UOB INVESTIGATION OCCUPATIONAL HEALTH SURVEILLANCE

Cover

• Document No.

• Surveillance recipient

• Audit Title (format: surname_firstname_department_year_followup)

• Conducted on

  Date

• Prepared by

• Department of this report

• Follow up on

  Select SKIN LUNG HAVS

  • SKIN
  • LUNG
  • HAVS

• Document status

  NOTES

  DRAFT REPORT

  REPORT

PERSON REPORTING

• First names

• Surname

• Address
  Address

• Date of birth

  Date

• National Insurance number

• Email address

• Phone number

• Mobile phone number

REPORT MEETINGS

• Meetings record

meeting

• Meeting type

  MEETING

  PHONE

  SITE

  OTHER

• Meeting date

  Date

REPORT WORK ACTIVITIES

• Department

• Post held

• Approximate start date in post

• Report on work activities

work activity

• Work activity

SKIN SURVEILLANCE FOLLOW UP

• Reason for inquires

  SURVELLANCE

  COMPLAINT

  OTHER

  NO INQUIRES

SKIN HAZARDS & RISKS

• Follow up

  Off

  On

• Common skin hazards are:
  Agricultural type work - with artificial fertilisers, fuels, solvents, wet work, handling plants, wood dust etc;
  Carpentry type work - dusts, wood preservatives, dyes, fungicides, glues, solvents, varnishes, wood dust, etc
  Cleaning type work - detergents, cleaning products, solvents, wet work, etc
  Construction type work - cement, dusts, solvents, wet work, building materials, etc
  Metalworking - cutting oils & fluids, solvents, metal shavings, chromium metal, nickel metal, etc
  Painting & decorating type work - aggressive hand cleaners, solvents & thinners, chromium, nickel, etc
  Veterinarian type work - animal proteins, animal excreta and secreta, disinfectants, wet work, anaesthetics, antibiotics, antiseptics, formaldehyde, gluteraldehyde, latex, etc

• Is this person exposed to skin risks at work (such as organic solvents, oils, detergents, cleaning materials, etc)

  YES

  NO

  N/A

• Are precautions taken to prevent expose.

  YES

  NO

  N/A

SKIN SYMPTOMS SUFFERED

• Follow up

  Off

  On

• Does the person suffer from skin problems

  YES

  NO

  N/A

• If they suffer from a skin problem, then record what problem they suffer from and which part of the body is affected.

• Does the condition appear to be caused or aggravated by something used at work

  YES

  NO

  N/A

• Does the condition make work more difficult

  YES

  NO

  N/A

• Treatment for skin problem

• Are they receiving treatment for their skin problem

  YES

  NO

  N/A

• Are you seeing a doctor for the current skin problem. Have they provided any advice and guidance.

  YES

  NO

  N/A

• Confounding factors

• Do they have any activities outside of work that may cause skin problems

  YES

  NO

  N/A

RESPIRATORY SURVEILLANCE FOLLOW UP

• Reason for inquires

  SURVELLANCE

  COMPLAINT

  OTHER

  NO INQUIRES

RESPIRATORY HAZARDS & RISKS

• Follow up

  Off

  On

• Common respiratory hazards are:
  Animal and plant proteins; some wood dusts; isocyanates; and gluteraldehyde

• Is this person exposed to respiratory risks (such as wood dust, silica dust, sensitising chemicals, etc)

  YES

  NO

  N/A

• Are controls in place to prevent or reduce expoure

  YES

  NO

  N/A

RESPIRATORY SYMPTOMS SUFFERED

• Follow up

  Off

  On

• Life style factors that may cause respiratory symptoms

• Does the subject smoke

  YES

  NO

  N/A

• How many per day

• General symptoms suffered that may indicate development of a chronic condition

• Symptoms suffered include eye irritation, soreness or watering of eyes

  YES

  NO

  N/A

• Symptoms suffered include persistant coughs, bouts of coughing or phlegm

  YES

  NO

  N/A

• Symptoms suffered include being woken at night with coughing or chest tightness

  YES

  NO

  N/A

• Symptoms suffered include recurring blocked nose, running nose or nasal irritation

  YES

  NO

  N/A

• Specific symptoms that may indicate an existing chronic condition

• Medical consultation for respiratory problems (eg chronic bronchitis)

  YES

  NO

  N/A

• Diagnosed as suffering from asthma

  YES

  NO

  N/A

HAVS SURVEILLANCE FOLLOW UP

• Reason for inquires

  SURVELLANCE

  COMPLAINT

  OTHER

  NO INQUIRES

HAVS HAZARDS & RISKS

• Follow up

  Off

  On

• Equipment that might cause HAVS are: chainsaws; concrete breakers & road breakers; cut off saws; hammer drills; hand held grinders; impact wrenches; jigsaws; needle scalers; pedestal grinders; polishers; power hammers & chisels; powered lawn mowers; powered sanders; scabblers; strimmers & brush cutters; etc

• Details of past exposure to vibration

HISTORY

• Approximate dates

• Exposure to vibration

• Details of current exposure to vibration

CURRENT

• Approximate year of first exposure

• Exposure source

• Frequency of exposure to this source

  DAILY

  WEEKLY

  MONTHLY

  LESS THAN MONTHLY

HAVS SYMPTOMS SUFFERED

• Follow up

  Off

  On

• Do they suffer from tingling of the fingers lasting more than 20 minutes after using vibrating equipment

  YES

  NO

  N/A

• Do they suffer from tingling of the fingers when not using vibrating equipment

  YES

  NO

  N/A

• Do they wake at night with pain, numbness or tingling in their hand(s) or wrist(s)

  YES

  NO

  N/A

• Do the fingers or hands go numb more than 20 minutes after using vibrating equipment

  YES

  NO

  N/A

• Have the fingers gone white on cold exposure

  YES

  NO

  N/A

• Do they have difficulty in warming fingers or hands when leaving the cold

  YES

  NO

  N/A

• Do there fingers or hands go white at any other time

  YES

  NO

  N/A

• Are they experiencing any other problems with the muscles or joints of the fingers, hands, wrists, arms or shoulders

  YES

  NO

  N/A

• Do they have difficulty picking up small objects (eg screws, button, etc)) or difficulty in gripping objects (eg container lids, pens, etc)

  YES

  NO

  N/A

• Do they have any neck, arm or hand injuries or have they had surgery to correct arm or hand injuries

  YES

  NO

  N/A

• Do they have any significant diseases of the joints, skin, nerves, heart or blood vessels that need to be taken into account

  YES

  NO

  N/A

• Are they taking any medication on a long term basis

  YES

  NO

  N/A

• Do they use any personal protective equipment to protect from the effects of vibration

  YES

  NO

  N/A

Signatures

• Person completing this report

  Sign

• Subject of this report

  Sign

• Others in attendance at the meeting

attendees

• Signature

  Sign

Further action required

• Respiratory surveillance follow up outcome

  Yes

  No

  N/A

• Skin surveillance follow up outcome

  Yes

  No

  N/A

• HAVS surveillance follow up outcome

  Yes

  No

  N/A

Recomendations

• Add recommendations and further actions needed

RECOMMENDATION

• Title - short one liner

• Department to action

• Recomendation

  HIGH PRIORITY

  MEDIUM PRIORITY

  LOW PRIORITY

  ADVISORY ONLY

  COMMENT

• Target date for completion

  Date

Signature

• Person completing this report

  Sign