Health Assessment & Surveillance

1. Health & Safety Management for QuarriesTopic Six Health Assessment & Surveillance

2. Objectives of this Section • To outline the difference between safety and health hazards. • To demonstrate a practical methodology for undertaking health risk assessments. • To outline the reasons for undertaking health surveillance. • To identify some common health hazards present in the quarrying industry.

3. Introduction • Health and safety law places a duty on employers to ensure the health as well as the safety of their employees. • Yet each year many more people become ill as a result of their work than are killed or injured in industrial accidents. • Most diseases caused by work do not kill, but can involve years of pain, suffering and discomfort for those affected.

4. Health and Safety Problems with identifying health risks: • The health risk may not be understood or well defined and the cause/effect relationship not established. • Health risks tend not to attract widespread publicity or demand the same urgent attention as safety risks. • Health risks appear to have little, if any, short term effect and it may be that ill-health does not occur for many years after exposure.

5. Health and Safety • Health risks may be more difficult to address, resulting in attention being directed to risks where control is more visible and likely to attract tangible benefits. • Comprehensive data on the occupational ill-health may simply not exist in many cases and in practice, the true extent of occupationally related ill-health may be unknown.

6. Typical Health Risks Risks to health from work activities include: • Skin contact with irritant substances, leading to dermatitis etc. • Inhalation of respiratory sensitisers, triggering immune responses such as asthma. • Badly designed workstations requiring awkward body postures or repetitive movements result in upper limb disorders, repetitive strain injury and other musculoskeletal conditions.

7. Typical Health Risks • Noise levels which are too high, causing deafness and conditions such as tinnitus. • Too much vibration, e.g. from hand-held tools leading to hand arm vibration syndrome and circulatory problems. • Exposure to ionising and non-ionising radiation including ultraviolet in the sun’s rays causing burns, sickness and skin cancer.

8. Occupational Health Occupational health is about protecting the physical and mental health of workers and ensuring their continual welfare in their working environment.

9. Occupational Health • Important aspects of occupational health include: • Ensuring fitness and physical capability to perform a job safely. • Health education and promotion. • Providing medical services including health surveillance. • Rehabilitation after illness or injury.

10. Health Risk Management

11. Hazard Identification • Most hazards can be identified based on knowledge and observation of the work activity, though specialist advice or assistance may be necessary. • The most common agents likely to present health hazards at quarries are

12. Dust Noise Vibration Oil, Fuel, Grease Skin respiratory sensitisers Manual handling Eyesight Welding fume Asbestos DSE Weighbridge    Office Staff    Loading Shovel     ?  Dumper     ?  Plant Operator    ? ?  ? Crusher Operator    ? ?  ? Foreman   ? ? ?  Driller   ? ?   Shotfirer   ? ?   Fitter   ?      ? ? Electrician   ?     ? Manager   ? ?   ?

13. Risk Assessment The two major elements that need to be considered are: • The potential consequences of exposure to the hazard. • The potential exposure to the hazard.

14. Risk Assessment (2)

15. Potential Severity The potential severity of exposure to the hazard is related to the properties of the hazard. For example: • The toxicity of a chemical. • The sound pressure level at the operators ear and the frequency of a noise source. • The intensity and penetrability of ionising radiation.

16. Potential Exposure Potential for exposure means the opportunity to do harm. In assessing the potential exposure to the hazard, it is necessary to consider: • The proportion of the work force who are or will be exposed to the hazard (in particular the frequency of exposure and length of time of exposure). • Any risk reducing control measures that are in place and their effectiveness in reducing the risk.

17. Potential Exposure • Where necessary some form of sampling and exposure measurements should be undertaken to determine the extent of the hazard at the time of the assessment. • These can then be compared with any occupational exposure limits (such as TLV’s and OEL’s) that have been set for the industry, as well as any in-house standards. • Such exposure measurements may also assist in determining any remedial action that is necessary.

18. Controlling the Risk If the assessment of risk shows that further action is necessary, then control measures should be selected according to the hierarchy of risk control:

19. Hierarchy of Risk Control • Elimination of the risk. This can be achieved through redesigning the activity or equipment to eliminate the release of the hazard. • Reduction of the risk at source through engineering controls. This can be achieved by enclosing the activity or equipment to capture and/or absorb the hazard, dilute the hazard or release it into a safer place. • Minimising the risk through procedural controls. This involves implementing systems and procedures so that work is carried out in a particular way that limits exposure to the hazard. • Use of appropriate personal protective equipment (PPE).

20. Risk Control • The use of PPE is the last resort for the control of the exposure of employees to hazards. • This is because PPE only protects the wearer and then only if worn properly. • Situations where the use of PPE may be necessary are: • Where adequate control of exposure cannot be achieved by the hierarchy. • As a ‘stop-gap; measure until those further measures have been introduced.

21. Examples of Hierarchy of Risk Control: Noise • Sound absorbent material around noisy machinery. • Use of sound absorbing wall and floor materials. • Cover the source of the noise (e.g. using hoods). • Arranging plant and equipment to create screens and reduce the level of reflected sound. • Isolating workers from the noise source. • As a last resort provide comfortable PPE.

22. Ensuring the use of Control Measures This is a responsibility of both the employer and employee achievable through adequate instruction and training by: • Working procedures, codes of practice or other procedural controls. • Educating the workforce on the hazards and risks involved in their work and how control measures will protect their health. • Effective supervision.

23. Proactive monitoring: Sampling & Exposure monitoring Active monitoring is achieved through sampling and exposure monitoring in order to: • Check the effectiveness of risk reducing control measures, as a failure in these measures results in an increased risk of harm occurring. • Confirm that Occupational Exposure Limits are not exceeded. • Tie in with the medical surveillance programme.

24. Health Surveillance Health surveillance means having a system to look for early signs of ill-health caused by work in order to: • Detect adverse effects early. • Prevent further harm being caused.

25. Health Surveillance The criteria for carrying out occupational health surveillance are: • There is an identifiable disease or condition associated with the work. • There are valid techniques to detect the condition at an early stage. • There is reasonable likelihood that the disease or condition will occur in the particular circumstances of the exposure. • That health surveillance will be of benefit to individuals or groups of workers.

26. Dust Noise Substance / Hazard Whilst dust is present in all quarries, the nature of the dust presents differing levels of risk. In general the highest risk is presented by dusts containing high levels of respirable crystalline silica. Limestone may have no free silica. Flint may be in excess of 90%. Quarrying is a noisy industry, typical levels being: Primary Crusher: 89-108 dB(A) Hand Drill: 106 - 110 dB(A) Possible Ill Health Effects Exposure to dust can affect chest health and can result in pneumoconiosis or silicosis. Long term irreversible hearing loss. Appendix 1: Hazard information from QPA Guide

27. Dust Noise Control Level Routine atmospheric dust monitoring is required. EH40 “Occupational Exposure Limits” lists standards for various dusts. E.g. Occupational Exposure Standards Limestone 10mg/m3 total inhalable dust/4 mg/m3 respirable dust. Coal: 2 mg/m3 respirable dust Kaolin: 2 mg/m3 respirable dust Maximum Exposure Limit Crystalline Silica: 0.3mg/m3 respirable dust TheNoise at Work Regulations 1989 set out three action levels: 1st Action Level – 85 dB(A) L EP,d -assessment must be carried out -ear protectors on request 2nd Action Level – 90 dB(A) L EP,d -          reduction of exposure required -          ear protectors to be provided -          ear protection zones required Peak Action Level – 140 dB(A) L EP,d - as 2nd Action Level Appendix 1: cont’d

28. Dust Noise Health Surveillance For new employees where a medical assessment is considered appropriate medical may include a respiratory questionnaire, lung function test and possibly x-ray if exposure to silica is likely. Where operatives are exposed to levels of respirable crystalline silica greater than 0.1 mg/m3, the Guidance in EH59 (latest revision) should be followed. For new employees where a medical assessment is considered appropriate audiometer should be carried out. It is good practice to carry out regular hearing checks on all employees whose daily personal noise exposures equal or exceed 90 dB(A); many employers already do this. 90 dB(A) is the same as the ‘second action level’ in NaW Regs – the level at which protection must be worn. The risk of hearing damage rises significantly at exposures above this level. Therefore, even when hearing protection is used, hearing checks (audiometry) should normally be provided when noise levels reach or exceed 95 dB(A), except where that exposure is likely to be only temporary, for example for a few weeks in a year. Appendix 1: cont’d

29. Dust Noise Precautions Avoid generation of dust in the first instance. Avoid exposure to dust. Maintain seals/filters etc for control rooms, vehicle cabs and other ‘dust refuges’. Where exposure cannot be adequately control by other means appropriate respiratory protective equipment should be used. Purchase less noisy equipment and keep it maintained. Reduce exposure below peak and second action level. Provide quiet refuges. Educate the workforce. Only approved PPE giving adequate attenuation should be used. All PPE must be properly maintained. Appendix 1: cont’d