result in a clear statement to the employing company on the status of the
worker. Upon completion of the OH assessment examining physician shall provide a medical fitness
certificate to the employee. The certificate shall contain employee basic personal information with
recent photographs, validity period, fitness status, limitations if any, medical surveillance or health
monitoring requirements and date of next medical assessment and shall bear the name, designation,
signature, and stamp of examining physician. Sample Fitness to work certificate is included in
Appendix 5. Typically, a worker may be regarded as:

14.1 Fit for Current Position

No disability interferes with the essential functions of the job.

14.2 Fit with Restriction

The employee may be fit for certain tasks but not for others. Temporary or partial restrictions can be
the cause of confusion and difficulty. The advice provided in a statement of fitness to work should
be clear and unambiguous; phrases such as ‘fit for light work’ should be specifically avoided, as they
are meaningless in a practical and legal sense. The advice should state what tasks the individual can
and cannot do, and for how long the restriction applies. Whether these restrictions can be
accommodated by the employer is for the line management and/or HR team to resolve. Transitional
duties are a particularly useful means of rehabilitating an employee back to work after a period of
illness or injury.

14.3 Temporary Unfit for Current Position

Examining physicians may recommend that the position/ job might worsen a person’s medical
condition or applicant may be unsafe to self and others due to medical conditions for a specified
period. Such a recommendation should be time bound and is at management discretion.

14.4 Permanently Unfit for Current Position

Examining physicians may recommend that the position/ job might worsen a person’s medical
condition or applicant may be unsafe to self and others due to medical condition permanently.

21
 14.5 Consequences
An assessment of unfit for a position can have serious implications for the employee, from losing a
position they hold, to not getting one they are otherwise qualified for. It is imperative, therefore, that
the assessment process is fair, consistent, and based on objective assessments of health and work
capacity.
To ensure the fair treatment of employees, many employers adopt some or all of the following
measures as good practice, with the specific goal of reducing the personal impact of an assessment
of unfit for work.

14.5.1 Accommodation
It is good practice to consider which of an individual’s tasks might be assigned to others, thus
permitting the individual to continue in the same position. The practicality of accommodating an
individual in this way will, of course, depend on the task; for example, a fireman who cannot climb a
ladder or use a hose is severely restricted, whereas an employee who occasionally has to work at
height but cannot do so because of vertigo could be assigned to floor duty only. Accommodation
can also take the form of physical modifications to the workplace or adjustments to the work
schedule. In many countries, such accommodation processes are a legal requirement.

14.5.2 Transfer to Alternative Work

The incapacity of an individual to fulfill the needs of a particular position does not mean that the
individual will automatically be considered unfit for other positions with different demands. Although
it may not always be possible, the employer should actively consider the options to transfer the
individual to a more appropriate position if one is available. In some countries, a transfer to alternative
work is a legal requirement.

14.5.3 Termination
The decision to terminate, not offer or modify employment for any individual is a matter for the line
management and/or the HR team. This should only be pursued after careful consideration of the
alternatives (i.e., accommodation and transfer to alternative work). A panel review of the medical
assessment (commonly known as a ‘Medical Board Review’) is good practice in the termination
process. It ensures that the medical recommendations are accurate and that alternative diagnoses
or outcomes have been sufficiently explored.

14.5.4 Appeals
Employers should establish an appeal process which permits the decisions made regarding fitness
to work to be reviewed. It is entirely a matter for the employer to decide on the value of this process.
It is good practice and is well-received by staff representative groups where appropriate.
In designing a program of OH assessment, the employer must also consider the consequences of
an individual’s failure or refusal to attend OH assessment. In most, if not all cases, such absence or
refusal will render the individual unfit for that work, because their capacity to do it safely cannot be
demonstrated.

22
15. OH Assessment Records
There are both legal and ethical issues around the security, transfer, and archiving of medical records.
OH professionals need to be aware of the many ways in which confidentiality may be compromised.
Personal health information is held to be especially sensitive data.

15.1 Security of OH Records

All contacts between an employee and an OH service should be recorded in the employee›s OH
record.
• The medical records should be securely stored in a lockable cabinet or room.
• Access to OH records should be restricted to OH staff.
• All OH staff should sign a confidentiality agreement.
• It is unethical to allow access to OH records to the non-OH staff, such as personnel managers.

15.2 Transfer of OH Records

• Companies may outsource OH services, change the OH provider, or go out of business.
Independent occupational physicians may retire or change jobs. In all these cases, OH records
will need to be transferred to an individual or organization that is in a position to maintain them
for the appropriate period (this maybe 40 years after the last entry in the records in some cases,
e.g., ionizing radiation records).
• When it is proposed that OH records are to be transferred, employees should be informed and
given the opportunity to request that their OH notes be archived rather than transferred.
• Where an organization closes, it may be appropriate to issue the OH records to the individual or
(with their consent) their Physician.

15.3 Archiving
• Employees leave, are dismissed, or retire, and over time the number of inactive OH records held
by an OH service will increase. Inactive files occupy valuable storage space. They can make it
difficult for administration staff to locate current OH notes. As a result, all OH services need to
have in place a standard operating procedure for archiving OH records.
• Archives may be held on or off-site. However, it is important that archiving medical records does
not compromise medical confidentiality.
• Readily accessible records detailing the location of all archived notes should be maintained. The
location of records should be tracked to avoid the loss or misfiling of records.
• OH notes may need to be abstracted at a later date from an archive for a number of reasons,
e.g., legal action, audit, or re-employment.

23
 16. References
[1] Jorma Rantanen, I. A. (2002, July 1). Standards, Principles and Approaches in Occupational Health
Services. Retrieved from International Labour Organisation (ILO): https://www.ilo.org/wcmsp5/
groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_110439.pdf
[2] International Labour Organization (ILO). (2013, December 17). A 5 step guide for employers,
workers and their representatives on conducting workplace risk assessments. Retrieved from
International Labour Organization (ILO): https://www.ilo.org/wcmsp5/groups/public/---ed_protect/-
--protrav/---safework/documents/publication/wcms_232886.pdf
[3] German Social Accident Insurance (dguv). (n.d.). Introduction: Guidelines for occupational
medical examinations. Retrieved from German Social Accident Insurance (dguv): https://www.dguv.
de/medien/inhalt/praevention/themen_a_z/arb_vorsorge/dguv_grundsatz/introduction.pdf
[4] Lele, D. V. (2018). Occupational Health Surveillance. The Indian Journal of Occupational and
Environmental Medicine, 117-120.
[5] Mines Occupational Safety and Health Advisory Board (MOSHAB) . (1999, NOVEMBER).
Guidelines. Retrieved from Government of Western Australia- Department Of Mines Industry
Regulation and Safety: http://www.dmp.wa.gov.au/Documents/Safety/MSH_G_
SafetyAndHealthRiskManagement.pdf
[6] Occupational Safety and Health Administration (OSHA). (2002). Job Hazard Analysis. Retrieved
from Occupational Safety and Health Administration (OSHA): https://www.osha.gov/Publications/
osha3071.pdf
[7] International Labour Organization (ILO). (2013). Training package on workplace risk assessment
and management for small and medium-sized enterprises. Retrieved from International Labour
Organization (ILO): https://www.ilo.org/global/topics/safety-and-health-at-work/resources-library/
training/WCMS_215344/lang--en/index.htm
[8] US Department of Labor. OSHA 3162-12R 2009. Screening and Surveillance Guide. Available at:
URL: http://www.osha.gov/Publications/osha3162.pdf
[9] Benjamin O. Alli (2008). Fundamental principles of occupational health and safety, International
Labour Office – Geneva: ILO.
[10] RantanenJ. And Fedotov, Igor A. (2002). Standards, Principles and Approaches in Occupational
Health Services. International Labour Organization (ILO). Available at: URL: https://www.ilo.org/
safework/info/publications/WCMS_110439/lang--en/index.htm
[11] National Patient Safety Agency. (2008). A risk matrix for risk managers [Ebook]. Retrieved from
https://www.neas.nhs.uk/media/118673/foi.16.170_-_risk_matrix_for_risk_managers_v91.pdf
[12] COHNA-ACIIST. (2003). Occupational Health Nursing Practice Standards [Ebook]. Retrieved
from http://cohna-aciist.ca/wp-content/uploads/2017/03/Occupational-Health-Nursing-Practice-
Standards-2003.pdf

24
17. Appendices

17.1 Appendix 1 – Hazardous Materials or Exposures Requiring Medical

Surveillance
Acrylonitrile

Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes – annual1
Emergency/exposure examination and tests Yes
Termination exam Yes – if no exam within 6 months of termination
Examination includes special emphasis on these body Respiratory, gastrointestinal1, thyroid, skin,
systems neuro logical (peripheral and central)
Work and medical history Required for all exams2
Chest x-ray Yes
Pulmonary function test (PFT) No
Other required tests Fecal occult blood1
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to
employee
Employee counseling re: exam results, conditions of Yes – by physician
increased risk
Medical removal plan No

Arsenic (Inorganic)

Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes 1
Emergency/exposure examination and tests Yes
Termination exam Yes – if no exam within 6 months of termination
Examination includes special emphasis on these body Skin, nasal, peripheral nervous system
systems
Work and medical history Required for all exams2 with focus on
respiratory symptoms; includes smoking history
Chest x-ray Yes
Pulmonary function test (PFT) No
Other required tests Urinary Total Arsenic
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to
employee
Employee counseling re: exam results, conditions of Yes – by physician
increased risk
Medical removal plan No

25
 Asbestos (incl. Synthetic Mineral Fibers and Man-Made Mineral Fibers)
Standard Requirements
Pre-placement exam Yes1,3
Periodic exam Yes – annual1 or more
frequently if determined by
physician
Emergency/exposure examination and tests No
Termination exam No
Examination includes special emphasis on these Pulmonary and gastrointestinal
body systems
Work and medical history Required for all exams2; special emphasis on
pulmonary, cardiovascular, gastrointestinal;
standardized form required;
Chest x-ray Yes1 only for diagnosis certified radiologist or
physician with expertise in pneumoconioses
required;
Pulmonary function test (PFT) FVC, FEV
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to employee
Employee counseling re: exam results, conditions Yes – by physician; includes informing employee of
of increased risk increased risk of lung cancer from combined effects
of smoking and asbestos exposure
Medical removal plan No

Benzene
Standard Requirements
Pre-placement exam Yes1,3,4
Periodic exam Yes – annual1,4
Emergency/exposure examination and tests Yes4 ,1 – includes urinary
phenol test
Termination exam No
Examination includes special emphasis on these Hemopoietic; add cardiopulmonary if respiratory
body systems protection used at least 30 days/year, (initially, then
every 3 years)
Work and medical history Required for initial and periodic exams (pre-
placement exam requires special history)2
Chest x-ray No
Pulmonary function test (PFT) Initially and every 3 years if respiratory protection
used 30 days/year; specific tester requirements
Other required tests CBC, differential, other specific blood tests;
repeated as required;
Evaluation of ability to wear a respirator Yes – if respirators are used
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to employee
Employee counseling re: exam results, conditions Yes – by physician
of increased risk
Medical removal plan Yes

26
Blood-Borne Pathogens (Hepatitis, B)
Standard Requirements
Pre-placement exam No – must offer Hepatitis B (HBV) vaccine
unless already immune or vaccine
contraindicated
Periodic exam No
Emergency/exposure examination and tests Specific post-exposure monitoring for
employee and source; HBV vaccine;
Termination exam No
Examination includes special emphasis on these body No
systems
Work and medical history No
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Yes – post-exposure incident
Evaluation of ability to wear a respirator No
Additional tests if deemed necessary Yes – for post-exposure incident; follow post-
exposure protocols
Written medical opinion Yes – licensed healthcare professional to
employer; employer to employee
Employee counseling re: exam results, conditions of Yes– by licensed healthcare professional;
increased risk counseling re: HBV vaccine and post-exposure
follow-up;
Medical removal plan No

1,3-Butadiene
Standard Requirements
Pre-placement exam Yes4 ,3 ,1
Periodic exam Yes4 ,1
Emergency/exposure examination and tests Yes4 ,1 – within 48 hours of exposure
Termination exam Yes4 – if 12 months have elapsed since last
exam
Examination includes special emphasis on these body Liver, spleen, lymph nodes, and skin
systems
Work and medical history Required annually and for all examinations2;
standardized form or equivalent; includes
comprehensive occupational and health
history;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Annually, CBC with differential and platelet
count; also within 48 hrs. after exposure in an
emergency situation and repeated monthly for
3 more months
Evaluation of ability to wear a respirator Yes – if respirators are used
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician or other licensed healthcare
professional to employer and employee
Employee counseling re: exam results, conditions of Yes – by physician or other licensed healthcare
increased risk professional
Medical removal plan No

27
 Cadmium
Standard Requirements
Pre-placement exam Yes4 ,3 ,1
Periodic exam Yes4 ,1
Emergency/exposure examination and tests Yes4 ,1
Termination exam Yes3
Examination includes special emphasis on these Respiratory, cardiovascular (BP), urinary
body systems
Work and medical history Required for pre-placement and periodic exams2;
standardized form required;
Chest x-ray Yes
Pulmonary function test (PFT) FVC, FEV
Other required tests Annually1, cadmium in urine, beta2- macroglobulin
in urine, cadmium in blood, CBC, BUN, serum
creatinine, urinalysis;
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to employee
Employee counseling re: exam results, conditions Yes – by physician; includes explanation of results,
of increased risk treatment, and diet, and discussion of decisions re:
medical removal; effect of smoking on cadmium
exposure
Medical removal plan Yes

Creosote
Standard Requirements
Pre-placement exam Yes
Periodic exam Yes – annual
Emergency/exposure examination and tests Yes1 – special medical surveillance begins within 24
hours
Termination exam No
Examination includes special emphasis on these Exam includes emphasis on the neurological system
body systems and Skin noting any abnormal lesions and Evidence
of skin sensitization
Work and medical history Required for all examinations; includes family and
occupational history, and environmental factors
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests No
Evaluation of ability to wear a respirator Yes, , if respirators are used
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer
Employee counseling re: exam results, conditions No
of increased risk
Medical removal plan Yes, if sensitization occurs

28
Chromium (VI), Hexavalent
Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes1
Emergency/exposure examination and Yes1
tests
Termination exam Yes3 – unless last exam was less than 6 months prior to date of
termination
Examination includes special emphasis Skin especially hands and forearms and respiratory tract
on these body systems
Work and medical history Required for all exams2; includes past, present and
anticipated future exposure; any history of respiratory system
dysfunction, asthma, dermatitis, skin ulceration or nasal
septum perforation; smoking status and history
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician
conditions of increased risk
Medical removal plan No

Coke Oven Emissions

Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes1
Emergency/exposure examination and No
tests
Termination exam Yes – if no exam within 6 months of termination
Examination includes special emphasis Skin
on these body systems
Work and medical history Required for all exams2; includes smoking history and
presence and degree of respiratory symptoms
Chest x-ray Yes
Pulmonary function test (PFT) FVC, FEV
Other required tests Weight, urine cytology, urinalysis for sugar, albumin, hematuria
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician; also, employer must inform employee of
conditions of increased risk possible health consequences if employee refuses any
required medical exam
Medical removal plan No

29
 Cotton Dust
Standard Requirements
Pre-placement exam Physical exam not specified;
other tests required
Periodic exam Physical exam not specified;
other tests required4 ,1
Emergency/exposure examination and No
tests
Termination exam No
Examination includes special emphasis Pulmonary
on these body systems
Work and medical history Medical history; standardized questionnaire required;
Chest x-ray No
Pulmonary function test (PFT) FVC, FEV1, FEV1/FVC Employees with specific abnormalities
are referred to specialists5 ,4 ,1
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary No
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician re: results of exam and any medical
conditions of increased risk conditions requiring further examination or treatment
Medical removal plan Yes – for inability to wear a respirator (6 months)

Crystalline Silica
Standard Requirements
Pre-placement exam Physical exam other tests required
Periodic exam Physical exam annual; other tests required
Emergency/exposure examination and No
tests
Termination exam No
Examination includes special emphasis Pulmonary
on these body systems
Work and medical history Medical history; standardized questionnaire required;
Chest x-ray No
Pulmonary function test (PFT) FVC, FEV1, FEV1/FVC Employees with specific abnormalities
are referred to specialists
Other required tests Yes, x ray only for diagnosis certified radiologist or physician
with expertise in pneumoconiosis required
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary No
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician re: results of exam and any medical
conditions of increased risk conditions requiring further examination or treatment
Medical removal plan Yes – for inability to wear a respirator (6 months)

30
1,2-dibromo-3-chloropropane
Standard Requirements
Pre-placement exam Yes
Periodic exam Yes1
Emergency/exposure examination and Yes – male reproductive;
tests repeat in 3 months
Termination exam No
Examination includes special emphasis Reproductive, genitourinary
on these body systems
Work and medical history Required for all exams2; Includes reproductive history;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician
conditions of increased risk
Medical removal plan No

Ethylene Oxide
Standard Requirements
Pre-placement exam Yes
Periodic exam Yes– annual1
Emergency/exposure examination and Yes1
tests
Termination exam Yes1
Examination includes special emphasis Pulmonary, skin, neurologic, hematologic, reproductive, eyes
on these body systems
Work and medical history Required for all exams; includes reproductive history and
special emphasis on some body systems;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests CBC, white cell counts with differential, hematocrit, he-
myoglobin, red cell count;
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician
conditions of increased risk
Medical removal plan No

31
 Formaldehyde
Standard Requirements
Pre-placement exam Yes4 ,1
Periodic exam Yes4 ,1
Emergency/exposure examination and Yes4
tests
Termination exam No
Examination includes special emphasis Evidence of irritation or sensitization of skin, respiratory
on these body systems system, eyes; shortness of breath
Work and medical history Required for all exams; includes reproductive history and
special emphasis on some body systems;
Chest x-ray No
Pulmonary function test (PFT) FVC, FEV1, FEF should be evaluated if respiratory protection
is used
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes– by physician; includes information on whether medical
conditions of increased risk conditions were caused by past exposures or emergency
exposures
Medical removal plan Yes

Hazardous Waste Operations and Emergency Response (HAZWOPER)

Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes – annually or at physician’s discretion1
Emergency/exposure examination and Yes1
tests
Termination exam Yes – if no exam within 6 months of termination/reassignment
Examination includes special emphasis Determined by physician;
on these body systems
Work and medical history Yes – with emphasis on symptoms related to handling
hazardous materials and health hazards, fitness for duty and
ability to wear PPE2
Chest x-ray No – unless determined by physician
Pulmonary function test (PFT) No – unless determined by physician
Other required tests No – unless determined by physician
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes– by physician
conditions of increased risk
Medical removal plan No

32
Isocyanates
Standard Requirements
Pre-placement exam Physical exam
other tests required
Periodic exam Physical exam annual; other tests required
Emergency/exposure examination and No
tests
Termination exam No
Examination includes special emphasis Pulmonary, skin
on these body systems
Work and medical history Medical history; standardized questionnaire required;
Chest x-ray No
Pulmonary function test (PFT) FVC, FEV1, FEV1/FVC
Other required tests No
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary No
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician re: results of exam and any medical
conditions of increased risk conditions requiring further examination or treatment
Medical removal plan Yes – for inability to wear a respirator (6 months)

Lead
Standard Requirements
Pre-placement exam Yes
Periodic exam Yes4 ,1
Emergency/exposure examination and Yes4 ,1
tests
Termination exam No
Examination includes special emphasis Teeth, gums, hematologic, gastrointestinal, renal,
on these body systems cardiovascular (BP), neurological; pulmonary status if
respiratory protection used
Work and medical history Required for all exams2; includes reproductive history, past
lead exposure, both work/non-work, and history of specific
body systems; see standard
Chest x-ray No
Pulmonary function test (PFT) No – unless deemed necessary by physician
Other required tests Hemoglobin, hematocrit, ZPP, BUN, serum creatinine,
Urinalysis with micro, blood- lead levels, peripheral smear
morphology, red cell indices5 ,1;
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician; includes advising the employee of any
conditions of increased risk medical condition, occupational or non-occupational,
requiring further medical examination or treatment
Medical removal plan Yes

33
 Mercury
Standard Requirements
Pre-placement exam Yes
Periodic exam Yes4 ,1
Emergency/exposure examination and tests Yes4 ,1
Termination exam No
Examination includes special emphasis on Eyes, skin, respiratory gastrointestinal, renal, cardiovascular
these body systems (BP), neurological 9CNS and PNS); pulmonary status if
respiratory protection used
Work and medical history Required for all exams2; includes reproductive history, past
mercury exposure, both work/non-work, and history of
specific body systems;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Urinary and blood inorganic Mercury others determined by
physician
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician to employer, employer to employee
Employee counseling re: exam results, Yes – by physician; includes advising the employee of any
conditions of increased risk medical condition, occupational or non-occupational,
requiring further medical, examination or treatment
Medical removal plan Yes

Methylene Chloride
Standard Requirements
Pre-placement exam 4 ,Yes1
Periodic exam 4 ,Yes1
Emergency/exposure examination and tests Yes4
Termination exam months of termination 6 Yes – if no exam within
Examination includes special emphasis on Lungs, cardiovascular (including BP and pulse), liver,
these body systems nervous, skin; extent of exam determined by examiner
based on employee’s health status, work, and medical
history
Work and medical history Required for all exams; example of work and medical
history form provided
Chest x-ray No
)Pulmonary function test (PFT No – unless deemed necessary by physician or other
licensed healthcare professional
Other required tests Laboratory surveillance may include tests as determined by
examiner including “before and after shift tests”;
Carboxyheamoglobin
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – by physician or other licensed healthcare professional
to employer and Employee of increased risk of harm from
combined effects of smoking and Methylene Chloride
Employee counseling re: exam results, Yes – by physician or other licensed healthcare professional
conditions of increased risk
Medical removal plan Yes

34
M ethylene di-aniline (MDA)
Standard Requirements
Pre-placement exam Yes3,4 ,1
Periodic exam Yes – annual 4 ,1
Emergency/exposure examination and tests Yes1,4
Termination exam No
Examination includes special emphasis on these body Skin, hepatic
systems
Work and medical history Required for all examinations2; includes
past work with MDA and other specific
items;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Liver function tests, urinalysis
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to
employee
Employee counseling re: exam results, conditions of Yes – by physician
increased risk
Medical removal plan Yes

Noise
Standard Requirements
Pre-placement exam Baseline audiograms are required within 6
months of exposure at or above 85dB.
Periodic exam Annual audiometric testing required
Emergency/exposure examination and tests No
Termination exam No requirements
Examination includes special emphasis on these body Auditory
systems
Work and medical history Yes
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Initial and annual audiometric testing,4 ,1
5;
Evaluation of ability to wear a respirator No
Additional tests if deemed necessary Yes, bone conduction audiometry
Written medical opinion No
Employee counseling re: exam results, conditions of Yes – if standard threshold shift or
increased risk suspected ear pathology
Medical removal plan No

35
 Organophosphate Pesticides
Standard Requirements
Pre-placement exam Physical exam other tests required baseline Red blood cell
and plasma Cholinesterase activity levels5
Periodic exam Physical exam annual;
Emergency/exposure examination and No
tests
Termination exam No
Examination includes special emphasis No
on these body systems
Work and medical history Medical history: standardized questionnaire required;
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Yes – if deemed necessary – estimated red cell and plasma
cholinesterase activity at end of workday after exposure
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary No
Written medical opinion Yes – physician to employer; employer to employee
Employee counseling re: exam results, Yes – by physician re: results of exam and any medical
conditions of increased risk conditions requiring further examination or treatment
Medical removal plan Yes – for inability to wear a respirator (6 months)

Respiratory Protection
Standard Requirements
Pre-placement exam Evaluation questionnaire or exam; follow-up exam when
required5
Periodic exam Yes – in specific situations5
Emergency/exposure examination and No
tests
Termination exam No
Examination includes special emphasis Yes5
on these body systems
Work and medical history Yes2
Chest x-ray As determined by physician or other licensed healthcare
professional
Pulmonary function test (PFT) As determined by physician or other licensed healthcare
professional
Other required tests As determined by physician or other licensed healthcare
professional
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician or other licensed healthcare professional to
employer and employee
Employee counseling re: exam results, Yes – by physician or other licensed healthcare professional
conditions of increased risk
Medical removal plan No

36
Vinyl Chloride
Standard Requirements
Pre-placement exam Yes1
Periodic exam Yes1
Emergency/exposure examination and Yes
tests
Termination exam No
Examination includes special emphasis Special attention to detecting enlargement of the liver, spleen
on these body systems or kidneys, or dys-function of these organs and abnormalities
in skin, connective tissue and pulmonary system;
Work and medical history Required for initial and periodic exams2; includes alcohol
intake, history of hepatitis, exposure to hepatotoxic agents,
blood transfusions, hospitalizations, and work history
Chest x-ray No
Pulmonary function test (PFT) No
Other required tests Blood test for total bilirubin, alkaline phosphatase, SGOT,
SGPT and gamma glutamyl transpeptidase
Evaluation of ability to wear a respirator Yes
Additional tests if deemed necessary Yes
Written medical opinion Yes – physician to employer; employer to employee
Employee counseling re: exam results, No
conditions of increased risk
Medical removal plan Yes

17.2 Appendix 2 – Risk Assessment Matrix: Guidance on likelihood

scoring
The assessment of ‘consequence’, the likelihood of a risk occurring is assigned a number from ‘1’ to
‘5’. The higher the number the more likely it is the consequence will occur. When assessing likelihood,
it is important to take into consideration the controls already in place. The likelihood score is a
reflection of how likely it is that the adverse consequence described will occur. Likelihood can be
scored by considering:
Frequency (how many times will the adverse consequence being assessed actually be realized?) or
Probability (what is the chance the adverse consequence will occur in a given reference period?).

Likelihood

1 Rare 2 Unlikely 3 Possible 4 Likely 5 Almost certain

5 Catastrophic 5 10 15 20 25

Consequences 4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Negligible 1 2 3 4 5

37
 For grading risk, the scores obtained from the risk matrix are assigned grades as follow:

3-1 Low risk 6-4 Moderate risk

12-8 High risk 25-15 Extreme risk

Figure 3. Risk Assessment Matrix

Table 3. Likelihood/ frequency description
Likelihood score 1 2 3 4 5
Descriptor Rare Unlikely Possible Likely Almost certain
Frequency (how This will Not Might Will probably Will undoubtedly
often it might probably expected to happen or happen/recur, happen/recur,
)happen never happen/ recur but it is not a possibly frequently
happen/recur recur, but it is occasionally persisting issue/
possible circumstances

Table 4. Likelihood/ frequency description

Likelihood score 1 2 3 4 5
Descriptor Rare Unlikely Possible Likely Almost certain
Frequency (how This will Not Might Will probably Will undoubtedly
often it might probably expected to happen or happen/recur, happen/recur,
)happen never happen/ recur but it is not a possibly frequently
happen/recur recur, but it is occasionally persisting issue/
possible circumstances

The severity of consequences could be measured on a 5-point scale:

• Negligee injuries: Minor cuts and bruises.
• Minor injury: Major cuts, bruises, sprains, illness, or injury resulting in less than 3 days lost
workdays.
• Major injury: Head injuries, internal bleeding, eye injuries, spinal injuries, fractures, dislocations,
poisoning, any illness or injury resulting in 3 days or more lost workdays.
• Fatality: Death.

Likelihood (of occurrence) could be measured on a 5-point scale:

• Rare: this will probably never happen/recur.
• Unlikely: do not expect to happen/recur but it is possible it may do so.
• Possible: Might happen or recur occasionally.
• Likely: will probably happen/recur, but it is not a persisting issue/circumstances.
• Almost certain: will undoubtedly happen/recur, possibly frequently.
Depending on the level of risk, the risks are then assessed, controlled, or reduced based on urgency
for action which would depend on the risk rating given below:

Risk rating Urgency of action

)16 - 8( High Immediate
)6 - 3( Medium months 3 Within
)2 - 1( Low Keep monitoring to keep risk at a low level

38
17.3 Appendix 3 – Generic Health Questionnaire
GENERIC HEALTH QUESTIONNAIRE

:‫الطبي‬: ‫مالحظات وتوجيه للمتقدمين للفحص الطبي‬

Guidance notes for Examinee:
‫•الهدف من هذا الفحص الطبي هو تحديد المشاكل‬
• The purpose of this medical assessment is to identify ‫الجسدية والنفسية التي قد تؤثر على قدرة المرشح على‬
physical and psychological problems which may .‫تنفيذ العمل المقترح بطريقة آمنة وفعالة‬
affect the ability of the examinee to carry out the •
duties of his job in a safe and effective manner. ‫تقديم المشورة للمرشح والشركة فيما إذا كانت هناك‬
• To advise the examinee and the company if there are .‫أسباب صحية تمنع المرشح من القيام بمهام العمل‬
medical reasons why the duties of the position may •
not be suitable for the examinee. ‫لتحديد التعديالت على العمل التي قد تكون الزمة لتمكين‬
• To identify those adjustments to employment that .‫الموظف من داءأداءاألداء وظيفته على المستوى المطلوب‬
may be required to enable the examinee to perform •
the job to the standard required. ‫توفير بيانات صحية مبدئية للكشفمبدئية للكشف عن أية‬
‫تغييرات على الوضع الصحي للموظف أثناء العمل لتغطية‬
• To provide a baseline health profile for statutory
.‫القانونية‬. ‫المسؤليةالمسؤولية القانونية‬
• Health surveillance to measure and detect any •
health changes during employment. ‫التأكد من أن العامل األجنبي خالي من أي مرض معد يمكن‬
• To make sure that examinee is free from any ‫ وذلك وفقًا لقواعد‬،‫االتصال‬,‫ان ينتقل من خالل االتصال‬
contagious disease as per GCC rules and regulations .‫وأنظمة دول مجلس التعاون الخليجي للفحص الطبي‬
for expatriate medical examination. •
• To provide information for epidemiological studies ‫توفير المعلومات للدراسات الوبائية التي قد يقوم بها قسم‬
by occupational health.. .‫الصحة المهنية في المستقبل‬

Purpose of medical examination: Occupational Health reception staff completes this section (√as appropriate)

Pre Employment Doha FTW Program Final Departure

Periodic Medical Offshore FTW Trainee
Job Transfer Fireman FTW Educational
Definite To Indefinite Health Surveillance Other

Service Extension Return To Work

PART I – MEDICAL QUESTIONNAIRE ‫ االستبيان الطبي‬-- ‫الجزء األول‬

The examinee must complete all sections in this Medical Questionnaire truthfully and to the best of your knowledge,
if needed assistance may be provided by the Occupational Health Nursing staff.

‫ يمكن طلب المساعدة التي يحتاجها من قسم‬،‫يجب استكمال جميع الفروع في هذا االستبيان الطبي بصدق وبقدر المستطاع‬
‫التمريض‬

Personal Details : : ‫معلومات شخصية‬

Full Name ‫االسم الكامالالسم الكامل‬
Gender ‫الجنس‬ Male ‫ذكر‬ Female ‫انثى‬ Date of Birth ‫تاريخ الميالد‬
Nationality ‫ الجنسية‬Religion ‫الديانة‬
Marital Status ‫ الحالة االجتماعية‬Staff No. ‫الرقم الوظيفي‬
Job Title ‫الوظيفة‬
Home Address ‫عنوان اإلقامة‬

Phone No. ‫ رقم الهاتف‬Mobile No. ‫رقم الجوال‬

Email ‫البريد اإللكتروني‬

39
 Name & address of Family Physician ‫أسم وعنوان طبيب العائلهالعائلة‬

E-Mail ‫البريد اإللكتروني‬

Any Family history of (√ as appropriate) ‫التاريخ المرضي العائلي‬: )√ ‫(ضع إشارة‬

Diabetes ‫السكري‬ Asthma ‫الربو‬
High Blood pressure ‫ارتفاع ضغط الدم‬ Epilepsy ‫الصرع‬
Stroke ‫الجلطة الدماغية‬ Any Mental Illness ‫اي امراض عقليه‬
High Cholesterol ‫ارتفاع الكولسترول‬ Tuberculosis ‫ السل‬- ‫الدرن‬
Heart Disease ‫امراض القلب‬ Cancer ‫السرطان‬

Vaccination Record: (√ as appropriate) ) √ ‫سجل التطعيمات (ضع إشارة‬

Have you ever been vaccinated for any of
Date ‫التاريخ‬ ‫هل أخذت أي من اللقاحات التالية؟‬
the following?
BCG ‫السل‬- ‫الدرن‬ Polio ‫شلل االطفال‬
Tetanus ‫الكزاز‬ Yellow Fever ‫الحمى الصفراء‬
‫الجدري المائي‬
Hepatitis A ‫االلتهاب الكبدي أ‬ Varicella
)‫(العنقز(العنقز‬
‫المكورة‬
Hepatitis B ‫االلتهاب الكبدي ب‬ Meningococcal
‫السحائيهالسحائية‬

Occupational Health History: If this section does not ‫ إذا لم يكن هذا القسمهذا القسم‬:‫التاريخ الصحي المهني‬
apply to you, put a cross. Do not leave blank! X ‫ ضع إشارة‬،‫مطابقًا‬,‫مطابقًا‬

Nature of last three jobs ‫ مسمى آخر ثالث وظائف شغلتها‬Dates ‫التاريخ‬

History of occupational hazard exposure (√as )‫تاريخ التعرض ألي أخطار مهنية سابقة (√ حسب مقتضى الحال‬
appropriate)

Working at Heights ‫العمل على ارتفاعات‬ Manual Handling ‫العمل اليدوي‬

Heavy equipment ‫تشغيل المعدات‬

Biological Risk ‫المخاطر البيولوجية‬
operation ‫الثقيلة‬

Driving Heavy
‫قيادة مركبة ثقيلة‬ Radiation Exposure ‫التعرض لإلشعاع‬
Vehicle

Vibration ‫اهتزاز‬ Dust ‫غبار‬

Noise ‫ضجيج‬ Nickel ‫النيكل‬

Chemical Exposure ‫التعرض للكيماويات‬ Organophosphate ‫الفوسفات العضوي‬

Benzene ‫البنزين‬ Mercury ‫الزئبق‬

H2S H2S ‫غاز‬ Cadmium ‫الكادميوم‬

‫استخدام مبيدات‬
Pesticide Use Lead ‫رصاص‬
‫اآلفات‬

40
 Questions No If YesYes, Please give details
‫السؤال‬ ‫ال‬ ‫ أذكر التفاصيل‬,‫أذكر نعم‬,‫إذا كانت االجابة نعم‬

Have you had any periods of continuous illness of

two weeks or more during the last 5 years?
‫هل أصبت بأي مرض أستمر لمدةأستمر لمدة أسبوعين أو‬
‫ سنوات الماضية؟‬5 ‫الـ‬5‫أكثر خالل الـ‬

Have you lost any time from work in the last 12

months due to illness or injury?
‫ الماضيهالماضية بسبب‬12 ‫هل تغيبت عن العمل في االشهر‬
‫المرض او االصابهاإلصابة؟‬

Have you been admitted to hospital during the last 5

years?
‫هل تم أدخالكأداخلك الى المستشفى خالل الخمس‬
‫السنوات الماضيهالماضية ؟‬

Have you ever made a claim for occupational injury

or ill health?
‫هل قمت بالمطالبهبالمطالبة بالتعويض عن اصابة العمل او‬
‫المرض؟‬

Have you ever been considered medically unfit for

any previous employment?
‫هل سبق لك ان اعتبرت غير الئق طبيًا للقيام بأي عمل سابق؟‬

Have you ever had to change jobs or works

assignments because of a health problem or injury?
‫هل كان عليك القيامعليك القيام بتغيير عملك أو وضيفتك‬
‫سبب وجود مشاكل صحية او اصابات‬

Has any abnormality ever been detected in your

chest x-ray?
‫هل لوحظ وجود أي مشكلة في فحص أشعة الصدر الخاص‬
‫بك؟‬

Do you have any special needs which you consider

would impact on the job for which you are applying,
are you registered with the government body for
special needs?
‫ أو‬،‫الخاصة‬,‫هل أنت مسجل ضمن ذوي االحتياجات الخاصة‬
‫هل لديك أي إعاقة تمنعك من القيام بالعمل؟‬

Are you aware of any health problems, symptoms, or

injuries associated with your current/past job(s)?
‫هل لديك علم بالمشاكل الصحيهالصحية‬
‫المرتبطهالمرتبطة بوظيفتك الحاليهالحالية او‬
‫السابقهالسابقة؟‬

Did you ever consider psychiatric help, attended

counseling sessions, had thoughts of self harmself-
harm?
‫ او ساورتك‬،‫هل فكرت يوما فى طلب مساعدة نفسية‬
‫األفكار فى تسبيب الضرر لنفسك؟‬

Have you ever been absent from work due to any

psychological problem?
‫هل سبق لك التغيب عن العمل بسبب أي مشكلة نفسية؟‬

41
 Lifestyle Habits: (√ as appropriate) )√ ‫ ( ضع(ضع إشارة‬:‫العادات الصحية‬
Are you a current smoker? ‫ هل تدخن حاليا؟‬Average Cigarettes ‫متوسط عدد السجائر‬
 Yes  No ‫ ال‬ ‫ نعم‬ Per Day? ‫في اليوم ؟‬

If not a current smoker, have ‫ اذاإذا كنت حاليا التدخنال‬For how long did ‫كم عدد سنوات‬
you ever smoked? ‫ هلتدخن هل دخنت من قبل؟‬you smoke? ‫التدخين؟‬
 Yes  No ‫ ال‬ ‫ نعم‬
Do you drink alcohol? ‫ هل تشرب الكحول؟‬If yes, an average ‫اذاإذا كانت االجابة‬
 Yes  No ‫ ال‬ ‫ نعم‬ per week? ‫نعم كم في‬
‫االسبوع؟‬
Are you involved in any ‫ هل تشارك في اي انشطه‬If yes, what type & ‫اذاإذا كانت االجابة‬
sporting activities? ‫ رياضيه؟‬frequency? ‫نعم اي نوع وكم‬
 Yes  No ‫ ال‬ ‫ نعم‬ ‫مرة؟‬
Do you have pets at home? ‫هل لديك حيوانات اليفة فى المنزل؟‬
 Yes  No ‫ ال‬ ‫ نعم‬

Medical History: :‫التاريخ المرضي‬

How would you rate your physical fitness? ‫كيف تقيم لياقتك البدنية؟‬
 Poor  Fair  Good  Excellent (Tick only one) )‫(إختر إجابة واحدة‬ ‫ ضعيف‬ ‫ مقبول‬ ‫ جيد‬ ‫ ممتاز‬

Chronic disease surveillance (√ as appropriate) )√ ‫األمراض المزمنة (ضع إشارة‬

 High blood pressure ‫ ارتفاع ضغط الدم‬
 Elevated cholesterol levels ‫ ارتفاع نسبه الدهون فى الدم‬
 Sedentary lifestyle ‫ نمط الحياهالحياة المتسم بقله الحركهالحركة‬
 Excess body weight ‫السمنة‬-‫ زيادهزيادة في الوزن‬
 Diabetes or elevated blood sugar levels ‫ السكري او ارتفاع مستوى سكر الدم‬
 History of heart disease ‫ االصابة بمرض في القلب‬
For questions you checked above, please describe the ‫ أذكر أي عالج تم وصفه أو‬:‫إذا كان لديك أي مشكلة سابقة‬
medical care advised or performed and your present ‫تقديمه لك‬
condition.

Please complete the following checklist indicating if you ‫يرجى اكمال القائمة التالية التي تبين ما إذا كان لديك أي من‬
have ever had the condition listed. For those checked »‫ إذا كانت اإلجابة «اإلجابة «نعم‬،‫المذكورة‬,‫الحاالت المذكورة‬
“Yes,” indicate whether the condition is current or in the ،‫الماضي‬، ‫أذكر ما إذا كانت الحالة مستمرة أو في الماضي‬
past and give details regarding onset date, diagnosis, list ‫ والتشخيص‬،‫األعراض‬، ‫وإعطاء تفاصيل عن تاريخ ظهور األعراض‬
all medications used, and any current limitation. For writing ‫ لكتابة‬.‫ وقائمة بجميع األدوية المستخدمة‬،‫والتشخيص‬،
the details, please use the back of this page. ‫ استخدم الجزء الخلفي من هذه الصفحة‬،‫التفاصيل‬,‫التفاصيل‬

Conditions (√ as appropriate) Yes No Current Past )√ ‫)(ضع إشارة‬Ö‫املرض( ضعإشارة‬

‫نعم‬ ‫ال‬ ‫حاليًا‬ ‫سابقًا‬
Any Vision problem )‫مشاكل الرؤيه نظر (لم تصحح بالنظارات‬
Any Color vision defect ‫عمى األلوان‬
Any Ear infection ‫التهاب االذن‬
Hay fever, sinusitis, severe headaches ‫صداع شديد‬/ ‫التهاب الجيوب‬/ ‫حمى القش‬
Any Hearing problem ‫مشاكل السمع‬
Persistent cough ‫سعال او كحة مستمرهمستمرة‬
Tuberculosis ‫ الدرن‬- ‫مرض السل‬
Bronchitis / emphysema ‫انتفاخ‬/ ‫التهاب الشعب الهوائيهالهوائية‬
‫الرئهالرئة‬
Pneumonia / pleurisy ‫ ذات الجنب‬/ ‫التهاب الرئوي‬
Asthma/ breathlessness ‫ ضيق التنفس‬/ ‫الربو‬

42
‫‪Any Blood vessel disorders / varicose vein‬‬ ‫اضطرابات االوعيهاألوعية الدمويهالدموية ‪/‬‬
‫الدوالي ( االوردهاألوردة)‬
‫‪Any Chest disease/pain /Breast problem‬‬ ‫مرض في الصدر ‪ /‬مشاكل الثدي‬
‫‪Any Heart disease‬‬ ‫امراض القلب‬
‫)‪Any Heart surgery (Bypass, Angioplasty‬‬ ‫عمليات القلب ( قسطرة(قسطرة ‪ /‬جهاز تنظيم‬
‫ضربات القلب)‬
‫‪Abnormal ECG findings‬‬ ‫أضطراباضطراب في تخطيط القلب‬
‫‪Any Bleeding disorders, Thrombosis,‬‬ ‫االنيميا ( فقر(فقر الدم) – اضطرابات تخثر‬
‫‪Anemia‬‬ ‫الدم‪,‬الدم‪ ،‬النزيف‬
‫‪Any joint pain or injury‬‬ ‫آالم أو إصابات في المفاصل‬
‫‪Broken bones, fractures fractures, or‬‬ ‫كسر – خلع في المفصل‬
‫‪dislocations‬‬
‫‪Back complaint / back injury /disc‬‬ ‫مشاكل الظهر ‪/‬اصابات الظهر ‪/‬مشاكل الدسك‬
‫‪problem‬‬
‫‪Muscle, tendon tendon, or ligament‬‬ ‫مشاكل العضالت – االربطهاألربطة – األوتار‬
‫‪problems‬‬
‫‪Gout / Arthritis‬‬ ‫النقرس ‪/‬التهاب المفاصل‬
‫‪Hernia‬‬ ‫فتق ‪ -‬فتاق‬
‫‪Stomach or duodenal ulcers‬‬ ‫قرحه المعدهالمعدة او قرحه االثنىاالثنا عشر‬
‫‪Chronic indigestion‬‬ ‫عسر الهضم المزمن‬
‫‪Any Intestinal problem‬‬ ‫مشاكل االمعاء‬
‫‪Hemorrhoids‬‬ ‫البواسير‬
‫‪Hepatitis / Other Liver Problems‬‬ ‫التهاب الكبد ( مشاكل(مشاكل الكبد)‬
‫‪Thyroid /Thyroid / Other Gland Problems‬‬ ‫الغده الدرقيهالدرقية (او مشاكل الغدد الصماء‬
‫)الصماء)‬
‫‪Any Gallbladder problems‬‬ ‫مشاكل المرارة‬
‫‪Any kidney disease/ urinary problem‬‬ ‫امراض الكليه أمراض الكلى‬
‫‪Any Gynecological / Obstetric problem‬‬ ‫امراض النساء ‪ /‬مشاكل الوالده الوالدة‬
‫‪Any skin problem Eczema, dermatitis‬‬ ‫مشاكل الجلد (االكزيما ‪ /‬التهاب الجلد ) الجلد)‬
‫‪Allergy to any medicine, food, chemicals‬‬ ‫حساسيه من االدويهاألدوية–االطعمهاألطعمة–‬
‫المواد الكيميائيهالكيميائية‬
‫‪Head injury‬‬ ‫اصابات إصابات الرأس فى الراس‬
‫‪Epilepsy, fainting, fits, blackouts‬‬ ‫الصرع ‪ /‬االغماء او غياب الوعي‬
‫‪Migraine / Vertigo‬‬ ‫الصداع النصفي ‪ /‬الدوار‬
‫‪Any psychiatric problems, depression,‬‬ ‫اي مشاكل عقليه ‪/‬نفسيه ‪ /‬إكتئاب اكتئاب‬
‫‪mania‬‬
‫‪Anxiety / Irrational Fear‬‬ ‫القلق ‪ /‬خوف غير منطقي‬
‫‪Persistent Stress‬‬ ‫استمرار التوتر‬
‫‪Mood Swing / Flight of Ideas‬‬ ‫التقلب المزاجي\ اضطراب الفكر‬
‫‪Intolerable Sleep Problems‬‬ ‫مشاكل او اضطرابات فىفي النوم‬
‫‪Any neurological problem‬‬ ‫اي مشاكل عصبيه أمراض األعصاب‬
‫‪Any major surgery‬‬ ‫اي جراحه كبرى‬
‫‪Any tropical disease, e.g., Malaria‬‬ ‫اي امراض مدارية او معدية (مثل المالريا)‬
‫‪Any vehicle accident-related injury‬‬ ‫اي أصابة أصابه ناتجة عن حادث سير‬
‫‪Any regular medication‬‬ ‫هل تتناول أي دواءأي دواء بانتظام‬
‫‪Any tumor or cancer‬‬ ‫اي ورم او سرطان‬
‫‪Any addiction, e.g., alcohol, drugs‬‬ ‫اي ادمان (الكحول أو األدويه مخدرات )‬

‫‪43‬‬
 Declaration: Please read the below statements the ‫ الرجاء قراءة ما يلي و التوقيعوالتوقيع أدناه‬:‫إقرار‬
statements andbelow and sign
I hereby declare that:
• I have read and understood the conditions in this form.
• I understand that,that the information I provide will be retained on in my employee file and that my employer
reserves the right to access and use the information, in the event of an accident, injury, sickness or claim for
workers’ compensation or for any other reasonable purposes, if so so, required by law.
• I consent to my employer occupational health department representatives in obtaining or exchanging further
medical information from my treating doctors or other health practitioners if required for the purposes of this
assessment.
• My answers relating to my medical and employment history are true and complete to the best of my knowledge.
Furthermore, there is nothing else regarding my health, well being well-being or ability to carry out the potential
role which my employer occupational health Medical Officers may need to know to assess me for the duties of
my job.
• I certify that the answers given by me on this health assessment form are true, complete, and correct to the best
of my knowledge and are made in good faith. I understand that false statements or omissions may void this
medical exam.
• I understand and agree that this report and any related health information provided by me, including
investigations results, may be supplied to other Physicians physicians in order to to establish my medical fitness.

Signature of Examinee ‫ التوقيع‬Date ‫التاريخ‬

44
17.4 Appendix 4 – Generic Medical Examination Form
GENERIC MEDICAL EXAMINATION FORM
)PART II - CLINICAL ASSESSMENT (To be completed by occupational health staff health staff

NURSING EVALUATION To be completed by the Nursing staff (√ as appropriate)

Height Weight BMI Waist (cms) BP Pulse/min PEFR
(cms) (kg) If BMI 35-30 (mm of Hg) (L / min)

Vision Distant Near Colour Vision Blood Group Spoken Voice

RE LE RE LE R Ear L Ear

Uncorrected  Normal  Normal  Normal

 Abnormal  Abnormal  Abnormal

Corrected safe

 Abnormal
unsafe

PHYSICIAN EVALUATION To be completed by Examining Medical Officer (N- Normal, X – Not examined, A-
Abnormal)
Please elaborate below any significant medical or surgical history, any treatment, significant current findings, and
medical management.

General

Head, Face, Neck

Eyes

Ears, Nose, Throat

Mouth, Teeth

Lungs and Chest

Cardiovascular

Hematological

Abdomen, Hernia

Breast (F)

Gynecologic, Pregnancy (F)

Genitalia

Anus, Rectum

Urinary System

Musculo- Skeletal

Spine, Extremities

Neurologic system

Mental Status

45
 Skin& Allergies

Endocrine system

Metabolic system

Malignancy Malignant diseases

SPECIAL INVESTIGATION
Please use this space to elaborate on your clinical findings, abnormal laboratory, other investigation results &
follow-up details.
Chest X-ray Examining Medical Officer Signature and Stamp
ECG
Spirometry
Date:
Audiometry
VO2 Max
Laboratory findings:

Radiology Dept. Stamp

REQUIRED HEALTH MONITORING AND MEDICAL SURVEILLANCE (√ as appropriate)

 Obesity, BMI reduction  Kidney Disorder  Liver Disorder
 Lipid Disorder  Cardiovascular Disorder  Mental Disorder
 Diabetes/ Impaired FBS  Respiratory Disorder  Hearing Conservation
 Hypertension  Infectious Disease  Skin Disorder
 Neoplasm

FITNESS STATUS FOLLOW-UP

Reason for delay in fitness status Date Additional Information

 Candidate not reporting for follow-up

 Laboratory results pending
 Health clearance needed from (MC)
 Awaiting GP or Specialist report
 Appointment with other Physician

FINAL OUTCOME For Occupational Health Medical Officer use only

 Fit for position  Fit with restriction  Fit with adjustment  Temporarily Unfit  Unfit for position

Signature of Medical Officer (OH) Official Stamp

Name: Date:

46
17.5 Appendix 5 – Some Occupations Requiring Medical Screening
Emergency Responders
Includes: Fire-fighters, police, civil defense, ambulance personnel, hazmat emergency responders etc.
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration
• Complete respirator evaluation questionnaire
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios
• Prostate-specific antigen (PSA) after age 40 for positive family
history, or if clinically indicated, after age 50 for all male members
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG

47
 Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz 4000 Hz 3000 Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• National Fire Protection Association (NFPA) 1582: Standard on
comprehensive occupational medical program for fire departments
(USA).

DIVER COMMERCIAL
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration
Physical Examination + +
• Review the health questionnaire
• Check logbook
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far) , Waist circumference
• Physician assessment
¶ General and systemic examination
¶ Otoscopy with Valsalva-test
¶ Neurology /locomotion system: Nystagmus (spontaneous and
after head movement), sharpened Romberg test, sensitivity and
motor function, gait, grasping small objects, reflexes (patella and
Achilles, etc.), cranial nerves
Psychological judgment + -
Chest X-ray + -
• Posterior-anterior view
Blood test + +
• Full blood count
• Fasting blood glucose

48
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear at each of the following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Post-exercise PEF/ FEV1
Aerobic capacity + -
Step test protocol
Frequency Before offering Annually
employment

Restrictions:
Refer to the below-mentioned standard.
References:
Fitness to Dive Standards: Guidelines for medical assessment of working
divers.
European Diving Technology Committee (EDTC).

COMMERCIAL PILOT - AERO PLANE, AIRSHIP, HELICOPTER

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration
• Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far)
¶ Color vision assessment
• Physician assessment
¶ General and systemic examination
¶ Neurology / locomotion system
Psychological judgement + +
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Fasting blood glucose
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin

49
 Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + Every 5 years
• A resting 12-lead ECG until age 30,
every 2 years
until age 40,
annually after
age 40
Audiometry + +
In each ear at each of the following frequencies:
500 Hz
1000 Hz
2000 Hz 4000 Hz 3000 Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• Qatar Civil Aviation Regulations No. 001 of 2016: Aircrew Licensing

Commercial Vehicle 3.5 to 7.5 ton

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views

50
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• Department of Transport (UK). DVLA. Medical Standards for fitness to
drive.

51
 Heavy Equipment - eg. Crane, Bulldozer
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL

Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz 4000 Hz 3000 Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol

52
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• Department of Transport (UK). DVLA. Medical Standards for fitness to
drive.

Health Care Workers

Includes: Physicians, Nurses, Nursing Assistants, Dentist, Therapists –physiotherapists, occupational therapists,
respiratory therapists, Technicians – ECG, respiratory, radiographer, laboratory, radiology, sterilization/CSSD

Physician
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR

53
 Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
A resting -12lead ECG
Audiometry + +
In each ear - following frequencies:
500 Hz
1000 Hz 4000 Hz 3000 Hz 8000 Hz
6000 Hz 2000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment

Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

Nurse, Nursing Assistant

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views

54
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

55
 Dentist
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting -12lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.

56
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment

Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

Physiotherapist / Occupational / Respiratory Therapist

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR

57
 Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

Technicians: ECG, Respiratory, Radiographer

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
• Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
• General and systemic examination
• Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views

58
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family history,
or if clinically indicated, after age 50 for all male members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment

Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

59
 Laboratory Technician, Radiology Technician
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family
history, or if clinically indicated, after age 50 for all male
members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and
bilirubin
Serology + -
• HIV, HBV, HCV, RPR

Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
• Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz

60
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

Sterilization Technician

ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC MEDICAL

MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3

Physical Examination + +
• Review the health questionnaire
• Nursing assessment
• Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
• General and systemic examination
• Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family
history, or if clinically indicated, after age 50 for all male
members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and
bilirubin
Serology + -
• HIV, HBV, HCV, RPR

61
 Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz
Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

62
 Sea Farers
Includes: Marine Skippers/Captains, boat masters and seaman etc
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration- Appendix 3
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision (Near & Far), color vision
• Physician assessment
¶ General and systemic examination
¶ Mental health screening
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Basic electrolytes
• Renal function (BUN, creatinine, uric acid)
• Fasting blood glucose
• Liver function tests (ALT, AST, GGT)
• Total cholesterol, HDL, LDL, lipid ratios, triglycerides
• Prostate-specific antigen (PSA) after age 40 for positive family
history, or if clinically indicated, after age 50 for all male
members.
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and
bilirubin
Serology + -
• HIV, HBV, HCV, RPR
Drug testing + -
• Amphetamine (AMP)
• Barbiturates
• Benzodiazepines
• Cocaine
¶ Marijuana Methadone
¶ Methamphetamine
¶ Opiate
¶ Phencyclidine
¶ Tricyclic antidepressants
ECG + +
• A resting 12-lead ECG
Audiometry + +
• In each ear - following frequencies:
500 Hz
1000 Hz
2000 Hz
3000 Hz 4000Hz
6000 Hz
8000 Hz

63
 Spirometry + +
• To measure the member’s forced vital capacity (FVC), forced
expiratory volume in 1 second (FEV1), and the FEV1/FVC ratio.
Aerobic capacity + +
• Step test or treadmill protocol
Functional capacity + +
• Grip strength
• Leg strength
• Arm strength Push-up
• Curl-up
• Sit-and-reach
Frequency Before offering Annually
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• CDC ‘Yellow Book’, USA, Atlanta, GA.

Teacher
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision
• Physician assessment
¶ General and systemic examination
Psychological judgement + +
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Fasting blood glucose
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and
bilirubin
Serology + -
• HIV, HBV, HCV, RPR
ECG + +
• A resting 12-lead ECG (above 30 years)
Audiometry + +
• In each ear - following frequencies:
• 500Hz – 8000Hz
Frequency Before offering Every 3 years
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• Occupational health advice on medical fitness to teach. Ireland
Department of Education

64
 Taxi Driver (1 to 7 passengers)
ASSESSMENT ELEMENTS PRE-EMPLOYMENT PERIODIC
MEDICAL MEDICAL
Health Questionnaire + +
• Complete questionnaire and sign declaration
Physical Examination + +
• Review the health questionnaire
• Nursing assessment
¶ Height, weight, BMI, BP, Vision
• Physician assessment
¶ General and systemic examination
Psychological judgement + +
Chest X-ray + -
• Posterior-anterior and lateral views
Blood test + +
• Full blood count
• Fasting blood glucose
Urinalysis + +
• Glucose, ketones, leukocyte esterase, protein, blood, and
bilirubin
Serology + -
• HIV, HBV, HCV, RPR
ECG + +
• A resting 12-lead ECG (above 30 years)
Audiometry + +
• In each ear - following frequencies:
• 500Hz – 8000Hz
Frequency Before offering Every 3 years
employment
Restrictions:
• Refer to the below-mentioned standard.
References:
• Department of Transport (UK). DVLA. Medical Standards for
fitness to drive.

65
 17.6 Appendix 6 - Generic Fitness to Work Certificate
Note: The following certificate shall be reproduced on company/ medical center letterhead having
full correspondence address after comprehensive evaluation of the candidate undergoing
occupational health medical examination. This certificate is invalid without photograph of candidate.
examining physicians signature . dates and official stamp.

Attach a recent
FITNESS TO WORK passport size
photograph of

CERTIFICATE
the candidate

Name: ...............................................................................................................................................................................................

Date of Birth: .................................................................... Nationality: ..........................................................................................

Qatar ID No.: ....................................................................... Company ID No.: ............................................................................

Company Name: .............................................................................................................................................................................

Job Title: ..........................................................................................................................................................................................

Above mentioned individual has been examined in accordance with Company Name Fitness
to work medical guidelines. (Strike out which is not applicable)
Medically fit for current position unrestricted
Medically fit for current position with restrictions I surveillance
Temporarily unfit for current position
Permanently unfit for current position

Details of work restrictions / surveillance if any:

1.
2.
3.
4.

Examining Physician Name: ...........................................................................................................................................................

Designation: ....................................................................................................................................................................................

Practice license no.: ........................................................................................................................................................................

Name of licensing organization: ...................................................................................................................................................

Date of examination: ......................................................................................................................................................................

Date of expiry of certificate: ..........................................................................................................................................................

Examining Physician Signature Stamp

Complete address for correspondence:

66
17.7 Appendix 7 - Audiometry Questionnaire
1. Personal details [To be completed by the Employee/Candidate, put an X as appropriate]
MIMS Record no.:
Name:
Gender: Male Female DOB/Age: Staff No.:

Nationality: Mobile/Phone No.:

Reason for test: Pre placement (baseline) Periodic (annual) FTW STS Exposure Final exit

2. Occupational Noise Exposure details [To be completed by the Employee/Candidate, put an X as

appropriate]
Job title:
Length of service with the present employer: years months

How long have you done the above-mentioned job: years months
List previous occupations involving excessive Noise or Vibration exposure [most recent first]
Dates : (From-To) Job title Used Hearing protection
 No  Sometimes  Always
 No  Sometimes  Always
Presently do you work in a noisy environment?  Yes  No
If yes, do you wear hearing protection on this job?  No  Sometimes  Always
If yes, describe the type of noise you are exposed to
 Continuous  Intermittent  Impulsive  Combination

Any noisy hobbies, e.g., using power tools,  Yes  No

If yes using PPE  Always  Sometimes  Never
Any second job that is noisy?  Yes  No
If yes using PPE  Always  Sometimes  Never
Military service,  Yes  No
If yes any exposure to Artillery fire Blast Explosion

Are you aware of any hearing loss?  Yes  No

If yes, have you had this evaluated?  Yes  No
If yes, when (Year) :

Time-wise, how did the loss occur?  Gradually  Suddenly  Recently  Childhood
 Unaware

How long has it been since your last exposure to  1-8hrs  14 hrs  24- 48hrs  > 48hr
noises without protection?
3. Medical Questionnaire [To be completed by the Employee/Candidate, put an X as appropriate]
If any of the below-mentioned condition applies to you presently or in the past, select (Yes) or (No) as appropriate.
Ear Problems  Yes Cold [Last one week only]  Yes Severe allergy  Yes
 No  No  No

Excess ear wax  Yes Discharge from ear  Yes Ear surgery  Yes
 No  No  No
Sinus problem  Yes  Yes Ear drum rupture  Yes
 No Recent ENT consultation  No  No
Ear pain  Yes  Yes Discomfort in ears  Yes
 No Using Hearing aid  No  No
Ear infection  Yes  Yes Difficulty in hearing  Yes
 No Ringing in ears  No  No

67
 Severe dizziness  Yes Childhood Diseases  Yes Red Measles  Yes
 No Medications  No  No
Medical Conditions
Mumps  Yes Aspirin  Yes High BP  Yes
 No  No  No
Gentamycin  Yes Streptomycin  Yes Scarlet Fever  Yes
 No  No  No
Family history of hearing  Yes Kanamycin  Yes Diabetes  Yes
loss  No  No  No
before age 50?
Cancer Chemotherapy  Yes Meningitis  Yes Head Injury  Yes
 No  No  No
Vertigo  Yes  Yes  Yes
 No  No  No
If applicable, please provide details here:

4. Recreational Exposure [To be completed by the Employee/Candidate, put an X as appropriate]

 Hunting  Auto racing  Power tools  Target practice

 Motorcycling  Loud music  Others (Specify) :

The information I have provided is true and complete to the best of my knowledge.
Employee/Candidate Signature: Date:

5. Otoscope Screening [To be completed by OH Nurse, put an X as appropriate]

 Clear – CL  Inflamed – IN  RE  CL IN PC PP TOC S

 Partial Cerumen – PC  Possible  Perforation – PP  LE  CL IN PC PP TOC S

 Scarring – S  Total Occlude Cerumen – TOC

6. OH Nurse Comments [put a X as appropriate]

 Audiometry can be performed

 Audiometry should be deferred
 OH MO consultation before audiometry

Employee needs awareness and education on hearing protection

OHN Name:................................................................................................................................................................................

Staff No.:...................................................................................................................... Date: ....................................................

68
17.8 Appendix 8 - Job Hazard Analysis Form
JOB

TITLE OF PERSON WHO SUPERVISOR: ANALYSIS BY:

DOES JOB:

DEPERTMENT: SECTION: Reviewed BY:

APPROVED BY:

SEQUENCE OF BASIC POTENTIAL ACCIDENTS RECOMMENDED SAFE JOB PROCEDURE

JOB STEPS OR HAZARDS Hazard Control Categories: Engineer Out (New Way to Do,
Beware of being too detailed, Hazard Classification Categories: Change Physical Conditions or Work Procedures, Adjust/Modify/
record only the information Stuck By/Against, Caught In/ Replace Work Station Components/Tools, Decrease
needed to describe each job Between, Slip, Trip, or Fall, Performance Frequency), Personal Protective Equipment (PPE),
action. Rule of thumb, no more Overexertion, Ergonomic Training, Improve Housekeeping
than 10 steps/task being (Awkward Postures, Excessive
evaluated Force, Vibration, Repetitive
Motion)

69
 17.9 Appendix 9 - Risk Assessment Form
Name of assessor Date

Time Work area

Task being assessed

New risk Action/ Action/

How Existing Additional
What is Who might Risk rating rating monitored monitored
might risk controls
the be (Residual) by whom? by when?
people be control
hazard? harmed?
harmed? measures
L C R L C R

Review Date Signature

70