Medical surveillance refers to the administrative and clinical procedures relevant to the supervision of the health of workers. All workers, whether they are employed in production, administration, sales or supervisory capacities should be covered by a health monitoring program.
The ILO Code of Practice on Asbestos provides useful guidance. In general, workers' health supervision should include:
1. A pre-assignment medical examination;
2. Periodic medical examinations;
3. Medical examinations in and where practicable following cessation of employment.
9.1 - HEALTH MONITORING PROGRAMS
1. The objectives of the pre-assignment medical examinations are:
€ to determine any condition which would be contradictory to occupational exposure to asbestos dust;
€ to establish baseline records for the future supervision of the health of workers;
€ to educate and advise workers about the risks associated with exposure to asbestos dust and other contaminants.
2. The objectives of periodic medical examinations are:
€ to detect the earliest signs of asbestos-related disease;
€ to detect any significant change in health status relative to the baseline examination;
€ to continue to educate and advise workers about health risks and to ensure that appropriate preventive measures are being taken to minimize risk.
3. The objectives of medical examinations in relation to cessation of employment.
Working disabilities medical examinations are used to:
€ confirm with certainty the presence of the illness
€ evaluate the condition of the disease (evolution);
€ evaluate the stage of the workers disease and set, if necessary, working disability modalities or any modification of the employees' task.
4. Only professionally qualified doctors specialized in radiographics analysis can perform medical examinations in accordance with national laws and regulations.
5. These medical examinations will be performed free of charge to the employees and if possible during working hours.
6. The employees who submit themselves to the health monitoring have the right to:
€ confidentiality of personnel and medical information;
€ detailed explanation of the objectives and the results of the health monitoring;
€ refuse or accept medical procedures that could be detrimental or cause problems;
€ be informed of possible asbestos-related disease.
7. Copies of medical records should remain at the disposal of employees, or upon request be made available to their personal physician.
8. Medical surveillance must never be used to replace environmental surveillance or effective engineering controls.
1. The Medical examination should include:
€ a clinical examination;
€ an X-ray of the thorax;
€ a lung function test (spirometry);
€ other appropriate examinations.
2. At each medical examination, the doctor should advise the worker about the health risks of asbestos, and in particular, the synergism between smoking and asbestos exposure.
3. The risks of smoking include the following:
€ fibrosis of the lung tissue;
€ lung cancer;
€ significant reduction of respiratory capacity;
€ emphysema;
€ cardio-vascular problems;
€ others.
4. Smoking significantly increases the risks of health problems. Seminars should be held regularly to encourage workers to quit smoking.
Frequency
(a) In Quebec, employees in contact with chrysotile asbestos must be examined every year.
(b) Employees not in contact with asbestos must be examined every 2 years.
(c) In special circumstances (e.g. when there is some suspicion of a possible asbestos-related disease or their has been long-term exposure), the examining doctor may specify more frequent examinations.
(d) After the examination the doctor must issue an occupational health certificate.
(e) The doctor must make written recommendations to the company's management (e.g. on individual protection, on preventive measures, on withdrawal from all asbestos exposure, etc.). Management must respect these recommendations.
Record Keeping
(a) All medical documents must be filled and kept during a minimum of 40 years after cessation of employment, depending on the country. In Québec, records are kept indefinitely.
(b) A register of every person on the payroll must be kept indicating:
€ dates of medical examinations and the location of the results;
€ last date of employment.
(c) Depending on government regulations, the data can be transferred to a central filing system, but confidentiality must still be enforced.
9.3 - ROLE OF THE MEDICAL DOCTOR
1. Periodical communication between the doctor and the plant manager must be organized. The agenda and decisions of these meetings must be recorded in writing.
2. The medical doctor must:
€ visit the plant regularly;
€ be informed of the monitoring and results and analyze them;
€ be informed of workers' individual exposure conditions.
3. The most advanced legislation in Canada concerning health surveillance exists in the Province of Quebec, where almost all of the asbestos mining and milling takes place. Existing legislation allows workers to choose their occupational physician in joint decision made by the Joint Occupational Health and Safety Committee. The selection is made from a list of occupational physicians supplied by government community health services. It is the responsibility of the government physician to prepare the medical surveillance program, in cooperation with the workers' and employers' representatives. The joint committee has the power to approve such a program, which comprises both the regulatory measures and those developed in conjunction with the physician. In case of dispute, government arbitration is enacted.
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