What is an Occupational Health Assessment?

In the workplace, there are numerous hazards that have the potential to cause harm to employees, such as injury and ill health. The health and safety risks they may be exposed to will depend on what their occupation is, what their tasks are and the environment in which they work.

Employers have a legal duty to protect their employees from health and safety risks whilst they are at work. Despite this, millions of workers still suffer from ill health as a result of their occupations.

According to the HSE health and safety statistics (2019/2020), there were:

• 1.6 million work-related ill health cases (new or long-standing).
• 32.5 million working days lost due to work-related ill health.
• £10.6 billion annual costs of new cases of work-related ill health.

Musculoskeletal disorders and stress, depression or anxiety were the main causes of ill health cases and working days lost.

These statistics highlight that work-related ill health has many associated costs and not just financial ones. If an employee becomes ill because of their work, it can impact them, their employer and society as a whole.

For example:

• The employee may not be able to continue work, which could affect their finances, their family, and their physical and mental wellbeing.
• The employer may lose a skilled worker, which could affect productivity and morale. They may also face enforcement action by the HSE, and the employee may claim compensation.
• Society contributes to the NHS and benefits through taxes. If an individual cannot work due to ill health, this can be a cost to the taxpayer.

Therefore, it is in everyone’s interest to ensure that employees are kept safe and healthy whilst they are at work. One way of achieving this is occupational health, which is a medical service that looks at the effects of work on employees’ health and vice versa.

Occupational health can be both proactive and reactive. It aims to prevent work-related ill health in the first instance and promotes physical and mental wellbeing. It can also identify actions needed to stop existing ill health from worsening and determines whether control measures are working by frequently monitoring employees’ health.

Occupational health is not about curing illnesses, although it can have many positive benefits and lead to diagnoses and treatment. It is a multi-disciplinary approach that covers many aspects of health.

In this article, you will look at what occupational health is, what occupational health assessments are and some examples of the different types.

What is occupational health?

To understand what occupational health means, let’s break it down:

• Occupational – means something that relates to a person’s job or profession.
• Health – “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO).

The World Health Organisation (WHO) and the International Labour Organisation (ILO) put a definition of occupational health together in 1950. It was defined as:

“The promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations by preventing departures of health, controlling risk and the adaption of work to people, and people to their jobs”.

This definition was updated in 1995 by the WHO and ILO during a committee on occupational health.

It included three objectives:

• The maintenance and promotion of workers’ health and working capacity.
• The improvement of the working environment and work to become conducive to health and safety.
• The development of the work organisation and working cultures in the direction which supports health and safety at work, and in doing so promotes a positive social culture and smooth operation and may enhance productivity of the undertaking.

As you can see, the definition of occupational health encompasses many aspects and emphasises employee wellbeing. It is a two-way relationship, which looks at how a person’s work affects their health and how their health affects their work. It is about keeping employees well at work, both physically and mentally.

You can find more about mental health and wellbeing by accessing our knowledge base. We also have a course on Workplace Mental Health where you can learn more about the overall concepts of mental health and wellbeing.

What is an occupational health assessment?

An occupational health assessment is a medical examination performed on employees and is carried out by a qualified occupational health professional. This can be a doctor, nurse, adviser, technician or another physician who has undertaken additional occupational health qualifications.

The type of occupational health provision within an organisation will usually depend on its size. Larger organisations with higher risks sometimes have occupational health specialists working in-house. Smaller organisations tend to use external providers as and when the need for occupational health arises.

The main purpose of an occupational health assessment is to assess an employee’s health in relation to their work. The occupational health professional then gives advice and makes recommendations to the employer on the adjustments needed to ensure the employee’s working environment is safe and healthy.

Ultimately, occupational health assessments are used to prevent work-related ill health. They can also be used to determine an employee’s fitness to work and can identify whether any pre-existing health conditions can increase the risks of ill health.

Occupational health assessment is a general term that covers many different types of specific assessments.

What are the different types of occupational health assessments?

There are many different types of occupational health assessment and too many to cover in this article. The occupational health assessments needed will depend on an employee’s job role, the tasks, the hazards they are exposed to, and any existing health issues. Employers should ensure that they use the findings of their risk assessments to help them determine the type of assessments required.

Some examples of occupational health assessments you will look at here are:

• Pre-employment assessments.
• Fitness for work assessments.
• Return to work and sickness absence management.
• Health surveillance and medical surveillance.
• Other types of assessments.

Pre-employment assessments

These type of assessments are also known as pre-placement health assessments, screening or checks. They are only usually carried out after an offer of employment has been made and accepted and should be completed before an employee starts their job.

Whether the individual will be appointed to the role will depend on a satisfactory assessment. However, employers must be careful not to discriminate against employees when carrying out these assessments. If an employer uses the results to prevent someone with a disability from getting the role and reasonable adjustments can be made, this may be unlawful under the Equality Act 2010.

That is why many organisations will not use pre-employment assessments until a job offer has been made. However, some roles will require assessments to be completed before a job offer due to the area of work, risks and the fitness standards required, e.g. train drivers and heavy goods vehicle drivers.

Pre-employment assessments typically consist of one, or both, of the following:

• Questionnaires – the prospective employee completes a questionnaire to determine if there are any problems and whether further assessment is required.
• Medical examinations and tests – if the questionnaire has identified an issue that requires further investigation, the employee may be asked to undergo a medical examination and tests.

The level of pre-employment assessment required will depend on the nature of the job. Some specific activities legally require medical examinations to be completed, e.g. work with asbestos and lead. Certain roles will also require testing due to legal requirements, e.g. eye tests for commercial drivers.

Pre-employment assessments should never be used to exclude an individual from a role.

The purpose of these assessments is to:

• Establish baseline health records for comparisons, e.g. vibration or hearing tests before working with vibrating tools or in a noisy environment.
• Risk assess how the job may affect their health and identify additional precautions.
• Ensure that they are medically suited and fit to do the duties and responsibilities required of the job.
• Determine whether reasonable adjustments can be made to help them in their role.

Employers should always seek advice on managing pre-employment assessments if they have any doubts regarding the legalities of a situation. Further guidance on pre-employment assessments.

Fitness for work assessments

Fitness for work assessments/examinations are also known as fit for role health checks. These are similar to pre-employment assessments. However, the difference is that employees are assessed periodically throughout their working life. Some fitness for work assessments are even a legal requirement for particular roles, e.g. commercial pilots, train drivers and heavy goods vehicle drivers.

The purpose of this type of assessment is to determine whether an employee is medically fit to perform their tasks effectively and safely. If they are unfit, they can put themselves and others at risk of injury and ill health.

This type of assessment may be required due to an individual having an existing health condition that could:

• Prevent or hinder them from doing the job effectively, e.g. if they have a musculoskeletal disorder that will result in them struggling to do any manual handling activities.
• Make particular tasks and work environments unsafe for them and others, e.g. if they are prone to seizures and their role is safety-critical, such as operating dangerous vehicles or machinery.
• Be made worse by the work, e.g. if they have asthma and the job requires them to work with isocyanates.
• Pose a risk to others in the community, e.g. if they have infections that could be transmitted via food, and they are a food handler.

Some examples of the roles that would require a fitness for work assessment are:

• Work at height.
• Confined space work.
• Work in temperature extremes.
• Diving operations.
• Lone working.
• Driving class 2 vehicles, i.e. heavy goods vehicles.
• Piloting commercial aircraft.
• Crane operation.
• Forklift truck operation.
• Night shift work.

These roles require a higher degree of physical and/or mental capability and fitness. For example, if there is an emergency in a confined space, an employee must be capable of quickly responding. Some are also safety-critical, which means that there could be serious consequences if the employee falls ill whilst doing their job.

Fitness for work assessments can also be used:

• To determine whether an employee’s existing ill health issues could affect their performance and safety.
• After an incident where existing ill health issues, such as alcohol or drug misuse, are suspected to be the cause.
• To assess whether an employee is fit to return to work following a prolonged period of sickness absence, e.g. ill health or an injury.

As with pre-employment assessments, employers must always keep the Equality Act 2010 in mind when conducting assessments and using the results.

Return to work and sickness absence management

Occupational health assessments can also be used when an employee has been absent from work due to sickness, particularly after a long-term absence. A referral can be made to an occupational health provider who assesses the employee and provides a report to the employer. This type of assessment can also tie in with fitness for work assessments.

The purpose of the assessment is to help the employer understand what the employee needs to return to work and to do the job effectively and safely. It also aims to address any issues that can result in any further sickness absences. The assessment may recommend a phased return to work, further referrals, adjustments (i.e. to their workstation) or more time away from work.

This type of assessment is not mandatory, and an employee does not have to agree to it. However, it is important as it can assist them to get back to work, and it ensures that they have the support needed to carry out their role. Employers should have policies and procedures for sickness absence and return to work management. NICE Guideline NG146 provides further guidance on managing long-term sickness absence and capability to work.

It is important to note that employers will also need to factor in COVID-19 when looking at sickness absence and return to work management and occupational health in general.

You can find further information on sickness absence and return to work on the HSE’s webpage.

Health and medical surveillance

Health surveillance is another example of an occupational health assessment, which covers many different types of checks. According to the HSE, health surveillance is “a system of ongoing health checks”.

It monitors the health of employees exposed to specific health risks, such as:

• Noise or vibration.
• Ionising radiation.
• Hazardous substances, e.g. solvents, fumes, dusts, biological agents and other substances hazardous to health.

There are numerous reasons why health surveillance is important. It allows ill health effects to be detected early, so further controls can be implemented to prevent them from worsening. It also improves on risk assessments and involves employees in decisions regarding their work and impacts on their health.

Certain types of occupational health monitoring may be required by law. Employers have a general duty under the Health and Safety at Work, etc. Act 1974 to ensure (so far as is reasonably practicable) the health, safety and welfare of all their employees whilst they are at work.

Employers also have a legal duty to implement a health surveillance programme if their employees are exposed to certain health risks. This requirement comes under the Management of Health and Safety at Work Regulations 1999 (regulation 6):

“Every employer shall ensure that their employees are provided with such health surveillance as is appropriate having regard to the risks to their health and safety which are identified by the assessment”.

Health surveillance is also a legal requirement under specific regulations, for example:

• The Control of Substances Hazardous to Health Regulations 2002 – exposure to certain hazardous substances.
• The Control of Noise at Work Regulations 2005 – exposure to certain noise levels.
• The Control of Vibration at Work Regulations 2005 – exposure to certain vibration levels.

Whether health surveillance is required will depend on the findings of the employer’s risk assessment. If the remaining health risks are significant after control measures have been identified and implemented, health surveillance will likely be required.

Health surveillance can involve questionnaires, examinations and tests. Some examples of the assessments carried out by an occupational health provider include:

• Lung function tests (spirometry) – to check for lung function.
• Hearing tests (audiometry) – to check for hearing loss.
• Skin checks – to check for dermatitis.
• Hand Arm Vibration Syndrome (HAVS) checks – to check for vibration-related health conditions.

The HSE has a section on health surveillance on their website.

There is also medical surveillance, which is different from health surveillance, as assessments have to be carried out by a relevant doctor. They are required under specific legislation relating to lead, asbestos, ionising radiation and certain hazardous substances. For example, biological monitoring – testing for lead in the blood.

Other types of assessments

There are many other types of occupational health assessments which cover health issues and risks, such as:

• Mental health and stress assessments.
• Display screen equipment (DSE) and ergonomic workstation assessments.
• Musculoskeletal assessments.
• Visual and eye tests.
• Workplace wellbeing checks.
• Health and lifestyle checks.

CIPD’s factsheet on occupational health details the types of services offered to employers to assist them with their legal obligations.

Summary

Millions of workers in the UK suffer from ill health as a result of their occupations. Therefore, their physical, mental and social wellbeing is of vital importance.

Employers must take their responsibilities towards employees seriously. If employees are made ill (or their health made worse) by work, it can have wide-ranging impacts. Employees are valuable assets; they should not suffer from ill health as a result of going to work.

Employers have legal duties to ensure the health, safety and welfare of their employees. Occupational health is part of this duty when employees are exposed to particular health and safety risks. It is also vital for managing sickness absence and returns to work and ensuring that employees are fit to carry out their roles effectively and safely.

There are many different types of occupational health assessments. They should be used as a complementary measure and based on the findings of risk assessments. Employers must firstly ensure that health and safety risks are properly assessed, and precautions are in place to prevent ill health and injuries where possible.

Where prevention is not reasonably practicable, then employers must reduce the risks to the lowest possible level. Occupational health assessments are a way of ensuring that employers are fulfilling their obligations to their employees by reducing the risks to their health.

Employers must always choose a competent occupational health provider and ensure that any assessments are carried out in line with relevant health and safety and employment laws. Employees must also consent before being referred to occupational health, and the information obtained must always be kept confidential.

IOSH’s guidance on occupational health management provides further details on what to consider when using an occupational health provider.