What is Health Surveillance at Work

Health Surveillance – Why? A Managers Guide

Health surveillance is required by law and a means of checking whether a worker’s health is affected by their work. Health surveillance includes medical tests such as hearing and breathing, questionnaires and inspections for workers considered most likely affected. Health surveillance programmes check for signs of health problems if there are any, this gives you the chance to do something to stop it getting worse.  This means that processes, rules or chemicals need changing.

So if health problems are found in a health surveillance programme, people are being harmed working for you.  If health risks aren’t controlled then this is your early warning system.

Health surveillance aims to:

  • Find poor health effects at an early stage so that changes in working practices made and stop things getting worse
  • Prevent disabling illness/disease from work processes
  • Assist in checking that the methods an employer has for protecting staff are working
  • Protects the health of workers

Professional occupational health services undertake a variety of health surveillance assessments either on or off-site. 

With some chemicals, dusts, fumes and vibration etc it may be necessary to ask health professionals or scientists (hygienists) to come in and give direct advice so that harm can be avoided from day one. In cases where there are new substances or the potential for causing severe harm, the health control measures used may be a bit over the top initially but this will reduce as the new substance or process starts and control measures kick in.

What Health Surveillance Tests should I Do?

What many do not understand is that for some substances or processes – there is no proper or targeted test.

A good example of this is stress. There is no reliable test you could apply to everybody to measure their likely response to workplace stress. You could assess their mental health but this may bear no relation to work at all. Another good example of not being able to check,  are workers who have a bad back which suddenly ‘goes’ or buckles. There is no scientific method of checking this out on everybody. So health surveillance in this type of situation, wastes people’s time for predicting how to help.  In fact, it’s worse than that Jim, many people believe that medical tests give them the ‘all clear’.  I often hear workers asking if they have passed their MOT (Ministry of Transport) test, believing that the tests check out general health.  Unfortunately they don’t.  Each health surveillance exercise targets a specific substance or a process.  Only wellbeing checks such as well man or woman could be linked to a full body check up.

Here are the 4 most common types of health surveillance in industry:

1. Hearing tests (Audiometry)

Sound waves represented by waves hitting an ear
Noise affecting hearing

This is testing a range of sound usually in a sound proof booth.  Workers have to press a button when they hear different sounds.  Following the test, the responses are grouped to see if there is hearing damage.

Working with

Noisy machinery or work that causes a lot of noise – the ‘safe’ noise levels are set out in the Regulations


According to evidence, over 1 million employees in Great Britain are exposed to levels of noise which may affect their long-term hearing. This can be prevented. Occupational health providers can do on site hearing tests for those who work in noisy areas, reporting back to the site on the results of assessments and any recommendations for increasing or decreasing the control measures for the future.

2. Skin checks – Skin surveillance

This is system of self-reporting skin problems or a responsible person checks workers hands and face or other likely areas of skin affected

Working with

Chemicals that can cause allergies such as epoxy resins, spices, food stuffs


Under The Control of Substances Hazardous to Health Regulations 2002 (COSHH), employees working with substances that may harm the skin should complete a questionnaire and undergo an examination by a medical person regularly.

3. Breathing checks – (Lung Function Testing or Spirometry)

Workers fill in regular questionnaires reporting any symptoms of breathing difficulty and may also have a lung function test.  This involves blowing into a machine which assesses if you have problems with breathing that may be caused by the chemicals, dusts, fumes that you work with.

Working with

Substances that cause or make asthma worse (e.g. flour dust, paint sprayers, epoxy resins)


Under The Control of Substances Hazardous to Health Regulations 2002 (COSHH), employees working with dusts such as flour should complete a questionnaire asking about any symptoms they may have or undergo a breathing test on a regular basis – mostly yearly.

4. Vibration Checks

Checking for signs of Vibration White Finger or Hand Arm Vibration  (HAV) to the nerves, circulation and muscles of the fingers, hands and arms.  The health professional will take you through some questions about your hands, arms etc and some simple tasks and health tests to see if there is any noticeable effect from working with the machines you use.

Working with

Hand held vibratory equipment (strimmers, hammer drills etc)


Under the Control of Vibration at Work Regulations employers should check the health of workers who may be affected by HAVs.

Who Has Health Surveillance?

Under UK law, an employer must assess the risks to workers.  If ab employer decides health surveillance is needed, (and there are many different types), then a programme of health checks should start.  New employees will need a test to look at their current health before they start working with the hazard. Workers should continue having medical checks on a regular basis throughout their time working with that particular substance or in that area.

The usual place to start the process is by issuing a health questionnaire to the workers (when recruited or at regular intervals) by the responsible person.  In larger companies this could be HR or a health and safety professional, in smaller, it could be you. Workers send their questionnaires direct to occupational health for assessment, or it could be someone in your workplace who has had special training e.g. a responsible person or technician.  It’s important to guarantee confidentiality when giving out the questionnaires otherwise you might not get the truth.

After the Questionnaire – What happens next?

The reviewer will look at the answers on the questionnaires, looking for any health issues linked to work.  If all is well then the Manager is notified that no health issues are found and the person is able to continue work.  Occasionally there could be health issues: in this case, the worker is asked to do further health tests and stopped from working with the hazard until control measures improve.  When a worker is found with a health issue linked to the work – a full review of the processes should follow.

The report back to the employer will also say when the next health assessment is due and any other helpful tips to protect the worker and could include a recommendation for a face to face appointment with an occupational health doctor or nurse depending on the seriousness of the health risks identified. Occasionally where health issues are found that are not work related, the worker is  advised to see their own GP for treatment and advice.

Employers responsibilities

  • When recruiting new staff (HR or responsible managers) must provide the correct questionnaires for completion taking account where the person is working and the type of health risks eg working in a noise hazard area
  • Provide the correct questionnaire on time to employees requiring regular health monitoring
  • Keep records to enable regular and systematic review of health with questionnaires or medical required eg skin questionnaire required annually
  • Encourage/insist employees take part in the health surveillance programme

Employee responsibilities

Employees should:

  • Complete questionnaires and answer questions truthfully, accurately and timely
  • Attend appointments – if unable to attend inform line managers as soon as possible
  • Notify management if any health issues arise in between scheduled health surveillance appointments
  • Comply with health and safety requirements to minimise health risks e.g. wear personal protective equipment
Two men shaking hands with one man crossing his fingers behind his back to denote he is not telling the truth
Keeping Secrets at Work


Occupational health staff work under their own professional standards.  Confidentiality is a huge issue in terms of their own work.  People tend to trust Doctors and Nurses and share health matters with openness and frankness.  Confidentiality is a cornerstone of this trust. Although the worker may share all of their personal medical history with occupational health it is on the understanding that this will not be shared with the employer unless the worker consents to this.  However, with health surveillance programmes, the Manager needs to know how work has affected the person so that others in that team are protected.

 Questions or concerns?

If you have any questions about the health of your workers or think you might need a health surveillance programme – contact a local occupational health service or go to the HSE website for more information.

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