Health surveillance in the event of exposure to major risks

Health surveillance is the set of medical checks aimed at protecting the health of those who are exposed to major risks while working or studying.

Depending on the severity of the risk and on its assessment, you may be required to undergo a health surveillance medical examination. This means that not everybody must undergo the examination.

Reference is made to Legislative Decree 81/2008.

Surveillance is mandatory when health risk levels are higher than negligible. These levels are identified by the Prevention and Protection Service in the Risk Assessment Document (DVR).

Specific risks include:

• chemical risk, carcinogenic risk, biological risk, physical risk (noise, vibration, electromagnetic fields or artificial optical radiation), biomechanical risk and manual handling of loads, display screen equipment risk, etc.

There is, in any case, a legal obligation to assess all potential risks to the health and safety of workers, including work-related stress, work at height, work in confined spaces, underwater work, outdoor work with exposure to extreme weather conditions, etc.

Under certain circumstances, surveillance is mandatory because carrying out special activities (e.g. night shifts) or jobs may pose a risk to your health and safety and to the health and safety of others. For example, mandatory drug testing is required for drivers, including occasional drivers, of earth moving and goods handling machinery (e.g. forklifts).

In the event of exposure to ionising radiation, see the dedicated health surveillance fact sheet.

To learn more

Summary of risk factors for which health surveillance is required by law [ .pdf 239Kb ]

Surveillance is mandatory for individuals who are exposed to higher levels than what is considered safe for the health of most people. These limits may be defined by law or be derived from technical standards.
Surveillance is also mandatory for individuals who carry out special activities or jobs that may pose a risk to their health and safety and to the health and safety of others (e.g. night shifts, driving forklifts, etc.). 
The Risk Assessment Document (DVR) specifies who is subject to health surveillance.

Depending on their role and job, the following persons may perform tasks that pose a risk to health:

• Teaching, research and professional staff;
• Non-employed staff and staff of public and private partner organisations, who carry out their activity at the University facilities;

Student community, PhD students, specialisation school students, interns, research fellows or grant holders.

Those who are not subject to mandatory health surveillance checks are entitled to undergo an eye test under the Health Promotion Programme or be examined by the Occupational Health Physician if they believe they are suffering from health problems in connection with their work.

In particular, the programme offers the following:

• Eye examinations: Anyone who systematically uses a personal computer for carrying out their tasks but is not subject to mandatory surveillance is entitled to this. Access is from the age of 40. The examination can then be repeated as often as display screen equipment users do (every 5 years, and every 2 years over 50 years of age).
• Vaccinations: Because of their role, the University emergency response staff (fire-fighting and first aid team) can be tested for tetanus and viral hepatitis B immunity. If necessary, they can voluntarily vaccinate against those diseases.

In addition, all fixed-term and permanent employees and research fellows have the opportunity to vaccinate against flu.

Features of the Health Promotion Programme

• The programme is entirely voluntary and those who wish to join must expressly state so.
• It relies on the availability of resources and on the logistics of the Occupational Medicine Service. In any case, priority must be given to the other mandatory institutional activities.
• It requires prevention to adhere to the principles of scientificity and proven effectiveness, having regard to the type of tests, age groups, frequency of any follow-up, etc.

How can you join the programme?

Send an email to servmedlav.medicinadellavoro@unibo.it, specifying your date of birth and structure.

In order to promote targeted inclusion of professional staff with a certified disability pursuant to Law 68/99, in cases where health surveillance is not required, at the employer’s request, the Occupational Health Physician provides a medical opinion considering the health status of the person concerned and the job assigned.

In general, also in other cases for which health surveillance is not required, the Occupational Health Physician may be called upon to provide an opinion in order to allow the employer to take specific and targeted measures, based on the reasonable accommodation principle, to remove any obstacles and promote autonomy at work, thus striking a balance between the health protection needs of the person concerned and the organisational needs of the University structures.

More information is available on the University Intranet.

Checks are carried out by the Occupational Health Physician. 

The physician assesses your health and fitness for work, taking into account the environment, risk factors and ways in which the activity is carried out.

Health surveillance consists of a medical examination and possibly of laboratory or instrumental tests or specialist consulting as determined by the Occupational Health Physician depending on the risks and in accordance with the most advanced scientific guidelines. 
For example:

• In the event of exposure to chemical risk, a blood sample is taken to check the health and functioning of the main organs and systems;
• In the case of display screen equipment users, vision is assessed by means of an eye test;
• In the event of exposure to noise, hearing is assessed by means of an audiometric test.

The tests to be undergone and the frequency of medical examinations, as well as any recommended vaccinations, are determined by the Occupational Health Physician depending on the risks present in each work setting, based on the findings of the Risk Assessment Document (DVR) and as set out in the Health Protocol.

See the University Intranet for the updated version of the General Health Protocol.

Medical examinations must be carried out:

• Preventively, to make sure that there are no contraindications to the job assigned;
• Upon resuming work, if you have been absent for medical reasons for more than 60 continuous days – you must personally request to undergo the examination after being notified by the competent office;
• Periodically, to check the health of those exposed to risk over time;
• Upon changing jobs, when completely different tasks involving new risks are assigned;
• Upon termination of employment, only in the cases provided for by law.

For examinations carried out preventively, upon changing jobs and upon termination of employment, the person who must undergo the examination is only summoned by Occupational Medicine after receiving the Individual Risk Exposure Data Sheet (SIER), to be completed with the help of the Local Safety Officer (ALS). The frequency is established by law and by the Health Protocol (once a year, every two, three, four or five years).

Under certain circumstances, medical examinations may be requested by workers. This request is granted if the Occupational Health Physician considers it relevant to occupational risks or health, which could worsen due to the activity carried out. In this case, the worker asks to undergo a medical examination via a specific form to be sent to Occupational Medicine (On-demand examination form).

Following the medical examination, the Occupational Health Physician will decide whether a worker is fit for a specific job and inform the same worker and the Employer in writing.

This decision refers to the worker’s fitness to carry out that type of task, characterised by the risks for which health surveillance is mandatory – for example, research in a certain chemistry laboratory, equipped with fume cupboards and adequate environmental ventilation, where toxic or carcinogenic substances are in use.

The decision may be as follows:

• Fit;
• Partially fit, with temporary or permanent prescriptions or limitations;
• Temporarily unfit;
• Permanently unfit.

Fitness with prescriptions or limitations requires the employer to act as instructed in order to protect the worker’s health (e.g. obligation to use protective equipment or prohibition to carry out certain tasks at risk).

If a worker is unfit for their job, where possible, the employer is required to find a different job that does not expose them to the risks for which they are deemed unfit.

If the worker does not agree with the physician’s decision, they may appeal within 30 days of the notification date before the local competent authority (Servizio Prevenzione Sicurezza Ambienti di Lavoro – SPSAL), which, after further investigations, will confirm, revise or cancel that decision.

For further information, see Legislative Decree 81/2008, Article 41, paragraph 6.

Health surveillance provides an opportunity to check compulsory (tetanus) or strongly recommended vaccination coverage depending on your exposure to biological/zoonotic risks (hepatitis B, A, rabies, etc.).

The availability of effective vaccines for those who are not already immune to a given biological agent is a special protection measure provided for by law.

The vaccine or booster will be administered by Occupational Medicine where necessary.

• Health surveillance aims to protect those who are exposed to risks while carrying out work, study, research or other activities at the University.
• Health surveillance is based on the Risk Assessment Document, from which the Occupational Health Physician derives the Health Protocol, i.e. the list of medical measures to be taken depending on a worker’s job and the risks present in a certain work setting, and their frequency.
• Health surveillance is mandatory for any jobs for which occupational risks are identified in the Risk Assessment Document (DVR). It encompasses medical checks aimed at assessing each worker’s health in relation to the specific risks to which they are exposed because of the type of work they do.
• Medical examinations are carried out by the Occupational Health Physician.
• Fitness for work is decided by the Occupational Health Physician following the medical examination. It certifies the absence (or existence) of contraindications to exposing a worker to a certain risk, or the need to comply with specific prescriptions or limitations to protect the worker’s health.
• Not everyone is required to undergo medical examinations for health surveillance – it depends on the contents of the Risk Assessment Document. While health surveillance might not be mandatory, the Occupational Health Physician may always be consulted in the event of any issues deemed to be work-related. Within the limits of available resources, eye examinations can also be requested.