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Health Monitoring Overview

What is Health Monitoring?​

Health monitoring (also called health surveillance) is the monitoring of a person to identify changes in their health status because of exposure to certain hazardous substances or work activities.

[!important] Legal Requirement Health monitoring is mandatory when required by WHS Regulations, usually involving exposure to specific hazardous substances.

When Health Monitoring is Required​

Health monitoring is required when:

  • A worker is carrying out ongoing work involving specific hazardous substances
  • Exposure may result in identifiable disease or health effect
  • There is a valid technique for detecting the disease or effect
  • The technique has minimal risk to the worker

Substances Requiring Health Monitoring​

Construction-relevant substances include:

  • Asbestos - for workers removing asbestos or exposed to airborne asbestos
  • Lead - for workers exposed to lead above action levels
  • Crystalline silica - for workers at risk of exposure to respirable crystalline silica
  • Isocyanates - in paints, adhesives, and foam products
  • Organophosphates and carbamates - in some pesticides

See WHS Regulations Schedule 14 for the complete list.

Purpose of Health Monitoring​

Health monitoring:

  • Detects early signs of work-related ill health
  • Identifies inadequate controls allowing excessive exposure
  • Verifies control effectiveness by showing no adverse health effects
  • Provides early intervention before serious disease develops
  • Informs risk assessment and control measures

[!note] Health Monitoring vs Health Surveillance "Health monitoring" and "health surveillance" are often used interchangeably. Both refer to medical monitoring required by regulations.

What Health Monitoring Involves​

Depending on the substance, monitoring may include:

  • Medical history and examination by a registered medical practitioner
  • Biological monitoring - testing blood, urine, or breath for substance levels
  • Lung function tests - for respiratory hazards like silica and asbestos
  • Hearing tests - for noise exposure (audiometry)
  • Skin examinations - for dermatological hazards
  • Chest X-rays - for lung diseases (silicosis, asbestosis)

PCBU Responsibilities​

Arrange Health Monitoring​

PCBUs must arrange health monitoring when required by regulations:

  • Identify which workers require health monitoring
  • Engage a registered medical practitioner experienced in health monitoring
  • Ensure monitoring occurs at required frequencies
  • Pay all costs of health monitoring

Inform Workers​

Before health monitoring:

  • Explain why monitoring is required
  • Describe what monitoring will involve
  • Inform worker of their right to receive results
  • Explain confidentiality of health information

Provide Information to Medical Practitioner​

Provide the doctor with:

  • Nature of the work
  • Substances the worker is exposed to
  • Extent and duration of exposure
  • Control measures in place
  • Previous health monitoring results (if available)

Respond to Results​

If monitoring indicates adverse health effects:

  • Review and improve control measures
  • Reduce worker's exposure
  • Consider modifying work duties if recommended
  • Provide rehabilitation if needed
  • Report to regulator if required

Keep Records​

Maintain records of:

  • Names of workers monitored
  • Dates of health monitoring
  • Health monitoring reports (kept confidentially)

Records must be kept for 30 years or longer for certain substances.

Worker Rights and Responsibilities​

Workers Must​

  • Participate in health monitoring when required
  • Provide accurate health history to medical practitioner
  • Attend monitoring appointments arranged by PCBU

Workers Have Right To​

  • Receive a copy of their health monitoring results
  • Understand what results mean
  • Privacy and confidentiality of health information
  • Not have health monitoring results used for discrimination

[!important] Confidentiality Health monitoring results are confidential medical information. PCBUs only receive information necessary to manage workplace risks, not detailed medical information.

Frequency of Health Monitoring​

Frequency depends on the substance and level of exposure:

Initial (baseline) monitoring:

  • Before or within period of commencing exposure work

Periodic monitoring:

  • During ongoing exposure work
  • Frequency varies by substance (annually, every 2 years, etc.)

Exit monitoring:

  • When worker ceases exposure work
  • Particularly important for substances with long latency diseases (asbestos)

Example - Silica Exposure:

  • Baseline: Before or within 6 weeks of starting silica exposure work
  • Periodic: Every 2 years during ongoing exposure
  • Exit: When ceasing silica exposure work

Health Monitoring Reports​

The medical practitioner provides:

To the worker:

  • Full health monitoring report including test results and findings

To the PCBU:

  • Certificate stating whether monitoring identified evidence of disease or effect
  • Recommendations for adjusting work practices or controls
  • Whether worker is medically fit to continue the work
  • NO detailed medical information or diagnosis

Acting on Health Monitoring Results​

If monitoring identifies adverse health effects:

Immediate Actions​

  • Remove worker from exposure or reduce exposure
  • Review control measures for adequacy
  • Consider if other workers are also affected
  • Seek medical advice on fitness for work

Investigation​

  • Investigate why controls failed to prevent exposure
  • Assess whether monitoring should be extended to other workers
  • Review risk assessment for the substance

Improvements​

  • Implement improved control measures
  • Monitor effectiveness of new controls
  • Increase frequency of health monitoring if needed
  • Provide additional training on controls

Reporting​

  • Notify SafeWork NSW if required
  • Notify workers' compensation insurer if work-related injury/disease
  • Update health and safety records

Construction Example: Silica Dust​

Scenario: Workers cutting, grinding, or drilling concrete, masonry, or stone

When Health Monitoring Required​

Workers at risk of exposure to respirable crystalline silica dust.

What is Monitored​

  • Baseline: Medical history, chest X-ray, lung function test
  • Periodic (every 2 years): Medical examination, lung function test, chest X-ray (if indicated)
  • Exit: Medical examination and tests as indicated

PCBU Actions​

  1. Identify workers - Those using power tools on concrete, stone, masonry
  2. Engage medical practitioner - Experienced in occupational health
  3. Provide information - Types of work, duration, control measures in place
  4. Arrange monitoring - Before work starts, then every 2 years
  5. Receive reports - Certificates indicating fitness for work
  6. Review controls - If monitoring indicates exposure occurring

If Silicosis Detected​

  • Immediately review and improve dust controls
  • Remove worker from further silica exposure
  • Arrange specialist medical treatment
  • Investigate controls failure
  • Assess other workers' exposures
  • Report to SafeWork NSW (notifiable disease)