Health Risk Assessment

1. Health Risk Assessment Hence, Health Risk Assessment:- A structured approach to identifying, evaluating and controlling health risks at work. Provides assurance that you are controlling health risks to be ALARP. Hence, Health Risk Assessment:- A structured approach to identifying, evaluating and controlling health risks at work. Provides assurance that you are controlling health risks to be ALARP.

2. What is HRA ? Refresh memories Boundaries of the HRA which may be described as an Assessment Unit (AU). All health hazards within the defined AU should be identified. For each health hazard identify: Harmful effect(s) Acute and/or Chronic - How it acts - Its Hazard Rating (RAM Consequence Category) The RAM divides risks into Low, Medium and High. Detailed review of controls for risks that are assessed as Medium or High. Low risks are managed for continuous improvement but it is still necessary to demonstrate compliance with occupational exposure limits. Medium or High determine whether controls meet relevant OELs and other control standards, and whether they achieve ALARP Recovery (preparedness) measuresRefresh memories Boundaries of the HRA which may be described as an Assessment Unit (AU). All health hazards within the defined AU should be identified. For each health hazard identify: Harmful effect(s) Acute and/or Chronic - How it acts - Its Hazard Rating (RAM Consequence Category) The RAM divides risks into Low, Medium and High. Detailed review of controls for risks that are assessed as Medium or High. Low risks are managed for continuous improvement but it is still necessary to demonstrate compliance with occupational exposure limits. Medium or High determine whether controls meet relevant OELs and other control standards, and whether they achieve ALARP Recovery (preparedness) measures

3. Identifying and Assessing Health Hazards Selection of team Identifying and assessing Health Hazards Identifying Control Standards Identifying nature and degree of Exposure Evaluating Risk to Health Deciding on Remedial Action

4. Selection of team Team Leader / Asset owner�Line manager such as OIM, plant manager or representative of facility being assessed Team Member � Individuals such as operational staff, line supervisor familiar with plant operation and process Local Advisor � Individuals such as medic/OH nurse, HSE advisor, who can advise on the HRA process and exposure controls Specialist Staff � Occupational hygienist, OH physician, toxicologist, ergonomist OIM � Offshore installation manager Line Manager may delegate responsibility. Team is �fluid� depending on the demands of individual assessments. The composition and expertise of the team will be dictated by the size and complexity of the Assessment Unit, by the nature and severity of the hazards and risks involved, and by the familiarity of the task. Specialists can be used in three ways: As part of the team As ongoing support to the team, being consulted as required To review the draft HRA before finalisation OIM � Offshore installation manager Line Manager may delegate responsibility. Team is �fluid� depending on the demands of individual assessments. The composition and expertise of the team will be dictated by the size and complexity of the Assessment Unit, by the nature and severity of the hazards and risks involved, and by the familiarity of the task. Specialists can be used in three ways: As part of the team As ongoing support to the team, being consulted as required To review the draft HRA before finalisation

5. Selection of team To gather necessary information team members must be able to: Observe the activity being performed Predict any potential departure from observed practice Ask supervisors, staff etc. the relevant questions Undertake simple diagnostic tests Identify and review relevant technical literature Gather the information systematically Form valid, justifiable conclusions about exposures and risks

6. How to select Assessment Units The assessment unit is what is within the boundaries of the HRA Assessment units should be self-contained, either physically or as a process It should cover all aspects of the working environment The nature and the severity of the hazards and risks involved, the familiarity of the task, available resources and country-specific requirements should be taken into account ASSESSMENT UNIT A unit comprising a complete operational site, a self-contained segment of a large or complex site, or a group supporting a single business process, so defined as to assist in the management of HRA within an organisation. The approach to implementing HRA depends on the organisational structure and type of work in the Operating Unit. In some circumstances it may be appropriate for a single HRA to be carried out to cover all the activities in a business. In others, HRA may be carried out covering one operational facility or activity like a refinery or a head office. Operating Units should define within their HSE-MS a structure for implementing HRA. The boundaries for each HRA should be defined and should cover the work environment in the broadest sense, including all work activities, whether they are carried out within the Company�s premises or the result of business travel requirements. Boundaries may also need to take account of country-specific requirements. In addition, the roles and responsibilities of line managers, specialist advisers, supervisors and the workforce should be clearly defined. ASSESSMENT UNIT A unit comprising a complete operational site, a self-contained segment of a large or complex site, or a group supporting a single business process, so defined as to assist in the management of HRA within an organisation. The approach to implementing HRA depends on the organisational structure and type of work in the Operating Unit. In some circumstances it may be appropriate for a single HRA to be carried out to cover all the activities in a business. In others, HRA may be carried out covering one operational facility or activity like a refinery or a head office. Operating Units should define within their HSE-MS a structure for implementing HRA. The boundaries for each HRA should be defined and should cover the work environment in the broadest sense, including all work activities, whether they are carried out within the Company�s premises or the result of business travel requirements. Boundaries may also need to take account of country-specific requirements. In addition, the roles and responsibilities of line managers, specialist advisers, supervisors and the workforce should be clearly defined.

7. Organisation and Preparation Collect pre reading material and references such as: Plans and drawings for plant specifications Incident / injury reports (incl. occupational illnesses) and incident investigations Plant and equipment fault reports Maintenance records for control measures Records of health surveillance and sickness absence Occupational hygiene surveys, health and safety surveys Minutes of health and safety committee meetings Look at records to identify plant specifications, past incidents and actions. Identify occupational illnesses like back injuries, chemical burns, dermatitis, stress and RSI. Maintenance records for control measures can be related to e.g. personal protective equipment, local exhaust ventilation. Examples of health surveillance records are audiometry results, biological monitoring results. Previous occupational hygiene surveys can contain noise dosimetry, plant noise contour plans, measurements of exposure to airborne agents. Look at records to identify plant specifications, past incidents and actions. Identify occupational illnesses like back injuries, chemical burns, dermatitis, stress and RSI. Maintenance records for control measures can be related to e.g. personal protective equipment, local exhaust ventilation. Examples of health surveillance records are audiometry results, biological monitoring results. Previous occupational hygiene surveys can contain noise dosimetry, plant noise contour plans, measurements of exposure to airborne agents.

8. What are Health Hazards A Health Hazard has the potential to cause harm to health Health hazards may be divided into the following groups: chemical biological physical ergonomic psychological �Health hazards� are also known as �agents hazardous to health� and �hazardous agents�. These terms are interchangeable. The Shell health hazard inventories gives examples health hazards typical to Shell operations, a summary of their harmful effects and where they may be encountered. Shell E&P Business: Health Hazard Inventory http://sww.siep.shell.com/hse/health/docs/ep990490.doc Shell OP Health Hazard Inventory http://sww.op.shell.com/ophse/linked_docs/hhi.xls Shell Chemicals Health Hazard Inventory http://sww-chemicals-hse.shell.com/livelink/llview.exe/7._Shell_Chemicals_Health_Hazard_Inventory_HE_98.html?func=doc.View&nodeId=36226&docTitle=7%2E+Shell+Chemicals+Health+Hazard+Inventory+HE+98%2E003 �Health hazards� are also known as �agents hazardous to health� and �hazardous agents�. These terms are interchangeable. The Shell health hazard inventories gives examples health hazards typical to Shell operations, a summary of their harmful effects and where they may be encountered. Shell E&P Business: Health Hazard Inventory http://sww.siep.shell.com/hse/health/docs/ep990490.doc Shell OP Health Hazard Inventory http://sww.op.shell.com/ophse/linked_docs/hhi.xls Shell Chemicals Health Hazard Inventory http://sww-chemicals-hse.shell.com/livelink/llview.exe/7._Shell_Chemicals_Health_Hazard_Inventory_HE_98.html?func=doc.View&nodeId=36226&docTitle=7%2E+Shell+Chemicals+Health+Hazard+Inventory+HE+98%2E003

9. Health hazards of primary concern Cause fatalities in the short or long term e.g. infectious diseases (short term), carcinogenic substances (long term) Expose the company to substantial future social and monetary liabilities e.g. noise induced hearing loss, repetitive strain injury, psychological stress Cause minor health effects which could cause severe business disruption e.g. major food poisoning outbreak

10. How to identify Health Hazards Walk through surveys Looking, smelling, talking, listening; use your senses! Refer to Health Hazard Inventories Use HRA Yellow Guide, appendix 2 Look at Records incident/fault reports, inspections, maintenance, sickness absence, hygiene surveys, operating procedures Use experience from elsewhere

11. Types of Effects Acute, immediate Lung, skin or eye damage from corrosive liquid Acute, late onset Sick building syndrome Chronic, intermittent / on-off Repetitive Strain Injury Chronic permanent Lung cancer Acute health effects are those which occur suddenly and in a short time (seconds to hours) following exposure. An acute exposure runs a comparatively short course. Acute exposure can also have a late-onset effect, eg. Sick building syndrome. Chronic health effects are those which occur gradually over a long period of time following repeated and prolonged exposure to relatively low levels or concentrations of a hazardous agent. In certain cases a short term exposure may result in a chronic health effect (short term exposure to asbestos-may lead to a mesothelioma). In many cases symptoms might be difficult to relate to any specific exposure before they appear repeatedly over a longer period in time. Acute health effects are those which occur suddenly and in a short time (seconds to hours) following exposure. An acute exposure runs a comparatively short course. Acute exposure can also have a late-onset effect, eg. Sick building syndrome. Chronic health effects are those which occur gradually over a long period of time following repeated and prolonged exposure to relatively low levels or concentrations of a hazardous agent. In certain cases a short term exposure may result in a chronic health effect (short term exposure to asbestos-may lead to a mesothelioma). In many cases symptoms might be difficult to relate to any specific exposure before they appear repeatedly over a longer period in time.

12. Identify Health Hazards and their harmful Effects Reinforce need to think of source and route when defining agent to harmful effect link Reinforce need to think of source and route when defining agent to harmful effect link

13. Cumulative exposure Individual susceptibility Threshold levels Knowledge gaps Workstyle changes Real world practices Cumulative Exposures It is important to look at all exposures to particular health hazards and not to focus on each hazard and exposure in isolation. Multiple exposures can happen either simultaneously or consecutively, adding to an individual�s total dose and potentially increasing the risk. If a combination of chemicals with similar toxicity is encountered, the effect will be the sum of the effects of all the chemicals, or even more. Similarly, if several short tasks are carried out, exposures from each task may be carried forward to the next. People may be exposed to health hazards in every aspect of their lives, including home, hobbies and leisure, as well as work. Where the same hazard is involved, this will add to the cumulative exposure of an individual. Individual Susceptibility Individual reaction to health risks varies from person to person, based on their heredity, age, sex, personal habits, life history to date, the state of their health at the time and other unclear factors. For example, a young, fit person may be perfectly capable of tolerating a certain level of exposure, but an older or weaker person may not. Previous health damage like a back injury, hearing loss or chemical sensitisation may also put certain individuals at particular risk. Pregnancy and subsequent nursing of babies have to be considered both for the health of the mother and the child. Individual susceptibility is particularly important when considering psychological hazards - what may be regarded by one person as a stimulating challenge may present an intolerable burden to another. Realistically, risk assessments have to be fairly generic - it would be impossible to assess how every individual will react to every health risk, so a standard reasonably fit, reasonably stable individual has to be generally assumed. Where a health risk has particular relevance to a group, for example smokers or pregnant women, and these are known to be in the exposed population, a further generic assessment for that group may be necessary. Health and medical surveillance and medical fitness standards should aim to protect individuals with a particular susceptibility which may represent an increased risk to them. Threshold Levels Most health hazards have a threshold level - a level below which the human body and its metabolism can cope without causing adverse health effects, referred to as the No-Observed Adverse Effect Level (NOAEL). With health risks with such a threshold, the severity of the effect is proportional to the exposure, down to the threshold (which is above zero). Below that threshold there is no health effect - the body�s defence and excretion mechanisms can cope with the exposure burden. A common example is exposure to solvent vapours causing acute effects to the central nervous system, but at low concentrations the effects cannot be seen. For some health hazards, it is not known whether there is a threshold level for the potential health effect. However, even in these cases, the likelihood of that effect manifesting itself is in proportion to the exposure, so the risk can be controlled by minimising exposure. Knowledge Gaps Our knowledge and understanding of health hazards has grown over the years, and continues to develop through additional toxicology and epidemiology studies. Nevertheless, there can always be some incompleteness. For example, we may have test data for the acute toxicity of a material but not chronic toxicity. In addition, an exposure limit or guideline has not been set for every material. In fact, it is estimated that about one million chemicals and preparations are traded - of these, only about a thousand have assigned Occupational Exposure Limits. Similarly, as knowledge changes, it becomes clear that some health hazards are more hazardous than was originally believed. This has led to a reduction in the Occupational Exposure Limit over time for many health hazards, for example, asbestos, benzene and ionising radiations. It is particularly important to have the latest Material Safety Data Sheet (MSDS) for all the products handled so that the most up to date information is available. Product blends change regularly, and the hazard ratings of the components may also change as knowledge grows. A file of MSDSs in the plant office can easily become outdated and could give inaccurate or completely wrong information. The line manager and occupational health specialist should keep their knowledge of health hazards up-to-date. This requires keeping abreast with information relating to hazards relevant to the business. Workstyle Changes When there are changes in workstyle resulting from new ways of working, it is necessary to take these into account by reassessing the risks to health. For example, many office workers spend a large proportion of their day using a computer. This is a major workstyle change in the last 10 years and the number of people at risk from work related upper limb disorders is now much larger. Workstyle changes that may need to be included in the HRA depending on the health hazard are: increased working hours, more demanding targets, less direct management and the increased pace of work. These factors can influence exposure levels. Real Work Practices It is a common feature that people may do things slightly differently from how they say they do, and even how they think they do. These small differences can have significant health impact. For example, a steward not changing overalls between housekeeping duties and food preparation, or a worker storing contaminated gloves in a �clean� area leading to cross contamination and potential contact by unprotected workers, can result in unpredicted health risks. Cumulative Exposures It is important to look at all exposures to particular health hazards and not to focus on each hazard and exposure in isolation. Multiple exposures can happen either simultaneously or consecutively, adding to an individual�s total dose and potentially increasing the risk. If a combination of chemicals with similar toxicity is encountered, the effect will be the sum of the effects of all the chemicals, or even more. Similarly, if several short tasks are carried out, exposures from each task may be carried forward to the next. People may be exposed to health hazards in every aspect of their lives, including home, hobbies and leisure, as well as work. Where the same hazard is involved, this will add to the cumulative exposure of an individual. Individual Susceptibility Individual reaction to health risks varies from person to person, based on their heredity, age, sex, personal habits, life history to date, the state of their health at the time and other unclear factors. For example, a young, fit person may be perfectly capable of tolerating a certain level of exposure, but an older or weaker person may not. Previous health damage like a back injury, hearing loss or chemical sensitisation may also put certain individuals at particular risk. Pregnancy and subsequent nursing of babies have to be considered both for the health of the mother and the child. Individual susceptibility is particularly important when considering psychological hazards - what may be regarded by one person as a stimulating challenge may present an intolerable burden to another. Realistically, risk assessments have to be fairly generic - it would be impossible to assess how every individual will react to every health risk, so a standard reasonably fit, reasonably stable individual has to be generally assumed. Where a health risk has particular relevance to a group, for example smokers or pregnant women, and these are known to be in the exposed population, a further generic assessment for that group may be necessary. Health and medical surveillance and medical fitness standards should aim to protect individuals with a particular susceptibility which may represent an increased risk to them. Threshold Levels Most health hazards have a threshold level - a level below which the human body and its metabolism can cope without causing adverse health effects, referred to as the No-Observed Adverse Effect Level (NOAEL). With health risks with such a threshold, the severity of the effect is proportional to the exposure, down to the threshold (which is above zero). Below that threshold there is no health effect - the body�s defence and excretion mechanisms can cope with the exposure burden. A common example is exposure to solvent vapours causing acute effects to the central nervous system, but at low concentrations the effects cannot be seen. For some health hazards, it is not known whether there is a threshold level for the potential health effect. However, even in these cases, the likelihood of that effect manifesting itself is in proportion to the exposure, so the risk can be controlled by minimising exposure. Knowledge Gaps Our knowledge and understanding of health hazards has grown over the years, and continues to develop through additional toxicology and epidemiology studies. Nevertheless, there can always be some incompleteness. For example, we may have test data for the acute toxicity of a material but not chronic toxicity. In addition, an exposure limit or guideline has not been set for every material. In fact, it is estimated that about one million chemicals and preparations are traded - of these, only about a thousand have assigned Occupational Exposure Limits. Similarly, as knowledge changes, it becomes clear that some health hazards are more hazardous than was originally believed. This has led to a reduction in the Occupational Exposure Limit over time for many health hazards, for example, asbestos, benzene and ionising radiations. It is particularly important to have the latest Material Safety Data Sheet (MSDS) for all the products handled so that the most up to date information is available. Product blends change regularly, and the hazard ratings of the components may also change as knowledge grows. A file of MSDSs in the plant office can easily become outdated and could give inaccurate or completely wrong information. The line manager and occupational health specialist should keep their knowledge of health hazards up-to-date. This requires keeping abreast with information relating to hazards relevant to the business. Workstyle Changes When there are changes in workstyle resulting from new ways of working, it is necessary to take these into account by reassessing the risks to health. For example, many office workers spend a large proportion of their day using a computer. This is a major workstyle change in the last 10 years and the number of people at risk from work related upper limb disorders is now much larger. Workstyle changes that may need to be included in the HRA depending on the health hazard are: increased working hours, more demanding targets, less direct management and the increased pace of work. These factors can influence exposure levels. Real Work Practices It is a common feature that people may do things slightly differently from how they say they do, and even how they think they do. These small differences can have significant health impact. For example, a steward not changing overalls between housekeeping duties and food preparation, or a worker storing contaminated gloves in a �clean� area leading to cross contamination and potential contact by unprotected workers, can result in unpredicted health risks.

14. Assigning Hazard Ratings

15. Hazard Ratings Consider Harm to: People Assets Reputation Select the category with the highest consequence rating! When selecting RAM Consequence Categories remember to consider �harm to people�, �assets� and �reputation�. Health hazards may result in individual ill health, which in turn may lead to liability claims, fines, production losses, raised insurance premiums, and damage to reputation. Select the category with the highest consequence rating.When selecting RAM Consequence Categories remember to consider �harm to people�, �assets� and �reputation�. Health hazards may result in individual ill health, which in turn may lead to liability claims, fines, production losses, raised insurance premiums, and damage to reputation. Select the category with the highest consequence rating.

16. Risk Assessment Matrix It is important that the main energy and resources for HRA are applied to those health risks which are having, or could have, a significant impact on the health of the workforce and the reputation of the company. The Risk Assessment Matrix (RAM) is the tool which allows assessment of the risk to the business from each identified health hazard and helps to: Prioritise potential health risks Determine which risks need a documented demonstration that controls are reducing the risk to As Low As Reasonably Practicable (ALARP) The potential risk posed to the business for each health hazard should be plotted on the RAM. This is a combination of Consequence (vertical axis), and Likelihood (horizontal axis).(see later slides) The hazard rating should be assigned to all identified health hazards for both acute and chronic harmful effects. Acute health effects are those which occur suddenly and in a short time (seconds to hours) following exposure, generally to higher levels or concentrations of a health hazard. An acute exposure runs a comparatively short course. Chronic health effects are those which occur gradually over a long period of time following repeated and prolonged exposure to relatively low levels or concentrations of a hazardous agent. In certain cases a short term exposure may result in a chronic health effect. Where the Hazard Rating differs between acute and chronic effects, select the most significant for application to the RAM. It is important that the main energy and resources for HRA are applied to those health risks which are having, or could have, a significant impact on the health of the workforce and the reputation of the company. The Risk Assessment Matrix (RAM) is the tool which allows assessment of the risk to the business from each identified health hazard and helps to: Prioritise potential health risks Determine which risks need a documented demonstration that controls are reducing the risk to As Low As Reasonably Practicable (ALARP) The potential risk posed to the business for each health hazard should be plotted on the RAM. This is a combination of Consequence (vertical axis), and Likelihood (horizontal axis).(see later slides) The hazard rating should be assigned to all identified health hazards for both acute and chronic harmful effects. Acute health effects are those which occur suddenly and in a short time (seconds to hours) following exposure, generally to higher levels or concentrations of a health hazard. An acute exposure runs a comparatively short course. Chronic health effects are those which occur gradually over a long period of time following repeated and prolonged exposure to relatively low levels or concentrations of a hazardous agent. In certain cases a short term exposure may result in a chronic health effect. Where the Hazard Rating differs between acute and chronic effects, select the most significant for application to the RAM.

17. Health Risk = Consequences X Probability (Likelihood) In order to determine the health risk to the business (high, medium or low) the hazard rating will be plotted against the probability (likelihood) of the effect in industry. This assessment is based on historical evidence, and will assess the business risks. It does not assess the individual�s risk of exposure to the agent. For the purposes of using the RAM for Health Risk Assessment, the RAM principle, as explained in the Yellow Guide works for Acute Health Hazards. However, for Chronic Health Hazards, because of the latency period that may occur before an actual endpoint is noticed (e.g. cancer, chronic respiratory disease etc.) it is more useful to describe likelihood in terms of whether an overexposure to the health hazard has occurred, e.g. carcinogen, rather than whether the ill health effect has occurred, e.g. cancer. Experience has shown that health, and environmental, hazards are not always assigned a RAM risk rating which reflects the full extent of their potential consequences. This is particularly true of hazards with chronic effects. To allow for this, the estimate of �Likelihood� for chronic health risks should be based on the historical exposure evidence. It is also recommended that decisions on Likelihood should tend towards the higher category. This is because the RAM assessment is only a screening mechanism to identify priorities. Where there are uncertainties, it is prudent to move to the next stage to begin more detailed assessmentIn order to determine the health risk to the business (high, medium or low) the hazard rating will be plotted against the probability (likelihood) of the effect in industry. This assessment is based on historical evidence, and will assess the business risks. It does not assess the individual�s risk of exposure to the agent. For the purposes of using the RAM for Health Risk Assessment, the RAM principle, as explained in the Yellow Guide works for Acute Health Hazards. However, for Chronic Health Hazards, because of the latency period that may occur before an actual endpoint is noticed (e.g. cancer, chronic respiratory disease etc.) it is more useful to describe likelihood in terms of whether an overexposure to the health hazard has occurred, e.g. carcinogen, rather than whether the ill health effect has occurred, e.g. cancer. Experience has shown that health, and environmental, hazards are not always assigned a RAM risk rating which reflects the full extent of their potential consequences. This is particularly true of hazards with chronic effects. To allow for this, the estimate of �Likelihood� for chronic health risks should be based on the historical exposure evidence. It is also recommended that decisions on Likelihood should tend towards the higher category. This is because the RAM assessment is only a screening mechanism to identify priorities. Where there are uncertainties, it is prudent to move to the next stage to begin more detailed assessment

18. Risk Assessment Matrix If a consequence has been heard of in the world, then by default you are immediately within the B Likelihood Category. You need to be pragmatic in applying Likelihood categories. Don�t forget that a detailed review of controls to reduce employee exposure is only carried out if the risk is medium or high. Low risks are managed for continuous improvement via standard procedures and staff competences. Remember that hazards which are assessed as Low risk may have a legal exposure limit which requires confirmation of compliance.If a consequence has been heard of in the world, then by default you are immediately within the B Likelihood Category. You need to be pragmatic in applying Likelihood categories. Don�t forget that a detailed review of controls to reduce employee exposure is only carried out if the risk is medium or high. Low risks are managed for continuous improvement via standard procedures and staff competences. Remember that hazards which are assessed as Low risk may have a legal exposure limit which requires confirmation of compliance.

19. The Health Hazards identified for your site or business unit have to each be specifically assessed in the RAM for their potential Health Risk ( both Acute and Chronic). In an effort to assist locations and businesses to do this, Generic Risk Assessment Matrix ratings have been assigned to selected health hazards by way of illustration of potential levels of risk � refer to Appendix 3 HRA YG. The Consequence Category of �harm to people� (RAM vertical axis) has been used as it is the category most likely to generate the highest RAM, but it is important to recognise that both Assets, and/or Reputation may also be relevant. The rating assigned to the Likelihood category (RAM horizontal axis) is based on typical �worst Group cases� and it is important to take account of any Business-specific guidance and local circumstances before finalising an assessment. The Likelihood has been assigned to the most significant harmful health effect, or consequence, for the health hazards listed. Refer to your Business Specific Health Hazard Inventory for further examples of health hazards relevant to your particular business. The Health Hazards identified for your site or business unit have to each be specifically assessed in the RAM for their potential Health Risk ( both Acute and Chronic). In an effort to assist locations and businesses to do this, Generic Risk Assessment Matrix ratings have been assigned to selected health hazards by way of illustration of potential levels of risk � refer to Appendix 3 HRA YG. The Consequence Category of �harm to people� (RAM vertical axis) has been used as it is the category most likely to generate the highest RAM, but it is important to recognise that both Assets, and/or Reputation may also be relevant. The rating assigned to the Likelihood category (RAM horizontal axis) is based on typical �worst Group cases� and it is important to take account of any Business-specific guidance and local circumstances before finalising an assessment. The Likelihood has been assigned to the most significant harmful health effect, or consequence, for the health hazards listed. Refer to your Business Specific Health Hazard Inventory for further examples of health hazards relevant to your particular business.

20. Low RAM Ratings Manage for continuous improvement via standard procedures and competences in HSE-MS (ensure these are adequate) ensure Exposure Limits and other control standards are met Low risks are managed for continuous improvement and exposure controls rely on standard procedures and competences as specified in the HSE-MS; a detailed review of controls is not required. However, it is important to remember that for Low risks it is still necessary to demonstrate compliance with occupational exposure limits. The relevant HSE-MS procedures and competences should be reviewed to ensure they are comprehensive and appropriate. It may be necessary to perform exposure measurements to confirm compliance with an exposure limit. Low risks are managed for continuous improvement and exposure controls rely on standard procedures and competences as specified in the HSE-MS; a detailed review of controls is not required. However, it is important to remember that for Low risks it is still necessary to demonstrate compliance with occupational exposure limits. The relevant HSE-MS procedures and competences should be reviewed to ensure they are comprehensive and appropriate. It may be necessary to perform exposure measurements to confirm compliance with an exposure limit.

21. Medium and High RAM Ratings Detailed review of controls Standards of control Who is exposed and when Estimate or measure exposure Compare existing controls against standards (are OELs met and risks As Low As Reasonably Practicable - ALARP?) Consider need for routine exposure monitoring and/or health surveillance For risks assessed as High give serious consideration to alternative ways of carrying out the operation The MHME requires that a detailed review of controls is carried out for those health risks that are assessed as Medium or High. The HRA should determine whether controls meet relevant occupational exposure limits and other control standards, and whether they achieve ALARP. The basis for establishing ALARP should be documented for all risks assessed as Medium or High For risks rated High on the RAM, alternative ways of carrying out the operation to avoid the risk must be given serious consideration as part of the HRA. The MHME requires that a detailed review of controls is carried out for those health risks that are assessed as Medium or High. The HRA should determine whether controls meet relevant occupational exposure limits and other control standards, and whether they achieve ALARP. The basis for establishing ALARP should be documented for all risks assessed as Medium or High For risks rated High on the RAM, alternative ways of carrying out the operation to avoid the risk must be given serious consideration as part of the HRA.

22. Control and Recovery Identify exposure Hierarchy of controls Control standards Use of control chart for individual risk Apply ALARP principle Exposure measurements Health Surveillance

23. What is exposure? Exposure is defined as: The amount of the hazard to which a person has been exposed(dose). This is a combination of the magnitude, frequency and duration of exposure

24. Exposure Duration Frequency Magnitude (extent of exposure) is affected by: Concentration/intensity of the agent Work practices Agent�s physical characteristic impacting on the exposure route Existing controls Duration of exposure is measured in minutes or hours per day/shift Frequency of exposure is measured in times per day/shift, week, month, year Extent of exposure, for example, the breathing zone concentration of the agent, chance of skin contact, noise level, strain on musculo-skeletal system. This is also affected by the work practices carried out by an individual, even employees who do the same job may have different exposure due to posture, working style and other factors like personal hygiene (no eating, drinking, smoking on the workfloor), the physical characteristics of the agent affecting the ease that the agent enters/impacts on the body, and the effectiveness of existing exposure control measures. All these factors determine largely to what extent a person is exposed to the agent. We can control exposure to a health hazard by reducing any one of these factors. The level of the exposure affects whether or not the harmful effects of a health hazard will be realised. This in turn is dependent on the severity of the hazard and how it impacts on the body. Duration of exposure is measured in minutes or hours per day/shift Frequency of exposure is measured in times per day/shift, week, month, year Extent of exposure, for example, the breathing zone concentration of the agent, chance of skin contact, noise level, strain on musculo-skeletal system. This is also affected by the work practices carried out by an individual, even employees who do the same job may have different exposure due to posture, working style and other factors like personal hygiene (no eating, drinking, smoking on the workfloor), the physical characteristics of the agent affecting the ease that the agent enters/impacts on the body, and the effectiveness of existing exposure control measures. All these factors determine largely to what extent a person is exposed to the agent. We can control exposure to a health hazard by reducing any one of these factors. The level of the exposure affects whether or not the harmful effects of a health hazard will be realised. This in turn is dependent on the severity of the hazard and how it impacts on the body.

25. Exposure routes This slide shows all possible exposure routes. The physical form of the agent is important in respect of how readily a hazard can enter or impact the body. Some examples are: This slide shows all possible exposure routes. The physical form of the agent is important in respect of how readily a hazard can enter or impact the body. Some examples are:

26. Hazards and Exposure routes

27. Target Organs The uptake into the body or impact on the body by health hazards can vary widely depending on the characteristic of the specific hazard. For each health hazard one or more target organs may be affected. Some hazards affect the organ through which the hazard enters the body, an example of this is noise. Other hazards may affect different organs from the exposure route, the target organ. Some examples of this are given in the table on the next slide. Exposure to solvents may affect the skin, the central nervous system, the reproductive system, the lungs and the liver. Inhalation of a nuisance dust will affect the lungs (and nose, mouth and throat) Inhalation of a toxic dust may also be absorbed into the blood stream to be carried round the body and affect other susceptible organs such as the liver or central nervous system. Stress or other psychological hazards may affect the heart, and may also lead to mental impairment. Heavy lifting or other manual handling may affect the musculo-skeletal system. The uptake into the body or impact on the body by health hazards can vary widely depending on the characteristic of the specific hazard. For each health hazard one or more target organs may be affected. Some hazards affect the organ through which the hazard enters the body, an example of this is noise. Other hazards may affect different organs from the exposure route, the target organ. Some examples of this are given in the table on the next slide. Exposure to solvents may affect the skin, the central nervous system, the reproductive system, the lungs and the liver. Inhalation of a nuisance dust will affect the lungs (and nose, mouth and throat) Inhalation of a toxic dust may also be absorbed into the blood stream to be carried round the body and affect other susceptible organs such as the liver or central nervous system. Stress or other psychological hazards may affect the heart, and may also lead to mental impairment. Heavy lifting or other manual handling may affect the musculo-skeletal system.

28. Hazard, exposure route and target organ

29. Factors Affecting Intake for chemical and biological agents Physical form Gas/vapour/liquid/solid Particle size Particle shape Solubility Carriers Breathing rate The physical form of chemical and biological agents influence the uptake. Solids can only be inhaled if they are of a specific particle size and shape. The size and shape determines which part of the inhalatory system can be reached. Liquids will not easily be inhaled, so intake through inhalation will be limited and the focus must then be on preventing skin contact. Gases and vapours can be inhaled easily. A higher breathing rate will affect intake through inhalation. The physical form of chemical and biological agents influence the uptake. Solids can only be inhaled if they are of a specific particle size and shape. The size and shape determines which part of the inhalatory system can be reached. Liquids will not easily be inhaled, so intake through inhalation will be limited and the focus must then be on preventing skin contact. Gases and vapours can be inhaled easily. A higher breathing rate will affect intake through inhalation.

30. Identify who is exposed Typical Job Types Plant Operators - divided by operational group Road Tanker Drivers - divided by product group Maintenance Staff - mechanical, electrical, vehicle etc. Cleaning Staff - plant and/or office Laboratory Technicians - sub-divide as appropriate Administrators - office based with minimal plant exposure Field Staff - geologists Members of the workforce who might be exposed to health hazards being assessed should be identified. The best approach is to divide the workforce into employee categories, known as Job Types, who carry out similar tasks involving potential exposure to particular hazards and, therefore, have broadly similar exposure profiles. The use of Job Types assigned on the basis of similarity of exposure profiles to health hazards is a major element in the HRA system. The use of Job Types allows assessments to remain valid when personnel change and also simplifies the keeping of records of exposure. When making an initial decision on Job Types an organisational chart is a useful aid in ensuring that all jobs are included. Allocation to Job Types should be on the basis of all normal and foreseeable tasks which are performed. It is also important to consider contractors whose activity involves exposure to the health hazards. Some Job Types are listed as an example in the slide. It should be noted that this is not a definitive list, job types must be allocated according to the actual exposure profiles. Eg. Plant operators may need to be divided by operational group Road tanker drivers, may need to be divided by product group, LPG, solvents, Gasolines, kerosines etc Maintenance staff: these may need to be divided into mechanical, electrical, vehicle etc The HRA should also identify those employees with an increased chance of individual risk. These include: ����������� Pregnant women and nursing mothers ����������� Untrained or inexperienced staff such as new recruits or temporary workers ����������� Staff working in confined or poorly ventilated areas ����������� Smokers. Smoking can, in some cases, increase the risk to health from exposure to some hazardous agents at work Members of the workforce who might be exposed to health hazards being assessed should be identified. The best approach is to divide the workforce into employee categories, known as Job Types, who carry out similar tasks involving potential exposure to particular hazards and, therefore, have broadly similar exposure profiles. The use of Job Types assigned on the basis of similarity of exposure profiles to health hazards is a major element in the HRA system. The use of Job Types allows assessments to remain valid when personnel change and also simplifies the keeping of records of exposure. When making an initial decision on Job Types an organisational chart is a useful aid in ensuring that all jobs are included. Allocation to Job Types should be on the basis of all normal and foreseeable tasks which are performed. It is also important to consider contractors whose activity involves exposure to the health hazards. Some Job Types are listed as an example in the slide. It should be noted that this is not a definitive list, job types must be allocated according to the actual exposure profiles. Eg. Plant operators may need to be divided by operational group Road tanker drivers, may need to be divided by product group, LPG, solvents, Gasolines, kerosines etc Maintenance staff: these may need to be divided into mechanical, electrical, vehicle etc The HRA should also identify those employees with an increased chance of individual risk. These include: ����������� Pregnant women and nursing mothers ����������� Untrained or inexperienced staff such as new recruits or temporary workers ����������� Staff working in confined or poorly ventilated areas ����������� Smokers. Smoking can, in some cases, increase the risk to health from exposure to some hazardous agents at work

31. Identify tasks: Use workplace experience Review historical records Discuss with staff involved in doing the task Visit work area/walk through survey Include tasks involved in: Normal operations Maintenance Abnormal conditions and foreseeable emergencies The collection of information on tasks, carried out by the different Job Types identified is assisted by: Taking account of workplace experience Speaking to staff representatives from the Job Types themselves as well as supervisors. Staff may be able to give a more detailed list than their supervisors. This activity is best performed by visiting the workplace The tasks included in the assessment should consist of all normal operations, maintenance activities and any abnormal conditions (such as vessel entry or plant start-up) as well as any foreseeable emergency activities. The collection of information on tasks, carried out by the different Job Types identified is assisted by: Taking account of workplace experience Speaking to staff representatives from the Job Types themselves as well as supervisors. Staff may be able to give a more detailed list than their supervisors. This activity is best performed by visiting the workplace The tasks included in the assessment should consist of all normal operations, maintenance activities and any abnormal conditions (such as vessel entry or plant start-up) as well as any foreseeable emergency activities.

32. Estimate exposure level

33. Estimate exposure level The frequency of exposure is expressed as times per day/shift, week, month or year The duration of exposure is expressed in hours The estimate/magnitude of exposure is expressed as mg/m3 or mg/l(gases, vapours and dusts), as ppm (gases and vapours) or as fibres/ml air (fibrous dusts) or other concentration or dose magnitude, depending on the route of entry (eg. inhalation, skin contact, ingestion, noise level, strain on musculoskeletal system) It may be that an occupational hygiene survey to measure personal exposure to the hazard has already been carried out on this, or a similar task. These surveys are a useful reference, but caution should be exercised when reading across exposure data from one operation to another, to ensure that conditions of exposure are sufficiently similar. Details on quantitative measurement of exposures are given in Nugget 5g. Guidance on making qualitative estimates of exposure are given on the following two slides. The frequency of exposure is expressed as times per day/shift, week, month or year The duration of exposure is expressed in hours The estimate/magnitude of exposure is expressed as mg/m3 or mg/l(gases, vapours and dusts), as ppm (gases and vapours) or as fibres/ml air (fibrous dusts) or other concentration or dose magnitude, depending on the route of entry (eg. inhalation, skin contact, ingestion, noise level, strain on musculoskeletal system) It may be that an occupational hygiene survey to measure personal exposure to the hazard has already been carried out on this, or a similar task. These surveys are a useful reference, but caution should be exercised when reading across exposure data from one operation to another, to ensure that conditions of exposure are sufficiently similar. Details on quantitative measurement of exposures are given in Nugget 5g. Guidance on making qualitative estimates of exposure are given on the following two slides.

34. Exposure may be acceptable when: evidently so operations are in accordance with suppliers� documented procedures previous measurements under similar or worst case conditions indicate low exposure process operated in accordance with recognised guidance on good practice Estimate exposure level-without exposure measurement Exposure to hazardous agents may be deemed to be ACCEPTABLE without quantitative measurements when: It is evidently so, For instance, the occasional use of a small photocopier in a well ventilated office would not lead to the build up of ozone Operations are in accordance with suppliers� documented procedures. Remember that this will depend on the supplier foreseeing the conditions of use. Previous measurements under similar or worst case conditions indicate low exposure. If there are any differences in circumstances between the previous measurements and the present conditions, you may need to consult someone competent to make this judgement. A process operated in accordance with recognised guidance or good practise. This guidance needs to come from a competent or authoritative source, eg. Government guidance, industry trade association.Exposure to hazardous agents may be deemed to be ACCEPTABLE without quantitative measurements when: It is evidently so, For instance, the occasional use of a small photocopier in a well ventilated office would not lead to the build up of ozone Operations are in accordance with suppliers� documented procedures. Remember that this will depend on the supplier foreseeing the conditions of use. Previous measurements under similar or worst case conditions indicate low exposure. If there are any differences in circumstances between the previous measurements and the present conditions, you may need to consult someone competent to make this judgement. A process operated in accordance with recognised guidance or good practise. This guidance needs to come from a competent or authoritative source, eg. Government guidance, industry trade association.

35. Exposure may be unacceptable when: there is evidence of fine dust deposits fume or particles are visible in light beams there are broken, defective or poorly maintained controls the process is not operated in accordance with recognised guidance on good practice complaints are made of discomfort or excessive odour ill-health related to exposure is detected Estimate exposure level-without exposure measurement Exposure to hazardous agents may be deemed to be UNACCEPTABLE without quantitative measurements in the following situations: When there is evidence of fine dust deposits on people�s clothing or on surfaces. It should be noted that some of the finest particulates which may cause disease are so small as not to be visible to the naked eye. However, these fine fume particles or dust particles may be visible in light beams-you may have noticed this effect when a shaft of sunlight crosses the room. Specialist light sources known as Tyndall beams may be used in the workplace to find particulates which are below the normally visible range. Where there are broken, defective or poorly maintained controls, then it is likely that exposure is unacceptable. The controls would have been required to reduce exposure, and, if they are no longer fully effective, then exposure levels may have increased. Similarly, where a process is not operated in accordance with recognised guidance or good practice then exposure may no longer be acceptable. While not all agents hazardous to health have distinctive odours or immediate effects on comfort, where complaints are made of discomfort or excessive odour then the possibility of unacceptable exposure should be considered. Remember though, that exposures may be unacceptable without such complaints occurring. Where ill health related to exposure is detected, then exposure is clearly unacceptable. However, there may still be a question, as with noise, as to whether the exposure occurs at work or during leisure hours. Exposure to hazardous agents may be deemed to be UNACCEPTABLE without quantitative measurements in the following situations: When there is evidence of fine dust deposits on people�s clothing or on surfaces. It should be noted that some of the finest particulates which may cause disease are so small as not to be visible to the naked eye. However, these fine fume particles or dust particles may be visible in light beams-you may have noticed this effect when a shaft of sunlight crosses the room. Specialist light sources known as Tyndall beams may be used in the workplace to find particulates which are below the normally visible range. Where there are broken, defective or poorly maintained controls, then it is likely that exposure is unacceptable. The controls would have been required to reduce exposure, and, if they are no longer fully effective, then exposure levels may have increased. Similarly, where a process is not operated in accordance with recognised guidance or good practice then exposure may no longer be acceptable. While not all agents hazardous to health have distinctive odours or immediate effects on comfort, where complaints are made of discomfort or excessive odour then the possibility of unacceptable exposure should be considered. Remember though, that exposures may be unacceptable without such complaints occurring. Where ill health related to exposure is detected, then exposure is clearly unacceptable. However, there may still be a question, as with noise, as to whether the exposure occurs at work or during leisure hours.

36. The hierarchy of controls is a list in preferential order of the means by which exposure to health hazards can be controlled Elimination Substitution (alternatives) Engineering (plant and equipment) Procedural Personal protective equipment Hierarchy of controls The hierarchy of control should always be considered when assessing the effectiveness of controls. The higher in the hierarchy, the more effective the control usually is. Elimination of the hazard is always the preferred control. When this is not possible, a control of a lesser hierarchy can be considered. This process is repeated until the proper control is selected for each hazard. The hierarchy of control should always be considered when assessing the effectiveness of controls. The higher in the hierarchy, the more effective the control usually is. Elimination of the hazard is always the preferred control. When this is not possible, a control of a lesser hierarchy can be considered. This process is repeated until the proper control is selected for each hazard.

37. Types of controls Note: We are not only referencing control standards for chemical agents. Ensure examples for all types of hazard groups are given, particularly relevant for engineering controls. When eliminating or substituting a hazard be careful not to introduce new hazards. Sometimes these new hazards can be worse than the original hazard. Note: We are not only referencing control standards for chemical agents. Ensure examples for all types of hazard groups are given, particularly relevant for engineering controls. When eliminating or substituting a hazard be careful not to introduce new hazards. Sometimes these new hazards can be worse than the original hazard.

38. Types of controls

39. Effectiveness of Controls To allow reasoned decision-making on health risk control selection, the Hierarchy of Control is applied. The Control options for health risks fall into a well recognised general hierarchy. The strongest options are highest in the hierarchy. Selection of the most appropriate control measures should result in the risk being ALARP. In general, the higher in the hierarchy a control measure is, the more effective and the more robust it is. Elimination, substitution or engineering may however be a costly effort in terms of process change, capital investment, maintenance cost, training etc. It should also not be overlooked that there can be significant running costs associated with controls lower in the hierarchy, such as a personal protective equipment programme both in terms of equipment and supervision. This balance of effectiveness versus cost is at the heart of ALARP (to be discussed in more detail in nugget 5e). Removal/Elimination/Reduction of the Hazard Elimination - get rid of the hazard, the practice that introduces it, or the situation that generates it Substitution - use something different, or use it in a less hazardous form Selection/Replacement - provide better equipment Engineering Controls Total Enclosure - keep the hazard within the plant Partial Enclosure with local exhaust ventilation Local Exhaust Ventilation General Ventilation Noise Insulation Mechanical lifting equipment Procedural Reduce numbers of employees exposed Reduce periods of exposure Good working procedures to minimise cross-contamination Good housekeeping, storage, maintenance procedures and facilities Good washing, laundry and personal hygiene procedures and facilities Protective Equipment Respiratory protective equipment Hearing protection Thermal extreme protection While the above list can only be partial, it illustrates a range of control options and where they fit in the hierarchy. To allow reasoned decision-making on health risk control selection, the Hierarchy of Control is applied. The Control options for health risks fall into a well recognised general hierarchy. The strongest options are highest in the hierarchy. Selection of the most appropriate control measures should result in the risk being ALARP. In general, the higher in the hierarchy a control measure is, the more effective and the more robust it is. Elimination, substitution or engineering may however be a costly effort in terms of process change, capital investment, maintenance cost, training etc. It should also not be overlooked that there can be significant running costs associated with controls lower in the hierarchy, such as a personal protective equipment programme both in terms of equipment and supervision. This balance of effectiveness versus cost is at the heart of ALARP (to be discussed in more detail in nugget 5e). Removal/Elimination/Reduction of the Hazard Elimination - get rid of the hazard, the practice that introduces it, or the situation that generates it Substitution - use something different, or use it in a less hazardous form Selection/Replacement - provide better equipment Engineering Controls Total Enclosure - keep the hazard within the plant Partial Enclosure with local exhaust ventilation Local Exhaust Ventilation General Ventilation Noise Insulation Mechanical lifting equipment Procedural Reduce numbers of employees exposed Reduce periods of exposure Good working procedures to minimise cross-contamination Good housekeeping, storage, maintenance procedures and facilities Good washing, laundry and personal hygiene procedures and facilities Protective Equipment Respiratory protective equipment Hearing protection Thermal extreme protection While the above list can only be partial, it illustrates a range of control options and where they fit in the hierarchy.

40. Control selection

41. Maintenance of controls A good indicator of possible unacceptable exposure is the presence of broken, defective or poorly maintained controls. It is self evident that control measures can only be effective when they work. In order to ensure required control measures are in working order it is necessary to have quality assurance systems in place to ensure they are maintained to the required standard. For engineering controls this should include a programme of preventative maintenance, routine inspections and regular testing of effectiveness. The results of inspection and testing would form an important record of diligence. For procedural systems there would need to be a documented record of the system and suitable instruction and training for the workforce. Effective supervision is a key component of ensuring that procedures are followed. Personal protective equipment (PPE) can require considerable routine maintenance, inspection and testing unless disposable items are used. Information, instruction and training are an important element in the continued effectiveness of PPE as is a good standard of supervision. The best quality PPE, fully maintained and tested, is useless if not worn when required. Where there is a requirement for emergency controls and procedures these should also be subjected to routine maintenance, inspection and test. The use of realistic emergency exercises which test all aspects of the system should be part of the testing regime. A good indicator of possible unacceptable exposure is the presence of broken, defective or poorly maintained controls. It is self evident that control measures can only be effective when they work. In order to ensure required control measures are in working order it is necessary to have quality assurance systems in place to ensure they are maintained to the required standard. For engineering controls this should include a programme of preventative maintenance, routine inspections and regular testing of effectiveness. The results of inspection and testing would form an important record of diligence. For procedural systems there would need to be a documented record of the system and suitable instruction and training for the workforce. Effective supervision is a key component of ensuring that procedures are followed. Personal protective equipment (PPE) can require considerable routine maintenance, inspection and testing unless disposable items are used. Information, instruction and training are an important element in the continued effectiveness of PPE as is a good standard of supervision. The best quality PPE, fully maintained and tested, is useless if not worn when required. Where there is a requirement for emergency controls and procedures these should also be subjected to routine maintenance, inspection and test. The use of realistic emergency exercises which test all aspects of the system should be part of the testing regime.

42. Control standards The Business-specific Health Hazard Inventories provide recommended references on health hazard controls which are key inputs to determining appropriate control standards. The Business-specific Health Hazard Inventories provide recommended references on health hazard controls which are key inputs to determining appropriate control standards.

43. Chemical agents Occupational Exposure Limits are levels of airborne concentrations of hazardous compounds that are considered safe for the workplace OEL�s and recommendations are set by competent national authorities OEL�s are normally used for chemical agents, but the concept can also be applied for physical, biological and psychosocial agents and for ergonomics What are exposure limits? Cf Appendix 6 of HRA Yellow Guide for details on chemical, physical, biological, psychosocial agents and ergonomics. Exposure limits vary in nature depending on the type of health hazard. If no limit has been set by the national authority, or if the national limit is less stringent than that recommended by a Shell Service Company, the Shell Service Company advised limit should be applied. However, complying with a national limit should always be the first priority. Occupational Exposure Limit (OEL) values are set by competent national authorities or other relevant national institutions as limits for concentrations of hazardous compounds in workplace air. OELs for hazardous substances represent an important tool for risk assessment and management and valuable information for occupational safety and health activities concerning hazardous substances. Although OELs are connected to National Laws or European Laws, the character of the OELs varies between different countries/States between obligation, indication and recommendation. Some States prepare more than one list, one with an obligatory (binding) character, one with a more indicative or orientating character. In all cases, it is strongly recommended that you consult the relevant national legislation. National scientific institutes and scientific committees prepare OEL-value levels. These may be based on cases of human exposure and effects on epidemiological studies of exposure-response relationships. Others are based on the results of animal studies. For some substances, international proposals or official values from other countries are included in the list. All concerned groups such as authorities, industry, employers and employees associations, consumers and the scientific community can provide proposals for new OELs. It is usual for the final decision regarding limit values to be taken by governmental authorities, often based on advice from committees consisting of members from all concerned groups. It is important to realize the fact that a substance does not appear on the OEL lists does not necessarily mean that it is harmless. With millions of substances in use in industry, it would be an impossible task to allocate every one an OEL, and so the lists only contain substances in common use, or with a well recognised hazard. For chemical hazards with no assigned exposure limit, the supplier should be asked to provide a working limit with evidence to support the limit and a measurement protocol. More information about a substance should be found in the relevant Material Safety Data Sheet (MSDS). This can be obtained from the producer or provider of the substance. Alternatively, Occupational Health Advisers can set an advised limit. OEL�s are usually used for chemical agents. The concept can however also be applied to other agents (physical, biological, psychosocial and ergonomics). Examples of this are given in the following slides. Cf Appendix 6 of HRA Yellow Guide for details on chemical, physical, biological, psychosocial agents and ergonomics. Exposure limits vary in nature depending on the type of health hazard. If no limit has been set by the national authority, or if the national limit is less stringent than that recommended by a Shell Service Company, the Shell Service Company advised limit should be applied. However, complying with a national limit should always be the first priority. Occupational Exposure Limit (OEL) values are set by competent national authorities or other relevant national institutions as limits for concentrations of hazardous compounds in workplace air. OELs for hazardous substances represent an important tool for risk assessment and management and valuable information for occupational safety and health activities concerning hazardous substances. Although OELs are connected to National Laws or European Laws, the character of the OELs varies between different countries/States between obligation, indication and recommendation. Some States prepare more than one list, one with an obligatory (binding) character, one with a more indicative or orientating character. In all cases, it is strongly recommended that you consult the relevant national legislation. National scientific institutes and scientific committees prepare OEL-value levels. These may be based on cases of human exposure and effects on epidemiological studies of exposure-response relationships. Others are based on the results of animal studies. For some substances, international proposals or official values from other countries are included in the list. All concerned groups such as authorities, industry, employers and employees associations, consumers and the scientific community can provide proposals for new OELs. It is usual for the final decision regarding limit values to be taken by governmental authorities, often based on advice from committees consisting of members from all concerned groups. It is important to realize the fact that a substance does not appear on the OEL lists does not necessarily mean that it is harmless. With millions of substances in use in industry, it would be an impossible task to allocate every one an OEL, and so the lists only contain substances in common use, or with a well recognised hazard. For chemical hazards with no assigned exposure limit, the supplier should be asked to provide a working limit with evidence to support the limit and a measurement protocol. More information about a substance should be found in the relevant Material Safety Data Sheet (MSDS). This can be obtained from the producer or provider of the substance. Alternatively, Occupational Health Advisers can set an advised limit. OEL�s are usually used for chemical agents. The concept can however also be applied to other agents (physical, biological, psychosocial and ergonomics). Examples of this are given in the following slides.

44. Occupational exposure limits Physical agents Occupational Exposure Limits also exist for many physical agents. For example for noise the Shell recommended criteria are 85 dB(A) (daily noise dose) or a design limit for equipment/processes of 85dB(A) at 1 meter. Examples of control standards for other physical agents are listed in appendix 6b of the Yellow Guide. Physical agents Occupational Exposure Limits also exist for many physical agents. For example for noise the Shell recommended criteria are 85 dB(A) (daily noise dose) or a design limit for equipment/processes of 85dB(A) at 1 meter. Examples of control standards for other physical agents are listed in appendix 6b of the Yellow Guide.

45. Occupational exposure limits Physical agents Occupational Exposure Limits also exist for many physical agents. For example for noise the Shell recommended criteria are 85 dB(A) (daily noise dose) or a design limit for equipment/processes of 85dB(A) at 1 meter. Examples of control standards for other physical agents are listed in appendix 6b of the Yellow Guide. Physical agents Occupational Exposure Limits also exist for many physical agents. For example for noise the Shell recommended criteria are 85 dB(A) (daily noise dose) or a design limit for equipment/processes of 85dB(A) at 1 meter. Examples of control standards for other physical agents are listed in appendix 6b of the Yellow Guide.

46. Engineering control standards

47. Procedural standards

48. Personal Protective Equipment Specifications for Personal Protective Equipment (PPE) For example: respiratory protective equipment, eye/face protection, hearing protection, skin protection (body and hand). All local legal requirements must be met. The HSE Panel Guide on Personal Protective Equipment (1989) gives a general review of standards for different types of PPE, although standards will require checking to ensure they are current. The use of PPE should only be considered when control measures in the categories above are not practicable, or as a secondary line of defence Specifications for Personal Protective Equipment (PPE) For example: respiratory protective equipment, eye/face protection, hearing protection, skin protection (body and hand). All local legal requirements must be met. The HSE Panel Guide on Personal Protective Equipment (1989) gives a general review of standards for different types of PPE, although standards will require checking to ensure they are current. The use of PPE should only be considered when control measures in the categories above are not practicable, or as a secondary line of defence

49. Personal protective equipment Adequate use of PPE includes an assessment of: PPE requirement for each task PPE selection to match the hazard PPE is practical & functional for the task PPE requirements are understood by employees (e.g. training & validated by testing) PPE is used correctly (e.g. training & validated by audit)) PPE is used when required (validated by audit) PPE is inspected and maintained regularly (validated by audit)

50. Are controls meeting the control standards? Control chart: tool for decisions Use of information on exposures and controls Combining �hazard rating� and �exposure rating� Use of Control Chart The control phase of the HRA should determine whether controls meet relevant occupational exposure limits and other control standards, and whether they achieve ALARP. The basis for establishing ALARP should be documented for all risks assessed as Medium or High (determined in stage 1 and 2; identify and assess) and may be contained within the HRA itself, or as part of an HSE Case. For risks rated High on the RAM, alternative ways of carrying out the operation to avoid the risk must be given serious consideration as part of the HRA. The Control Chart is a tool, which has proven to be helpful in deciding on the need for action to strengthen controls and for assigning priorities in remedial action planning. As such it can assist decisions on whether risks are controlled to As Low As Reasonably Practicable. It uses the information on exposures and controls collected for each task to assign a rating to the effectiveness of the controls. This is done by estimating the potential for over-exposure to the hazard taking account the existing controls, and comparing this with appropriate standards. The resulting �Exposure Rating� can then be plotted against the �Hazard Rating� (RAM Consequence Category for harm to people) to give an indication of the adequacy of the controls, the need for any corrective action and also the priority for each action. This plot is termed the �Control Chart�. This process should not be confused with risk assessment using the RAM (see module 4), though the definitions for the Consequence Categories are the same as those in the RAM. The definitions for the Hazard Ratings and Exposure Ratings are given below, followed by the Control Chart itself. The control phase of the HRA should determine whether controls meet relevant occupational exposure limits and other control standards, and whether they achieve ALARP. The basis for establishing ALARP should be documented for all risks assessed as Medium or High (determined in stage 1 and 2; identify and assess) and may be contained within the HRA itself, or as part of an HSE Case. For risks rated High on the RAM, alternative ways of carrying out the operation to avoid the risk must be given serious consideration as part of the HRA. The Control Chart is a tool, which has proven to be helpful in deciding on the need for action to strengthen controls and for assigning priorities in remedial action planning. As such it can assist decisions on whether risks are controlled to As Low As Reasonably Practicable. It uses the information on exposures and controls collected for each task to assign a rating to the effectiveness of the controls. This is done by estimating the potential for over-exposure to the hazard taking account the existing controls, and comparing this with appropriate standards. The resulting �Exposure Rating� can then be plotted against the �Hazard Rating� (RAM Consequence Category for harm to people) to give an indication of the adequacy of the controls, the need for any corrective action and also the priority for each action. This plot is termed the �Control Chart�. This process should not be confused with risk assessment using the RAM (see module 4), though the definitions for the Consequence Categories are the same as those in the RAM. The definitions for the Hazard Ratings and Exposure Ratings are given below, followed by the Control Chart itself.

51. Hazard rating categories The hazard rating indicates the potential to cause harm. For several agents hazards ratings have been established and listed in health hazard inventories. (links provided) The hazard rating indicates the potential to cause harm. For several agents hazards ratings have been established and listed in health hazard inventories. (links provided)

52. Exposure Rating The Exposure Rating should take into account control measures used to reduce exposure via all relevant routes, e.g. inhalation, skin contact, hearing, effects on musculo-skeletal system, etc. dependent on the hazard. It is easiest to assign a particular Exposure Rating category if measurement data are available, since that data can be compared directly against the OEL. Care must be taken to ensure that the data are representative of the current situation, and, if possible, data from normal and extreme conditions should be obtained. However, exposure measurement data are only one indicator of adequacy of control and are not always readily available. The Exposure Rating category should also consider the reliability of the existing control measures, including engineering methods, procedures and personal protective equipment, to reduce exposures. This is done by comparing the controls with standards of good practice using experience and judgment. Appendix 4 of the HRA yellow guide provides guidance on how to do this. Appendix 6 of the HRA yellow guide gives guidance on selection of OELs and other control standards with which to compare. It is emphasised that the use of personal protective equipment (PPE) as the main measure of exposure control is not robust. In such situations, the type of PPE must be checked to ensure it is appropriate for the type and level of the hazard, and maintenance and training programmes must be confirmed. Where PPE is the main form of control, then the Exposure Rating will always be C as a minimum.The Exposure Rating should take into account control measures used to reduce exposure via all relevant routes, e.g. inhalation, skin contact, hearing, effects on musculo-skeletal system, etc. dependent on the hazard. It is easiest to assign a particular Exposure Rating category if measurement data are available, since that data can be compared directly against the OEL. Care must be taken to ensure that the data are representative of the current situation, and, if possible, data from normal and extreme conditions should be obtained. However, exposure measurement data are only one indicator of adequacy of control and are not always readily available. The Exposure Rating category should also consider the reliability of the existing control measures, including engineering methods, procedures and personal protective equipment, to reduce exposures. This is done by comparing the controls with standards of good practice using experience and judgment. Appendix 4 of the HRA yellow guide provides guidance on how to do this. Appendix 6 of the HRA yellow guide gives guidance on selection of OELs and other control standards with which to compare. It is emphasised that the use of personal protective equipment (PPE) as the main measure of exposure control is not robust. In such situations, the type of PPE must be checked to ensure it is appropriate for the type and level of the hazard, and maintenance and training programmes must be confirmed. Where PPE is the main form of control, then the Exposure Rating will always be C as a minimum.

53. Control Chart When the Hazard and Exposure Ratings are combined in a Controls Chart they provide a visual representation of the urgency of action required to strengthen controls. The position on the chart represents a qualitative interpretation of the need for improved controls to ensure health risks are minimised. Risks can be reduced by moving the Exposure Rating from right to left by improving controls, and the Hazard Rating from bottom to top by substituting with less hazardous alternatives, where it is practicable to do so. The shading splits the need for action to improve controls in to three priorities - First, Second and Third, with a Fourth level not requiring immediate action. Please note that for those agents with the potential to cause irreversible health effects, permanent total disability or death, i.e. Hazard Ratings of 3, 4 or 5, the need for improved controls has been weighted to ensure they receive attention with appropriate priority, even where the Occupational Exposure Limit is not exceeded with the existing controls. When the Hazard and Exposure Ratings are combined in a Controls Chart they provide a visual representation of the urgency of action required to strengthen controls. The position on the chart represents a qualitative interpretation of the need for improved controls to ensure health risks are minimised. Risks can be reduced by moving the Exposure Rating from right to left by improving controls, and the Hazard Rating from bottom to top by substituting with less hazardous alternatives, where it is practicable to do so. The shading splits the need for action to improve controls in to three priorities - First, Second and Third, with a Fourth level not requiring immediate action. Please note that for those agents with the potential to cause irreversible health effects, permanent total disability or death, i.e. Hazard Ratings of 3, 4 or 5, the need for improved controls has been weighted to ensure they receive attention with appropriate priority, even where the Occupational Exposure Limit is not exceeded with the existing controls.

54. Evaluate the Adequacy of Controls What is the nature of the hazard to health ? Use Hazard Rating (RAM Consequence Category) What is the nature and degree of exposure for the task ? Assign Exposure Rating Combine in Control Chart The Control Chart, which has proven to be helpful in deciding on the need for action to strengthen controls and for assigning priorities in remedial action planning. As such it can assist decisions on whether risks are controlled to As Low As Reasonably Practicable. It uses the information on exposures and controls collected for each task to assign a rating to the effectiveness of the controls. This is done by estimating the potential for over-exposure to the hazard taking account of the controls in place, and comparing this with appropriate standards. The resulting �Exposure Rating� can then be plotted against the �Hazard Rating� (RAM Consequence Category for harm to people) to give an indication of the adequacy of the controls, the need for any corrective action and also the priority for each action. This plot is termed the �Control Chart�. This process should not be confused with risk assessment using the RAM though the definitions for the Consequence Categories are the same as those in the RAM. The Control Chart, which has proven to be helpful in deciding on the need for action to strengthen controls and for assigning priorities in remedial action planning. As such it can assist decisions on whether risks are controlled to As Low As Reasonably Practicable. It uses the information on exposures and controls collected for each task to assign a rating to the effectiveness of the controls. This is done by estimating the potential for over-exposure to the hazard taking account of the controls in place, and comparing this with appropriate standards. The resulting �Exposure Rating� can then be plotted against the �Hazard Rating� (RAM Consequence Category for harm to people) to give an indication of the adequacy of the controls, the need for any corrective action and also the priority for each action. This plot is termed the �Control Chart�. This process should not be confused with risk assessment using the RAM though the definitions for the Consequence Categories are the same as those in the RAM.

55. Remedial Action Plan The Remedial Action Plan must cover: Recommendations divided into four levels of action (first, second, third priority and no immediate action required) Is recommendation agreed or not? Responsible person Due date

56. Actions Control Chart (1)To aid priority setting Action 1st priority Stop the exposure; notify management immediately Identify all sources Implement immediate control improvements e.g. PPE Consider need for exposure measurement Identify and implement work practice and control improvements Review HRA, including measurements

57. Actions Control Chart (2)To aid priority setting Action 2nd priority Reduce exposure to below OEL (Hazard Ratings 1-2) Consider reducing to below 0.5 x OEL (Hazard Ratings 3-5) Identify and implement work practice and control improvements (*) Consider need for exposure measurement (*) Review HRA, including measurements (*) Action 3rd priority Actions with asterisk under 2nd priority Action � No Immediate Action Required Normally no need for immediate action to improve controls. Manage for continuous improvement

58. Definitions of ALARP � balancing the reduction in risk against the time, difficulty and cost of achieving it� This level represents the point, objectively assessed, at which the time, difficulty and cost of further reduction measures become unreasonably disproportional to the additional risk reduction obtained. ALARP Definition The level of ALARP must be at least equal to that required by regulation and must exceed it to a level that can be realistically afforded. Note: The students should know the difference between �practicable and �reasonably practicable�. Practicable means more than physical possible and it is influenced and related to current knowledge and invention. On the other hand reasonable practicable relates to the lowest level below �tolerability level at which it is considered reasonable to control exposure to health hazards. Thus it implies that a higher standard of care is required in law when considering the concept �practicable� than �reasonably practicable�. The greater the risk is, the less weight will be given to the cost-factor. The level of ALARP must be at least equal to that required by regulation and must exceed it to a level that can be realistically afforded. Note: The students should know the difference between �practicable and �reasonably practicable�. Practicable means more than physical possible and it is influenced and related to current knowledge and invention. On the other hand reasonable practicable relates to the lowest level below �tolerability level at which it is considered reasonable to control exposure to health hazards. Thus it implies that a higher standard of care is required in law when considering the concept �practicable� than �reasonably practicable�. The greater the risk is, the less weight will be given to the cost-factor.

59. ALARP is influenced by the following factors: risk to be avoided sacrifice involved in taking measures to avoid the risk (money, time and trouble) comparison of the two ALARP All risks over which the employer can exercise control or mitigate the consequences must be considered. (this is the HRA-process) The sacrifice must be larger as the risks are larger. The comparison between the two will lead to a test of �gross disproportion�. The greater the risk, the more that should be spent in reducing it. Other factors influencing the balance of ALARP are societal concerns, the transfer of risks (introducing new risks when removing others), changed circumstances. All these factors need to be taken into consideration when balancing the risks against the costs to further reduce the risks. All risks over which the employer can exercise control or mitigate the consequences must be considered. (this is the HRA-process) The sacrifice must be larger as the risks are larger. The comparison between the two will lead to a test of �gross disproportion�. The greater the risk, the more that should be spent in reducing it. Other factors influencing the balance of ALARP are societal concerns, the transfer of risks (introducing new risks when removing others), changed circumstances. All these factors need to be taken into consideration when balancing the risks against the costs to further reduce the risks.

60. List the measures that have been taken to reduce the risk Go on to identify an additional option which might be introduced to reduce the risk further Give reasons why this additional control is not adopted ALARP- rule of thumb

61. ALARP For RAM Medium and High risks it is necessary not only to confirm the adequacy of control and recovery measures in place but to demonstrate that the risks are controlled to As Low As Reasonably Practicable (ALARP). This involves balancing the reduction in risk against the time, difficulty and cost of achieving it and requires judgements, balances and trade-offs. It aims to achieve a performance that is better than required by regulation to a level that can be realistically afforded. It is a management judgement for which there are no hard and fast rules. Reasonable practicability is essentially about the comparison and selection of control options. Where several control options are possible, these should be compared, and the ones which take the risk to ALARP should be implemented. So in the example below, controls meeting the first two options are unacceptable because they do not meet the tolerability level (in a health situation, the Occupational Exposure Limit). Controls meeting the third and fourth options do meet that criterion, but for a small additional cost, a large risk reduction is possible at option 5. At the sixth option, to achieve further control would involve costs considerably out of proportion to the reduction in risk. The fifth option is therefore ALARP. For RAM Medium and High risks it is necessary not only to confirm the adequacy of control and recovery measures in place but to demonstrate that the risks are controlled to As Low As Reasonably Practicable (ALARP). This involves balancing the reduction in risk against the time, difficulty and cost of achieving it and requires judgements, balances and trade-offs. It aims to achieve a performance that is better than required by regulation to a level that can be realistically afforded. It is a management judgement for which there are no hard and fast rules. Reasonable practicability is essentially about the comparison and selection of control options. Where several control options are possible, these should be compared, and the ones which take the risk to ALARP should be implemented. So in the example below, controls meeting the first two options are unacceptable because they do not meet the tolerability level (in a health situation, the Occupational Exposure Limit). Controls meeting the third and fourth options do meet that criterion, but for a small additional cost, a large risk reduction is possible at option 5. At the sixth option, to achieve further control would involve costs considerably out of proportion to the reduction in risk. The fifth option is therefore ALARP.

62. Is risk to health ALARP? Yes, when only a small reduction in risk would require an unreasonable amount of time, trouble, difficulty or cost. Otherwise Select appropriate additional controls/barriers considering Hierarchy of controls including recovery preparedness measures Other measures like: measurements, monitoring, health surveillance, maintenance of controls, instruction & training Priorities for implementation What remedial action? If it is decided that the risk to health is not controlled to �as low as reasonably practicable�, then some additional controls are required. The hierarchy of controls places the most effective and reliable control strategies at the top of the hierarchy, while those that are less effective or reliable are placed at the bottom of the hierarchy. It is desirable to choose contrrols as near as possible to the top of the hierarchy. If it is decided that the risk to health is not controlled to �as low as reasonably practicable�, then some additional controls are required. The hierarchy of controls places the most effective and reliable control strategies at the top of the hierarchy, while those that are less effective or reliable are placed at the bottom of the hierarchy. It is desirable to choose contrrols as near as possible to the top of the hierarchy.

63. Identify who may be exposed to health risks Identify the relevant exposures to individuals in the workplace Assess your work environment to determine when you need to do exposure monitoring/measurements Exposure measurements

64. Verification of the efficiency of control measures Justification for additional control measures Choice of control measures (eg for noise control) To establish and document historical records of exposure levels for all workers To ensure and demonstrate compliance with regulatory and other exposure guidelines Epidemiological studies or investigating reported health effects To alleviate employee concerns Purpose of exposure measurements ..

65. Baseline - to define range and distribution of exposure for defined jobs Worst case � to identify potentially high exposure Detailed � when baseline study provides insufficient data Routine � periodic exposure monitoring to check that control measures remain effective Compliance - to ensure that exposure is below regulatory and other guidelines Objectives of exposure measurement Worst case measurements are usually carried out as part of a baseline study, in order to indicate compliance with an exposure limit. All exposure measurements must be carried out by a competent person and according to specified, validated measurement protocols. A competent person for carrying out exposure measurements is an occupational hygienist. Particularly setting up the measurement protocols must be left to the experts. There is a difference between measurements, usually performed to identify sources of exposure and to indicate the levels of exposure and monitoring, measurements used to check whether controls are adequate and effective. Monitoring is done on a routine base, where as measurements are usually performed in order to gain basic information concerning exposure.Worst case measurements are usually carried out as part of a baseline study, in order to indicate compliance with an exposure limit. All exposure measurements must be carried out by a competent person and according to specified, validated measurement protocols. A competent person for carrying out exposure measurements is an occupational hygienist. Particularly setting up the measurement protocols must be left to the experts. There is a difference between measurements, usually performed to identify sources of exposure and to indicate the levels of exposure and monitoring, measurements used to check whether controls are adequate and effective. Monitoring is done on a routine base, where as measurements are usually performed in order to gain basic information concerning exposure.

66. Personal Monitoring worker exposure with normal work procedure breathing zone for inhalation exposure near ear for noise exposure full shifts / task samples Area (Environmental) Monitoring contaminant concentration in work area plant conditions effectiveness of controls Monitoring methods

67. Biological Monitoring Determine body absorption of potentially hazardous substance from all sources Measure changes in the composition of body fluid, tissue or expired air May be used to indicated inadequate control, improper work procedure Provides accurate information about the absorbed dose of a substance in the body Not all substances have a method or a BLV (biological Limit Value) Monitoring methods

68. Where to Sample When to Sample Whom to Sample How long to Sample How many samples to take Sampling Strategy These are the basic questions that need to be answered before any sampling takes place. The sampling strategy must be set up by a competent person, an occupational hygienist or a occupational health physician for example.These are the basic questions that need to be answered before any sampling takes place. The sampling strategy must be set up by a competent person, an occupational hygienist or a occupational health physician for example.

69. Monitoring and health surveillance aims to (periodically) assess exposures and health in order to Confirm the effectiveness of existing control measures Collect data for the detection and evaluation of hazards to health Confirm compliance with predetermined criteria Required by law Health Surveillance Monitoring and surveillance can be done by routine exposure monitoring to check the effectiveness of controls. Health surveillance is another way of checking the effectiveness of controls by actually checking whether employees have (early) adverse health effects. If exposure measurements are above OEL or if adverse health effects are demonstrated, this indicates the need to improve the existing controls. In this case the controls are not ALARP. Monitoring and surveillance can be done by routine exposure monitoring to check the effectiveness of controls. Health surveillance is another way of checking the effectiveness of controls by actually checking whether employees have (early) adverse health effects. If exposure measurements are above OEL or if adverse health effects are demonstrated, this indicates the need to improve the existing controls. In this case the controls are not ALARP.

70. Medical Surveillance selection criteria Is there a risk to health (based on HRA) The prevention/intervention potential ("can we do something about it?") Can we detect it? Are the detection methods suitable? Medical Surveillance Which criteria should businesses use in selecting criteria [occupational/environmental hazards or health effects] for monitoring & surveillance? There are four general categories of criteria to use in selection of targets for HS: is there a risk?, the prevention/intervention potential ("can we do something about it?"), can we detect is? And are the detection methods suitable? Additionally, the "on-going" nature of the problem is a criterion used in the decision of whether a surveillance system should be established, as opposed to the conduct of a special study. Special exploratory studies may be used as pilot studies, prior to the decision on establishment of a surveillance system. This is especially important in the case of new/emerging environmental diseases. Surveillance systems are established for various purposes: Immediate health action also called "case-based surveillance" detection and prevention of epidemics/outbreaks Planning and evaluation also called "rate-based surveillance" determination of magnitude and trends identification of high-risk groups and modifiable risk factors assessment of control activities Etiologic investigation outbreak/cluster investigation future analytic studies 1.Is there a risk to health? Determination of the magnitude of a health problem may be done in the context of a formal health risk assessment. Considerations which influence estimates of magnitude include: the frequency of cases of disease or exposure, or the prevalence of the hazard or its sources (empirical data); the number of people exposed to the hazard; the extent to which a specific outcome can be traced to an environmental cause; and, existence of specially sensitive or vulnerable sub-populations. 2.Can we do something about it? Determination of the prevention/intervention potential for a health problem requires assessment of the extent of proven preventive interventions and estimation of the likelihood of success of unproven interventions. The best information on proven interventions comes from the published literature, but informal networks of public or occupational/environmental health practitioners are also useful sources, when the published literature is scant. As discussed above, the strongest justification for the establishment of a health surveillance system is its close link with public health or occupational/environmental action. 3.Can we detect it? 4. Are the methods suitable?Which criteria should businesses use in selecting criteria [occupational/environmental hazards or health effects] for monitoring & surveillance? There are four general categories of criteria to use in selection of targets for HS: is there a risk?, the prevention/intervention potential ("can we do something about it?"), can we detect is? And are the detection methods suitable? Additionally, the "on-going" nature of the problem is a criterion used in the decision of whether a surveillance system should be established, as opposed to the conduct of a special study. Special exploratory studies may be used as pilot studies, prior to the decision on establishment of a surveillance system. This is especially important in the case of new/emerging environmental diseases. Surveillance systems are established for various purposes: Immediate health action also called "case-based surveillance" detection and prevention of epidemics/outbreaks Planning and evaluation also called "rate-based surveillance" determination of magnitude and trends identification of high-risk groups and modifiable risk factors assessment of control activities Etiologic investigation outbreak/cluster investigation future analytic studies 1.Is there a risk to health? Determination of the magnitude of a health problem may be done in the context of a formal health risk assessment. Considerations which influence estimates of magnitude include: the frequency of cases of disease or exposure, or the prevalence of the hazard or its sources (empirical data); the number of people exposed to the hazard; the extent to which a specific outcome can be traced to an environmental cause; and, existence of specially sensitive or vulnerable sub-populations. 2.Can we do something about it? Determination of the prevention/intervention potential for a health problem requires assessment of the extent of proven preventive interventions and estimation of the likelihood of success of unproven interventions. The best information on proven interventions comes from the published literature, but informal networks of public or occupational/environmental health practitioners are also useful sources, when the published literature is scant. As discussed above, the strongest justification for the establishment of a health surveillance system is its close link with public health or occupational/environmental action. 3.Can we detect it? 4. Are the methods suitable?

71. Document & Review HRA Appropriate Depth of Records Linked with Medical Records Informing Staff Archiving of Records Reviewing Records

72. Appropriate Documentation Records should: be retrievable Internal/external audits, authorities and review meet legal requirements be detailed enough to ensure audit trail on how conclusions were reached allow traceability from individual name via Job Type to tasks include exposure monitoring and health surveillance

73. Informing Staff of Findings Involves staff in HRA process Ensures that: Health risks are understood Control measures are used Staff can alert assessment teams on changes May be a legal requirement

74. Archiving of Records As required by local law and/or practice 30 - 40 years are typical Allows for re-introduction of old processes

75. Reviewing HRAs Senior management will confirm the status of HRA through HSE annual letter Action Items Short term reviews of action items Against target dates and responsible persons Change in process, hazard, legislation etc Change in controls New information on the effect Incidents, illnesses, complaints, new knowledge On an agreed cycle Between 1 and 5 years dependent on risk