Guidance

Annex 6 (regulation 17) health surveillance

Updated 16 May 2023

Annex 6 - (regulation 17) health surveillance

1. Current knowledge indicates that exposure to free asbestos fibres can give rise to the following diseases:

• Asbestosis - A progressive scarring of the lungs (pulmonary fibrosis) due to exposure to any type of asbestos dust. It may take some years for the disorder to be noticeable. It produces increasing breathlessness and a dry cough. A thickening of the lung surface can also occur in those exposed to asbestos—this may also result in noticeable disability. The scarring and thickening may get worse after the person concerned has ceased to be in contact with asbestos.

• Mesothelioma - A rare but dangerous tumour for which there is no known medical treatment. Usually it occurs in the lining of the chest (pleura) but it can occur in the abdominal cavity. It is usually associated with exposure to crocidolite (blue asbestos); but it can be caused by other types of asbestos. Some people develop the tumour after relatively little exposure to asbestos. The tumour does not usually occur until at least 15 years after first exposure and it is common for this period (known as the “latent period”) to extend to 40 years. Some experts think that this tumour is not exclusively due to asbestos.

• Bronchial Carcinoma - A cancer of the lung usually associated with people who have had asbestosis. (It is not yet certain whether people who have not had asbestosis can get this cancer.) Smoking increases the likelihood of this cancer.

• Gastro-Intestinal Carcinoma - Gastro-intestinal cancers including those of the colon, rectum (colorectal), stomach (gastric), oesophagus, pancreas, liver and bile duct.

1. An assessment of each worker’s state of health must therefore be undertaken prior to the beginning of exposure to dust arising from asbestos or materials containing asbestos at the place of work. This assessment must include a specific examination of the chest. A new assessment must be made at least once every three years for as long as exposure continues. An individual health record is to be established for each worker exposed to dust from asbestos.

2. The doctor and/or authority responsible for the medical surveillance of workers exposed to asbestos must be familiar with the exposure conditions or circumstances of each worker. To this end the employer must enter the workers responsible for carrying out the activities involving exposure to asbestos in a register, indicating the nature and duration of the activity and the exposure to which they have been subjected. The doctor and/or the authority responsible for medical surveillance shall have access to this register. Each worker shall have access to the results in the register which relate to him personally. The workers and/or their representatives shall have access to anonymous, collective information in the register.

3. Health examination of workers should be carried out in accordance with the principles and practices of occupational medicine. It should include at least the following measures:

• keeping records of a worker’s medical and occupational history which could include information on any previous work undertaken with asbestos where such information is available,
• a personal interview,
• a general clinical examination, with particular reference to the chest,
• lung function tests (respiratory flow volumes and rates).

1. The doctor and/or authority responsible for the health surveillance should decide on further examinations, such as sputum cytology tests or a chest X-ray or a tomodensitometry, in the light of the latest occupational health knowledge available.”

2. Following the health surveillance referred to above, the doctor or authority responsible for the medical surveillance of the workers should advise on or determine any individual protective or preventive measures to be taken; these may include, where appropriate, the withdrawal of the worker concerned from all exposure to asbestos.

3. Information and advice must be given to workers regarding any assessment of their health which they may undergo following the end of exposure.

4. The doctor or authority responsible for the medical surveillance of workers may indicate that medical surveillance must continue after the end of exposure for as long as they consider it necessary to safeguard the health of the person concerned.

5. The worker concerned or the employer may request a review of the assessments referred to in paragraph 2.

6. The register referred to in paragraph 3 and the medical records referred to in paragraph 4 shall be kept for at least 40 years following the end of exposure.

7. The documents referred to in paragraph 2 shall be made available to the Secretary of State in cases where the undertaking ceases trading;

8. The Secretary of State shall be notified of, and keep a register of, recognised cases of asbestosis.