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| Block 3: Occupational Health Management - Section 6: Impairment & Disability |
| OHM 6.1: Approach to the certification process |
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| Block 3: Occupational Health Management - Section 6: Impairment & Disability |
| OHM 6.1: Approach to the certification process |
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revising designing an ohp
real focus in on step 8 o this
so it is sort of revision over phases 1 and 2
The process of certification of fitness to work can be regarded as comprising three phases (see algorithm in Appendix 2). IT WOULD BE GREAT IF EACH STEP COULD BE LINKED TO THE ALGORITHM DIAGRAM WHICH COULD THEN BE THE PAGE PUT UP WITH THE LINKS TO EXCERTPS FROM THE TEXT BELOW. IS THAT POSSIBLE GEORGES?
Professionals involved in the planning of medical surveillance programmes frequently underestimate this phase. It comprises three steps:
Step 1: Risk assessment
Step 2: Occupational risk and exposure profiling (OREP)
Step 3: Setting standards for medical surveillance
Risk assessment is covered in the Health Risk Assessment guideline. For the purposes of this guideline, the objectives of risk assessment can be regarded as a process that identifies all the relevant health hazards and the degree to which the various occupations are exposed to these hazards. Remember, “risk” is the product of both the hazards (the capacity to cause harm) and also its relevant exposure. A clear understanding of these risks is essential prior to setting medical standards for these occupations. At the end of this risk assessment process each occupation should have a clearly defined “Occupational Risk and Exposure Profile” (“OREP”). These risks should include both exposure risks and liable risks.
Once these are established, the Occupational Medicine Practitioner should set medical standards for each of these occupations, which, in turn, are determined by the OREPs. These are described in the SOP on designing Worker Allocated Surveillance Programmes (“WASPs”).
To assist Occupational Medicine Practitioners in this exercise, as well as to set national benchmarks, the mining occupational health advisory committee has published guidelines regarding the minimum standards of fitness to perform work in a mine. This document is available to all Occupational Medicine Practitioners.
This is described in detail in the Medical Surveillance guideline. Two forms of medical screening can be conducted:
The circumstances in which these examinations are conducted will vary tremendously from company to company. Some companies will have their own infrastructure and employed medical staff. At these, the medical examinations will be conducted on site. At smaller companies, some of these services will be conducted by off-site contracted medical practitioners. However this is conducted, the final common pathway is the issuing of a medical certificate of fitness. This is either handed directly to the employee (or applicant), who takes it to the Human Resources personnel for actioning. Should the medical practitioner’s examination identify conditions that render the applicant (or current employee) unfit to continue working in his/her occupation, this needs to be handled in a fair and sensitive manner. This comprises a third phase of the process of certification – medical adjudication – and is discussed below.
Employees currently employed by the company:
Once the medical surveillance sequence is completed (the relevant tests have been conducted), the responsible Occupational Medicine Practitioner is required to evaluate the findings and decide as to whether or not the person is fit for the occupation envisaged. Should the inherent requirements of the occupation be met, as defined by the “OREP” ?EXPOSURES and matching “WASP”, ?CLINICAL ABNORMALITIES the “certificate of fitness” is signed accordingly. If the requirements are not met, a decision is to be taken as to how to deal with this (see below).
Prior to the introduction of the current Labour Relations Act, in which an applicant is seen in a similar light to a current employee, surveillance programmes often carried more stringent requirements for new applicants. Currently, the practice is to apply the standards agreed in the code of practice for all participants in the medical surveillance programme in an equal fashion. However, some discretion is allowed to the responsible Occupational Medicine Practitioner where some uncertainty exists as to the fitness of the candidate. A current employee is known to the company and the Occupational Medicine Practitioner, and therefore there is a work history, including a good knowledge of the employee’s past work performance, which is not the case for a new applicant. Current employees with good work performance records who are found to have borderline health requirements or whom are found not to meet inherent health requirements which are not of a critical nature (“relative exclusion”), may be authorised to continue, simply on the basis that they have a past record that indicates they are able to work safely in the occupation.
New applicants:
The Labour Relations Act requires the employer to regard a new applicant in the same light as an employee. In reality this does not always work in this manner. Technically, the sequence described for the “Unfit employee” (below) should apply to new applicants as well, however many will argue that it is not reasonable to keep a post open for a new applicant, whilst he/she goes for treatment or rehabilitation for a medical condition that renders that applicant unable to meet the requirements of the job.
For example, should three applicants be considered for a single occupation, of which one has a treatable medical disorder, which disqualifies him/her from the occupation, the law requires that the company should still, (technically), consider that person in the same light as the other two. That affected person should be allowed the option to have the medical condition treated before the exclusion is applied. Whether or not this is reasonable business practice (as opposed to legal application) when this disability is a medium-term temporary partial disability is arguable. A concrete example might be where an applicant has a visual impairment and applies for an occupation for which normal visual function is an inherent requirement. Technically, if the visual impairment is medically treatable, (for example by means of an operation), the applicant should be regarded in the same light as the others. However, if the applicant argues that he/she can only have the operation in a month’s time, for whatever reason, does this change the situation? From a legal point of view, for this applicant to be excluded on the grounds of this impairment, the company would need to show that there is an immediate need for the services of the applicant for that occupation. Hence it can be seen that similar principles apply to employees entering into the system for the first time as well as those currently employed, with adaptations where relevant.
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