The registered medical practitioner carrying out or supervising a health monitoring program is expected to have the appropriate skills, qualifications and experience. The following information outlines the key elements of a health monitoring program that a registered medical practitioner engaged to carry out or supervise this work is expected to show.
Planning a health monitoring program
Establish and maintain arrangements for the development of a health monitoring program:
- consult the person conducting a business or undertaking (PCBU) and workers to establish the relationship between the health monitoring program and the risk assessment process, and
- ensure a mechanism is established to consider worker concerns.
Establish the relevant hazardous chemical(s) to which the workplace population is exposed and the appropriate type of health monitoring:
- utilise the workplace risk assessment to identify:
- the hazardous hazardous chemical(s), and
- the degree of likely worker exposure, and
- identify the appropriate type(s) of health monitoring.
Establish an information base for the performance of the health monitoring program:
- source all relevant information including guidelines for health monitoring and safety data sheets (SDS) for the hazardous chemical of concern
- ensure the information is readily available.
Establish mechanisms for specimen collection, transport and analysis:
- identify an accredited laboratory and engage them to carry out and report on the specified tests within agreed timelines
- establish a protocol which is approved by the accredited laboratory for specimen collection and testing which specifies:
- appropriate collection techniques (including spirometry and lung function tests)
- specimen containers, and
- specimen transport conditions prior to receipt for analysis, and
- specify a protocol and measures to prevent specimen contamination, control infection and dispose of biological wastes.
Establish delegation in the performance of health monitoring:
- develop a protocol to define the roles and responsibilities of all persons involved in health monitoring based on skills relevant to activities to be performed.
Ensure that all staff required to perform health monitoring activities are adequately trained to perform the activities assigned to them:
- provide sufficient instruction to all staff required to perform health monitoring activities to enable them to competently perform the activities assigned to them.
Implementing a health monitoring program
Undertake the prescribed history, examination and testing with reference to the Health monitoring guides for hazardous chemicals:
- list occupational and medical history
- perform and record the appropriate physical examination, and
- prescribe the appropriate tests to monitor exposure.
Ensure specified procedures for collection, transport and storage of biological specimens are followed to reduce the sources of error:
- perform the correct procedure for the collection of the specimens
- observe special requirements for transport of the specimens
- ensure special conditions for storage of the specimens while awaiting analysis are available, and
- recognise and minimise likely sources of error for each test procedure.
Advise workers of potential health effects of chemicals used in the workplace:
- recognise and explain the potential health effects related to the hazardous chemicals
- explain in lay terms any symptoms or signs, which suggest exposure to hazardous chemicals, and
- explain the routes of entry into the body and the most likely route of exposure for the work conditions for the hazardous chemicals.
Recognise the limitations of tests:
- recognise the limitations to routine tests used to monitor worker exposure to hazardous chemicals and consider these when interpreting results, and
- arrange a confirmation, repeat or additional testing when indicated.
Interpret the results of tests in the light of the individual's general state of health:
- interpret test results by reference to appropriate standards and clinical findings
- assess serial results to establish the significance of any trend that suggests an adverse reaction caused by exposure to a hazardous chemical, and
- identify individual or group results requiring corrective action at the workplace.
Notify PCBU of results and implications of health monitoring:
- provide a report that explains the results of health monitoring to the duty holder
- reports of health monitoring:
- clearly indicate if elevated levels of exposure or abnormal results and their possible association with workplace exposures are explained
- clearly indicate if a worker has been advised to have further tests or medical counselling, and
- are written with appropriate safeguards on worker confidentiality
- interpret the results of health monitoring, including any trends, with regard to implications for the workplace
- advise appropriate preventive and remedial action at the workplace in the report, and
- recommend further investigations or referrals as indicated by health monitoring results.
Arrange appropriate management of the worker including:
- treatment or referral for workers with abnormal results
- rehabilitation of a worker with a clinical abnormality related to hazardous chemicals affecting work capability, and
- referral to treating doctor for management of incidental findings.
Decide on recommendations in relation to a review of control measures by the PCBU, including considerations of when a worker should be removed from work that triggered the requirement for health monitoring or return to work with that hazardous chemical:
- removal from working with a relevant hazardous chemical is indicated by the results of health monitoring
- return to work with the relevant hazardous chemical is permitted by the results of health monitoring, and
- the PCBU should be recommended to provide the health monitoring report to the WHS regulator.
Evaluating a health monitoring program
Ensure that the health monitoring procedures follow the health monitoring requirements of the model WHS Regulations and this guide.
Ensure that health monitoring procedures are developed in consultation with the PCBU and workers:
Ensure that examination and testing procedures used for health monitoring are appropriate and adequate:
- demonstrate appropriate and consistent examination techniques
- demonstrate the ability to differentiate abnormal clinical signs
- demonstrate the ability to assess clinical and testing competencies of any delegated person involved in health monitoring
- demonstrate knowledge of the appropriate tests for a given hazardous chemical, and
- ensure all samples are collected, transported and analysed in accordance with the laboratory protocol.
Ensure correct interpretation of individual test results:
- interpretation of individual test results is based on the health monitoring guidelines where relevant
- knowledge of the implications of cumulative exposure is demonstrated
- knowledge of potential actions in response to individual health monitoring results is demonstrated
- selection of appropriate diagnostic testing and/or referral for confirmation of test results is demonstrated, and
- a random sample of decisions is audited by peer review.
Interpret group data to identify adverse trends in health monitoring:
- knowledge of the importance of determining adverse health monitoring trends is demonstrated, and
- group results are referred for specialist advice where appropriate.
Communicate with the PCBU:
- ensure all health monitoring results, and actions from those results are communicated in a form and language (written or oral) that is understandable to the PCBU
- provide information in a timely manner
- inform the PCBU in writing of the appropriate action to modify individual or group exposures
- follow-up to ascertain the PCBU has acted on advice, and
- know the information that the PCBU should provide.
Ensure that the practitioner's decisions concerning actions based on health monitoring are correct:
- a random sample of cases is audited by peer review, and
- the decisions and recommendations made are consistent with this guide and the WHS Regulations.
Ensure that the practitioner assesses dissatisfaction expressed by the PCBU or worker:
- information is sought as to the reasons for dissatisfaction and
- corrective action is taken where appropriate.
Seeking advice on a health monitoring program
Recognise when to seek advice regarding health monitoring from health and safety specialists:
- advice is sought to:
- implement a program of health monitoring
- interpret results of health monitoring
- review individual results and aggregate data
- explain the meaning of results to the PCBU or workers in the context of the workplace, and
- assess the need for a review of control measures.
Consult with the PCBU where the involvement of other professionals is recommended:
- the reasons for further specialist advice are discussed with the PCBU.
Recognise when to seek advice from an occupational physician on the requirements for health monitoring for chemical(s) not listed in the model WHS Regulations:
- advice is sought where workers may be exposed to undesirable levels of chemical(s) not listed in the model WHS Regulations.
Additional elements for occupational physicians
Planning, implementing and advising on a health monitoring program
A registered medical practitioner who is also an occupational physician, is able to plan, implement, evaluate and advise on health monitoring programs for any hazardous chemical requiring health monitoring revealed by the assessment processes, including those for which there are no existing guidelines.
For chemicals that do not have existing guidelines, develop a program of health monitoring:
- develop protocols for health monitoring for the chemical
- implement the program of health monitoring where required
- evaluate the effectiveness of any health monitoring protocol
- identify health effects of specific hazardous chemicals and carry out appropriate health examinations
- identify biological monitoring tests suitable to assess exposure to specific hazardous chemicals
- identify biological effects of specific hazardous chemicals, and
- identify the limitations of any investigation selected to monitor exposure to a specific hazardous chemical.
Advise on special sub-groups and individuals who may have characteristics that increase their susceptibility to hazardous chemicals:
- identify individuals likely to be more susceptible to adverse health effects of hazardous chemicals
- identify subgroups having increased susceptibility to particular adverse health effects of hazardous chemicals
- advise existing and prospective workers with identified increased susceptibility to hazardous chemicals, and
- advise the PCBU about the fitness for work in specific processes of individuals with increased susceptibility.
Consult with the PCBU on the need for review of control measures:
- identify and consult the appropriate personnel in the workplace
- advise the PCBU on appropriate procedures to control exposure to hazardous chemicals, and
- advise the PCBU when there is a need to review the control of hazardous chemicals when indicated by the results of health monitoring.
Updating and monitoring a health monitoring program
A registered medical practitioner who is also an occupational physician is able to interpret the medical, toxicological and epidemiological literature and apply this knowledge in order to adopt best practice in health monitoring.
Review new information and testing techniques to ensure the most appropriate current health monitoring:
- regularly peruse the peer reviewed literature
- conduct relevant computerised data base searches, and
- interpret the significance of literature reports in the light of the particular workplace.
Review the assessment documents for changes to technology and use of hazardous chemicals in the workplace:
- regularly access the workplace assessment documents and reports, and
- review the health monitoring program when changes occur either in technology or how the relevant hazardous chemical is used in the workplace.
Advising other workplaces and practitioners on a health monitoring program
A registered medical practitioner who is also an occupational physician is able to provide advice to other registered medical practitioners, workplaces and other health professionals on the appropriateness, planning, implementation and evaluation of health monitoring programs.
Advise on the appropriateness of proposed or existing health monitoring programs:
- review the proposed or existing program of health monitoring, and
- provide appropriate advice in the context of the given workplace.
Advise on the interpretation of individual and aggregate data:
- provide advice on the interpretation of individual or aggregate health monitoring data, and
- consider the particular workplace processes and control measures when interpreting data.
Advise on the appropriate consultation with the workplace concerning health monitoring results:
- provide advice on adverse results in the context of the particular workplace, and
- provide advice on the need for a review of control measures.