NSC 512

NATIONAL OPEN UNIVERSITY OF NIGERIA
COURSE CODE: NSC512
COURSE TITLE: OCCUPATIONAL NURSING
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Course Developer/Writer Dr. Pauline Ezenduka Department of Nursing Sciences
University of Nigeria Enugu Campus, Enugu
Programme Leader Prof. A. Adebanjo National Open University of Nigeria
Course Reviewer: Dr (Mrs) Akon Emmanuel Ndiok, Department of Nursing Science
Faculty of Allied Medical Sciences, University of Calabar
REVIEWED 2022
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NSC512: OCCUPATIONAL NURSING (3CU)
COURSE GUIDE
TABLE OF CONTENTS
Introduction
What you will learn in this course
Course Aim
Learning Outcomes
Working through this course
Course Materials
Study Units
Recommended Texts
Assignment File
Presentation schedule
Assessment
Tutor Marked Assignments (TMAs)
Final Examination and Grading
Course Marking Scheme
Course Overview
How to get the most out of this course
Tutors and Tutorials
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Introduction
This course is titled Occupational Nursing. It presents an overview of the Occupational
health is a healthcare specialty devoted to the prevention and management of
occupational and environmental injury, illness, and disability. The specialty has grown
to encompass other dimensions of healthcare, including the promotion of health and
productivity along with the support for a safe workplace. The course aims to provide
students with knowledge, attitude and specific skills involved in policy and issues
relevant to health and safety by devoting attention to individuals and groups in the
workplace. Occupational health nursing is the nursing practice that provides for and
delivers clinical service to workers and workplaces. Occupational health nurses (OHNs)
are to provide health education, case management, and safety programs. The practice
of occupational health is focused on promotion and restoration of health, prevention of
illness and injury, and protection from work-related hazards.
NSC512: Occupational Nursing is a three credit unit course for students in the Bachelor
of Nursing Science programme. It is one of the electives in the second semester of the
final year.
The course is broken to 4 modules with 20 study units. This course will introduce
students on how to;
• Protect human health against health and safety hazards occurring in the work
environment
• Promote human health, workplaces for all ages and healthy aging by appropriate work
culture, work organization and support to social cohesion
• Promote mental health, healthy life style and preventing major non-communicable
diseases using specific workplace health policies and management tools
• Maintain work ability thus also employability throughout working life
• Reducing health care costs caused by employees’ and employers’ injuries, diseases,
illnesses and premature retirement resulting from or influenced by occupational,
environmental, life style and social health determinants
• Use resources effectively and efficiently and protecting the natural environment and
creating health supportive environment.
• Improve societal communication and literacy on health, environment and social
cohesion.
At the end of the course, the learner is expected to demonstrate clear understanding of
the basic work ethics, safety precautions and how to mitigate hazards in the health
workplace.
This course guide provides you with what to expect in the course, how to work through
the course material as a distance learner saddled with the responsibility of studying on
your own and your overall responsibilities and expectations. Tutorial sessions are also
linked up with the course to provide the needed support you required.
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2.0 Course Competencies
Today, Nigeria has a growing population of about 216.7 million people majority of who
are in the rural areas. There is still a great imbalance in the provision of medical care
facilities and it has become a great challenge to provide same for the larger population.
The overall aim of this course NSC512: Occupational Nursing is to provide learners
with proper understanding of basic work ethics, safety precautions and how to mitigate
hazards in the health workplace. It is hoped that you will be better equipped to
contribute meaningfully to health living for all and sundries.
3.0 Course learning Outcome

To achieve the aims set out above, the course sets the overall objective. In addition,
each unit has specific learning outcomes stated at the beginning of a unit. Learners are
advised to read them carefully before going through the unit. You will have to refer to
them during the course of your study to monitor your progress. You are encouraged to
always refer to the Unit learning outcome after completing a Unit. This is the way you
can be certain that you have done what was required of you in the unit.
The wider objectives of the course are set below. By meeting these objectives, you
should have achieved the aims of the course as a whole.
On successful completion of the course, you should be able to:

• Understand the basic ethics of occupational workplace
• Describe the historical development of occupational health in the ancient times
• Describe generally the benefits of Occupational health
• Explain the preventive measures to health problems
• Discuss the management of the common health problems in the work
environment
• Describe the implication of occupational health to both the employer and the
employees.
4.0 Working through This Course

To complete this course, you are required to study through the units, the recommended
textbooks and other relevant materials. Each unit contains some self-assessment
exercises and tutor marked assignments and at some point in this course, you are
required to submit the tutor marked assignments. This will be followed by an end of
term examination.
5.0 Study Units

STUDY UNITS
Unit 1: Historical Development of Occupational Health
Unit 2: Basic Concept in Occupational Health
Unit 3: Roles and functions of Occupational Health Nursing Practices in Organizations
Unit 4: Education and training of Occupational Health Nurse
Unit 5: Occupational Health Problems
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Unit 6: Occupational Health Diseases
Unit 7: Occupational Accidents
Unit 8: Occupational Health Poison
Unit 9: Occupational Health Hazards
Unit 10: Pollution Prevention in Industries
Unit 11: Occupational Health and Safety
Unit 12: Industrial Legislation
Unit 13: Independent Practice
Unit 14: Evaluation of Occupational Health Practices
Unit 15: Workplace Health Management
Unit 16: Workplace Regulatory Requirement
Unit 17: Workplace Injury Management
Unit 18: Health Professional Involved in Evaluation
Unit 19: Occupational Rehabilitation
Unit 20: International Labor Organization
6.0 References and Further Readings

Achalu, F.I. (2000). Occupational Health and Safety. Lagos: Simarch Nigeria Limited.
Asogwa, S.E. (2007). A Guide to Occupational Health Enugu: Snaap Press Ltd.
Clark, M.J.O. (1999). Nursing in the Community. USA: Appleton and Lafe.
Henderson, V. & Nite, G. (1978). Principles and Practices of Nursing. (6th Ed) New
York: Macmillan Publishing Co. Inc.
th
Hunter, D. (1978). The diseases of occupations. (6 ed). Sevenoaks, Kent, Hodder &
Stoughton, 1978.
Rantanen, J. et al. (1994). New Epidemics in Occupational Health. International
symposium. Helsinki. Finnish Institute of Occupational Health.
Health and safety executive. Successful health and safety management. Norwich, H.M.
Stationery Office, 1998 (ISBN 07176 1276 7).
7.0 Assignment File

The assignment file will contain the Tutor Marked Assignment (TMA) which will
constitute part of the continuous assessment (CA) of the course. There are 15
assignments in this course with each unit having an activity/exercise for you to do to
facilitate your learning as an individual.
Presentation Schedule
This presentation schedule in this course provides with important dates for completion
of each tutor marked assignment. Please try to meet the deadlines.
Assessment
There are two aspects to the assessment of the course. These are the Tutor marked
assignment and written examination. In tackling the assignments, you are expected to
apply information, knowledge and strategies gathered during the course. The
assignments must be turned in to your tutor for formal assessment in accordance with
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the stated presentation schedules. The works you submit to your tutor for assessment
will count for 30% of your total course work. At the end of the course you will need to
sit for a final written examination of three hour’s duration. This examination will also
count for 70% of your total course mark.
How to get the Most from the Course

In distance learning, the study units replace the university lecture. This is one of the
greatest advantages of distance learning. You can read and work through specially
designed study materials at your own pace and at time and place that suit you best.
Think of it as reading the lecture notes instead of listening to a lecturer.
In the same way that a lecturer might set you some reading task, the study units tell you
when to read your other material. Just as a lecturer might give you an in-class exercise,
your study units provide exercise for you to do at appropriate points.
Online Facilitation
What is online facilitation? To answer this question, refresh your mind on the meaning
of facilitation. Facilitation could mean assistance, enabling or help. So, if you are
facilitating it means you will be provided with assistance or help. This can be done
through face-to-face or virtual. Our focus in this course is on the virtual. To facilitate
online means providing a guide/assistance to the learner(s).
8.0 Tutor Marked Assignment (TMA)

There Tutor-marked assignments in the each of the unit of this course. You are advised
in your own interest to attempt and go through all the assignments at your own pleasure.
You will be able to complete the assignments from the information and materials
contained in your reading and study units. Those to be submitted for evaluation will be
communicated to you through the Study Centre. There is other self-activity contained
in the instructional material to facilitate your studies. Try to attempt it all. Feel free to
consult any of the references to provide you with broader view and a deeper
understanding of the course.
9.0 Final Examination and Grading

The final examination of NSC512 will be of 2 hours duration and have a value of 70%
of the total course grade. The examination will consist of questions which have bearings
with the attempted self-assessment exercises and tutor marked that you have previously
encountered. Furthermore, all areas of the course will be evaluated. Make sure you give
enough time to revise the entire course.
Course Marking Scheme

The following table includes the course marking scheme
Table 1
Assessment Marks
Assignment 1 – 10 10 assignments for the best 3
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Total = 10% x 3 = 40%
Final examination 70% of overall course marks
Total 100% of course marks
10.0 Course Overview

This table indicates the units, the number of weeks required to complete the
assignments.
Unit Title of Work Week Assessment
Activity
Course Guide Week 1
Module 1 Introduction to Occupational
Nursing
Unit 1 Historical Development of Week 2
Occupational Health
Unit 2 Basic Concept in Occupational Health
Unit 3 Roles and functions of Occupational Week 2
Health Nursing Practices in
Organisations
Unit 4 Education and training of Week 3
Occupational Health Nurse
Module 2 Occupational Health Problems

Unit 5 Occupational Health Problems Week 3
Unit 6 Occupational Health Diseases Week 4
Unit 7 Occupational Accidents Week 4
Unit 8 Occupational Health Poison Week 5
Unit 9 Occupational Health Hazard Week 5
Unit 10 Pollution Prevention in Industries Week 5
Module 3 Occupational Safety Requirements
and Practice
Unit 11 Occupational Health and Safety Week 6
Unit 12 Industrial Legislation Week 6
Unit 13 Independent Practice Week 7
Unit 14 Evaluation of Occupational Health Week 7
Practices
Unit 15 Workplace Health Management Week 8
Unit 16 Workplace Regulatory Requirement Week 8
Unit 17 Workplace Injury Management Week 9
Module4 Industrial Legislation and Labour
Organisation
Unit 18 Health Professional Involved in Week 9
Evaluation
Unit 19 Occupational Rehabilitation Week 10
Unit 20 International Labour Organisation Week 10
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11.0 How to get the most out of the course
In distance learning, the study units replace the university lecture. This is one of the
greatest advantages of distance learning. You can read and work through specially
designed study materials at your own pace and at time and place that suit you best.
Think of it as reading the lecture notes instead of listening to a lecturer.
In the same way that a lecturer might set you some reading task, the study units tell you
when to read your other material. Just as a lecturer might give you an in-class exercise,
your study units provide exercise for you to do at appropriate points.
The following are practical strategies for working through the course:
• Read the course guide thoroughly.
• Organize a study schedule.
• Stick to your own created study schedule.
• Read the introduction and objectives very well.
• Assemble your study materials.
• Work through the unit.
• Keep in mind that you will learn a lot by doing all your assignment carefully.
• Review the stated objectives.
• Don’t proceed to the next unit until you are sure you have understood the
previous unit.
• Keep to your schedules of studying and assignments.
• Review the course and prepare yourself for the final examination.
12.0 Tutors and Tutorials

There are 8 hours of effective tutorial provided in support of this course. Details will
be communicated to you together with the name and phone number of your facilitator
through the study center.
Your tutor will mark and comment on your assignments, keep a close watch on your
progress and any difficulties you might encounter and also provide assistance to you
during the course. You must ensure that you submit your assignment as and at when
due. You will get a feedback from your tutor as soon as possible to the assignments.
Do not hesitate to contact your tutor or study centre on phone or email in case of any of
the following circumstances:
You do not understand any part of the study units or the assigned reading
You have difficulty with the self-test or exercises.
You have questions or problems with an assignment, tutors comments or grading of an
assignment.
You are encouraged to attend the tutorials to allow for face to face contact with your
tutor and ask questions which you needed answers immediately. It is also an
opportunity to discuss any grey area with your tutor. You can equally prepare questions
to the tutorial class for meaningful interactions. You are sure to gain a lot from actively
participating in the discussion.
Best of Luck.
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MODULE 1: INTRODUCTION TO OCCUPATIONAL HEALTH
Unit 1 Historical Development of Occupational Health
Unit 2 Basic Concepts in Occupational Health
Unit 3 Roles and functions of Occupational Health Nursing Practices in Organisations
Unit 4 Education and training of Occupational Health Nurse
UNIT 1 HISTORICAL DEVELOPMENT OF OCCUPATIONAL HEALTH

1.1 Introduction
1.2 Learning Outcomes
1.3 Historical Development of Occupational Health
1.3.1 Development in Ancient Times
1.3.2 Development in Britain
1.3.2.1 First Direct Medical Involvement in Industry in Britain
1.3.3 Development of Occupational Health in United States of America
1.3.3.1 Early Research in Occupational Health in USA
1.4 Development in Developing Countries
1.5 Development in Nigeria
1.6 International Occupational Health
1.7 International Labor Organization
1.8 The World Health Organization
1.9 Future Trends of Occupational Health
1.10 Summary
1.11 References/Further Readings/Web Sources
1.12 Possible Answers to Self-Assessment Exercises
1.1 Introduction
Occupational health is a course that deals with the study of the health problems
employees’ face in their work environment and how those health problems are managed
to protect the health status of employee and their family. It exposes the different sources
through which the employees are affected. The processes of detecting the health
problems are similar to investigative processes obtainable in established health
institutions. The unit examines the historical development of occupational health; the
role of health team members and the efforts of international organizations to ensure that
safety measures are provided and workers get their compensation from employers. The
unit looks at the historical development of OH in both developed and developing
countries including Nigeria. It also looks at the contributions made by International
Labour Organization (ILO) and the World Health Organization (WHO) in the
protection of health and safety of people at work settings.

By the end of this unit you should be able to:
• Describe the historical development of occupational health in the ancient times.
• Explain the historical development of Occupational Health in Britain and
United States of America as example of developed countries.
• Describe the historical development of Occupational Health in developing
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countries including Nigeria.
• Describe the contributions made by ILO and WHO in the protection of health
and safety of employees at work settings.
1.3 Historical Development of Occupational Health

The history of the industrialized countries shows that social and economic development
is closely interdependent. To this day no nation has achieved sustainable economic
development by neglecting social programmes, nor has any achieved social well-being
without standing on sound economic ground. The essential link between the social and
economic phase is the working population. All wealth is directly or indirectly obtained
from the efforts of the working population. (Reich and Okubo, 1992).
A healthy employer is the key factor for sustainable social and economic development.
They contribute seriously to the wealth of the industries. As workers became the back
bone of industrialization, massive and indiscriminate employment of vulnerable
groups, children and women became the order. Most of the employees were
inexperienced and unskilled on the type of tasks involved in the occupation. Employees
then became special risk group. Poor and unsafe working conditions, rapid introduction
of new industries, invention and application of new tools for mass production and other
processes brought about serious danger not anticipated to the employees. (Reich and
Okubo, 1992). All these resulted in significant dangers to both employees and their
families. They became exposed to various occupational diseases and serious accidents
aggravated by endemic diseases like malnutrition, worm infestation, malaria and others.
Death toll was much. Hence the origin of Occupational Health as means of protecting
the health and welfare of employees.
1.3.1 Occupational Health Development in Ancient Times

The historical development of Occupational Health dates back to the ancient days.
During that period, industrialization was in rudimentary form. Un-mechanized farming
was the main occupation for all nations. Slave labor was extensively used to build many
of the wonders of the ancient world in Britain, USA, Egypt, Rome and numerous other
countries. For example, in Britain, slaves were used to build underground and surface
rail lines, some architectural buildings and their designs among others. Apart from
slaves, prisoners of war were also used. They were subjected to harsh conditions in
underground mines and queries. They died in large numbers due to poor health and
poor working conditions. The inhuman treatment and poor health care continued till the
16th and 17th centuries when the early medical pioneers in the field of health and safety
at work emerged (Asogwa, 2000, p 8-16). Among them were Georgius Agricola and
Bernadino Ramazzine.
According to Asogwa (2007), Georgius Agricola (1494 - 1555) wrote an article titled -
"De Re Metallica”. It was published in 1556 after his death). This article focused on the
working conditions in mines and industries especially mining accidents and illnesses.
He observed that the major hazards in mining were radiation from radioactive rocks
and silicosis. Another medical personnel concerned with the health of workers was an
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Italian, Bernadino Ramazzine (1633 - 1714). His contributions in the field of workers'
health earned him the title, "Father of Occupational Medicine". He stressed that the
occupation of the patient must be sort in clinical clerkship in addition to those direct
questions about the persons Occupation, advocated by the Greek, Hippocrates. When
he was 67 years old, he published his first great work "De Morbis Artificum Diatriba"
– the first systematic study of trade diseases. Ramazzini wrote as follows (Asogwa,
2000, p. 8 - 9).
"There are many things a doctor, on his first visit to a patient ought to find out either
from the patient or from those present. When a doctor visits a working class's home, he
should be content to sit on a three legged stool, if there isn't a guided chair, and he
should take time for his examination, and to the questions recommended by Hippocrates
in his work, "Affections". I may venture to add one more question: What occupation
does he follow? ("Quid aitem exerceat?").
In the main, it is only when dealing with the common people that the doctor must think
of dangerous trades. Hence, Ramazzines' motto - "Medcina Munus Plebios Curantis est
interrogate quas artes exercent" (translated roughly to mean that the doctor treating
commoners should enquire about their job). The actions of these pioneer doctors
brought some changes in the life of the employees.
1.3.2 Occupational Health Development in Britain

Industrial revolution in Britain marked the origin of occupational health. According to
Asogwa (2007) it dates back to the early eighteenth century, with the invention of the
seed drill by Jethro Tull and the use of coke to smelt iron by Abraham Darby, both in
1709. This resulted in the employment of women and children in factories. They had to
work long hours under very harsh and unhealthy circumstances. Both layman and
medical practitioners by their writings and other ways fought against these ills and
pressed seriously for reforms. In this regard, many authorities, such as Dr. Charles
Turner Thachrah (1795 - 1833) and Lord Anthony Ashley Cooper (1801 - 1885) made
serious contributions. Dr. Thachrah was known as "Father of British Industrial
Medicine". As reported by Asogwa (2007: p. 2). Thachrach wrote and published a book
in 1833 Titled
"The Effects of the Principal Arts; Trade and Professions and of Civic States and Habits
of Living on Health and Longevity, with suggestions for the Removal of many of the
Agents which produce Disease and shorten the Duration of Lie".
Lord Cooper, an aristocrat, as a member of the British Parliament helped to promote

legislation which reduced the hours of work and improved the conditions of work of
women and young persons employed in mines, factories and other workplaces. In order
to ensure safety and health protection of workers in Britain, Medical doctors were
seriously engaged.
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1.3.2.1 First Direct Medical Involvement in Industry in Britain
The first medical involvement in industry took effect in 1898, Sir Thomas Morrison
Leggee (1863 - 1932) was appointed the first British Medical Factory Inspector (or
"Occupational health Consultant as he is known today). He introduced the idea of
notifying occupational diseases especially lead poison. He stressed a number of
preventive aspects of occupational health practice known as Legge's Aphorisms as
follows:
1. "Unless and until the employer has done everything and everything means a good
deal - the workman can do next to nothing to protect himself; although he is
naturally willing enough to do his share".
2. "If you can bring an influence to bear external to the workman - that is one over
which he has no contract - you will be successful and if you cannot or do not, you
will never be wholly successful".
3. "Practically, all industrial lead poisoning is due to the inhalation of dust and fume,
and if you stop their inhalation you stop the poisoning".
4. "All workmen should be told something of the danger of the material with which
they come into contacts, and not be left to find it out for themselves - sometimes at
the cost of their lives".
Numbers 1, 2 and 4 are sometimes referred to as Legge's Three Aphorisms as they deal
with the general methods of prevention of diseases and ailments in industry.
The protection of juveniles in industry resulted in the appointment of Factory Doctors
in Britain. The sufferings of these groups of people have attracted the attention of many
people. The protection of their health became a major aim of all factory and social
legislations in UK following
Industrial Revaluation. Consequently, the Factories Act of 1839 was inter alia to
regulate the Labor of Children and Young Persons in Mills and Factories. However, it
was the 1884 Act that provided for the appointment of a certifying surgeon who had to
examine young people and declare them fit for factory employment. This term was
applied to the doctors who were officially employed for the purposes to perform the
same function. By the factories Act of 1948 the name changed to Appointed Factory
Doctor.
1.3.3 Development of Occupational Health in United State of America

According to Allender and Spradley (1996: p. 581 - 599) Modern occupational health
in America is an outgrowth of the 19th century industrial revolution in England.
Deplorable work conditions and worker exploitation created a growing public concern
and spawned the development of many protective laws. This influence was felt in the
United States, which was rapidly becoming an industrialized nation. Between 1890 and
1914, more than 16.5 million immigrants from all over the world poured into the United
States. As industrial growth escalated, these new citizens worked in the plants,
factories, rail roads and mines, creating a new market for manufactured goods.
Workers, children as well as adults, commonly worked 12 to 14-hour shifts, 7 days a
week, under unspeakable conditions of grime, dust, physical hazards, smoke, heat, cold
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and noxious fumes. People accepted work-related illnesses and injuries as part of the
job and lived shorter lives, frequently dying in their forties and fifties, with workers in
some trades dying in their thirties (Lee, 1978).
No connection was made between work conditions and health. Employers attributed
employees' poor health and early deaths to the workers' personal habits on the job or
their living conditions at home. Physicians, uneducated in the relationship between
work and health, blamed industrial related diseases, such as silicosis, lead poisoning,
and tuberculosis, on other causes.
1.3.3.1 Early Research in Occupational Health in USA

Public awareness and understanding were necessary before changes could be made to
improve working conditions. That understanding was based on continuing research into
occupational health.
In 1700, Bernadino Ramazzini, an Italian Physician known as the "father of
occupational medicine", appeared on the scene. He conducted the earliest systematic
study of occupational disease. His treatise was entitled Discourse on the Disease of
Workers. Ramazzini had the foresight, when attempting a diagnosis, to ask about the
patient's occupation. He was of the view that there is relationship between a person's
work and his health condition. Despite his influence, interest in information concerning
worker's health evolved slowly.
It was not until early 1900s that the Public Health Service conducted one of the first
scientific studies on occupational hazards by investigating dust conditions in mining,
cement manufacturing, and stone cutting. Other studies were also conducted. The
findings revealed that lead poisoning was as high as 22% among the pottery workers
studied. A study on garment production using 1914 workers revealed that a high
incidence of tuberculosis was related to poor ventilation, overcrowding, and
unsatisfactory work conditions. Other investigations revealed phosphorus poisoning
among workers in the match industry (1912), and mercury poisoning in those who
manufactured felt hats (1930s) (Lee, 1978). The public was awakening to the effect of
work conditions on people's health.
The birth of Labor movement increased the demand for healthful and safe working
conditions. Worker's compensation laws provided for occupational injury and disease
coverage and other efforts were made to protect workers against health hazards in the
workplace. Unfortunately, it took such disastrous events as the Triangle Shirtwaist
Factory Fire to create the impetus for further legislation. This notorious fire, which
occurred in New York City in 1911, took the lives of 154 workers, most of whom were
young women. Investigations after the incident revealed non-existence fire escapes and
locked exit doors. This tragic event resulted in establishment of the first serious safety
laws to project working people from danger (Morris, 1976 as cited by Allender and
Sopraldley, 1996, p. 6, 589).
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Self-Assessment Exercises 1
1. The history of the industrialized countries shows that social and
economic development is closely interdependent True / False
2. Modern occupational health in America was an outbreak of the 19th
century industrial revolution in _______________
a. Canada
b. England
c. America
d. Poland
3. ________________ is known as the father of occupational Medicine
a. Allender and Sopraldley
b. Thomas Morrison
c. Bernadino Ramazzi
d. Jethro Tull
1.4 Development in Developing Countries

The occupational health in most developing countries was as a result of
industrialization. Formally, the major occupation in these countries was mainly
mechanized Agriculture. By then the cellular surface of the earth was easily repaired
because civilization was based purely on an agricultural society where recycling
depended on the natural processes.
As more countries in the developing parts of the world started to industrialize, the
surface of the earth including the health of the living creatures became seriously
affected. The development of occupational health in these countries, many of which
were attaining political and economic emancipation, followed the path already laid
down by their industrialized colonial masters. Certain features in these newly emergent
nations have mirrored the situations in their colonial masters with the result that what
one sees is not only a replication of some of the Labor Laws relating to occupational
health and safety but also the pattern of occupational Health as it exists in the countries
of their former colonial masters with whom they still maintain strong economic ties
(Asogwa, 2007, p. 12). The health problems resulting from the industrialization
necessitated the services of health personnel to save the life of the employees in
industries and other work environments. Chief among the health personnel are the
medical doctors and nurses.
The doctors, (usually, general practitioners), were the earliest health personnel engaged
in the services of occupational health. They were employed either as general
practitioners on either part time or full time basis. The employment of full-time medical
doctor service was only possible with few large scale industries and establishments
owned by multi nationals' companies and factories. The doctors employed were mainly
those with special knowledge of occupational hazards. In same way, nurses with
community or public health knowledge and skills were also employed. However, the
number was very few. The doctors engaged in industries carried out general medical
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practice in industry and not industrial medicine (Asogwa, 2007 p. 12). The services
provided were mainly curative as against preventive medicine.
The type of services provided depends on the nature of the industry. For small and
medium scale firms "Retainership system of Services" was adopted: In this case, the
employers utilized the services of the doctor in his clinic while the payment was done
by the employer based on the number treated for the period. The services were extended
only to the worker's one wife and four children below the age of 18 years. But in larger
firm’s full-time general duty medical officers and in some cases specialist in various
fields are engaged. Some industries that employ more of unskilled labor provided
Medicare only for their expatriates and senior management staff while unskilled
laborers were denied such services. Labor was cheap because many were struggling to
be employed and retirement could be done at will.
1.5 Development in Nigeria

Development of occupational health in Nigeria followed the pattern in other developing
countries. Originally, the main occupation was un-mechanized agriculture and animal
husbandry. The workforces were mainly women and children. Payment for work was
not known. Workers were exposed to many types of health hazards. Treatment then was
not organized. Later, manufacturing including construction came into being. Modern
occupational health, reported Achalu, (2000, p. 25) started as a result of colonization
and industrialization by Britain.
Modern occupational health, reported Achalu, (2000, p. 25) started as a result of

colonization and industrialization by Britain. The first occupational health services in
Nigeria was introduced by the Medical Examination Board of Liverpool Inferminary in
1789 with the main aim of caring for the health of British slave dealers from Africa to
Britain. However, after the abolition of slave trade, the Royal Niger Company of Britain
increased its exploration and trading activities in Nigeria. The Company organized its
own health services which were later inherited by the United African Company (UAC).
During the British colonial rule, many of their soldiers were dying of malaria. This led
Colonel Lugard to establish health services to take care of the health and welfare of
soldiers and other colonial administrators. Later, during the Second World War, the
Medical Corps was separated to cater for the military alone leading to the creation of
Public Health Service which became the nucleus of the National Health Service.
After the world war, many industries started emerging chief among them were
construction of rail lines and coal mining. This attracted employment of many Laborers
especially young men. These workers commonly worked 12-14 hours shift; 7 days a
week under unspeakable conditions of grime, dust, physical hazards, accidents, smoke,
heat and noxious fume among others. Feeding was very poor; workers were dying in
their forties and fifties. People had no knowledge between work conditions and health.
They accepted work related illnesses and injuries as part of the job and lived shorter
lives. Employers attributed workers' poor health and early death to workers' personal
habits on the job and their living conditions at home. Little or no attention was paid to
12
prevention of the hazards in work places. Payment was very poor and dismissal very
common because job seekers were many. Workers' reaction to poor conditions at work
resulted in killing of coal miners in Enugu. That exposed the working conditions of coal
miners and the origin of worker's day in Nigeria. These developments and awareness
lead to the establishment of some occupational health services in some Nigerian
industries and occupational health legislations Act in Nigeria.
The earliest practices that can be regarded as occupational health services in Nigeria
were carried out by British Companies like UAC, John Holt. This was followed by
establishment of some occupational health services by Nigerian governments in the
Railway Corporation and Coal Mines. Such services included pre-employment and
periodic medical examination, treatment of minor illnesses and accidents. In some
cases, general practitioners were hired on part time basis, especially in urban centres to
take care of the sick injured workers. The increased industrialization and its impact on
health, safety and welfare of workers lead to the creation of occupational health unit in
the Federal Ministry of Health and the Institute of Occupational Health in Oyo State
Ministry of Health. These agencies organized courses for managers, safety officers,
medical officers, occupational hygienists, and other personnel involved with the
protection, maintenance and promotion of health and welfare of workers in Nigeria.
1.6 International Occupational Health

As industrialization spread from one country to another, according to Asogwa (2007:
p. 4) so also is the diseases and ailments associated with different trades. Gradually,
occupational health was being recognized as a distinct area of medicine deserving
special attention in those countries that were the pioneers of industrialization in Europe
and America. Many different approaches were followed in these countries but the final
goal was essentially the same. The main aim and goal were to safeguard lives and ensure
that the well-being of working people are protected maintained and promoted. The
oldest international bodies in modern times concerned with global health and safety of
people at work are the International Labor Organization (ILO) and the World Health
Organization.
1.7 International Labor Organization

The International Labor Organization (ILO) was founded in 1919 in Geneva,
Switzerland under the League of Nations to promote international Labor standard and
improvement of working conditions. The ILO programmes, as well as international
labor Standards in the form of conventions and recommendations, were approved and
adopted by the annual international Labor Conference held in Geneva. The Conference
consists of two governments, one employer and one worker representative from each
member states (Reich and Okubo, 1992, p. 236). Hence ILO is said to be a tripeptide
body made up of representatives from governments, employers and employees
(Asogwa, 2007, p. 4). The International labor Office with regional offices in Africa,
Asia, Europe, Latin America, the Middle East and a number of governing body execute
the programmes under supervision of the governing body, half of whose members were
elected from governments and a quarter from employer and worker groups (Reich &
Okubo 1992).. ILO's health work included safety and health of all types of workers
13
especially from chemical and other industrial risks, hygiene of seamen, social and
medical insurance systems and workmen's compensation. In compliance with multi-
disciplinary approach, it collaborates with the World Health organization (WHO) in
holding a number of Joint Expert Committee meetings in the field of occupational
health and safety and publishes inter alia International Medicine guide for slips and ship
sanitation.
The International Programme for the Improvement of Working Conditions and

Environment (known as PTA PIACT) activities, emphasize that the Improvement of
occupational safety and health and working conditions should be considered as a
complex problem in which various factors are interrelated, such as protection against
risks in the working environment, adaptation of work processes to the physical and
mental capabilities of workers, improvement of work schedules and job content (ILO,
1984; Copper, 1990). A multidisciplinary approach is stressed.
Self- Assessment Exercise 2

1. The occupational health in most developing countries was as a result of
________________
2. The International Labor Organization (ILO) was founded in
________________
1.8 The World Health Organization

The World Health Organization (WHO) is the specialized agency of the United Nations
founded in 1948 with headquarters in Geneva Switzerland. It has the responsibility for
global health. Its major role in the field of occupational health started with the report of
the First Joint WHO/ILO Committee on occupational Health in 1950 which stated the
purpose of occupational health as follows (Asogwa, 2007:p.5)…
"Occupational health should aim at the promotion and maintenance of the highest
degree of physical, mental and social well-being of workers in all occupations; the
prevention among workers of departures frown health caused by their working
conditions the protection of the workers in their employment from risks resulting from
factors adverse to health, the placing and maintenance of the workers in an occupational
environment adapted to his physiological and psychological equipment and to
summaries; the adaptation of work to man and each man to his job".
Occupational health, as in other areas of Public Health, lays emphasis on preventive

medicine. Occupational health practice is comprehensive. Some of the preventive
measures could only be achieved by safe working environment, other conditions that
encourage and promote healthful living; and ergonomics in machine design and
operations (Reich & Okubo, 1992).
14
1.9 Future Trends of Occupational Health
The major goal for occupational health is to promote and maintain the highest level of
physical, mental, social and emotional health of all workers. In practice, this goal is
only beginning to be realized in selected work places. Nevertheless, it is a worthy
investment and an essential objective in the realization of a productive working
community (Allender & Spradley, 1992).
The rapid and fundamental changes in businesses in the 1990s have added three critical
issues that affect the occupational health practice. First, increasing worldwide
competition requires business to remain competitive by reducing and/or controlling
operating costs at the lowest level possible. Secondly, there has been an increase in
technological hazards that require sophisticated approaches as well as knowledge of
toxicology, epidemiology, ergonomics and public health principles. Third, health care
costs continue to escalate at faster rates than most company profits (Vail, 1997).
Until the late 1800s, agriculture was the main industry in both developed and
developing countries. Now, the trend, especially in United States and in Nigeria is
towards the service industries. This demands an increase in the number and proportion
of service workers.
The environment - both physical and social, is also changing. Today's worker is exposed
to various air and water pollutants over extended period of time; to food additives and
preservatives, to complex laundry and cleaning compounds and to many other hazards.
Industrial workers came into contact with many new substances utilized in processes.
Many workers come to work with all kinds of psychological and physiological
tendencies to certain kinds of health problems such as alcohol and drugs. Many workers
are emotionally or physiologically dependent on certain drugs and some may combine
drugs with alcoholic beverages thereby compounding the original problems. Many
come to work with alcohol already in their systems. They drink because of stress from
inner conflicts or problems either at home or in their work environment.
Current occupational health nurse practices will continue to evolve to meet future
needs. The focus will shift from one-on-one health services to a new role involving
broader business and research skills. Future role will involve:
1. Analysis of trends (health promotion, risk reduction and health expenditures).

2. Developing programmes suited to corporate needs.
3. Recommending more efficient and most effective in-house health services.
4. Determining cost-effective alternatives to health programmes
5. Collaborating with others to identify problems and propose solutions.

1. The World Health Organization (WHO) is the specialized agency of the United
Nations founded in 1948 with headquarters in _________________________
15
1.10 Summary
In this unit, you have learnt that: Occupational health originated in Britain as a result of
industrial revolution by the workers. Nigeria has keyed into occupational health
practice for the betterment of her health workers. The health of workers was seriously
affected with hazards from their occupation.
International organizations contributed to the protection of the health and safety of
workers.

Achalu, E.I. (2000). Occupational Health and Safety. Lagos: Simarch Nigeria Limited
(Splendid Publishers).
Allender, A. & Spradley, B.W. (1996). Community Health Nursing Concepts and
Practice.
Anton J.J. (1979). Occupational Safety and Health Management. New York: McGraw-
Hill Book Company.
Asogwa, S.E. (2007). A Guide to Occupational Health Practice in Developing
Countries Enugu: Snaap Press Ltd.
Reich, M.R., & Okubo, T. (1992). Protecting Workers' Health in the Third World
National and International Strategies New York: Greenwood Publishing Group Inc.

Answers to Self-Assessment Exercise 1
1. True
2. B- England
3. C- Bernadino Ramazzi

1. Industrialization
2. 1919

1. Geneva, Switzerland
16
UNIT 2 BASIC CONCEPTS IN OCCUPATIONAL HEALTH
CONTENTS
2.1 Introduction
2.2 Learning Objectives
2.3 Basic Concepts in Occupational Health
2.3.1 Aims and Objectives of Occupational Health
2.3.2 Rationale for Occupational Health
2.4 Benefits of Occupational Health Promotion
2.5 Occupational Health Benefits to Industries and Other Occupations
2.6 Relationship between Work and Health
2.7 Effects of Work on Health
2.8 Effects of Disease on Work Capacity and Health
2.9 Factors affecting Occupational Health
2.10 Summary
2.11 References/Further Readings/Web sources
2.1 INTRODUCTION
The unit describes briefly some of the key features of the basic concepts that make up
Occupational Health. It discusses the rationale as well as the aims and goals for which
Occupational Health was set up. It further examines the effects of Occupational Health
on both the employer and the employee. The need for occupation health was also
explained.
2.2 LEARNING OBJECTIVES

By the completion of this unit, you should be able to:
• Define Occupational health
• State at least six aims and objectives of Occupational health
• Explain the rationale for establishing Occupational health
• Describe generally the benefits of Occupational health
• Explain the relationship between work and environment.
• Describe the effects of work on health
• Describe factors that affect successful Occupational health
• State the needs for maintenance of Health in industries.
2.3 BASIC CONCEPTS IN OCCUPATIONAL HEALTH

Occupational health is a means of protecting and maintaining the physical,
psychological and social health of workers and their families. It can also be viewed as
the study of factors or conditions influencing the health and well-being of workers not
only in the place of work but also at home with the aim of promoting health, safety and
welfare of the workers and their family. The joint International Labour Organization
(ILO) and the World Health Organization (WHO) constituted in 1950 and revised in
1995, defined Occupational Health as the “promotion and maintenance of the highest
degree of physical, mental and social well-being of workers in all occupation”. ILO
17
further summarized Occupational Health definition as the “prevention of departure
from health among workers caused by their working conditions; the promotion of
workers in their employment from risks resulting from factors adverse to health, the
placing and maintenance of the worker in occupational environment adapted to their
physical and psychological well-being; and the adaptation of work to man and man to
his work. Dr. Yakemi describe it as the health investment for workers to help them
spend their working lives in a healthy way both mentally and physically and enable
them enjoy better health in later life as well. It is the sum total of all the activities and
programmes that are aimed at preventing, protecting and maintaining the highest level
of health and safety among workers in any work environment which can be industrial,
non-industrial or private or organizational.
1.3.1 Aims and Objectives of Occupational Health

The aims and objectives of occupational health are to:
1. Describe the meaning of Occupational Health.
2. Ensure that the physical and mental demands of the job matches the anatomical,
physiological and psychological capabilities of the individual worker meant for the job.
3. Identify work hazards that occur in the work place/environment.
4. Identify potential, physical, chemical, biological, ergonomic and psychosocial
stressors in a variety of work environments.
5. Explain the industrial legislations enacted in Nigeria for the protection of health and
welfare of workers.
6. Explain ways of protecting the working individuals from any health hazard in their
work environment.
7. Describe the role of Occupational Health team members and the role of the nurse in
protecting and promoting the health and safety of workers.
8. Provide health education and rehabilitation services for workers who have emotional,
physical injuries and psychological problem.
9. Provide information on the benefits of occupational health.
10. Promote and maintain the highest degree of physical, mental and social well-being
of workers in work environment.
11. Prevent workers from departure from health due to the health and other conditions
arising from the type of job they perform.
2.3.2 Rationale for Occupational Health

Reasons supporting the establishment of Occupational Health are deduced from the
sufferings of workers in the process of performing tasks in their respective occupation.
Man's working years are mainly spent in work environment which has subjected man
to untold pain and suffering.
In developing countries including Nigeria, people were living in the vicious cycle of
poverty and disease. This brought about establishment of various industries for
economic progress to break the cycle of poverty and disease. As productive
instruments, factories of all kinds started emerging in great numbers with increasing
diversity of both processes (Reich & Okubo, 1992). The products became more and
more obvious. The invention and application of new tools and introduction of new
18
machines for mass production brought about untold pains, and health problems not
anticipated. Examples of such problems included respiratory, renal and gastrointestinal
problems; accidents. As workers were the main survival of industrialization, their health
became a priority to the nation especially in developing countries like Nigeria where
health implications were felt much. The health risks were aggravated by endemic
diseases such as malnutrition, warm infestation, bacteria and parasitic infections along
with problems of migration from rural to urban indiscriminate employment of
vulnerable groups and hazards associated with rapid introduction of new processes and
products. Apart from human and materials loss, working time and economic lost were
much.
The increasing use of chemicals in industries and agricultural production created new
hazards for the workers. The resultant ugly health problems and their consequences
became more and more obvious. Yet, Occupational Health hazards have rarely received
priority attention from policy makers.
What made the matter worse was that many employers ignored the problem or even
denied the existence of health problems to workers. This was because labour was
plentiful; people seeking for job were numerous. A disabled worker could easily be
replaced, wages were very low. This seemed to encourage industrial owners and
managers to neglect safety (Auton, 1979). Accidents were believed to be inevitable and
so were regarded as an "act of God". The outcome of these was enactment of industrial
legislation such as Factory Acts and Workmen's Compensation Acts for the survival of
workers, prevention and control of industrial health hazards, accidents and other
illnesses.
2.4 Benefits of Occupational Health Promotion

Generally, the introduction of Occupational health in industries and other occupations
can benefit everybody especially the management, the employers and the employees.
The workplace is an ideal setting for promoting the health and well-being of the
employees and the employers. This is because a large number of the population spends
greater number of their time and energy at work environment each day. In essence, the
work place is the second home for any employer. Also Occupational Health is meant
not only for the worker but is extended to the family members and the entire community
directly or indirectly. When the employees are healthy physically, emotionally and
psychologically the atmosphere within the occupational setting becomes encouraging,
relaxed and inviting. The productivity increases, the company stands better chance of
growth.
Introduction of Occupational Health into the companies reduces items of loss and cost
reduction due to absenteeism as a result of illness and accidents. Through Occupational
Health, conditions that cause illness and accidents are far more reduced if not prevented.
The benefits of Occupational Health at work settings could be summarized thus:
1. Improvement of worker's health behaviour due to relaxed atmosphere in the work

setting.
19
2. Improved worker's health.
3. Improved workers moral and job-satisfaction.
4. Improved workers efficiency and productivity.
5. Lower sickness rates, lower accidents and injury rates.
6. Reduced absenteeism, reduced labour turnover.
7. Reduced health cost to the employee, the management and the employers.
8. Improved corporate image and industrial relations.
9. Lower compensation for occupational illnesses and injuries.
10. Improved intra-personal and inter-personal relationship within the companies, the
family and in the community.
20
Self – Assessment Exercise 1
1. ________________is a means of protecting and maintaining the
physical, psychological and social health of workers and their families.
2.The aims and objectives of occupational health includes the following
EXCEPT
a. Provide information on the benefits of occupational health.
b. Identify work hazards that occur in the work place/environment.
c. provide medicine for farmers
d. Provide information on the benefits of occupational health.
2.5 Occupational Health Benefits to Industries and Other Occupations

The benefits to industries and other occupations are many.
1. It brings to light the nature of the occupation, the type of material they produce and
benefits of the industry to the general populace.
2. There is labour turn over.
3. It reduces industrial item production loss due to employee absenteeism due to illness
or accidents.
4. The chances of liability compensation by employers for occupational illnesses and
accident and injuries, including deaths is reduced if not entirely controlled. This is
because when employees are healthy, the productivity is high, and cost benefit to the
employer is increased. A sick and unhealthy worker is a problem to the employer
because: it causes absenteeism; increased cost of treatment; reduction in work force and
more importantly it causes damages to the Industries / occupations. (Achalu, 2000). For
example, a sick employer in the bank can make a mistake of over payment or create
poor relationship with customer; or a sick employer in agricultural setting is likely to
cause crop destruction while a sick health worker is unlikely to attend to sick clients
adequately thereby causing long hospitalization and death.
2.6 Relationship between Work and Health

The knowledge and understanding of the relationships and interactions between work
and health is important in the practice of occupational health and safety. Both work and
health positively and negatively affect each other. Work is supposed to be a means of
economic survival and source of satisfaction and happiness where properly planned and
executed. It also provides for social status and companionship as well as shared
responsibility. But on the negative aspect, it can result to stress, dissatisfaction and
threat to employee's health and well-being and their attendant morbidity and death. It
means that work has effect on health and vice versa. The working environment and the
working conditions can positively or negatively affect the employees' health protection
and health maintenance. Also, the workers’ health can affect his or her performance
and productivity depending on environmental dispositions and the nature of
occupational organization and policies. Poor health reduces productivity and worker's
efficiency.
21
2.6 Effects of Work on Health
There are many benefits that can be obtained. Achalu (2000) listed them as follows:
1. Work serves to relieve boredom.
2. It provides avenue for creativity.
3. It serves as means of personal/economic gain and means of livelihood.
4. It contributes to life satisfaction and happiness.
5. It serves as source of challenge for human growth and development.
6. It creates opportunity for socialization and companionship.
7. Good health increases capacity to work.
8. It increases capacity to enjoy work.
9. It increases capacity to desire satisfaction at work.
10. It promotes productivity and increases worker's performance.
11. It encourages emotional and psychological satisfaction.
12. It reduces stress and promotes intra and interpersonal relationship in the work
setting.
13. It increases alertness to danger.
2.7.1 Negative Effects of Work on Health

The negative effects of work on health form the basis for Occupational Health both in
developed and developing countries. The nature, situation and conditions of work
determine the type and nature of occupational hazards (diseases and accidents)
prevalent in a particular occupation/industry. Even the work processes, products and
bye products can constitute a health hazard to the workers, their immediate families and
their neighborhoods (Achalu, 2000). The hazards can affect many organs of the body
causing some pathological changes that can threaten the health and well-being of
workers. The threat can result in physical, mental, social and behavioral changes and
even death if prompt treatment is not instituted. This is why it is very necessary for
occupational health practitioners to have thorough knowledge of the hazards associated
with each occupation for quality care provision and accuracy in diagnosis. The workers
should also be well educated on the hazards in their particular occupation. This will
enable them take precautionary measures and then comply with the occupational safety
measures provided for them. The specific effects of poor health include the following:
1. Poor health is a hydra that erodes the company growth and productivity.
2. It leads to poor disposition of workers and their capacity to function effectively at
work.
3. It leads to poor performance of the employees
4. It reduces productivity due to absenteeism from illness.
5. It contributes to risks for the workers and to other members of entire family.
6. It causes company to pay compensation to the injured worker.
7. It brings about stresses and low moral to both work and the employer.
22
2.8 Factors Affecting Occupational Health
Many factors have affected the successful outcome of Occupational Health especially
in the developing world countries.
1. Lack of geographic accessibility of Occupational Health services adversely affects
efforts to improve Occupational Health conditions of workers in majority of cases
especially where the occupation is in a remote area.
2. The system of public roads and transport services in most developing countries are
inefficiently provided especially in Nigeria. This situation makes it very difficult to
reach workers located in rural or small towns far from big urban centers. Many of these
workers operate in terrible conditions.
3. The quality and quantity of health services affect Occupational Health conditions.
4. The persistence of poverty in most countries remains a fundamental determinant of
Occupational Health conditions. In majority of cases people in developing countries do
not have access to essential necessities of food, housing, public services, clothing and
safety required for survival.
5. Income is associated with level of education. The lower the educational level, the
lower the wages.
6. Poor nutrition generally affects worker's health. Some workers find it difficult to
fulfill their minimum nutritional necessities even if they spend their entire take home
pay on food only. For example, some studies carried out in the Province of Colombia
by Farcadas (1984), it was found that the caloric requirements for workers in textile
industries and metal-working are 3,500kcal/day, for construction workers more than
4,500kcal/day, and for agriculture and mining workers 5,000kcal/day. Some 30 percent
of the study population had caloric intake of less than 2,500kcal/day; 40 to 50 percent
had an intake of about 2,700kcal/day; and the rest had an intake between 2,700 and
3,100kcal/day. Very few people had intakes over 3,100kcal/day. This created a vicious
cycle; for malnutrition becomes reflected in both health and work output which in turn
results in lower wages which make it more difficult to buy food.
2.9 Needs for the Maintenance of Health in Industrial Communities

The following strategies stand (Asogwa, 2007).
1. Treatment and prevention of epidemic and endemic communicable diseases, and
provision of adequate housing, environmental sanitation, nutrition and social services,
including health education of workers and management.
2. Prevention of occupational injuries and diseases, including the mechanical, chemical
and biological risks in modern agriculture.
3. Planning and organization of medical care; including services for small or dispersed
working groups.
4. Initial and further training for all types of health staff, ensuring an emphasis on
preventive and curative services.
5. Introduction and enforcement of statutory minimum standards of health, safety and
medical care in industry.
23
1. Mention four (4) benefit of occupational health to industries
2. Mention seven (7) negative effects of work on health
2.10 SUMMARY
In this unit, we have learnt that:
• Occupational health is the sum total of all the activities and programmes aimed
at preventing and protecting the health and safety of workers.
• Rationale for occupational health is the affliction of workers with numerous
health problems in work environment.
• Everybody, including employers, workers and management stand to benefit
from introduction of occupational health in various ways.
• There are positive and negative effects of work on health.
• Various factors including inaccessibility of health facilities, persistence of
poverty affect occupational health.
24
Splendid Publishers.

Countries. Enugu: Snaap Press Ltd.
Anton, T.J. (1979). Occupational Safety and Health Management. McGraw-Hill. Inc.
Reich, M.R. & Okubo, T. (1992). Protecting Workers Health in the Third World Nation
International Strategies. USA: Greenwood Publishing Group Inc.
Schram, R.A. (1971). A History of Nigeria Health Services. Ibadan: University Press.
Nigeria.
Clark, M.J.O. (1999). Nursing in the Communities. USA: Appleton art. Lange.
Lucas, A.O. & Gilles, H.M. (1984). A Short Textbook of preventive Medicine for the
Tropics, 2nd edition. London: Hodder & Stoughton.
Rogers, B. (1994). Occupational Health Nursing: Concepts and Practice. Philadelphia:

W.B. Sanders Company.

Answers to Self-Assessment Exercise 1:
1. Occupational health
2. C- provide medicine for farmers
1. a. It brings to light the nature of the occupation, the type of material they produce
and benefits of the industry to the general populace.
b. There is labour turn over.
c. It reduces industrial item production loss due to employee absenteeism due to illness
or accidents.
d. The chances of liability compensation by employers for occupational illnesses and
accident and injuries, including deaths is reduced if not entirely controlled.
2. a.Poor health is a hydra that erodes the company growth and productivity.
b. It leads to poor disposition of workers and their capacity to function effectively at
work.
c. It leads to poor performance of the employees
d. It reduces productivity due to absenteeism from illness.
e. It contributes to risks for the workers and to other members of entire family.
f. It causes company to pay compensation to the injured worker.
g. It brings about stresses and low moral to both work and the employer.
25
Unit3: Roles and functions of Occupational Health Nursing Practices in
Organizations
3.1 Introduction
3.3 Roles and functions of Occupational Health Nursing Practices in Organizations
3.4 Functions of Occupational Health Nursing?
3.5 Summary
3. 7 Possible Answers to Self-Assessment Exercises
3.1 Introduction
Occupational health nursing is a specialist branch of public health nursing with its roots
in traditional nursing care. Occupational health nurses are all registered nurses – in
other words, they have been through years of rigorous training to qualify as nurses and
obtain their official registration. They have subsequently maintained their registration
by recording further education and experience and paying registration fees to the
Nursing and Midwifery Council (NMC). Practice is regulated by the Nursing and
Midwifery Council (the regulatory body whose primary function is to protect the
public). Issues of accountability, confidentiality, professional standards and guidelines
affect all nurses, and nurses are always conscious of the fact that they work within a
legal framework. So, an occupational health nurse is a qualified, registered, accountable
professional with years of experience of confidentially supporting, treating and helping
people (often at very difficult times in their lives) in both hospital and community
settings. They should thus have excellent communication and problem-solving skills,
and most have significant management experience, e.g. running a hospital ward. A
nurse qualified in occupational health has an additional qualification which may be
placed on the NMC specialist community public health nurse (SCPHN) register. This
unit on the role of the occupational health nurse sets the scene by outlining the job
functions, historical context and some of the governing principles and key issues of
importance to occupational health nursing professionals today.

• State the various roles of occupational health nursing
• State at least six functions of Occupational health nursing
• Explain the Occupational health
• Describe the roles of occupational health nursing practice
3.3 Roles of Occupational Health Nursing Practices in Organizations

This unit describes the role of the occupational health nurse in workplace health
management, a new and exciting concept that is designed to improve the management
of health and health related problems in the workplace. Specialist occupational health
26
nurses plays a major role in protecting and improving the health of the working
population in Nigeria as part of this strategy.
Occupational health nursing is the nursing practice that provides for and delivers
clinical service to workers and workplaces. Occupational health nurses (OHNs) also
provide health education, case management, and safety programs. The practice of
occupational health is focused on promotion and restoration of health, prevention of
illness and injury, and protection from work-related hazards. Registered nurses provide
an array of services to business and industry and fill diverse roles in occupational health,
including those of clinician, educator, case manager, corporate director, and consultant
(AAOHN, 2007).
The first record of occupational health nursing in the United States dates back to 1888.
The profession has since evolved with the growth of industry and service and today
provides a valued role in the workplace. According to the findings from the 2008
National Sample Survey of Registered Nurses Health Resources and Services
Administration of the U.S. Department of
Health and Human Services (2010), approximately 7.8% of all licensed registered
nurses are working in public and community health, including occupational health. The
use of healthcare professionals has long been supported, and these professionals have
demonstrated value in supporting the health and safety of the workplace and the
workforce. With today’s workforce becoming increasingly diverse, these demographic
changes result in new safety and health issues. As a result, workers are more likely to
have increased risks of work-related diseases and injuries.
Occupational health is a small healthcare specialty that was initially devoted to the
prevention and management of occupational and environmental injury, illness, and
disability. The specialty has grown to encompass other dimensions of healthcare,
including the promotion of health and productivity along with the support for a safe
workplace. The specialty of occupational health is focused on policy and issues relevant
to health and safety by devoting attention to individuals and groups in the workplace.
Occupational health nurses can also make a major contribution to the sustainable
development, improved competitiveness, job security and increased profitability in
enterprises and communities by addressing those factors which are related to the health
of the working population. By helping to reduce ill health occupational health nurses
can contribute to the increased profitability and performance of organizations and
reduce health care costs. Occupational health nurses can also help to reduce the
externalization of costs onto the taxpayer, by preventing disability and social exclusion,
and by improving rehabilitation services at work. By protecting and promoting the
health of the working population, and by promoting social inclusion, occupational
health nurses can also make a significant contribution towards building social capital
in Nigeria.

1. State three (3) Roles of Occupational27
Health Nursing Practices in
Organizations
3.4 Functions of Occupational Health Nursing
The basic tenets of occupational health nursing practice are to promote health at work
and to protect the health of the worker. Aw et al. (2007) define occupational health as:
a multifaceted and multidisciplinary activity concerned with the prevention of ill health
in employed populations. This involves a consideration of the two-way relationship
between work and health. It is as much related to the effects of the working environment
on the health of workers as to the influence of the workers’ state of health on their
ability to perform the tasks for which they were employed. Its main aim is to prevent,
rather than cure, ill health from wherever it arises in the workplace.
In general terms occupational health is about the relationship between work and health
and health and work, and paying attention to this is part of good risk management for
any successful business. The general functions of an occupational health service (OHS)
identified by the World Health Organization (WHO2002 pp. 11–12) provide a classic
framework. Dorward (1993) listed the functions of occupational health nursing as:
• Health surveillance of the work environment
• Accident prevention
• Prevention of occupational ill health
• Treatment of illness and injury at work
• First aid Organisation
• Promotion of health and prevention of ill health
• Counselling
• Rehabilitation
• Keeping records and producing reports
• Liaison and cooperation (internally and externally)
• Administration of the occupational health unit
• Research
Most occupational health nurses perform a wide-ranging and varied role, which may
include activities such as health screening and health surveillance, establishing and
managing occupational health services, case management, and running a travel clinic
and health promotion programmes. Some are involved with teaching and clinical
supervision and mentoring. Many participate in or conduct research, surveys and while
the responsibility for workers’ safety and health rests with the employer, the OHS will
be required to give expert advice to employers, individual workers and their
representatives, and to carry out essentially preventive functions. These functions
should aim at:
• Establishing and maintaining a healthy and safe work environment;
• Maintaining a well-performing and motivated workforce;
• The prevention of work-related disease and accidents; and
• The maintenance and promotion of the work ability of workers.
They hence may comprise the following:
28
• Identification and assessment of the health risk in the workplace;
• Surveillance of the work environment factors and work practices that affect
workers’ health, including sanitary installations, canteens and housing, when
such facilities are provided by the employer;
• Participation in the development of programmes for the improvement of
working practices, as well as testing and evaluation of health aspects of new
equipment;
• Advice on planning and organization of work, design of workplaces, choice and
maintenance of machinery, equipment and substances used at work;
• Advice on occupational health, safety and hygiene, and on ergonomics and
individual and collective protective equipment;
• Surveillance of workers’ health in relation to work;
• Promoting the adaptation of work to the worker;
• Collaboration in providing information, training and education in the fields of
occupational health, hygiene and ergonomics;
• Contribution to measures of vocational rehabilitation;
• Organization of first aid and emergency treatment; and
• Participation in the analyses of occupational accidents and occupational
diseases.
1. State five (5) functions of Occupational Health Nursing Practices in

Organizations
3.5 Summary
This unit summarizes the various roles and functions of occupational health nursing.
Nursing professionals have long been important assets in various aspects of healthcare,
including hospitals, public and community health settings, Military and educational
settings, and in industrial and workplace settings. Occupational health nursing was
originally known as “industrial nursing,” evolving during the Industrial Revolution.
Throughout the years, occupational health nursing has taken on a variety of roles, and
the scope of practice has expanded considerably, giving rise to opportunities for nurses
to care for workers in various workplace settings.


Countries. Enugu: Snaap Press Ltd.
Anton, T.J. (1979). Occupational Safety and Health Management. McGraw-Hill. Inc.
29
Reich, M.R. & Okubo, T. (1992). Protecting Workers Health in the Third World Nation
International Strategies. USA: Greenwood Publishing Group Inc.
Schram, R.A. (1971). A History of Nigeria Health Services. Ibadan: University Press.
Nigeria.
Clark, M.J.O. (1999). Nursing in the Communities. USA: Appleton art. Lange.
Lucas, A.O. & Gilles, H.M. (1984). A Short Textbook of preventive Medicine for the
Tropics, 2nd edition. London: Hodder & Stoughton.
Rogers, B. (1994). Occupational Health Nursing: Concepts and Practice. Philadelphia:

W.B. Sanders Company
30
3.7 Answers to Self-Assessment Exercises
1. a. Specialist occupational health nurses plays a major role in protecting and
improving the health of the working population in Nigeria as part of this strategy.
b. Occupational health nurses (OHNs) also provide health education, case management,
and safety programs.
c. By protecting and promoting the health of the working population, and by promoting
social inclusion, occupational health nurses can also make a significant contribution
towards building social capital in Nigeria.
• Health surveillance of the work environment
• Accident prevention
• Prevention of occupational ill health
• Treatment of illness and injury at work
• First aid Organisation
• Promotion of health and prevention of ill health
• Counselling
• Rehabilitation
• Keeping records and producing reports
• Liaison and cooperation (internally and externally)
• Administration of the occupational health unit
31
Unit 4: Education and Training of Occupational Health Nurse
4.1 Introduction
4.3 Education and Training of Occupational Health Nurse
4.4 Specialist Occupational Health Nurses
4.5 Occupational Health Nursing As a Profession
4.6 Modules in Occupational Health Nursing Education and Training
4.7 Summary
4. 9 Possible Answers to Self-Assessment Exercise
4.1 Introduction
Occupational health nursing aims to ensure the health, safety, optimum working
capacity and the well-being of the working population. Occupational health nursing
considers not only the individual but also the individual in his / her working
environment. Continuous change in the working environment means changes in the
specialty of occupational health nursing and, in consequence, of the education of
occupational health nurses. Occupational health nursing education is a post graduate
activity based on a life - long - learning principle. Each nurse undertaking a course on
this core curriculum should already have achieved the first level qualification of a nurse
as established in the Nigeria directives preferably with experience in public health care.
The WHO recommendations regarding the education of a qualified nurse state that the
education is health related instead of illness related and also includes knowledge in
occupational health nursing. Ideally the student occupational health nurse would be a
nurse qualified or graduated in public health nursing, but it is recognized that there may
be many nurses in the EU working in industry, commerce or hospital services who do
not meet this criteria. In consequence while this core curriculum is capable of being
taught at a sophisticated level it can also be used as a syllabus for very basic
occupational health learning.

• State measures of Education towards Occupational health
• State training modules of Occupational health
• List professional associated with Occupational health training.
• Describe generally the benefits of Occupational health Education on
professionals
4.3 Education and Training of Occupational Health Nurse

Occupational health nursing aims to ensure the health, safety, optimum working
capacity and the well-being of the working population. Occupational health nursing
considers not only the individual but also the individual in his/her working
environment. Continuous change in the working environment means changes in the
32
specialty of occupational health nursing and, in consequence, of the education of
occupational health nurses.
Occupational health nursing education is a post graduate activity based on a life - long
- learning principle. Each nurse undertaking a course on this core curriculum should
already have achieved the first level qualification of a nurse as established in the EU
directives preferably with experience in public health care. The WHO
recommendations regarding the education of a qualified nurse state that the education
is health related instead of illness related and also includes knowledge in occupational
health nursing. Ideally the student occupational health nurse would be a nurse qualified
or graduated in public health nursing, but it is recognized that there may be many nurses
in the EU working in industry, commerce or hospital services who do not meet this
criteria. In consequence while this core curriculum is capable of being taught at a
sophisticated level it can also be used as a syllabus for very basic occupational health
learning.
Variation in the entrance requirements for General Nurse educational programmes,

differences in the length of the programmes and the depth of knowledge required to
qualify as a Registered Nurse in different countries has led to Registered nurses being
prepared and qualified at different levels within Europe. Steps are now being taken to
harmonies the level of education and qualifications for nurses.
4.4 Specialist Occupational Health Nurses

As has been discussed the specialist Occupational Health Nurse is a fully trained
Registered Nurse who, in addition to their General nursing education and training, will
have undertaken an additional period of formal study in occupational health, leading to
a recognized specialist qualification in occupational health nursing, most often at
University degree level. There is some variation in the course content and standards
that apply in the specialist occupational health nurse programs in different countries.
4.5 Occupational Health Nursing As a Profession

Occupational health nursing can be defined as a goal - oriented activity based on the
client’s needs which focuses on work and the working environment. The aim is to
change the working environment in collaboration with the worker in order to maintain
or improve health and safety for all individuals.
The occupational health nurse;
• has her / his own professional responsibility
• is included in the OHS team as an independent professional
• is concerned with and has the responsibility to evaluate and
• develop her / his own work and methods used
• can have administrative management responsibility of her / his own work
• is an expert in health promotion in the work environment
4.6 Modules in Occupational Health Nursing Education and Training

Education of occupational health nurses should be based on the nursing sciences. The
scientific approach should be considered both in the education as well as in the methods
33
used. The substance should be based on documented knowledge, evaluated and / or
scientifically proved as well as empirical knowledge.
The settings in which training is given may vary in accordance with the health and
educational structures of the country or region in which the education and training takes
place. Part - time, modular or distance learning should not be excluded from planning
programmes based on this curriculum.
To ensure that the professional occupational health nurse has the multiple skills and
knowledge required, the following modular training programme should be considered.
Occupational health nursing consists primarily of:
• interaction and collaborating skills and group interaction skills
• educational informative counselling and training skills
• dynamics of communication
• administration of occupational health services
• develop nursing science and research
The education programme is focused on the occupational nursing process. The contents
in the modules develop and support the occupational health nurse’s working process.
Below is the guideline of the various modules;

Module 1 - Health promotion in OH Nursing
• Activities supporting and promoting working capacity and the methods used
• Working environment hazards and their effects on health
• Environmental surveys and follow - up
• Labour protection / Legislation
• Ecological health care
Module 2 - The work of an Occupational health Nurse and Interaction
• Fundamentals of Nursing in OHS
• Development of the work of an OHN
• Marketing and communication methods
Module 3 - Planning an Occupational Health Service
• Current questions concerning health policy
• OHS as a part of the health care system
• Working life and legislation on work
• Health Economics
• International aspects of OHS
Module 4 - Administration and Organizations
• Service and expert organizations
• Organizational systems
• Management and strategies
• OHS as a part of corporate strategy
• OHS as a part of entrepreneurship
Module 5 - Evaluation and Development of Occupational Health Services
• Epidemiology
34
• Work and research on work
• Research methods
• Efficiency and quality assurance
Self-Assessment Exercise 1
1. The WHO recommendations regarding the education of a qualified

nurse state that ______________________
2. what are the modules in occupational health nursing education
4.4 Summary
The education and training of Occupational Nurses are very important to the workplace
environment and as such, scheduled courses and trainings should be given to the nurses
in order to improve their enhancement and competences towards their work
specification. The training of Occupational Nurses are post graduate programs which
helps them improve their basics studies already done while in practice.
Education and training of Occupational Health Nurses (1997). IN; the Nurses
Contribution to the Health of the Worker. Report No.9. Stockholm,
International Commission on Occupational Health; Scientific Committee on
Occupational Health Nursing (SCOHN), (ISBN 91 630 4761 6)
Federation of Occupational Health Nurses in the European Union (FOHNEU) A Core
Curriculum for Occupational Health Nursing in Europe. Helsinki. FOHNEU, 1995
Lennaugh, A. (1997). Setting up occupational health services, In: Occupational Health
Nursing. Ed. Oakley, K. Whurr Publishers Ltd, London, 1997. (ISBN 1 86156 042)
Turning initiative into independence: information for would-be nurses entrepreneurs,
London, Royal College of Nursing, 1997.
Guidelines on the nurse entrepreneur providing nursing services, International Council
of Nurses. 1994
Kitson, A. E. D (1989). A framework for quality: a patient-centered approach to quality
assurance in health care. Royal College of Nursing, 1989. (ISBN 1 870687 22 1)
International Code of Ethics for Occupational Health Professionals. (1992) Singapore,
International Commission on Occupational Health.
Behrens, J. & Westerholm, P. E.D: Occupational health policy, practice and evaluation.
nd
Proceedings of the 2 International
Conference on Health Services Research in Occupational Health. Bremen, Germany,
17-19 November 1994. Copenhagen, WHO Regional Office for Europe, 1996.
Macdonald et al., (1995). Quality and audit in occupational health, London, Faculty of
Occupational Medicine of the Royal College of Physicians, (ISBN 1 873240 000 X)
Menckel, E. & Westerholm, P. ed: Evaluation in Occupational Health practice. Oxford.
Butterworth and Heinemann. 1999. (ISBN 0-7506-4303-X
35
1. The education is health related instead of illness related and includes knowledge in
occupational health nursing.
2. Module 1 - Health promotion in OH Nursing
• Activities supporting and promoting working capacity and the methods used
• Working environment hazards and their effects on health
• Environmental surveys and follow - up
• Labour protection / Legislation
• Ecological health care
Module 2 - The work of an Occupational health Nurse and Interaction
• Fundamentals of Nursing in OHS
• Development of the work of an OHN
• Marketing and communication methods
Module 3 - Planning an Occupational Health Service
• Current questions concerning health policy
• OHS as a part of the health care system
• Working life and legislation on work
• Health Economics
• International aspects of OHS
Module 4 - Administration and Organizations
• Service and expert organizations
• Organizational systems
• Management and strategies
• OHS as a part of corporate strategy
• OHS as a part of entrepreneurship
Module 5 - Evaluation and Development of Occupational Health Services
• Epidemiology
• Work and research on work
• Research methods
• Efficiency and quality assurance
36
MODULE 2: OCCUPATIONAL HEALTH PROBLEM
Module Structure
Unit 5 Occupational Health Problems
Unit 6 Occupational Health Diseases
Unit 7 Occupational Accidents
Unit 8 Occupational Health Poison
Unit 9 Occupational Health Hazard
Unit 10 Pollution Prevention in Industries
UNIT 5 Occupational Health Problems

Unit Structure
5.1 Introduction
5.2 Learning Objectives
5.3 Occupational Health Problem
5.3.1 Definition of Occupational Health Problems
5.3.2 Types of Occupational Health Problems
5.4 Occupational Health Problems in Industries
5.5 Occupational Health Problems in Health Institutions
5.6 Occupational Health Problems in Agricultural Settings
5.7 Occupational Health Problems in Educational Institutions
5.8 Factors that Contribute to Health Problems
5.9 Preventive Measures
5.10 Management of the Health Problems
5.11 Summary
5.12 References/Further Readings
5.13 Answers to Self – Assessment Exercise
5.1 Introduction
This unit exposes you to the nature of occupational health problems workers face in
their work environment. It is a fascinating study that informs you of the type of
occupational problems that can occur in diverse occupations such as industries/factories
agricultural settings, educational institutions, health institution among others. The unit
also discusses the factors that contributed to the problems, the preventive measures and
the type of management that could be provided by the health professional to ensure
survival of the employees.

At the completion of this unit, you should be able to:
• Explain the meaning of occupational health problems
• List the types of occupational health problems commonly seen in different
occupations
• Explain how working conditions contribute to employees' increased risk for
health problems
• Describe the factors that contribute to the health problems
• Explain the preventive measures to health problems
37
• Discuss the management of the common health problems in the work
environment.
5.3 Occupational Health Problems

The occupation or the nature of work performed by a person exposes him or her to
health hazards associated with that occupation. Diverse occupations exist. They include
traditional manufacturing industries (automobile. automotive and appliances); service
industries (banking, health care, and restaurant); education, agriculture, construction,
mining, and newly high technology firms like computer chips manufacturing
companies and many others. Each of these occupations has peculiar health hazards
associated with it. These health hazards interact with numerous nutritional, hygienic,
microbial and social factors in the worker's environment to aggravate their effects on
health. There is also interaction between work hazards and chronic diseases such as
malaria, diabetes, hypertension and cancer. Types of health problems include Labour
accident, occupational diseases, chemical hazards and many others. The figures are
uncertain due to reporting irregularities. The hazards seriously affected the health of the
employees and invariably their productivity. Death toll was much and morbidity very
serious. They employers paid no attention to the sufferings of the employees. This
brought about the provision of occupational health services to alleviate the sufferings
of the employees and to provide preventive and management services for the welfare
of employees.
5.3.1 Definition of Occupational Health Problems

Occupational health problems can be regarded as diseases, accidents and other hazards
arising from the work environment or situations that arise in the attempt to perform
tasks in any occupation. It is a compensable disease that arises out of and in the course
of employment (Henderson and Nite 1978, p. 243). The definition hinges on the
condition that entitles the worker to compensation from the employer.
5.3.2 Types of Occupational Health Problems

Types of OH problems being treated in an industrial clinics and hospitals depend on the
diseases and health hazards obtainable in a particular industry or occupation because
each industry/occupation has its own peculiarities (Asogwa, 2007). Health problems
commonly noticed in American but also seen with industrialization in developing
countries like Nigeria include;
1. Occupational lung diseases (including lung cancer, pneumonoconioses, and
occupational asthma)
2. Musculoskeletal injuries such as back injuries, neck injuries, arthritis, vibration
problems and white finger diseases.
3. Occupational cancers (other than lung cancers).
4. Traumatic deaths, amputations, fracture and eye loses.
5. Cardiovascular diseases (including myocardial nifarction, stroke and
hypertension).
6. Reproductive health problems such as prematurity, abertica.
38
7. Neurotoxic illnesses.
8. Noise induced hearing loss.
9. Dermatologic problems (including dermatoses, burns, and lacerations).
10. Psychological disorders.
39
(Source: National Institute of Occupational Health and Safety quoted by Achalu
(2000, p. 31)
The list and figures according to Reich and Okubo are not certain because of reporting
irregularities. But they confirm the existence of serious and increasingly diversified
problems. For example an estimate proved that the world's acute pesticide poisoning
recorded in the third world countries is as a result of chemicalization of agriculture.
1. Define the term occupational health problem.
2. Mention five (5) types of Occupational Health Problems learnt.
5.4 Occupational Health Problems in Industry

Workers in industries do face numerous occupational health problems. Such problems
seriously affect their productivity and life span. The main problems include: Problem
of social and environmental pollution, air pollution, noise pollution, ergonomic and
chemical pollution.
1. Social and environmental health problems. They include increases in migration
of both skilled and unskilled workers from rural to urban centers causing
overcrowding and environmental pollution. The migration results in
unemployment, poverty, lower standard of living delinquent behaviour such as
abuse of drugs and alcohol, prostitution, robbery, and psychological problems
among others. These outcomes bring about stress, anxiety and their implications.
Apart from environmental pollution, there is problem of poor housing,
overcrowding, poor working conditions and malnutrition.
2. Traumatic injuries are common especially where protective measures are not
taken seriously. Most known injuries include musculo-skeletal injuries,
traumatic amputations, bruises, lacerations. These do cause serious set-back in
the industries concerned. There could be lost of economy due to absenteeism
and poor productivity.
3. Air pollution is a serious health problem of industrialization. Apart from
contamination of air and the entire environment through automobile and
industrial fumes, it introduces harmful pollutants from the exhaust of internal
combustion and diesel engines. The pollutants affect the entire body organs and
cells causing such risk conditions as cancer, degenerative and chronic diseases
including irritation of respiratory and cardiac problems, loss of visibility leading
to accidents (Achalu, 2000, p. 28). Air pollution also affects the plant growth
negatively resulting in poor food production and nutritional problems such as
malnutrition and anaemia. The end result being morbidity and mortality.
4. Excessive noise pollution: Noise is a form of energy that is transmitted through
the air as waves with varying pressure (Achalu, 2000, p. 28). Noise is measured
in decibels. The lowest sound, the human detects is one decibel and the highest
is 150 decibel is damaging to the ear. Example of industries that can produce
40
loud noise include: automobiles, milling/grinding machines, panel beating
workshops, stereo equipment workshops, generator producing industries and
many others. These industries produce serious health problems which are often
neglected. Problems from the noise include poor hearing, loss of concentration,
irritation, fatigue, restlessness and in serious cases loss of hearing.
5. Excessive temperature and humidity in industries have their own problems. This
occurs in industries where the industrial processes make atmospheric control
difficult. Examples of such industries are textile mills, laundries, breweries. The
resultant problems include eye inflammations, respiratory and gastro-intestinal
problems and even exhaustion resulting from atmospheric extremes.
6. Poisonous - harmful substances other than gases and fumes can be present in
industries to cause problems. Chemicals used in industrial plant operations can
act as poisons to cause harm to the skin. Chemical chronic poisoning can occur
in workers improperly handling materials in routine operations without
protective measures.
5.5 Occupational health problems in Health Institutions

Health workers in health institutions (hospitals, clinics, health centres etc) are faced
with numerous health problems which impact seriously on their status. The hospital
environment by its nature is full of hazardous problems. The problems could be
classified into endogenous and exogenous (Asogwa, 2007, p. 38).
a) Exogenous problems are such that were brought into the hospital environment
by the health worker suffering from such a condition such as tuberculosis,
Human Immunodeficiency Virus (HIV), chicken pox and other conditions that
have long incubation period and cannot be diagnosed early for preventive
measures to take place.
b) Endogenous problems are those acquired within the hospital from patients,
patients' relations or even from workers. Example of such problem include
hepatitis B, HIV, other blood sera (that is hazards due to exposure to infected
blood and other body fluids), other problems include protozoa infections such as
malaria parasites. The hazard could occur through needle stick injuries,
lacerations from razor or Lancet or scalpel blades that were infected and other
sharp instruments.
c) Hazards resulting from radiation such as x-rays used for radiotherapy. This can
result in radiation injuries like cancer. This is seen mostly in workers in x-ray
departments where radio-active substances are used for therapeutic purposes.
d) Problems due to exposure to communicable diseases such as tetanus,
chickenpox, and other blood borne pathogens. This is a major concern when
caring for infected patients. The presence of resistant organisms causes extra
concern and makes treatment difficult. Workers who have frequent contact with
blood and blood products and those engaged in intravenous therapy have a
special risk for exposure to hepatitis B.
41
e) Problems due to exposure to food and water borne diseases include diarrhea,
gastroenteritis, caused by schistosomiasis, salmonella’s organisms. These
problems occur due to contamination of food and water within the environment
of the health institution.
f) Problems resulting from hazardous chemical agents do occur. Anaesthetic
gasses can increase the risk of spontaneous abortion in pregnancy; maternal
illness and death in severe cases and the risk of foetal malformation or death in
severe cases. Chemotherapeutic agents used in the treatment of cancer are
extremely toxic. Contact with many drugs, especially antibiotics during
preparation and administration may cause the health worker to develop
sensitivity. This can cause transitory problems such as hand and skin rashes and
other undesirable effects. Cleaning agents and disinfectants used in hospitals can
cause some hazards if not properly used.
g) Back and joint injuries are common occupational problems among hospital
workers. These problems interfere with the working life of people. They occur
due to improper body alignment before and after lifting patients and equipment.
h) Other problems include occupational stress which may be due to pressure of
work, shortage of personnel, interpersonal relationship with other staff or with
supervisor or with patients or patients' relations or even with self. There could
be physical attack from violent and emotionally unstable patients; burn outs due
to pressure of work or other various psychosocial stresses at work. Health
workers mostly at risk of health problems include doctors, nurses, laboratory
staff, radiographers, mortuary attendants, cleaners, physiotherapists and many
others. The major sources of the health problem could be hospital wards, hospital
clinics, theatres, laboratory, mortuary and other areas where patients are being
treated and blood and other body fluids and specimens are taken for
investigation.
1. Workers in industries do face numerous occupational health problems,
mention 5 occupational health problems
2. Differentiate between exogenous problems and endogenous problems
5.6 Occupational Health Problems in Agricultural Settings

In developed and developing countries including Nigeria, agricultural work is the main
occupation for majority of the people. The type of agricultural work varies and ranges
from mechanized to non-mechanized farming. The activities involved included:
clearing the ground, planting, weeding, harvesting, and processing, among others. Then
for animal husbandry it involves breeding, raising and caring for animals. The health
problem can occur from any of the activities and could be grouped into general and
42
specific health problems. The general problems include: cardio-vascular, respiratory,
nutritional problems and accidents.
Specific problems are those connected with various agents of diseases such as physical,
biological and chemical hazards (Achalu, 2000, p. 52).
Biological hazards include zoonosis or diseases transmitted by animals during caring
and handling of animal products and wastes. Examples of such health problems include:
anthrax, brucellosis, bovine tuberculosis, laser fever, rabies, bird flew and many others.
These problems arise during planting, harvesting and primary processing of all types of
crops as well as problems arising from breeding, raising and caring for animals,
tendering market gardens and nurseries.
Parasitic diseases transmitted due to contact with polluted water in farm lands and poor
sanitary conditions of agricultural environment include: hookworm disease
(ankylostomiasis), schistosomiasis especially in irritant and riverine farm lands,
tetanus, sleeping sickness, malaria, skin rashes and many others. Allergic diseases do
occur due to inhalation of vegetable pollen dusts, animal dusts, organic chemicals and
reaction to certain food substances. Such diseases include asthma, byssinosis from
cotton dust, bagassosis from sugar cane bagasse, allergic conjunctivitis from rubber,
dermatitis from wood dust, and allergic skin reaction to certain grasses and chemicals.
Physical problems do occur as a result of exposure to prolonged heat and sunlight, noise
from farm machinery, dust and fumes, puncture wounds from sharp instruments and
woods, cuts, bruises and lacerations. These can cause severe preventable diseases like
tetanus, bacteria infections and gangrene of the wound. Other problems include
backache resulting from prolonged bending, heavy load and wrong posture. Accidents
and other injuries do occur and they can result from liquid or gas splashing,
electrocution due to electrical faults, falling from height such as palm trees, mango
trees, tractor accidents, and so on.
We also have records of stings and bites such as human bite, snake bite, dog bite,
scorpion bite and many others. When the stings and bites occur, the treatment is always
an emergency in order to save life and protect the individual. Human bites do occur
over ownership of farm, and it is the most dangerous if treatment is not taken at once.
Social problems include: low income, poverty, lack of healthcare and health facilities,
water borne diseases like diarrhoea, cholera, schistosomiasis, dysentery, parasitic
problems like hook worm, tape worm, and other water borne diseases got from polluted
stagnant dirty waters in the farm land as well as sanitary conditions (Achalu, 2000, p.
52). Food poisons also do occur either as a result of contamination at the harvesting or
preparation or servicing or even eating with soiled hand or contaminated plates and
cutleries.
Work place violence is a serious cause of health problems. It may occur over ownership
of farm land or economic trees. This can cause interpersonal or even communal
violence, body injuries and death in severe cases.
43
Health Problems of Education Institutions
Educational institution (primary, secondary and tertiary) is purely a learning institution
where teachers and students interact. The proprietor of the school is the employer while
teachers and students are regarded as employees. Both teachers and students are
exposed to various occupational problems. Teachers face such problems as:
1) Accidents - might occur resulting in injuries like falls, chalk board dropping
from the wall or knocking the feet against had objects.
2) Infections can occur. It could be transmission from infected student or from the
school environment through the use of infected animals for practical
demonstration or contaminated environment e.g. chickenpox, measles.
3) Needles prick injuries occurring during practical demonstrations on how to
inject animals or vaccination and immunization of animals.
4) Varicose veins in severe cases resulting from long standing and pressure.
5) Respiratory problems due to inhalation of chalk particles and particles from dust
within the school environment.
6) Dehydration due to talking, heat on radiation, convention and conduction of
heat.
7) Electrocution due to faulty electrical appliances in the school premises and in
the offices. It can occur during laboratory demonstrations or even during
teaching process.
8) Loss of voice due to strains on the vocal cord during long period of talking in
large classes. The teacher has to try to increase the volume of the voice while
teaching to carry the class along.
9) Anxiety and its implications like hypertension, other cardiac anomalies resulting
from strains and stresses in school. The stress can be caused by the pressure of
work; from students especially with stubborn students; from, employers, from
self-due to inner tensions from inability to fulfill one's desires, stresses from
work overload; generated by caring for students and their personal problems;
poor remuneration and irregular payment of salary. Other causes of anxiety and
stresses include organizational structure of the school, job insecurity facing
teachers; students parent intrusions, relationship with school workers and co-
teachers as well as relationship with supervisor. Most importantly poor
knowledge and skills to teach.
Other causes of emotional dissatisfaction include back pain, frequent headache, pains
and disabilities, and other illnesses. The health problems of the teacher can cause
absenteeism and decreased productivity, poor learning and poor students' performance.
Indirectly this could cause poor growth of the school.
44
5.8 Factors that Contribute to Health Problems of Workers
The factors that contribute to worker's problems in occupational setting include:
biophysical, psychological, social, behavioral and health systems (Clark, 1999).
Biophysical
Human biological factors are those related to maturation and aging, genetic inheritance,
and physiological functions (Clark, 1999). Maturation and aging: The age compositions
of workers in occupational settings do affect their health. If the employees are mainly
adolescents and young adults, health problems likely to occur with some frequency
included: sexually transmitted infections like syphilis, gonorrhea, HIV; pregnancy,
hepatitis, drug abuse, alcoholism and other social vices. They may also be at increased
risk of injury due to their inability to settle down for work; limited job training, and
skills, lack of experience, experimentation, impatience and inability to concentrate. The
health problems that may be noticed among the middle aged employees are: heart
problems like hypertension, stroke, palpitations, renal problems and cancers in most
cases. They may also be at increased risk of mental depression, anxiety, and other
emotional problems due to pressure of work in the families, work environment and in
the society.
Health problems that may occur in elderly employees over 65 years of age are reduced
capacity to function, problems of muscuoskektal system, sensory impairment, poor
coordination, frequent high risk occupational accidents and dementia. Factors that
influence their continued desire to remain in the employment may be associated with
economic constraints, loneliness and many personal problems. Another contributory
problem is a situation where there is shortage of skilled manpower and inability of
employers to enforce prohibition on retirement at specific age.
Genetic Inheritance
Genetic inheritance factors likely to be of great importance in the workforce are those
related to race, gender and genetic inheritance like sickle cell disorder. For example, in
a large African American Labour force, hypertension may be prevalent. In an Asian
population particularly if large numbers are refugees, communicable diseases such as
Tuberculosis and parasitic diseases may be common (Clark, 1999, p. 645).In
underdeveloped countries like Nigeria, labor force hypertension and mental stresses
may be prevalent.
The sex composition of the employees do determine the types of health problems that
may occur: For example, if large numbers of employees are women of child bearing
age, there is need to provide pre and post natal services, monitor more closely
environmental conditions that may cause genetic changes or damage to unborn child
causing malformations and death; monitoring for infertility, spontaneous abortion, low
birth weight, pre and post maturity, birth defects, chromosomal abnormalities,
preeclampsia and an increased incidence of childhood cancers (Clark, 1999, p. 645). If
an employee has genetic inheritance like sickle cell disorder, there is need to provide
an environment that discourages precipitation of painful crises such as adequate
ventilation, assignment of less strenuous jobs and environment free of dust, and fumes
45
and smokes. Monitoring for conditions that can precipitate bone pain crisis and
provision of facilities for treatment of crisis before reaching the clinic for management.
Physiological Factors
Conditions prevalent in occupational settings include traumatic injuries, lung diseases,
cardiovascular problems, renal problems, neuro-toxic disorders, cancers, skeletal
problems, injuries of all kinds, sensory impairments and many others. These health
problems are related to the work environment, personal behaviours of employees within
and outside the work environment. Other problems that may occur are the out breaks
of dermatologic conditions that indicate the presence of hazards in the work
environment that need control measures. They include: variety of rashes, pruritus,
chemical burns and desequemation. These dematiologic problems affect seriously the
production capacity and loss of income to the company. Psychological problems of
anxiety and stress may manifest as a result of stressors associated with work overload,
the organizational structure of the company/occupation, job insecurity, interpersonal
and intrapersonal relationships with co-workers or employers or supervisors and
attitudes of racial or ethnic discrimination in workplace. Other sources of stress most
frequently identified by workers include: lack of control over the contents, processes
and pace of one's work; unrealistic demands and lack of understanding by supervisors;
lack of predictability and security regarding one's job and future; and the cumulative
effects of occupational and family stressors. Employers most often perceive employee's
lifestyles, and health habits as the primary contributors to stress.
The Physical Dimension

Physical environmental factors contribute to a variety of health problems employees’
face in the work settings. The categories of the health problems include: chemical
hazards, physical hazards such as radiation, noise, vibration and exposure to extremes
of heat and cold; electrical hazards, fire, heavy lifting and uncomfortable working
positions, and potential falls (Clark, 1999, p. 648).
With poor lighting or high noise levels, the employee may face the adverse effects of
vision and hearing respectively. Heavy objects that must be moved may cause
musculoskeletal injuries, hernia and potential for falls and exposure to excessive heat
or cold in many workplaces.
Other factors related to physical environment is the use of toxic substances in work
performance which may be inform of solids, liquids, gasses, vapors, dust, fumes, fibers
or mists (Clark 1999 quoting California Occupational Health Programme, 1992). The
toxic substances can cause respiratory, dermatologic and other health problems. Heavy
metals like lead can cause lead poison. Other metals of concern include mercury,
arsenic and cadmium. Areas to be assessed for the presence of heavy metal potentials
for toxic exposure in the work settings include substances used in setting and their
levels of demonstrated toxicity, portals of entry into human body, established legal
exposure limits, extent of exposure, potential for interactive exposures and the presence
of existing employee health conditions that put the individual affected at greater risk of
exposure-related illnesses.
46
The use of heavy equipment or sharp tools can cause occupational injuries. It can also
cause hand-arm vibration syndrome especially in using tools that vibrate or visual
disturbances related to the use of computer display terminals. Another recent hazard
discovered generated by widespread computer use is the potential for tendinitis and
other similar conditions stemming from the use of word processors. Extreme or
awkward postures have been associated with low back problems and repetitive or high
force movements with carpal tunnel syndrome.
Social Dimension
The social environment of the work setting can influence employee health status either
positively or negatively. The nature of the influence depends on the social interactions
among employees, attitudes toward work and health and the presence or absence of
racial, sexual or other tensions can all affect the health status of the employees and their
productivity within the occupation.
Four spheres of influence in the workplace social environment do affect the health
status of the employees. The first sphere of the influence is concerned with health
related behaviours of employees; the second sphere of influence on health status occurs
among groups of co-workers. The third sphere of influence is the management sphere
such as attitudes toward health and health-related policies and the effects of the policies
or their lack on employee’s health status. For example, to value wellness and health
promotive efforts, they must perceive them to be valued by employers. The fourth
sphere of influence involves legal, social and political action that influences the health
of employees. An example of this is the regulation of conditions in the work
environment by agencies such as occupational safety and health administration.
Through legislations society can mandate that business and industry create specific
conditions that enhance the health of employees; companies over a certain size should
offer employees a health maintenance organisation as one option for health insurance
coverage. The final social dimension factor in the work setting that is not currently
compensable but is drawing increasing attention is workplace violence (Clark, 1999).
Behavioral Dimension
Life style factors to be considered include; the type of work performed, consumption
patterns, patterns of test and exercise and use of safety devices. The type of work an
employee performs within the work setting can significantly influence the employee's
health; determines the risk of exposure to various physical hazards and level of stress
experienced; it influences the extent of the exercise employees obtain.
The consumption patterns of interest include those related to food and nutrition,
smoking and drugs and alcohol use. The nutrition influence on the health status is well
known. Smoking is harmful to health and may increase the adverse effects of other
environmental problems particularly those that affect respiration. Over indulgence in
substance abuses such as caffeine, may pose health problems to employees.
Rest and Exercise: occupational places do place many physical and psychological
demands on the employees. These demands result to inadequate rest and recreation.
47
Same problem is faced by employees who work constantly to ensure progress and those
who keep other jobs in an attempt to make ends meet. Many occupations are
recognizing that exercise provides physical and psychological relaxation, alertness and
relieve muscle tension making it ready to work again. It reduces heart attack and injury
and even sleep at work and accident. It causes better coordination, reduces hazards,
accidents and better work output. These benefits have made employers of labour to
promote physical exercises by providing activities for recreation in work settings.
5.9 Preventive Measures

Preventive measures to occupational health problems include:
1) Pre-employment medical examination of all employees to rule out presence of
any health problems and potential for hazard in the job.
2) Immunization of employees at risk of infections such as tuberculosis, hepatitis
B and HIV, where applicable.
3) Periodic monitoring of all employees in all occupations especially those in high
risk areas e.g. periodic x-ray examination of staff working in x-ray units, or those
working in lead producing industries, heavy metal industries.
4) Regular inspection, of food preparation, servicing and storage facilities as well
as inspection of food preparation environment.
5) Ensuring the use of wholesome water for drinking and food preparation
(pathogen free chlorinated water) to avoid water borne infections and making
sure that water containers are free from contamination.
6) General hygiene of the work environment especially that of the hospitals,
schools and many others to avoid accidents and infection dissemination.
7) Provision of safety devices such as eye gurgle, booth, helmet, lead apron and
many others.
5.10 Management of the Health Problems

1) All workers should be screened on employment and those found sick should be
screened and treated properly. All those at risk of tuberculosis (TB), hepatitis B
and HIV should be immunized and post immunization antibody response
estimated after a stipulated interval to ensure positive result. Then such
employee should be assigned to a unit in the workplace that is safe for him or
her.
2) All employees working in x-ray department or where there is risk of radiation
hazards should be posted to another section of the unit. Special precautions
should be taken by all employees working in radiation areas or handling
radioactive materials to avoid exposure above the threshold limit for a specific
period. The standard required for safety must never be compromised and the use
of dangerous and unsafe equipment should be avoided.
48
3) All food handlers should be examined periodically and those sick should be
treated and then allowed sick off to ensure quick recovery before handling food
substances.
4) Any incident of food or water poisoning should be properly investigated and
precautionary measures taken to avoid further spread and occurrence. Those
already affected should be screened and properly treated before resuming duty.
5) The health worker should identify the presence of any health hazards in the
physical environment that contribute to health problems and then ensure that
such health hazard is removed by encouraging the employers.
6) Nurses who work in settings where such agents are prepared and administered
should seek additional education regarding their administration, not only in
relation to the client's safety but also in relation to personal safety (Asogwa,
2007). The hospital employer is responsible for providing the equipment to
maintain safety when handling the agents. The effects of known health hazards
on the employee should be determined or lessened and treatment provided based
on findings. All employees with emotional and psychological problems or those
experiencing uncomfortableness due to stresses in the work environment should
be monitored, counselled and guided on ways to solve the identified cause of
stresses and effort made to remove the stressors.
7) Health education on prevention of stressors and their management should be
intensified. Those seriously affected should be allowed off sick and then
followed up for proper treatment and rehabilitation.

1. mention at least five (5)Health Problems of Education Institutions
2. mention two (2) Management of the Health Problems
5.11 SUMMARY
In this unit, we have learnt that occupational health problem can be regarded as
diseases, accidents, hazards arising from the work environment or health problems that
employers face in performing tasks in occupational settings.
• Types of Occupational health Problems Commonly seen in different
occupations; such as industries, health institutions, schools, agriculture and other
occupations include accidents, infections, stresses, physical and mental
instability. The factors that contribute to the health problems include
biophysical, physical, and physiological among others. The preventive measures
included monitoring to identify those at risk; immunization of those at risk of
communicable diseases like tuberculosis, chickenpox, hepatitis B, HIV and
others. Management of the affected employees included proper treatment of the
sick ones; those working at x-ray department should be provided with film
bandages to ensure radiation free and then posted to another section where
49
radiation is free. Employees suffering from food and water borne diseases should
be screened and treated adequately.
• Employers suffering from stresses should be counselled and guided. The stressor
should be identified and removed and health education provided on how to come
off the stresses.
5.12 REFERENCES/FURTHER READINGS
Achalu, F.I. (2000). Occupational Health and Safety. Lagos: Simarch Nigeria Limited.
Asogwa, S.E. (2007). A Guide to Occupational Health Enugu: Snaap Press Ltd.
Henderson, V. and Nite, G. (1978). Principles and Practices of Nursing. (6th Ed) New
Reich, M.R. Okubo, T. (1992). Protecting Worker's Health in the third World. National
and International Strategies. New York: An Imprint of Green Wood Publishing Group
Inc.
5.13 Answer to Self-Assessment Exercises
Answer to Self-Assessment Exercise 1

1. Occupational health problems can be regarded as diseases, accidents and other
hazards arising from the work environment or situations that arise in the attempt to
perform tasks in any occupation.
2. a. Occupational lung diseases
b. Musculoskeletal injuries
c. Occupational cancers
d. Traumatic deaths, amputations, fracture and eye loses.
e. Cardiovascular diseases.
f. Reproductive health problems such as prematurity
g. Neurotoxic illnesses.
Answer to Self-Assessment Exercise 2

1. a, Exogenous problems
b. Exogenous problems
c. Hazards resulting from radiation
d. problems due to exposure to communicable disease
e. problems resulting from hazardous chemical agents
2. Exogenous problems are such that were brought into the hospital environment by
the health worker suffering from such a condition such as tuberculosis, Human
Immunodeficiency Virus (HIV), chicken pox and other conditions that have long
50
incubation period and cannot be diagnosed early for preventive measures to take place.
While exogenous problems are those acquired within the hospital from patients,
patients' relations or even from workers. Example of such problem include hepatitis B,
HIV, other blood sera (that is hazards due to exposure to infected blood and other body
fluids), other problems include protozoa infections such as malaria parasites. The
hazard could occur through needle stick injuries, lacerations from razor or Lancet or
scalpel blades that were infected and other sharp instruments.
Answer to Self- Assessment Exercise 3

1. a. Accidents - might occur resulting in injuries like falls, chalk board dropping from
the wall or knocking the feet against had objects.
b. infections can occur. It could be transmission from infected student or from the
school environment through the use of infected animals for practical demonstration or
contaminated environment e.g. chickenpox, measles.
c. Varicose veins in severe cases resulting from long standing and pressure.
d. Respiratory problems due to inhalation of chalk particles and particles from dust
within the school environment.
e. Dehydration due to talking, heat on radiation, convention and conduction of heat.
f. Electrocution due to faulty electrical appliances in the school premises and in the
offices. It can occur during laboratory demonstrations or even during teaching process.
g. Loss of voice due to strains on the vocal cord during long period of talking in large
classes. The teacher has to try to increase the volume of the voice while teaching to
carry the class along.
2. a. All workers should be screened on employment and those found sick should be
screened and treated properly. All those at risk of tuberculosis (TB), hepatitis B and
HIV should be immunized and post immunization antibody response estimated after a
stipulated interval to ensure positive result. Then such employee should be assigned to
a unit in the workplace that is safe for him or her.
b. All employees working in x-ray department or where there is risk of radiation hazards
should be posted to another section of the unit. Special precautions should be taken by
all employees working in radiation areas or handling radioactive materials to avoid
exposure above the threshold limit for a specific period. The standard required for
safety must never be compromised and the use of dangerous and unsafe equipment
should be avoided.
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UNIT 6 Occupational Health Diseases
Unit Structure
6.1 Introduction
6.3 Occupational Health Diseases
6.3.1 Classification/Types of Occupational Diseases
6.4 Causes of Occupational Diseases
6.5 Occupations that can Predispose Workers to Diseases
6.6 Methods of Detection of Occupational Diseases
6.7 Prevention and Control of Occupational Diseases
6.8 Implications of Occupational Diseases
6.9 Reportable Occupational Diseases
6.10 Summary
6.12 Answers to Self-Assessment Questions
6.1 Introduction
The unit introduces the learner to the nature of occupational diseases that could be
contacted by the worker in the process of task performance within the occupational
environment. The diseases could compromise the workers' health status as well as limit
their life span. The magnitude of morbidity and mortality associated with such diseases
is high especially if they become chronic and proper treatment not provided. According
to Stanhope and Lancaster (2001, p.946) each day an average of 137 individual workers
die from work related diseases. The problem is that some of the diseases do not manifest
early enough for treatment to be started. It could manifest when the worker must have
retired, thus making it difficult to find the actual cause. For example, Silicosis can take
up to 15 years to develop while some cases of Mesothelioma can only became evident
25 years after the worker was last exposed to asbestos. Lung diseases in workers occur
gradually over time, continued Stanhope and Lancaster. All these made it impossible
for early diagnosis and life saving measures to be instituted. The Unit also discusses
the classification, causative agents, prevention and control of occupational diseases,
reportable diseases, as well as the implications to both the employers and the
employees.

At the completion of this unit you should be able to:
• Explain the meaning of occupational health diseases
• Describe the types of occupational diseases
• Explain the predisposing factors to occupational diseases
• Describe the methods that can be used in detecting occupational health
• Discuss the prevention and control of occupational diseases
• Describe the implication of occupational health to both the employer and the
employees.
52
6.3 Occupational Health Diseases
Occupational health disease can be defined as a compensable disease contacted by the
worker due to exposure to hazards in the work places. Adobe (1996) defined it as any
condition arising from work place exposures which compromises worker's physical,
mental and social wellbeing. Asogwa (2007) defined it as diseases associated with
particular processes or agents which the worker is exposed to in the course of his work.
Osanyigbemi was quoted by Achlu (2000 p. 29) defined occupational disease as those
diseases which occur with characteristic frequency and regularity in occupations where
there are specific hazards. It can also be explained as any chronic ailment that occurs
as a result of occupational activities. By the definitions, it means that there must be
interaction of the worker with the environment before the disease can occur.
6.3.1 Classification of Occupational Diseases

Occupational diseases can be classified in different forms. Classification put forward
by Asogwa (2007) and Park (2002) is according to the target organ systems of the body
and hey includes:
1. Occupational diseases of the respiratory system
2. Occupational diseases of the liver
3. Occupational diseases of the cardiovascular system
4. Occupational diseases of the Gastro-intestinal system
5. Occupational diseases of the Genito-urinary system
6. Occupational diseases of the skin or dermatologic system
7. Occupational diseases of the musculo skeletal system
8. Occupational diseases of the haemopioetic system
9. Occupational diseases of the physical agent.
Types of Occupational Diseases

The types are hereby presented according to the systems of the body being affected.
1. Respiratory Diseases
They are diseases that can affect the organs of the respiratory system such as the nose,
nasal cavity, the trachea, the bronchus, and the Lungs. Such diseases include: acute
inflammatory diseases, Rhinitis, pneumonia, asthma, pneumoconiosis, dyspnoea,
cough which can be dry and productive, pleural plague diseases, cancers, farmers lung
disease, anthracosis, silicosis, asbestosis, bagassosis, byssinosis, tabacosis and others.
The diseases can cause impairment of air entry into the lungs by either narrowing the
airways or producing ventilatory failures. Some of the respiratory diseases can causes
permanent damage to the respiratory systems especially the lungs. They can gradually
affect the worker by gradually reducing the working capacity thereby causing serious
setback in industrial production.
2. Occupational Diseases of the Liver

Industrial or occupational diseases that affect the liver gain access into the body through
the skin abrasions and alimentary track to the liver cells to cause the following disease
hepatitis, cancer, hepatomegaly, multilobular cirrhosis of the liver, fatty degeneration
of the liver, uremia and so on.
53
3. Occupational Diseases of the Cardio-vascular System
They are diseases conditions that affect the heart and the blood vessels. Such diseases
include: hypertension, anaemia, heart failure, angina pectoris, myocardial infection,
stroke, leukemia, arrhythmias, coronary heart diseases, other cardiac anomalies and
many others. Most of these diseases incapacitate the workers especially the chronic
ones.
4. Occupational Diseases of the Gastro-intestinal System

Common diseases of gastro-intestinal track reported by workers included: diarrhoea,
vomiting, typhoid, gastritis, gastric ulcer, constipation, cancer, gastro enteritis,
oesophageal fistulae and many others. The diseases mostly occur through ingestion of
substances, chemicals and through starvation or wrong timing of feeding.
5. Occupational Diseases of the Genito Urinary System

Common diseases affecting the system included: Cancers, diabetes mellitus, renal
stone, renal failure, haematuria, kidney failure, typhoid fever, acute nephrosis,
nephrotic syndrome and many others.
6. Occupational Diseases of the Skin (dermatologic)

The diseases include: irritant contact dermatitis, allergic diseases, skin cancers, acne,
skin pigmentation, and thickening of the skin, skin manifestation, thickening of the
skin, skin manifestation of systemic toxicity, heat and cold damages, parasitic diseases
such as mites. These are common diseases experience by workers in different
occupations and they can be quite incapacitating.
7. Occupational Diseases of the Musculo Skeletal System

They include: osteoporosis, muscular pains, and rickettsiae
8. Occupational Diseases of the haemopoetic system include leukaemia, anaemia,

lymphopenia, thrombocytopenia and many others.
9. Occupational Diseases of the Physical Agent include dermatitis, e.g. allergic

hypersensitivity, and non-allergic irritants; inflammatory conditions, boils; Rhinitis,
6.4 Causes of Occupational Diseases

Pre-disposing Factors to Occupational Diseases;
1. Lack of provision of protective (safety) devices by the employers of labour.
2. Inadequate or non-use of safety devices by the respective worker. The non-
compliance to company rules can predispose the worker to various illnesses.
3. The health status of the worker. A worker who is ill and stressed up is likely to be
affected. A worker who is anemic due to ill-health like malaria or due to poor nutrition
is likely to develop further complications.
4. Poor personal and environmental hygiene.
54
5. Lack of periodic medical investigation or examinations of the workers to identify
those likely or already developing ill-health so that treatment can be started early. Types
of medical examination should include x - ray and laboratory investigations.
6. Lack of practice of most containment and preventive measures.
7. Exposure to defective equipment and instruments.
8. Exposure to dermatologic agents which could be endogenic. Such substances include
absorption of gold, mercury arsenic biological agents like Bacillus anthraces and
mechanical agents.
9. Ingestion of toxic substances and dangerous agents such as contaminated food
substances, vegetables and fruits.
10. Exposure to hazards like lead, toxic materials, fumes, dust and other substances.
11. Inhalation of gases, fumes, organic substances like silica sulphate, iron dusts, coal
dusts and others.
12. Carelessness of workers and hazardous life styles like excessive smoking, alcohol
intake and ingestion of non-prescribed and adulterated and fake drug. Inability of the
worker to go for medical check-up as preventive measure.
6.5 Occupations that can Predispose Workers to Diseases

Occupational groups from which workers can contact diseases are: industries, factories,
service industries like health institutions, banks, educational institutions, agriculture,
construction industries like road construction, and mining, catering and processing, hair
dressing. Electrical industries, building and construction, leather manufacturing and
many others.
1. Occupational health disease_______________ can be defined as a compensable

disease contacted by the worker due to exposure to hazards in the work places.
2. Occupational diseases can be classified in different forms EXCEPT
a. Occupational diseases of the respiratory system
b. Occupational diseases of the liver
c. Occupational diseases of the cardiovascular system
d. Occupational disease of the Thrombosis
6.6 Methods of Detection of Occupational Diseases

Since some health hazards responsible for occupational health diseases are known and
documented while some are largely unknown, there is need to attempt to identify the
unfamiliar and unknown hazards in the work places in order to control them. The
methods of detection put forward by Asogwa (2007 p.70) included: biological
monitoring, epidemiological methods, and environmental measurements.
1. Biological Methods
This takes the form of pre-employment medical examination for basic data, and
periodic medical examinations and laboratory tests to detect diseases if any. Laboratory
55
tests can take the form of hematological studies, urine tests, and stool analysis while
medical examination can be chest-x-ray. Those with suspected cases of dermatitis
should be kept away. The tests do help to detect early the presence of diseases and to
plan appropriate preventive and curative intervention programmes to curtail the spread
and damage to the health status of the individual.
2. Epidemiological Methods
Epidemiology in an industrial setting aims at studying the determinants, distribution
and deterrents of diseases among workers. Epidemiological studies therefore help to
detect both the occupational and non-occupational work related diseases among
workers. For effective preventive measures to be planned. Example of work-related
association between stressful occupations and diseases can be peptic ulcer,
hypertension, gastric upset and others. The assessment aims at prevention of spread of
the disease.
3. Environmental Measurement
These are used to detect agents of known hazards in the work place before the diseases
occur. This helps to identify the hazards early enough in order to prevent or reduce the
adverse effects of such hazards. Example, dust sampling and measurement in a coal
mine or cement industry can reduce the incidence of coal workers. Pneumoconiosis,
Noise measurement with meters in manufacturing industries would help reduce the
incidence of defeaness and use of gas detectors to measure the level of various gases
like carbon monoxide can help reduce carbon monoxide poisoning. Other methods of
detection that could be employed include: history taken from the worker.
6.4 Prevention and control of Occupational Diseases

The practice of making prevention a priority in different occupations is of primary
importance in occupational practice. This is because work-related illnesses are
frequently irreversible (Allender and Spradley 2001.p 592). For example development
of a mesothelioma from asbestos exposure is a condition for which there is no cure.
Same applies to other conditions. Some can even lead to morbidity and mortality.
Prevention is the only answer. The preventive and control measures put forward by
Achalu (2000 pp. 62-65) and Asogwa (2007, pp.72-75). Complete elimination of
hazardous agents. This can be achieved through the following methods.
a) Substitution of the Process

This means replacing the harmful substances by the less harmful ones which are equally
effective or nearly so. Example, the use of fiber glass instead of asbestos in the
production of roofing sheets or the substitution of noisy machinery with less noisy ones.
b) Change of Work Process

Example, the use of scanning technique instead of x-ray in carrying out investigations.
56
2. Containment Measures
This involves containment at the source of the hazards. It is a method of getting rid of
dusts, vapors and fumes from a point source. Example, the use of exhaust ventilation in
chemical laboratory, wet drilling in mixers or wet mining in coal mines.
3. Total Enclosure of Hazards

This involves preventive measures when the work process is enclosed to avoid
exposure. It is relevant to work groups like radiation workers suchas x-ray and
transformer station workers. The radioactive material is enclosed in a lead shield,
thereby preventing the associated hazards to the worker.
4. The use of partial enclosure of hazards of dangerous machine process section. That
is, isolation of such machines.
5. Limitation of Time of Exposure

This is usually the practice in situations where radiation or noise is the hazard.
According to Asogwa (2007), the maximum tolerance daily dose should be known and
the hours of work arranged so that no worker stays longer than the prescribed period of
time.
6. Segregation of Hazardous Processes

By this method, those not concerned with its operation are protected thereby reducing
the number of those at risks. In operations involving emission of irritant gases, workers
should be made to use breathing apparatus like protective mask and respirators for
prevention.
7. Adequate Ventilation in the Work Environment

This reduces high temperature by air movement, maintains adequate dilution of
atmospheric contaminants, and reduces the nuisance or harmful effects of such
contaminants in the air. Ceiling fans fixed at appropriate places in sufficient numbers
will be of help in maintaining adequate ventilation.
8. Cleanliness of the Workplace also called Good Housekeeping

This is very essential especially in hospital environments, as it eliminates the
accumulation of dangerous materials in the workplace. Sweeping and washing of the
floor with disinfectant should be carried out at regular times daily, preferably at the end
of the day’s work or before the start of business in the mornings. This should be
arranged in such a way as to allow the workers go home with others. This also improves
the workers morale and productivity. It can be achieved by establishing and maintaining
rules of conduct in the workplace. Such protective devices should include face masks,
hand gloves, goggles, boots, helmets, apparels and many others.
9. Personal Cleanliness
Personal hygiene contributes in avoiding accidental consumption of dangerous
substances. Preferably, workers employed in inherently dirty jobs should come to work
in their clean clothes while their working apparels should be kept and laundered in the
57
work environment. The employers should contribute by providing facilities for
changing and washing of the working apparels. Workers should also be provided with
specific places for eating and smoking during recreation periods. There is need for
massive health education and campaign on the need for how to use those devices,
followed by adequate supervision to see that such workers put on those protective
devices, if much success is to be recorded. There is also the need for the industries
especially manufacturing and service industries like hospitals to provide all the needed
protective devices to avoid things like the individual workers buying inferior protective
devices himself because of cost.
10. Legislation
This can be used to eliminate or reduce exposure of workers to occupational hazards.
This is because, if the industrialists are not legally compelled to protect the workers,
they may not do anything to help prevent workers' exposure to hazards, especially when
they still make their profits and workers are always there to be hired and dismissed at
will with the slightest flimsy excuses. According to workplace safety and Insurance
Bureau (WSIB, 2007), occupational diseases can be prevented by:
a) Finding out what materials and substances were being used in their workplace with
the aim of ensuring safety provisions.
b) Finding out how to work safely around materials and equipment in their workplace.
c) Use protective equipment provided by their employer. Make sure that they know
how to use the facilities if not ask questions.
d) Be alert to the symptoms of change in your health status and be able to report on
time.
e) Always tell the company doctor where they work, what they do and what substances
they work with because this information will help in making accurate diagnosis.
f) Keep records of all jobs and industries that they worked with in order to find the
cause of the illness.
11. Periodic health education of all the workers to provide them with adequate
knowledge of all the hazards that can cause diseased associated with their occupation
and the preventive measures to adopt, as well as the importance of keeping safety rules
of the occupation.
12. All the workers should be trained and retrained periodically on how to use the
protective devices provided by the management in the language familiar to them;
regular supervision and monitoring to ensure compliance to the proper use of the
devices; information on safety provisions and their importance should be displayed on
the posters and notice boards and the sign posts mounted at strategic positions in the
company. At times hand bills should be provided for personal keeps for constant
consultation and reminder. Managers should show good example by using the devices
always.
6.8 Implication of Occupational Health Diseases

Occupational health diseases have implication(s) to both the employers and the
employees. To the Employees;
58
1. The disease condition can seriously affect them physically, mentally, socially and
psychologically and that of their family well-being.
2. Such disease conditions like hypertension and stroke can lead to permanent disability
to the employee thereby making him or her nonproductive. This will further affect the
employee generally as well as reduce his life span.
3. There could be increased morbidity and mortality among workers.
4. The ill-health can lead to low productivity with decreased income
5. It could lead to reduced work force.
6. Respiratory diseases can cause permanent damage to the respiratory systems
especially the lungs. These can gradually affect the worker and by gradually reducing
the working capacity thereby causing serious industrial set back.
7. The diseases can create physical and emotional problems that can affect the general
behavior of the worker.
Threat of Occupational Diseases

The treat differs according to the causative agent. Some of them are:
1. Silicosis causes fibrosis of the lungs leading to emphysema. This can result to
permanent disability and death among the workers.
2. There could be physical deformity resulting from diseases such asstroke,
hypertension or even diabetes. This can incapacitate the worker making him/her
nonproductive especially if treatment is not started on time.
3. Cardiac diseases such as angina pectoris, heart failure.
6.9 Reporting of Occupational Diseases

In Nigeria, according to Asogwa (2007 p.293) the following diseases occurring in
occupational settings are reportable by Law by the factory owners:
1. Lead poisoning, including poisoning by any preparation or compound of lead or their
squeal.
2. Phosphorus poisoning by phosphorus or its compounds or their sequelae
3. Mercury poisoning, by mercury, its amalgams and compounds and their sequelae.
4. Manganese poisoning by arsenic or its compounds and their sequelae
5. Carbon bisulphide (disulphide) poisoning
6. Benzene poisoning, including poisoning by any of its homologies, their nitro and
amido derivatives or their sequelae.
7. Chrome ulceration due to chronic acid or bichromate of potassium, sodium or
ammonium, or any preparation of these substances.
8. Anthrax
9. Silicosis
10. Pathological manifestations due to: a) radium or other radio-active substances b) X-

rays
11. Toxic jaundice due to tetrachlorethane or amido derivatives of benzene or other
poisonous substances
12. Toxic anemia
59
13. Primary epitheliomatous ulceration of the skin due to the handling or use of tar,
pitch, bitumen, mineral oil, paraffin or the compounds, products or residues of these
substances.
14. Poisoning by halogen derivatives of hydrocarbons of the aliphatic series.
15. Compressed air illness (cassion disease)
16. Asbestos.
1. Methods of detection of occupational diseases includes ____________,

____________and ____________
2. Mention three (3) implications of occupational health diseases.
6.10 SUMMARY
In this unit we have discussed the following:
• The meaning of occupational diseases for awareness creation
• Types of diseases a worker can contract in the process of job performance in any
occupation he/she engages himself.
• The pre-disposing factors to those diseases and also,
• The precautionary and preventive measures a worker can adopt in order to avoid
the occurrence of the disease as well as the type of treatment that can be applied
for better cure.

Achalu, E.I. (2000). Occupational Health and Safety. Lagos: Splendid Publishers
Anderson Asogwa, S.E. (2007). A guide to Occupational Health Enugu: Snaap Press
Ltd.
Henderson, V. and Nite, G. (1978). Principles and Practices of Nursing. (6th Ed) New
Reich, M.R. Okubo, T. (1992). Protecting Worker's Health in the Third World. National
and International Strategies. New York: An Imprint of Green Wood Publishing Group
Inc.
60
6.12 ANSWER TO SELF ASSESSMENT EXERCISES
Answer To Self-Assessment Exercise 1
1. Occupational health disease
2. Occupational disease of the Thrombosis
Answer To Self-Assessment Exercise 2

1. Biological method, Epidemiological method and Environmental method
2. a. The disease condition can seriously affect them physically, mentally, socially and
psychologically and that of their family well-being.
b. Such disease conditions like hypertension and stroke can lead to permanent disability
to the employee thereby making him or her nonproductive. This will further affect the
employee generally as well as reduce his life span.
c. There could be increased morbidity and mortality among workers.
61
UNIT 7 Occupational Accidents
UNIT 7 Occupational Health Diseases
Unit Structure
7.1 Introduction
7.3 Occupational Accidents
7.3.1 Types of Occupational Accidents
7.3.2 Predisposing Factors to Occupational Accidents
7.4 Principles of Occupational Accidents
7.5 Prevention and control of Occupational Accidents
7.6 Treatment of Occupational Accidents
7.7 Reportable Accident Cases in work Environment
7.8 Treatment Proper: Reassurance of Victims in Work Environment
7.9 Transportation of Accident Victims in Work Environment
7.10 Rehabilitation of Accident Victims
7.11 Summary
7.1 Introduction
The success of any occupation is measured by the progress made and the safety of its
workers. The need for the employees’ safety from the occupational hazards is highly
commendable. Every worker expects to live longer and so needs to be free from all
hazards including accidents that can limit or threaten their survival and that of their
families. The most common of such hazards is accident. They need to be safe and secure
in relation to himself, his family and his work so that their health will be prolonged and
work output increased thereby promoting the growth of the industry. Nevertheless,
accidents occur and constitute the most important threat to survival of workers.
Occupational injuries do create serious health problems for the working population.
They are costly, not only in terms of health and personal loss but also in loss of
productivity. They also increase the work load of caring professions like nursing. There
is need to discuss the meaning, types of accidents, causes, preventive measures and how
those affected can be effectively managed and then rehabilitated back to their
occupation.

At the completion of this Unit, learners should be able to:
• Define occupational accidents
• State the types of accidents in work environment
• Describe the predisposing factors to occupational accidents
• Explain the methods of prevention and control of occupational accidents
• Describe the management of accident cases in occupational settings
• Describe ways of protecting employees from occupational accidents.
62
7.3 Occupational Accidents
Accident is one of the major occupational health problems of the employees. It is an
unexpected and serious sudden event that can occur anywhere and then result in both
bodily and property damages. Accident, according to Mroz, 1978 occupational accident
is a sequence of sudden, unplanned events which have the potential for producing
personal injury or property damage. It is an unplanned event usually associated with
unpleasant outcome (Asogwa, 2007). It is an unexpected, unanticipated and sudden
event that results in bodily injury, property damage and death. It causes both human
and economic and material losses to both paid and non-paid occupations such as
industries, health institutions, agricultural, educational, banking and numerous other
occupations.
7.3.1 Types of Occupational Accidents

There are different types of occupational accidents and each has its peculiar types of
accidents. The types of accidents can generally be grouped into: Main types arising
from all types of occupations. Specific accidents occurring in specific occupations.
General types include: puncture wounds, bruises, scalds, sprains, contusions, fractures,
dislocations, crush injuries, amputations, enucleation, asphyxiation, unspecified
injuries among others. Injuries arising from industries include: Amputation, lacerations,
puncture wounds, electrocution, fractures, head injuries and sprains etc. Accidents
arising from health institutions include: needle prick injuries, sprains, cuts from sharp
instruments, slip disc, falls, fractures, anesthetics accidents, eye injuries, burns from
acids and other chemicals. Accidents arising from Agricultural occupation include: cuts
from hoe, knives, gunshot wound especially in land disputes, scorpion, human and
animal bites like snake bite, drowning, falls, contusions, accident in banks include: back
injuries, syncope, falls and others The Causes or Precipitating Factors of Accidents The
causes of accidents to workers are varied. Some of the causes are known while others
are unknown. The known causes can happen without signs. The main causes can be
attributed to the following: The type of occupation where the person is employed. It
could be manufacturing industries such as those cited by Reich and Okubo like
machinery and equipment, wood and furniture, Hide, Clothing and Textiles; Chemicals,
Tobacco, non-metal minerals, minerals and paper and printing industries. It could result
from agricultural or health institutions among others.
The causes continued Reich and Okubo could also be as a result of:
i. Unsafe human behaviors/human failure.
ii. Environmental factors.
iii. Defective machinery.
iv. Work characteristics.
Unsafe human behaviors according to Mroz, 1978 are the principal cause of up to 80%
of accidents. Causes include: Psychological and attitudinal factors like anger, hatred,
fear, anxiety and joy. The relations to these factors can push the worker to ignore safety
precautions and then act carelessly and recklessly thereby acting out what he/she could
not in normal self. Unsafe personality traits such as attitudes, exaggerated opinion of
63
self-importance; over confidence, abnormal needs for excitement. Undesirable attitudes
resulting in erratic and unpredictable behaviors. Complex personality traits such as
exaggerated opinion of self-importance; over confidence in self, abnormal need for
excitement. Employees with these traits tend to focus all their attention on themselves
and act irresponsibly against themselves and others. They over estimate their abilities,
exercise and therefore display in attention and disregard safety precautions, subject
themselves and even others to accident.
Unhealthy habit formation such as intake of self-prescribed medical drugs like
sedatives, tranquillizers, antihistamines etc. these may produce alteration in normal
physical abilities causing drowsiness, confusion, sleepiness, blurred vision, perceptual
problems that can lead to accident. Excessive alcohol intake interferes with the body’s
psychological processes, alter the person’s mood, attention, judgment etc. all these
unsafe behaviors can hinder judgment and other mental processes, body fatigue leading
to reduced efficiency of the individual. Unnecessary risk-taking behaviours and
competition commonly seen among adolescents, young drivers overtaking at bends,
over speeding rushing to overtake other vehicles etc. these can lead to fatal accidents.
In an attempt to protect self ,company property and family members from armed
robbers people have built miniature prisons in their homes and work places with the
result of being trapped in the event of accidents such as fire outbreaks; unnecessary
risks include: keeping loaded pistols under the pillow, keeping drugs at reach of
children, keeping bottle of fluids like kerosene, bleach, fuel and other dangerous fluids
and substances without label carelessly in the work sites and in the house at reach of
children, swimming when you don’t know how to do so, riding motor-cycle in a very
busy road and other unnecessary careless acts etc. Other personality factors include age,
lack of knowledge, experience, skills, ill-health and physical unsuitability of the worker
such as visual or hearing impairment, epilepsy, unfriendliness with co-workers or
employers, emotional problem like fear, inability to follow instructions and
concentration (Achalu,2000.p68).
7.3.2 Predisposing Factors to Occupational Accidents

Environmental Factors
These are conditions of the work environment that can precipitate accident to workers.
They include nature and man-made factors.
a. Nature factors include those factors that can obscure visibility such as: rain, dust,
smoke, wind, sunlight, foreign body in the eyes, others include floods, tornados,
earthquakes, land slide, extreme temperatures, and inadequate ventilation. Man-made
factors that cause accidents include: filthy environment, slippery floors, improper
storage of items, use of generators, candles, insecticides pesticides etc.
b. Locality of the work environment, physical hazards, working arrangement like time
of the day, day of the week, attitude of supervisors towards work and safety in the
environment where the industry is sited. Defective Agents – it could be due to poor
design, manufacturers fault, mechanical or structural failures, rusted connections, poor
handling of machines, shovels, knife.
Other predisposing factors to accident include; bad lifting technique causing spinal
injuries; assaults in work site, direct explosion on the unit, carbon monoxide from
combusting fuel, wood oil, vehicles, generators, faulty electrical appliances.
64
7.4 Principles of Occupational Accidents
The general principles of accident prevention applicable to all occupations irrespective
of size proposed by Asogwa (2007, p 187-188) include:
• The prevention of accidents is an essential part of good management.
• Both workers and management must cooperate to reduce accidents.
• The organization of safety in the plant is the responsibility of the management.
• Each plant should have a definitive and well known policy on safety.
• There must be available organization and resources to carry out the policy.
• The best known method which can be introduced must be applied at the work
place.
1. Who defined Occupational Accident as a sequence of sudden, unplanned
events usually associated with unpleasant outcome?
a. Arewa
b. Asojwa
c. Mroz
d. Achalu
2. Types of Occupational Accident can be grouped into __________,
______________ and ____________
a. General type, main type and specific type
b. Main type, peculiar type , special type
c. Specific type, soft type and hard type
d. Peculiar type, backward type and main type
7.5 Prevention and control of Occupational Accidents

• The understanding of the causes of accidents and how the employee is affected
within the environment is beneficial in prevention and control of accidents.
Literature abounds on the preventive measures. The following measures could
be applied as suggested by Achalu (2000):
• Provision of safe premises, safe procedures, safe machines for workers by the
employers.
• Provide workers with adequate training on the importance and proper use of
safety devices such as eye goggle, booths, ear plugs, hoes, cutlasses, hand
gloves, face mask as the case may be according to factory rules.
• Pre-employment and periodic examination of all employees should be ensured.
This is to evaluate the health and fitness status of the employees before
employment as a baseline data and also to determine what becomes of the
workers’ health with time due to the nature of work done.
• Provide workers with information regarding the inherent risks of any occupation
before he is allowed to work alone on the job.
• Protective clothing should be properly designed according to the anthropometric
measurement of the workers to avoid discomfort while performing tasks. This,
65
according to Asogwa (2007 p179) discourage unwillingness of the workers to
use the clothing properly or even do without it claiming that it is uncomfortable
and makes him clumsy. Workers should also be motivated to use the clothing
for safety measures. Effective training and encouragement of workers on proper
use of safety knowledge, skill and various work procedures.
• There should be well defined policy guidelines on safety precautions in each
plant.
• All aspects of the factory should be adequately ventilated to avoid excessive heat
or humidity – extremes of temperature.
• Avoid pouring water, oil or other chemicals that can make the work environment
slippery to cause accident.
• Prepare and display at strategic positions within the work environment bill
boards, posters, sign posters indicating danger zones, safety measures, unsafe
danger zones, safety measures, unsafe acts in work place, the need for
compliance and disciplinary measures.
• Inculcation of personal hygiene and provision of facilities for conveniences.
• All defective machines and equipment should be repaired or replaced to avoid
accidents. Modification in the use of dangerous machinery and hazardous
operations should be adhered to.
• The use of worn-out hand tools, e.g., hammers, Chisel should be discouraged.
Proper design and shielding of all machinery with efficient interlocks may
eliminate completely the risk of damage to the worker from splashing chemicals
or damage from flying objects thereby avoiding accidents.
• Studying the biomechanics of human gait to determine forces and torques acting
at the interface between the floor and the sole of the shoe can assist to improve
friction characteristics of floor surfaces and shoe soles to reduce accident risks
as a result of falls.
• All staff in health institutions should adopt the stringent measures in the use and
disposal of needles and sharp objects.
• Workers’ metabolic demands for a job done in hot and humid environments
should be evaluated to recommend a work-rest regime that will prevent heat
stress. Recreational facilities and canteen for feeding should be provided.
Prevention of musculoskeletal accidents should be avoided by:

• Evaluating lifting tasks to determine biomechanical stresses acting at the lower
back and designing lifting tasks to ensure that the stresses do not cause back
injuries;
• Evaluating work station layout to discover potential causes of postural stress and
recommending changes to eliminate or reduce non-natural work postures that
could cause cumulative trauma disorders.
• Eliminating awkward postures can also reduce fatigue (Federal Ministry of
Health, 2001). The Ministry also stated that: Work space minimum space should
be allowed between body and body components or worker and the point of
friction. The work table, control boards, stacking racks should be designed either
66
in sitting or standing position. This will enable easy reach and grip strength.
Also, all had-controlled operations should be at the elbow level.
7.6 Treatment of Occupational Accidents

• The survival of an employee after an accident depends on effective management.
The type of management to be provided should depend on the type of injury
sustained. Some injuries could be minor while some could be serious enough to
affect life. In all cases, in order to provide prompt and effective management,
the following should be provided in work settings:
• Establishment of an occupational health service at workplace to ensure a healthy
workforce. Effective first aid services. There should be groups of workers
selected from each work section to be trained as first-aiders for early treatment
accident cases. First aid boxes should be placed at strategic positions within the
work environment.
i. Prompt referral of serious cases to appropriate hospitals.
ii. Rehabilitation of injured and reabsorption into the occupation.
iii. Training of a rescue team in high risk places coal mining.
iv. Keeping accidents records to determine trends of accidents and for comparison.
v. This should be analysed periodically to discern trends and evaluate the efficacy
of the counter measures.
7.7 Reportable Accident Cases in work Environment

Reportable accident cases are those accidents required to be reported; are those that can
result in disability lasting up to five days of absenteeism from work. They include such
cases as: Amputation of a body part, head injury, fractures, and burns especially up to
second degree burns. Apart from recording the serious cases, minor injuries should also
be recorded immediately they occurred. The following should be indicated. Name of
the victim, sex age, and marital status, type of duty, cause of accident, location where
the accident happened and location of the factory where the victim works. These data
are essential for future reference and comparison.
The accident form should be in triplicate and should be filled out by the first-aid
provider specialist or by the foreman where a specialist is not available. A copy should
be kept with the occupational health service, another one with the foreman while the
third one remains in the register or file. Both the foreman and occupational health
service should transfer the information in the accident report form into their accident
report register. The victim’s case should be reported by the doctor treating him or her
indicating
Minor injuries: First aid treatment lost working time of less than one shift.
Major injuries: Hospital admission for at least one working shift.
Fatalities: Where one or more persons were killed.
Before the worker resumes duty, he should report to the health service where he will be
certified fit and given written confirmation for the foreman for records and
determination of any benefits.
67
7.8 Treatment Proper: Reassurance of Victims in Work Environment
The first line of management is to encourage the victim and reassurance that there is
still hope. Attend to the following:
i. If there is lack of breathing movements or events affecting breathing, first ensure that
the victim is still alive.
ii. Arrest bleeding if any with any available material.
iii. Accompany victim to the factory clinic where available, otherwise refer to hospital.
iv. Provide management as prescribed or as deemed necessary.
v. Rehabilitate the victim
vi. Include relations of the victim in the management.
vii. Keep record of the treatments given as well as the type of accident.
viii. Reporting of Accident cases.
7.9 Transportation of Accident Victims in Work Environment

Transportation of the victim should always be limited to situations in which an
immediate danger to life of the victims exists or to situations in which professional
ambulance or rescue personnel are not available. Under these circumstances, the first-
aid provider should observe the following: Unless the victim’s life would be in further
danger, never move him until his breathing has become adequate, his bleeding has been
controlled, and his wounds, which could be fracture or dislocations have been splinted.
If for his immediate safety, the victim must be moved, before such measures can be
taken, always protect and support the injured parts during the movement.
Where possible, bring the transportation device (vehicle or stretcher) to the victim
rather than carrying him to it. When lifting and carrying the victim, gently support the
head, neck, back and extremities, keeping the body aligned all the times. When
transporting a victim, never force him or her to travel in a sitting position instead,
always place the victim in a reclining or semi reclining position, the necessary space
best afforded by a station wagon. Since the few minutes saved by a high-speed ride is
almost always unimportant for the victim’s recovery, drive within the posted speed
limits and reduce the speed especially at bends.
7.10 Rehabilitation of Accident Victims

The aim of rehabilitation is to restore the victim to his fullest physical, mental and social
capacity. Recognition of the victim’s physical, social and economic roles is very
essential. Rehabilitation should aim at solving the problems and it should start from the
moment of injury sustenance thus:
At the scene of the accident, the victim should be reassured and encourage. This gives
him courage and hope. At the initial time of hospitalization, the following should be
done:
Prevention of complications arising from long period of bed rest, urinary tract
infections, venous thrombosis, muscle wasting, joint stiffness, contracture etc by good
nursing and physiotherapy.
68
During hospitalization, there should be continued provision of all planned care such as
medication, personal hygiene, feeding, psychological and emotional care etc. these
should be continue until discharge from the hospital. Involve the relations in the care
of the victim. Remedial exercises should be encouraged. Provision of aids and other
appliances to make up for lost functions particularly with mobility in the form of
artificial limbs is necessary.
Resettlement at work: this is started when the victim has gained physical recovery and
has been certified fit to be engaged as before the injury. He can be re-instated in his
former position where his condition permits or be retrained and assigned another
responsibility his condition allows.

1. In reassurance of victim in work environment, the first line of management is
to encourage the victim that there is hope? True or False
2. The aim of rehabilitation is to restore the victim to his fullest _______,
_____________ and ________________ capacity.
7.11 Summary
In this unit, we learnt that occupational accident is an unexpected, unwanted, unplanned
sudden event. It is an occurrence arising from unsafe acts or unsafe conditions, unsafe
practices etc. Common injuries include: fractures, sprains, amputations, head injuries
etc. Implications to workers include pains, injuries, disabilities, emotional and
psychological implication and even death. Implications to employers include human,
financial and material loss.

Achalu, E.I (220) Occupational Health and Safety, Lagos: Simarch Nigeria Ltd
Akinsola, H.A (1993). A to Z of Community Health and Social Medicine in Nursing
Practice with Special Reference to Nigeria. Ibadan: 3Am Communication.
Nwankwo, O.B (2003). Occupational Health and Industrial Safety Concepts and
Principles. Owerri: Concave Publishers.
Olushanya, MR (2001). Health Supervision at Work Place. A Paper delivered at a Train
the Trainer Program – Occupational Nursing.
Onu, M.S (2003). Fundamentals of Public Health for the Tropics. Personal and
Community Health; Perspectives. Owerri: Oni Publishing House.
HYPERLINK http://www.ncsu.edu/ehs/accidents/occacc.htm
www.ncsu.edu/ehs/accidents/occacc.htm
HYPERLINK http://www.ncfh.org/pateduc/en-work.htm
www.ncfh.org/pateduc/en-work.htm.
69
Answers to Self-Assessment Questions 1
1. C- Mroz
2. A- General type, main type and specific type
Answers to Self-Assessment Questions 2
1. True
2. Physical, mental and social capacity.
70
UNIT 8 Occupational Health Poison
Unit Structure
8.1 Introduction
8.3 Occupational Health Poison
8.3.1 Sources of Occupational Poisons
8.3.2 People at Risk
8.3.3 Clinical Manifestations of Some Occupational
8.3.3.1 Clinical Features of Asbestosis
8.3.3.2 Clinical Manifestation of Arsine Poison
8.4 Mercury and Mercury Compounds
8.5 Diagnostic Procedures of Detecting Occupation Poisons
8.6 Strategies for Prevention
8.7 How Poisoning Incident can be reported
8.8 Implications on the Employees
8.9 Precautionary Measures to be taken
8.10 Summary
8.12 Tutor-Marked Assignment
8.1 INTRODUCTION
The increasing hazards faced daily by many workers at their jobs call for concern. The
employees may not suffer the consequences of the hidden hazards (chemical,
radiations) directly or indirectly until years later. These chemicals or radiations are
poisonous to the body. Occupational poisons are serious injury that is job-related. It
usually happens on worksite such as a factory or construction site. This can occur as a
result of leakage, failure of chemical plant or as a major accident
(Usman 2001). Achalu (2000 pg.43) defined occupational poisons as those substances,
elements, compounds or mixtures used in industries that interferes with the metabolic
processes of the body and produces acute or chronic ill health. These poisons can enter
the body by inhalation, ingestion or absorbed through the skin contact. They include
heavy metals, chemicals and solvents fumes, gases, and vapor. This write up focuses
on occupational poisons.
8.2 LEARNING OUTCOMES

• After reading through this unit you should be able to:
• Define occupational poisons
• Describe occupational poisons and their sources
• Enumerate people at risk
• Describe clinical manifestation of some occupational poisons
• Discuss diagnostic procedures of detecting occupational poisons
• State strategies for prevention
• Describe how the poison incident can be reported
• Discuss the implications on the employees
• Discuss precautionary measures to be taken.
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8.3 OCCUPATIONAL HEALTH POISON
Definition
Poison is any substance that can impair function of otherwise injure the body;
something that destroys body organs or body systems, given something with intent to
kill
8.3.1 Sources of Industrial Poisons

Sources include:
1. Heavy metals like all lead compounds. Example lead oxides, lead carbonate, lead
sulphide. Among these lead compounds the most dangerous is lead carbonate while
lead sulphide is the least toxic (Park 2005). Metallic mercury, one can get this from
industries that manufacture batteries, lead smelting, lead ores, pipes, paints, solder,
rubbers, and shoe makers. Health workers are likely to come contact with such.
2. Chemicals: Strong acids, concentrated alkalis in the work environment
3. Chemical in form of dust, gases, fumes.
Dusts causing poison include:
a) Inorganic dusts - asbestos, coal mining dust, silica dust, arsenic dust. One can get
these from mine, textile, construction, acetaldehyde, butyl alcohol, paint, rope and
string in thermal insulation, floor tile, cement, removal of sludge from tank that held
sulphuric acid.
b) Organic dusts-examples include: vegetable dust, cotton dust, sugar cane dust. It is
found in striping, grinding of card machines.
Gases: arsine, aniline, carbon tetrachloride, carbon monoxide, hydrogen cyanide,
hydrogen sulphide. One can get these from insecticides, leather, smelter, dyes,
perfumes, pharmaceutical products, dry cleaning agents. Fumes – arsine
4. Organic compounds are: phosphorus, ammonia. One can get these from fertilizers,
pesticides used in agriculture, organic phosphorus insecticides.
5. Other compounds include benzene, carbon tetrachloride, manganese toluene, and
xylene.
8.3.2 People at Risk of Occupational Poisons

According to Marie (1991) the following people are at risk of occupational poisons.
1. Health workers - Nurses, laboratory scientist radiographers, doctors, anesthetists etc.
2. Employees in mining industries, coal miners, quarry.
3. Employees at cosmetic industries due to dye, spray, perfumes.
4. Employees in laundries and dry cleaning establishments.
5. Carpenters, welders, bankers.
6. Farmers, veterinary workers.
7. Workers in textile, construction companies.
8. Employees in cement, asbestos industries.
9. Employees in oil refineries.
10. Aerospace workers.
72
11. Employees in ceramics, glass producing industries/
12. Shoemakers
8.3.3 Clinical Manifestations of some Clinical Health Poison

This depends on the types of poison and the parts of the body affected clinical
manifestations of some of the occupational poisons are mentioned.
8.3.3.1 Clinical Features of Lead Poisoning:

Abdominal colic, loss of appetite obstinate constipation, blue line on the gum, anemia,
wrist drop. Organic lead poisoning affects most central nervous system causing
insomnia, headache, mental confusion, delirium. Encephalopathy following exposure
to organic lead compounds is characterized by mental dullness, loss of ability to
concentrate, loss of memory, tremor, deafness, convulsion, aphasia, coma etc where
there is severe poisoning.
8.3.3.2 Clinical Features of Asbestosis

1. Progressive breathlessness
2. Initially unproductive cough which becomes mucoid or mucopurulent at late stage
3. Listlessness
4. Loss of weight suggestive of malignant changes
5. Cyanosis in advance cases
6. Dull on percussion in advanced stage
7. Dullness is suggestive of pleural effusion (Asogwa 2007 pg.121)
3.3.2 Clinical Manifestation of Arsine Poison

If the haemopoietic system is involved it presents the following signs and symptoms.
Their effects when mild are sudden and are characterized by malaise, nausea, and
vomiting, shivering, giddiness and epigastric pain. Haemoglobinuria, anaemia due to
powerful haemolytic nature of arsine. Pot wine urine and jaundice are present. In severe
case blockage of renal tubules with anuria and hepatic damage are observed. Clinical
features when mucocutaneous tissues are affected. In sub-acute poisoning there is
catarrhal inflammation of mucous membranes, conjunctivitis, laryngitis, tracheitis,
eczema, tons skin lesions at skin folds and other moist areas. Arsine dust produces
perforation of nasal septum, chronic poisoning produces dermatitis, ulcer, trophic
changes in the nails and loss of hair and bronzing. In mild cases the bronzing is best
seen in the eyelids, temples, neck and nipples in fair-coloured individuals. In people
with dark skin it may be difficult to see even in severe cases.
Assessment Exercises 1
1. ___________________ is any substance that can impair function of otherwise
injure
8.4 the body;
Mercury andsomething
Mercurythat destroys body organs or body systems, given
Compounds
something with intent to kill
Poisoning due to metallic or organic mercury compounds include headache, intention
2. Mention
tremor thattwo (2) sources
affects of industrial
the following poison fingers, eyelids, lips, and tongue.
structures:
3. People atmay
Movement Riskbeofmore
Occupational
exaggeratedPoisons
as the includes
conditionthe followingComplete
progresses. EXCEPTpersonality
a. Bankers 73
b. Aerospace works
c. Farmers
d. Health workers
changes may occur with intellectual impairment, memory loss, insomnia, anxiety.
Poisoning from organic compounds affect nervous system more than inorganic
mercury.
Clinical Features of Organo and Phosphorus Compounds Include the following by
(Asogwa 2007 pg.147): Initial symptom may be mild or non-specific. There may be
headache, nausea, unusual fatigue. Taking food or smoking makes symptom worse.
Diarrhea, vomiting, pinpoint pupils, convulsion are signs of pulmonary congestion. It
occurs in a matter of 2 - 8 hours. Death may result shortly after appearance of
symptoms.
8.5 Diagnostic Procedures for Detecting Occupational Poisons

Some occupational poisons are known and documented while some are not known. It
therefore becomes important to detect the unfamiliar and unknown in order to control
them. This can be achieved by the following:
1. Biological Monitoring
This takes the form of pre-employment health assessment, pre-placement assessment,
and periodic health assessment. Basic health data are collected through history and
laboratory tests. Chest X-rays are also utilized. The hallmark of biological monitoring
is for early detection of poisoning and to plan appropriate preventive and curative
measures to curb the spread and damage.
2. Epidemiological Methods
This aims at studying the distribution, determinants and deterrents of disease and
ailment among segments of work force. It detects both occupational poisons and non-
occupational ones among workers through association between condition and certain
diseases.
3. Environmental Measurements
It is used to detect agents of known hazards in the work site before the risks occur. It is
particularly very relevant in disabling and irreversible diseases. For example dust
measurements in coal mine would help reduce the incidence of pneumoconiosis
(Asogwa 2007 pg 71-72).
8.6 Strategies for Prevention

• Conduct pre-employment and pre placement health assessment. This is to
determine exclude individual's fitness for particular work or the susceptility to
the effect of work process or the environment in which the work is to be done.
• Monitor health status of employees from time to time. The frequency of
examination depend on the work process individual undertakes.
• Conduct inspection of industries to ensure compliance and research to establish
the hazardous level of various chemicals.
74
• Integration of safety training into the actual work situation.
• The occupational health officers, health inspectors and medical advisers and
trade unions should inform, educate employees on hazards associated with each
work process and safety measures recommended.
• Monitor the use of protective devices among the employees.
8.7 How Poisoning Incident can be reported

According to Asogwa (2007), when any disablement occurs in an industry. The first aid
specialist or foremen fills the poison form. The forms are filled in triplicates. The
accidents registered are as well filled. After the victim has been attended by doctor, the
diagnosis, disposal and duration of incapacity are equally entered in triplicate forms as
well asoeisonais registered. A written notice in a prescribed form with the prescribed
particulars is sent through the factory occupier. Where the occupier is not the employer
of the victim the employer will send the particular to the district inspector. The report
is made if there is a loss of life or disablement for more than three days. It can equally
be reported when there is suspected or proven disease.
8.8 Implications of Occupational Poisoning on the Employees

The implications of occupational poisoning on the employees are enormous and are
discussed under the following headings; deformity, psychological depression/trauma,
economic loss, health social implications.
Disabilities
An employee affiliated with occupational poisoning may come down with minor or
permanent disablement. Example, contact with corrosive acids. They may leave
contracture, and physiological dysfunction of organs and systems, the employee may
be left with permanent disability even after recovery. The disability sustained may be
so severe that life of such employee is at jeopardy, the employee may be falling sick
often and on, which may throw him/her out of job completely, loss of job will
compound his health problems, hasten death.
Psychological Trauma/Depression
Distortion in the body image or appearance carries a lot of emotional depression, as the
employee thinks on how to cope with alternated body image. Where the employee is
single He/she thinks of these, can I still get wife/suitor of my choice, can I bear children,
how to carry on family responsibilities among other things;. All these constitute
psychological trauma.
Social Isolation
Disability depending on the nature and site may hinder the employee from attending
social functions or withdrawal from other people, this result in loss of acquaintances
thus social isolation with its resultant affects the worker.
Economic Implications
Financial losses occur following occupational poisoning. Even though the employer
pays compensation but the employee may have some other things he does outside
factory work. In that case he can no longer attend to that resulting in economic loss.
Recovery from such hazard may result in shift from former trade of the employee to a
75
less skilled one with low remuneration. Again the employee may be to take care of
him/her and this amounts to heavy financial involvement to the family. Thus economic
loss is seriously felt by the employee.
8.9 Precautionary Measures to be taken

Asogwa (2007) and Akintola (2005) highlighted on the precautionary measures to be
adopted thus:
Health Assessment
This includes pre-employment, pre-placement health assessment as well as periodic
medical examinations to exclude any underlying health problems that may predispose
an employee to hazards in the work process or environment. Again for early detection
of pathological changes and institute measures to avert such.
Work environment must be inspected from time to time. This aims at ensuring safe
work environment and promotes and protects health of employees.
• Employers must ensure that his plant is well designed and meet the safety
requirement specifications and his work process.
• Inherent risks of any process must be explained to the workers before he is left
alone on a job.
• Double standards of safety should not be condoned.
• Design of protective clothing should be in line with the anthropometric
measurements of the workers.
• Well planned and executed education of workers should be carried out in a
language the workers understand.
• Vague concepts of safety and accidents prevention should be avoided.
• Hazards and consequences of negligence should be made as concrete as possible
through life case studies and factual material drawn from work situations in
which the people are employed.
• Safety training should be integrated into the actual situation so that the worker
is constantly reminded of the need to practice safety measures.
• Guard for dangerous parts of machinery.
• Regular inspection and repair of machines should be documented in a book when
such has been done and found in order.
1. Diagnostic procedures for detecting occupational poisons includes
Biological monitoring, Epidemiological method, and Environmental method.
True/ False
2. List and explain three (3) implications of occupational poisoning on
employee.

Asogwa S.E (2007). A Guide to Occupational Health Practices in Developing
Countries. Enugu: Snaap Press Limited.
76
Allender A. and Bradley B.W (1996). Community Health Nursling’s Concept and
Practice, Philadelphia: Lippincolt Williams and Wilkins.
Kramer S.S (2005). Microsoft Encarta Encyclopedia. Http: Lucas A.O and Gilles H.M
(1984). A Short Textbook of Prevention Medicine for the Tropics. 2nd ed. London:
Hodder and Stoughton.
Ladou J. (2006). Current Occupational and Environmental Medicine. 4th ed. London:
McGraw Hill professional.
POSSIBLE ANSWERS TO SELF- ASSESSMENT EXERCISES

Possible Answers to Self- Assessment Exercises 1
1. Chemical and Dust (Organic and Inorganic dust)
2. A- Bankers
Possible Answers to Self- Assessment Exercises 2
1. True
Disabilities
An employee affiliated with occupational poisoning may come down with minor or
permanent disablement. Example, contact with corrosive acids. They may leave
contracture, and physiological dysfunction of organs and systems, the employee may
be left with permanent disability even after recovery. The disability sustained may be
so severe that life of such employee is at jeopardy, the employee may be falling sick
often and on, which may throw him/her out of job completely, loss of job will
compound his health problems, hasten death.
Psychological Trauma/Depression
Distortion in the body image or appearance carries a lot of emotional depression, as the
employee thinks on how to cope with alternated body image. Where the employee is
single He/she thinks of these, can I still get wife/suitor of my choice, can I bear children,
how to carry on family responsibilities among other things;. All these constitute
psychological trauma.
Social Isolation
Disability depending on the nature and site may hinder the employee from attending
social functions or withdrawal from other people, this result in loss of acquaintances
thus social isolation with its resultant affects the worker.
Economic Implications
Financial losses occur following occupational poisoning. Even though the employer
pays compensation but the employee may have some other things he does outside
factory work. In that case he can no longer attend to that resulting in economic loss.
Recovery from such hazard may result in shift from former trade of the employee to a
less skilled one with low remuneration. Again the employee may be to take care of
him/her and this amounts to heavy financial involvement to the family. Thus economic
loss is seriously felt by the employee.
77
UNIT 9 ENVIRONMENTAL HEALTH HAZARDS
Module Structure
MODULE 2 ENVIRONMENTAL HEALTH HAZARDS
UNIT 9 ENVIRONMENTAL HEALTH HAZARDS

Unit Structure
9.1 Introduction
9.3 Environmental Health Hazards
9.3.1 Environmental Health Hazard: Definition
9.3.2 Misconception about the Meaning of Hazard
9.4 Environmental Media
9.5 Classification of Environmental Health Hazard
9.6 Conclusion
9.7 Summary
9.1 INTRODUCTION
Examples of human activities presented in module 1 indicate that, man’s ability to
tinker with or dominate his or her environment has obvious consequences. One of such
is the creation of environmental agents capable of impacting on human and the
environment. In this unit, we will look at environmental hazards, it definitions, types
and classifications.

At the end of this unit, you should be able to:
Define environmental hazard
Ascertain the misconceptions about the meaning of hazards
Describe environmental media
Illustrate different classifications of environmental health hazard
9.3 ENVIRONMENTAL HEALTH HAZARDS

9.3.1 Environmental Hazards: Definition
Environmental hazard' is a generic term for any situation or state of events which poses
a threat to the surrounding environment. This term incorporates topics like pollution
and natural hazards such as storms and earthquakes. An environmental hazard is also
any substance, agent, equipment, object, human behaviour or factor that is capable of
injury, disability, disease or death in humans or has the potential for polluting or
degrading the environment (Olaniran et al, 1995).
9.3.2 Misconception about the meaning of Hazard
Some misconceptions about the meaning of ‘hazard’ should be cleared. The word
‘hazard’ is not synonymous with injury or disease. A hazard is only capable of causing
78
injury if and only if certain environmental conditions exist. Few examples are given to
illustrate this point.
1. A parked vehicle is a hazard but will not cause harm until it is recklessly driven by a
drunk driver or there is a break failure.
2. Injury from a sharp, pointed object (a knife) can only occur of there is an accident
through misuse or carelessness.
3. A big polythene bag appears harmless but very hazardous to children if they are left
unchecked. It can lead to suffocation and death.
4. Human faeces (excreta) a very hazardous waste, cannot cause illhealth unless a
person ingest water and food contaminated with faeces. It must therefore be emphasized
that hazard is not an injury or a disease although the terms are usually erroneously used
interchangeably
(Olaniran, et al, 1995).
9.4 Environmental Media
Exposure by individuals to environmental health hazards is normally through a
medium. Exposure can be by inhalation through the nose, ingestion by mouth or
absorption through the skin. Thus, the pathway in the environment through which
hazards must pass before impacting on human health are collectively known as
environmental media (Olaniran, et al, 1995).The environmental media are:
• The air we breath
• The food we eat
• The water we drink
• The soil which we cultivate
• Inanimate objects in our environment
• Occupation and Socio-cultural events
9.5 Classifications of Environmental Health Hazards
Environmental health hazards can be classified into 4 broad groups depending on nature
and type. The groups are:
• Physical
• Biological
• Chemical
• Socio-cultural/Psychosocial
Most of the physical hazards are easily observable, detectable and measurable and are
found in our immediate surroundings, but mainly in the occupational and home
environment. Some of the biological hazards cannot be seen by the naked eyes, but
most are present in all components of environment. Biological hazards are detectable
and measurable using microbiological or biological techniques. Chemical hazards are
the most numerous and complex. Most are found in the workplace and are measurable
using sophisticated laboratory techniques. Socio-cultural hazards are the most difficult
to detect and measure because they are usually ill-defined attributes of man. Examples
of hazards in each of the 4 groups are thus presented below:
Self- Assessment Exercise
79
1. What is environmental hazard?
2. Mention four (4) misconceptions about the meaning of hazard
3. What are the four (4) main classification of environmental health hazards
9.6 SUMMARY
Hope you enjoyed reading through this unit. This unit took a broad look at the meaning
and misconceptions of environmental hazard, as well as environmental media and
classifications of environmental health hazards. Now let us attempt the questions below.

Olaniran, N. S., Akpan, E. A., Ikpeme, E. E. and Udofia, G. A. (1995). Environment
and Health (Module 11). Nigerian Conservation Foundation, Lagos: Macmillan
Nigeria
Weinhold, B. (2007). Air Pollution and Inflammation. Environmental Health
Perspectives, Vol 115, Number 7, July, 2007.
Wijen, F. and Pieters, J. (2005). A Handbook of Globalization and Environmental
Policy Northampton, MA: Edward Elgar.
Aral, M. M., Brebbia, C. A., Maslia, M. L. and Sinks, T. (2005). Environmental
Exposure and Health. Billerica, MA: WIT Press, 2005.
9.9 POSSIBLE ANSWERS TO SELF- ASSESSMENT EXERCISES

1. Environmental hazard' is a generic term for any situation or state of events which
poses a threat to the surrounding environment
2. a. A parked vehicle is a hazard but will not cause harm until it is recklessly driven
by a drunk driver or there is a break failure.
b. Injury from a sharp, pointed object (a knife) can only occur of there is an accident
through misuse or carelessness.
c. A big polythene bag appears harmless but very hazardous to children if they are left
unchecked. It can lead to suffocation and death.
d Human feces (excreta) a very hazardous waste, cannot cause illhealth unless a person
ingest water and food contaminated with faeces. It must therefore be emphasized that
hazard is not an injury or a disease although the terms are usually erroneously used
interchangeably
3. Physical, Biological, Chemical, and Socio-cultural/Psychosocial
80
UNIT 10 POLLUTION PREVENTION IN INDUSTRIES
CONTENTS
10.1 Introduction
10.2 Objectives
10.3 POLLUTION PREVENTION IN INDUSTRIES: Overview of Pollution
Prevention Concepts
10.3.1Sources of Pollution Reduction
10.3.2 Good Operating Practices in Industries
10.3.3 Technology Changes
10.4 Impute Material Substitution
10.5 Product Changes
10.6 Recycling
10.7 Summary
10.8References/Further Readings
10.9 Answers to Self- Assessment Exercises
10.1 INTRODUCTION
This is s general introduction to an overview of pollution prevention concepts. Here we
will look at source reduction, good operating practices, technology change, product
change and most importantly, recycling. Observations indicates that most countries
now argue for recycling practices because it is very cost effect and environmentally
friendly. Happy reading!

At the end of this unit, you should be able to:
• Determine an overview of pollution prevention concepts
• Determine source reduction in industries
• Identify good operating practices in industries
• Illustrate technology changes and pollution prevention.
10.3 Overview of Pollution Prevention Concepts

Pollution prevention encompasses both source reduction and in-process recycling.
Source reduction is thus defined as any practice that reduces the amount of any
hazardous substance, pollutant, or contaminant entering any waste stream prior to
recycling, treatment, or disposal, and that reduces the hazards to public health and the
environment associated with the release of such substances, pollutants, or
contaminants. Thus governments, businesses and industries, and individuals should
prevent or reduce pollution at its source wherever feasible. Where source reduction
cannot be achieved, it is advocated that responsible parties reuse and recycle to reduce
the quantity of hazardous waste requiring treatment. If there are no feasible pollution
prevention alternatives, environmentally sound treatment should be applied with
disposal used only as a last resort. Techniques that merely transfer contaminants from
one medium to another without a net reduction in the quantity and toxicity of hazardous
constituents do not meet the definition of pollution prevention. This unit describes and
81
gives examples of the various pollution prevention measures encompassed in source
reduction and recycling.
10.3.1 Source Reduction in Industries

Source reduction lessens or eliminates the quantity of hazardous and toxic wastes
generated and the expense and environmental impacts associated with managing these
wastes. In addition, source reduction usually results in significant cost savings realized
from raw material conservation. Source reduction encompasses good operating
practices, technology changes, input material substitutions, and product changes
(Sherry, 1988a).
10.3.2 Good Operating Practices in Industries

In general, industries can realize a high return from a minimal investment by
implementing good operating practices. Good operating practices are procedural,
administrative, and institutional measures, which include improving inventory control,
preventing accidental spills, segregating waste streams, and scheduling production runs
that maximize production and minimize waste. Getting management to commit to
pollution prevention is a first step toward instituting an effective source reduction
program. This commitment might be demonstrated by a written policy statement
circulated to company employees and posted in visible locations and by encouraging
employees to adopt the principles of pollution prevention. Demonstrating
management’s dedication to pollution prevention and its importance to company
operations can galvanize the work force and help employees view pollution prevention
as a priority in their everyday work activities. Other management and personnel
practices, such as employee training, incentives, and bonuses, also can encourage
employees to reduce waste.
Maintaining an orderly inventory system and proper storage conditions can greatly
reduce material waste from deterioration, inefficient use, and spills. For example, an
inventory system that employs a “first-in/first-out” management method and keeps a 1-
or 2-month supply of materials is less likely to result in material disposal because of
product expiration. Implementing a material tracking system that tracks material use by
individual employees or work groups allows managers to identify individuals or
production teams with above-average materials use. Using tight-fitting lids and spill-
proof containers with spigots, minimizing traffic, and employing proper environmental
controls in storage areas also will extend material supplies and prevent spills. Frequent
inventory inspections will result in early detection of leaks and spills. Other good
housekeeping practices include containing and reusing materials dripped from parts as
they are transferred during a process and providing funnels or other equipment that
avoids spills when transferring materials. Regularly scheduled preventative
maintenance reduces the occurrence of malfunctions and leaks, which will reduce the
volume of wastes discharged to the sewers. Modifying production schedules to
minimize required equipment changeovers will reduce the quantity of wastes generated
82
by equipment cleaning. Segregating hazardous and non-hazardous waste streams
avoids making the entire waste stream hazardous and reduces the volume of waste
requiring treatment or costly disposal. Also, maintaining separate waste streams can
enhance the industry’s ability to reuse or reclaim waste materials. For example, by not
mixing two different spent solvents, the purity of the waste materials is maintained,
making recycling easier.
Another action, often overlooked, is examining the cleaning products (e.g., cleaners,
degreasers, and floor finishes) used by a company to determine whether they are
contributing to the toxic loadings in wastewater when discharged through sink and floor
drains. Cleaning products with toxic constituents can be replaced with substitutes that
do not contain harmful elements. A good housekeeping program should include a
review of the cleaning products used in house. Many companies use good operating
practices as a first step toward reducing toxic materials use (Greiner and Rishard, 1992;
Sherry, 1989b).
10.3.3 Technology Changes

Technology changes can range from minor modifications to existing processes, to
major investments in new manufacturing equipment.
Technology changes involve changes in any of the following areas:

1. Production processes.
2. Equipment, layout, or piping.
3. Use of automation.
4. Process operating conditions, such as flow rates, temperatures, pressures, and
residence times.
Production processes can be modified to eliminate the need to change over equipment
if a unit can be dedicated to one process. Mechanical methods can be used in lieu of
solvent use for cleaning and stripping parts. Various process changes can be
implemented to reduce drag-out of process solutions, including adjusting the speed of
withdrawal of the part from the process solution, allowing more time for the part to
drip, and positioning the part to maximize runoff of the solution. Many companies have
experimented with technology changes to prevent pollution.
10.4 Input Material Substitutions

This technique involves replacing the input material that contains a problem pollutant
with a different material that performs the same function without generating a toxic or
hazardous waste. Input material substitutions reduce or eliminate the problem
pollutants that enter the production process. Input modifications that avoid the
generation of problem wastes during production also fall under this source reduction
category. Process changes might sometimes be required to accommodate input material
changes. Examples of input material substitution include: United Piece Dye Works of
Edenton, North Carolina, met stringent effluent discharge limits on phosphorous by
making chemical substitutions in the production process rather than building expensive
treatment systems. The company conducted a detailed evaluation of production
processes, process chemistry and the chemicals used to identify sources of phosphorus.
83
It then made process modifications to reduce use of phosphate chemicals by substituting
chemicals not containing phosphate. For example, the use of hexametaphosphate was
reduced and the use of phosphoric acid was eliminated. These chemical substitutions
reduced the level of phosphorus in the company’s wastewater from 7.7 mg/l to less than
1 mg/l. This reduction was achieved without any capital expenditures for phosphorus
removal (Griener et al, 1992).
10.5 Product Changes

A final source reduction technique consists of product modifications. By altering the
product in such a way that the problem pollutant is no longer required in the production
process, businesses can eliminate generating the problem waste. Product modifications
also can reduce environmental releases of problem pollutants related to the use of a
particular product. Product change generally falls into one of three categories: product
substitution (e.g., an entirely new product); changes in product composition (e.g., minor
modification to an existing product); and product conservation (e.g., increasing the
working life of an existing product). Examples of product changes include:
The paint manufacturing industry has taken steps to reformulate its products to reduce
hazardous constituents. Paint manufacturers have continued to improve water-based
paints and find applications for them that were previously dominated by solvent-based
paints. Water-based paints do not contain toxic or flammable solvents that contribute
to the potential hazards of solvent-based paints. The use of water-based paints
eliminates discharge to sewers of volatile organics in rinse water from production-line
cleaning operations. In addition, volatile organics are not released to the atmosphere by
water-based paints (Griener et al, 1992).
10.6Recycling
Recycling options involve the reuse and reclamation of spent input materials, such as
solvents, detergents, inks, and other chemicals. Reuse substitutes spent input materials
for new input materials in the manufacturing process. Reclamation, on the other hand,
recovers valuable material from spent input materials for incorporation in some other
process or product. Recycling can be integrated within the process through a closed
loop system or can be conducted separately, using centralized onsite waste recycling
systems or commercial materials recyclers. Waste reprocessed or reclaimed can be used
on site or sold or given to other businesses for use in their operations. Some states
maintain networks to facilitate waste exchanges. The following examples illustrate
recycling initiatives:
Mao/a Milk and Ice Cream Company in New Bern, North Carolina, recover ice cream
and milk products for reuse in ice cream products and animal feed. Initial re-use
activities in 1986 prevented the loss of over 17,000 pounds of milk and decreased 5-
day biochemical oxygen demand (BODJ by 17,000 pounds over a 4-month period.
Soon after Mao/a began recovering milk and ice cream wastes, the City of New Bern’s
treatment plant showed a 14.7 percent reduction in B0D5 and a 22.8 percent decrease
in suspended solids. The recovery and reuse program also has translated into reduced
chemical usage, less sludge accumulation, and reduced power requirements for the New
Bern treatment plant. In 1988, Mao/an estimated it saved $24,000 per month in
84
wastewater treatment costs and recovered product. Upon full implementation of the
reuse and recovery program, Maola hopes to recover as much as 2,410 gallons per day
of ice cream ingredient valued at $480,000 annually (Greiner, et al., 1992).
SELF ASSESSMENT EXERCISE 1

1. Pollution prevention encompasses both ______________ and
_________________
2. Technology changes involves changes in the following areas
a. Production process
b. Dumping process
c. Casting method
d. Recovery process
3. A final reduction techniques consist of ____________
4. Recycling options involve the _____________ and _________of spent input
materials
10.7 SUMMARY
In this unit, we looked at several pollution-prevention techniques, especially those
obtainable in industries. Hope you enjoyed your studies.

Greiner, T.J., and P.H. Richard. (1992). Facility Inspections: Obstacles and
Opportunities. Unpublished.
Santa Clara Valley Nonpoint Source Pollution Control Program. (1991). Best
Management Practices for Automotive-Related Industries. San Jose, CA.
Sherry, S. (1988a). Minimizing Hazardous Wastes: Regulatory Options for Local

Governments. Sacramento, CA: Local Government Commission.
Sherry, S. (1988b). Reducing Industrial Toxic Wastes and Discharges: the Role of
POTWS. Sacramento, CA: Local Government C.
10.9 ANSWER TO SELF ASSESSMENT EXERCISE

1. Sources reduction and in- process recycling
2. A- Production process
3. Product modification
4. Reuse and reclamation
85
MODULE 3 OCCUPATIONAL SAFETY REQUIREMENTS AND PRACTICE
Module Structure
Unit 11 Occupational Health and Safety
Unit 12 Industrial Legislation
Unit 13 Independent Practice
Unit 14 Evaluation of Occupational Health Practices
Unit 15 Workplace Health Management
Unit 16 Workplace Regulatory Requirement
Unit 17 Workplace Injury Management
UNIT 11 Occupational Health and Safety

Unit Structure
UNIT 11 OCCUPATIONAL HEALTH AND SAFETY CONTENTS
11.1 Introduction
11.3 Occupational Health and Safety
11.4 Importance of Occupational Health and Safety
11.5Costs of Occupational Injury/Disease
11.6 Health and Safety Programme
11.7 Summary
11.9 Possible answers to Self- Assessment Exercises
11.1 INTRODUCTION
This unit provides trainees with general background information on occupational health
and safety, and on the magnitude and variety of health and safety problems worldwide,
and explains the role of the health and safety representative.
11.2 OBJECTIVES
At the end of this unit, learners will be able to:
Explain that occupational health and safety is more than accident prevention
Explain why management's commitment to health and safety is crucial
Explain why training is a critical component of any health and safety programme
Recognize a number of occupational hazards and some of the types of work generally
associated with those hazards
Discuss the range of hazards in their own workplaces.
11.3 Occupational Health and Safety

Occupational health and safety is a discipline with a broad scope involving many
specialized fields. In its broadest sense, it should aim at:
1. The promotion and maintenance of the highest degree of physical, mental and social
well-being of workers in all occupations;
2. The prevention among workers of adverse effects on health caused by their working
conditions;
86
3. The protection of workers in their employment from risks resulting from factors
adverse to health;
4. The placing and maintenance of workers in an occupational environment adapted to
physical and mental needs;
5. The adaptation of work to humans.
In other words, occupational health and safety encompasses the social, mental and
physical well-being of workers, which is the “whole person”. Successful occupational
health and safety practice requires the collaboration and participation of both employers
and workers in health and safety programmes, and involves the consideration of issues
relating to occupational medicine, industrial hygiene, toxicology, education,
engineering safety, ergonomics, psychology, etc.
Occupational health issues are often given less attention than occupational safety issues
because the former are generally more difficult to confront. However, when health is
addressed, so is safety, because a healthy workplace is by definition also a safe
workplace. The converse, though, may not be true - a so-called safe workplace is not
necessarily also a healthy workplace. The important point is that issues of both health
and safety must be addressed in every workplace. By and large, the definition of
occupational health and safety given above encompasses both health and safety in their
broadest contexts.
Poor working conditions affect worker health and safety:

1. Poor working conditions of any type have the potential to affect a worker's health
and safety.
2. Unhealthy or unsafe working conditions are not limited to factories — they can be
found anywhere, whether the workplace is indoors or outdoors. For many workers, such
as agricultural workers or miners, the workplace is “outdoors” and can pose many
health and safety hazards.
3. Poor working conditions can also affect the environment workers live in, since the
working and living environments are the same for many workers. This means that
occupational hazards can have harmful effects on workers, their families, and other
people in the community, as well as on the physical environment around the workplace.
A classic example is the use of pesticides in agricultural work. Workers can be exposed
to toxic chemicals in a number of ways when spraying pesticides: they can inhale the
chemicals during and after spraying, the chemicals can be absorbed through the skin,
and the workers can ingest the chemicals if they eat, drink, or smoke without first
washing their hands, or if drinking water has become contaminated with the chemicals.
The workers' families can also be exposed in a number of ways: they can inhale the
pesticides which may linger in the air, they can drink contaminated water, or they can
be exposed to residues which may be on the worker's clothes. Other people in the
community can all be exposed in the same ways as well. When the chemicals get
absorbed into the soil or leach into groundwater supplies, the adverse effects on the
natural environment can be permanent.
87
Overall, efforts in occupational health and safety must aim to prevent industrial
accidents and diseases, and at the same time recognize the connection between worker
health and safety, the workplace, and the environment outside the workplace.
11.4 Importance of Occupational Health and Safety

Work plays a central role in people's lives, since most workers spend at least eight hours
a day in the workplace, whether it is on plantation, in an office, factory, etc. Therefore,
work environments should be safe and healthy. Yet this is not the case for many
workers. Every day workers all over the world are faced with a multitude of health
hazards, such as: dusts, gases, noise, vibration and extreme temperatures.
Unfortunately some employers assume little responsibility for the protection of

workers' health and safety. In fact, some employers do not even know that they have
the moral and often legal responsibility to protect workers. As a result of the hazards
and a lack of attention given to health and safety, work-related accidents and diseases
are common in all parts of the world.
11.5 Costs of Occupational Injury/Disease

Work-related accidents or diseases are very costly and can have many serious direct
and indirect effects on the lives of workers and their families. For workers some of the
direct costs of an injury or illness are:
1. The pain and suffering of the injury or illness;
2. The loss of income;
3. The possible loss of a job;
4. Health-care costs.
It has been estimated that the indirect costs of an accident or illness can be four to ten
times greater than the direct costs, or even more. An occupational illness or accident
can have so many indirect costs to workers that it is often difficult to measure them.
One of the most obvious indirect costs is the human suffering caused to workers'
families, which cannot be compensated with money.
The costs to employers of occupational accidents or illnesses are also estimated to be
enormous. For a small business, the cost of even one accident can be a financial disaster.
For employers, some of the direct costs are:

• Payment for work not performed;
• Medical and compensation payments;
• Repair or replacement of damaged machinery and equipment;
• Reduction or a temporary halt in production;
• Increased training expenses and administration costs;
• Possible reduction in the quality of work;
• Negative effect on morale in other workers.
Some of the indirect costs for employers are:

88
• The injured/ill worker has to be replaced;
• A new worker has to be trained and given time to adjust;
• It takes time before the new worker is producing at the rate of the original
worker;
• Time must be devoted to obligatory investigations, to the writing of reports and
filling out of forms;
• Accidents often arouse the concern of fellow workers and influence labour
relations in a negative way;
• Poor health and safety conditions in the workplace can also result in poor public
relations.
Overall, the costs of most work-related accidents or illnesses to workers and their
families and to employers are very high.
On a national scale, the estimated costs of occupational accidents and illnesses can be
as high as three to four per cent of a country's gross national product. In reality, no one
really knows the total costs of work related accidents or diseases because there are a
multitude of indirect costs which are difficult to measure besides the more obvious
direct costs.
11.6 Health and Safety Programme

I. The Scope
For all of the reasons given above, it is crucial that employers, workers and unions are
committed to health and safety and that:
• Workplace hazards are controlled - at the source whenever possible;
• Records of any exposure are maintained for many years;
• Both workers and employers are informed about health and safety risks in the
workplace;
• There is an active and effective health and safety committee that includes both
workers and management;
• Worker health and safety efforts are ongoing.
Effective workplace health and safety programmes can help to save the lives of workers
by reducing hazards and their consequences. Health and safety programmes also have
positive effects on both worker morale and productivity, which are important benefits.
At the same time, effective programmes can save employers a great deal of money.
II. Extent of the Problem Worldwide

A. Accidents
In general, health and safety in the workplace has improved in most industrialized
countries over the past 20 to 30 years. However, the situation in developing countries
is relatively unclear largely because of inadequate accident and disease recognition,
record keeping and reporting mechanisms.
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It is estimated that at least 250 million occupational accidents occur every year
worldwide. 335,000 of these accidents are fatal (result in death). (Since many countries
do not have accurate record-keeping and reporting mechanisms, it can be assumed that
the real figures are much higher than this.) The number of fatal accidents is much higher
in developing countries than in industrialized ones. This difference is primarily due to
better health and safety programmes, improved first-aid and medical facilities in the
industrialized countries, and to active participation of workers in the decision-making
process on health and safety issues. Some of the industries with the highest risk of
accidents worldwide are: mining, agriculture, including forestry and logging, and
construction.
Identifying the cause of an accident

In some cases, the cause of an industrial injury is easy to identify. However, very often
there is a hidden chain of events behind the accident which led up to the injury. For
example, accidents are often indirectly caused by negligence on the part of the employer
who may not have provided adequate worker training, or a supplier who gave the wrong
information about a product, etc. The consistently high fatal accident rates in
developing countries emphasize the need for occupational health and safety education
programmes that focus on prevention. It is equally important to promote the
development of occupational health services, including the training of doctors to
recognize work-related diseases in the early stages.
B. Diseases
Some occupational diseases have been recognized for many years, and affect workers
in different ways depending on the nature of the hazard, the route of exposure, the dose,
etc. Some well-known occupational diseases include:
• Asbestosis (caused by asbestos, which is common in insulation, automobile
brake linings, etc.);
• Silicosis (caused by silica, which is common in mining, sandblasting, etc.);
• Lead poisoning (caused by lead, which is common in battery plants, paint
factories, etc.);
• Noise-induced hearing loss (caused by noise, which is common in many
workplaces, including airports, and workplaces where noisy machines, such as
presses or drills, etc. are used).
There are also a number of potentially crippling health problems that can be associated
with poor working conditions, including:
• heart disease;
• musculoskeletal disorders such as permanent back injuries or muscle disorders;
• allergies;
• reproductive problems;
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• stress-related disorders.
Many developing countries report only a small number of workers affected by work-
related diseases. These numbers look small for a variety of reasons that include:
• Inadequate or non-existent reporting mechanisms;

• A lack of occupational health facilities;
• A lack of health care practitioners who are trained to recognize
• Work-related diseases.
Because of these reasons and others, it is fair to assume that in reality, the numbers of
workers afflicted with occupational diseases are much higher. In fact, overall, the
number of cases and types of occupational diseases are increasing, not decreasing, in
both developing and industrialized countries.
Identifying the cause of occupational disease

The cause of work-related diseases is very often difficult to determine. One factor is the
latency period (the fact that it may take years before the disease produces an obvious
effect on the worker's health). By the time the disease is identified, it may be too late to
do anything about it or to find out what hazards the worker was exposed to in the past.
Other factors such as changing jobs or personal behaviours (such as smoking tobacco
or drinking alcohol) further increase the difficulty of linking workplace exposures to a
disease outcome.
Although more is understood now about some occupational hazards than in the past,
every year new chemicals and new technologies are being introduced which present
new and often unknown hazards to both workers and the community. These new and
unknown hazards present great challenges to workers, employers, educators, and
scientists that are to everyone concerned about workers' health and the effects that
hazardous agents have on the environment.
III. The Range of Hazards

There are an unlimited number of hazards that can be found in almost any workplace.
There are obvious unsafe working conditions, such as unguarded machinery, slippery
floors or inadequate fire precautions, but there are also a number of categories of
insidious hazards (that is, those hazards that are dangerous but which may not be
obvious) including:
• Chemical hazards, arising from liquids, solids, dusts, fumes, vapors and gases;
• Physical hazards, such as noise, vibration, unsatisfactory lighting, radiation and
extreme temperatures;
• Biological hazards, such as bacteria, viruses, infectious waste and infestations;
• Psychological hazards resulting from stress and strain;
• Hazards associated with the non-application of ergonomic principles, for
example badly designed machinery, mechanical devices and tools used by
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workers, improper seating and workstation design, or poorly designed work
practices.
Most workers are faced with a combination of these hazards at work. For example, it is
not difficult to imagine a workplace where you are exposed to chemicals, unguarded
and noisy machines, hot temperatures, slippery floors, etc. all at the same time. Think
about your own workplace. Are there various hazards there that you can think of?
Workers do not create hazards - in many cases the hazards are built into the workplace.
The trade union position on occupational health and safety is to ensure that work is
made safer by modifying the workplace and any unsafe work processes. This means
that the solution is to remove the hazards, not to try to get workers to adapt to unsafe
conditions. Requiring workers to wear protective clothing which may not be suited or
designed for the climate of your region is an example of forcing workers to try to adapt
themselves to unsafe conditions, which is also shifting the responsibility from
management to the worker.
It is important for unions to maintain this position because many employers blame
workers when there is an accident, claiming that the workers were careless. This attitude
implies that work can be made safer if workers change their behaviour or if employers
only hire workers who never make mistakes. Everyone makes mistakes — it is human
nature, but workers should not pay for mistakes with their lives. Accidents do not stop
simply by making workers more safety conscious. Safety awareness may help but it
does not remove unsafe work processes or conditions. The most effective accident and
disease prevention begins when work processes are still in the design stage, when safe
conditions can be built into the work process.
IV. Importance of Management Commitment

In order to develop a successful health and safety programme, it is essential that there
be strong management commitment and strong worker participation in the effort to
create and maintain a safe and healthy workplace. An effective management addresses
all work-related hazards, not only those covered by government standards.
All levels of management must make health and safety a priority. They must
communicate this by going out into the worksite to talk with workers about their
concerns and to observe work procedures and equipment. In each workplace, the lines
of responsibility from top to bottom need to be clear, and workers should know who is
responsible for different health and safety issues.
V. The Importance of Training

Workers often experience work-related health problems and do not realize that the
problems are related to their work, particularly when an occupational disease, for
example, is in the early stages. Besides the other more obvious benefits of training, such
as skills development, hazard recognition, etc., a comprehensive training programme
in each workplace will help workers to:
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• Recognize early signs/symptoms of any potential occupational diseases before
they become permanent conditions;
• Assess their work environment;
• Insist that management make changes before hazardous conditions can develop.
VI. Role of the Health and Safety Representative

As health and safety representative your role is to work proactively (this means taking
action before hazards become a problem) to prevent workers from being exposed to
occupational hazards. You can do this by making sure management eliminates hazards
or keeps them under control when they cannot be eliminated.
Steps to help you reach your goals are:

1. Be well informed about the various hazards in your workplace and the possible
solutions for controlling those hazards.
2. Work together with your union and the employer to identify and control hazards.
3. Although these Modules have been developed for the protection of workers, you may
occasionally need to share some of this information with your supervisors and employer
in the process of working towards a safe and healthy workplace. Being a health and
safety representative is not always easy, but helping to protect the lives of your fellow
workers is worth all the time and effort you put into the job.
Identifying Hazards in the Workplace

1. Welder — a welder can be burnt from the sparks and there is always the danger of
the work process starting a fire. There is the problem of the intense light which can
cause permanent eye damage as well as the fumes given off by the process which can
damage the lungs.
2. Mechanic - Depending on the precise nature of a mechanic's duties, there may be
safety problems from cuts and falls, etc., and exposure to chemical hazards: oils,
solvents, and asbestos and exhaust fumes. Mechanics can also have back and other
musculoskeletal problems from lifting heavy parts or bending for long periods.
3. Textile worker - The textile worker faces a variety of problems. First there is the
problem of safety with many machines around that are often unguarded, as well as the
risk of fire with so much combustible material in the workplace. Then there are the
hazards of noise and vibration. There is also exposure to dust from the material which
can seriously affect the lungs. Exposure to cotton dust can lead to the occupational
disease known as byssinosis.
4. Tractor driver - One of the most serious problems with tractors is that they often
overturn and, if they have no safety cab, the driver can easily be crushed. Other
problems include noise, vibration and exposure to chemical herbicides and pesticides
when being sprayed by tractor.
5. Electronics assembly worker - An electronics assembly worker can suffer eye
problems from doing close work, often in poor light. Because such workers sit still for
long periods with inadequate seating, they can also suffer from back and other
musculoskeletal problems. For some workers there are the dangers of solder fumes or
solder “flecks” in the eye when the excess solder is cut off with pliers.
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1. What are the aims of occupational health and safety?
2. Occupational health and safety encompasses of the ____________,
________________ and _______________ well begin of workers
3. Mention four (4) costs of occupational injury
4. Identify four (4) Occupations and Hazards in the Workplace
11.7 SUMMARY
Hazards in the workplace can be found in a variety of forms, including chemical,
physical, biological, psychological, non-application of ergonomic principles, etc.
Because of the multitude of hazards in most workplaces and the overall lack of attention
given to health and safety by many employers, work-related accidents and diseases
continue to be serious problems in all parts of the world. Therefore, trade unions must
insist that employers control hazards at the source and not force workers to adapt to
unsafe conditions. Management commitment to health and safety and strong worker
participation are two essential elements of any successful workplace health and safety
programme. The most effective accident and disease prevention begins when work
processes are still in the design stage.

Santa Clara Valley Nonpoint Source Pollution Control Program. (1991). Best
Management Practices for Automotive-Related Industries. San Jose, CA.
Sherry, S. (1988a). Minimizing Hazardous Wastes: Regulatory Options for Local

Governments. Sacramento, CA: Local Government Commission.
Sherry, S. (1988b). Reducing Industrial Toxic Wastes and Discharges: the Role of
POTWS. Sacramento, CA: Local Government Co.
11.9 POSSIBLE ANSWERS TO SELF- ASSESSMENT EXERCISES

1. a. The promotion and maintenance of the highest degree of physical, mental and
social well-being of workers in all occupations;
b. The prevention among workers of adverse effects on health caused by their working
conditions;
c. The protection of workers in their employment from risks resulting from factors
adverse to health;
d. The placing and maintenance of workers in an occupational environment adapted to

physical and mental needs;
e. The adaptation of work to humans.
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2. Social, physical and mental well begin
3. a. The pain and suffering of the injury or illness;
b. The loss of income;
c. The possible loss of a job;
d. Health-care costs.
4. a. Welder — a welder can be burnt from the sparks and there is always the danger of
the work process starting a fire. There is the problem of the intense light which can
cause permanent eye damage as well as the fumes given off by the process which can
damage the lungs.
b. Mechanic - Depending on the precise nature of a mechanic's duties, there may be

safety problems from cuts and falls, etc., and exposure to chemical hazards: oils,
solvents, asbestos and exhaust fumes. Mechanics can also have back and other
musculoskeletal problems from lifting heavy parts or bending for long periods.
c. Textile worker - The textile worker faces a variety of problems. First there is the
problem of safety with many machines around that are often unguarded, as well as the
risk of fire with so much combustible material in the workplace. Then there are the
hazards of noise and vibration. There is also exposure to dust from the material which
can seriously affect the lungs. Exposure to cotton dust can lead to the occupational
disease known as byssinosis.
c. Tractor driver - One of the most serious problems with tractors is that they often
overturn and, if they have no safety cab, the driver can easily be crushed. Other
problems include noise, vibration and exposure to chemical herbicides and pesticides
when being sprayed by tractor.
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UNIT 12 INDUSTRIAL LEGISLATION
CONTENTS
12.1 Introduction
12.3 Definition of Industrial Legislation
12.3.1 Historical Development Industrial Legislation
12.3.2 Types of Industrial Legislation
12.3.3 Legislation Related to Occupational Health
12.3.4 Purposes of Legislation
12.4 Basic Obligations
12.5 Management, Leadership and Employee Participation
12.6 Employee Participation
12.7 Hazard Identification
12.8 Information and Training
12.9 Industrial Legislation in Nigeria
12.10 The Factories Act
12.10.1 Welfare
12.11 Workmen’s Compensation Law of 1990
12.12 Highlights of Pertinent Regulations
12.13 Summary
12.15 Possible answers to Self- Assessment Exercises
12.1 INTRODUCTION
The safety of a worker’s life in any paid occupation has been a major concern to all
governments. The advent of industrialization made people to diver their attention for
survival away from agriculture. The essential means of survival could not be achieved
without careful technology as a new productive economic approach (Reich and Okubo
1992). Industrialization brought about a change in survival order caused by
environmental pollution, industrial accidents and diseases, and unhealthy working
conditions. Morbidity and mortality especially among the young and women became a
serious issue. Employers of labour were insensitive to the sufferings of workers. This
brought about enactment of policies as legislation by both governments implemented
by regulatory bodies to save the life of workers. This unit discusses the meaning of
industrial legislation, historical development with particular reference to Nigeria; types
and purposes of legislation. It also discusses the provisions of factory Act and
Workmen’s compensation Laws as they apply to Nigeria. Summary of the pertinent
Legislation is also included.

• explain the meaning of industrial legislation
• trace the historical development of industrial legislation especially in Nigeria
• describe the types of industrial legislation
• discuss the provisions of factory acts and workmen’s compensation laws
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• state the pertinent legislations.
12.3 Definition of Industrial Legislation

According to Advanced Learner’s Dictionary (2001), “legislation is a set of laws passed
by parliament. Legislation is a policy that guides actions”. It is accepted that the extra
encouragement of potential regulatory action or litigation many organizations would
not act upon their implied moral obligations (Ladon, 2006). It means that legislation is
a law set up to ensure that employers comply with the rules established to ensure safety
of workers in any occupation.
12.3.1 Historical Development of Industrial Legislation

Industrial legislation developed as a burning desire to have full emancipation of
workers in industries that were used as slaves before the advent of industrial legislation.
In the olden days, slaves were used to build the many wonders of the world like in
Egypt, Rome and other parts of the world. War prisoners were not left out who were
subjected to may harsh conditions in underground mines and quarries. There was no
change until Georgius (1494 – 1555) wrote an article “De Re Metallica” which was
published a year after his death. He wrote on the working condition in mines and
industries basically on the mining accidents and illnesses, radiation and silicosis.
Bernardino Ramazzini, a physician and professor of Medicine in Universities of
Mordena and Padua also wrote and published his great work, De morbis Artificum
Diatriba” the first systemic study of trade diseases. His contributions earned him the
title “father of Occupational Medicine.” (Asogwa 2007). He stressed that occupation of
patient must sort for while carrying out treatment of patients. Industrial Revolution in
Britain started early in the eighteenth century with the invention of Seed drill by Jethro
Tull and the use of Coke to smelt iron by Abraham Darby in 1709. This led to the
employment of women and children in factories who had to work long hours under
unhealthy conditions and harsh circumstances. Medical practioners and laymen wrote
and fought against the ills and pressed for reforms.
Doctor Charles turner Thachrah (1795 – 1833) and Lord Anthony Haley Cooper (1801
– 1885) made significant contributions. Dr Thachrah was known as the “Father of
British Industrial Medicine.” He published a book titled “the Effects of the Principal
Arts, Trade and Profession and
Civic State and Habits of living on Health and Longevity, with suggestions for the
Removal of many Agents which produce Disease and shortens the Duration of lie.”
Lord Cooper, an aristocrat when as a member of the British parliament helped to

promote legislation that reduced the hours of work and improved conditions for
workwomen and children working in mines, factories and other work places, (Asogwa,
2007). The first direct medical involvement was the appointment of Sir Thomas
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Morrison (1863-1932) in 1898 as the first medical factory inspector (occupational
health consultant). He introduced the idea of notifying occupational health diseases
causatives like lead. He emphasized a number of preventive aspects of occupational
health practice known as: Ledge’s Aphorisms. “Unless and until the employer has done
everything means a good deal the work man can do next to nothing to protect himself,
although he is naturally willing to do his share.”
“If you can bring an influence to bear externally to the workman, that is one over which
he has no control – you will be success and if you cannot or do not, you will never be
wholly successful.”
“Practically all industrial lead poisoning is due to inhalation of dust and fume and if
you stop their inhalation, you stop the poisoning.”
“All workmen should be told something of the danger of the material with which they
come in contact and not be left to find it out for themselves sometime at the cost of their
lives.
As industrialization spread from country to country so also did the diseases and ailments
associated with different trades, so occupational health was recognized as district areas
of medicine. The oldest international body in modern times concerned with global
health and safety of people at work is the international labour organization (ILO). The
organization was founded in 1919 under the League of Nations. ILO is a tripartite
organization made up of representation of government, employers and workers
especially from chemical and industrial risks, hygiene of seamen, social and medical
insurance systems and workmen compensation. In collaboration with the world health
organization (WHO), it holds a number of joint expert committee meetings in the field
of occupational health and safety and publishers inter alia “international medicine
Guide for ship’ and Guide to ship sanitation.”
In the United States between 1890 and 1914 more than 16.5 million migrated from all
over the world into the States as industrial growth escalated. These new citizens worked
in factories plants, rail roads and mines, creating a new market for manufactured goods.
Children and women worked under harsh conditions twelve to fourteen hours shifts,
seven days a week under unspeakable conditions of grime dust and physical hazards,
smoke, heats cold and noxious fumes. (Ezenduka, 2007). Workers accepted work
related illness and injuries as part of the job. The life expectancy was low, people dying
at their forties and fifties with workers in some trade dying in their thirties (Allender
and Spadlly 1996). Most of the work related diseases like silicosis, lead poisoning and
tuberculosis were attributed to other causes. The first research carried out in 1900 and
other studies the followed after proved that diseases like tuberculosis were related to
the work environment, poor ventilation, overcrowding and unsatisfactory working
conditions. Other investigations revealed phosphorous poisoning, radium poisoning
watch making and mercury poisoning in those who manufactures felt hats. There was
public awakening to the effect of work conditions. The birth of labour movement
increased the demand for healthful and safe working conditions.
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Different states took different approaches to legislation. In European Union, in 1996,
the European Agency for safety and Health at work was founded and this starts with
elimination of hazard and ends with personal protective equipment. In the United
Kingdom, legislation is drawn and enforced by health and Safety executives and local
authorities under the health and Safety at Work Act of 1947. This embraces the concept
of risk Assessment.
12.3.2 Types of Industrial Legislations

There are three types of industrial legislations:
• Protective Industrial Legislation.
• Labour relations legislation.
• Collective agreements between unions and employers.
Protective Legislation - this law deals with regulation of maximum hours of work and
minimum wages for women and minors. It regulates hazardous practices affecting
workers (employees). There are other legislation under protective legislation in which
industrial employee is entitled to benefits. It also guarantees workers compensation for
industrial accidents and social security legislation such as unemployment insurance and
disability insurance. (Encarta
Encyclopedia 2005).
12.3.3 Legislation Related to Occupational Health

The occupational health and safety services provided by the employer are influence by
influenced by specific legislation at Federal and State know since the second century
(Remazzim 1713), public policy that effectively controlled occupational hazards was
not enacted until the 1960s. The mine safety and Health Act of 1968 was the first
legislation that specifically required certain prevention programs for workers. This was
followed by the Occupational Safety and Health Act of 1970, which established two
agencies to carry out the Act’s purpose of ensuring “safe and healthful working
conditions for working men and women”. Within the context of the occupational Safety
and Health Act, the Occupational Safety and Health Administration (OSHA), a federal
agency within the U.S Department of Labour was created to develop and enforce work
place safety and health regulations. OSHA sets the standards that regulate workers
exposure to potentially toxic substances, enforcing these at the federal, about
compliance can be obtained from federal, regional and state OSHA offices.
The National Institute for Occupational Safety and Health (NIOSH) was established by
the Occupational Safety and Health Act of 1970 and is part of the centers for Disease
Control and Prevention (CDC). In 1996, NIOSH and its partner agencies (the National
Institute of Arthritics and Musculo Skeletal and Skin Disease, the National Institute of
Environmental Health Sciences and the National Heart, Lung and Blood institute)
unveiled the National Institute for Occupational Research Agenda- (NORA), a frame
work to guide occupational safety and health research into the next decade. The NIOSH
agency identifies monitors and educates about the incidence, prevalence and prevention
of work related illness and injuries and examines potential hazards of new work
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technologies and practices. NORA, with its research-priority agenda, is responsible for
providing targeted research in areas with the highest likelihood of reducing the still-
significant toll of workplace illness and injury.
Even though the National Institute for Occupational Health Administration (OSHA)
was created by the same act of congress, they have different functions. The functions
of OSHA are:-
1. To determine and set standards for hazardous exposures in the workplace.

2. To enforce the occupational health standards this includes the right of entry for
inspection.
3. To educate employers about occupational health and safety.
4. To develop and maintain a database of work related injuries, illness and deaths.
5. To monitor compliance with occupational health and safety standards.
The functions of NIOSH are:

1. To conduct research and review findings and to recommend permissible exposure
levels for occupational hazards to OSHA.
2. To identify and research into occupational health and safety hazards.
3. To educate about occupational health and safety.
4. To distribute research findings relevant to occupational health and safety.
12.3.4 Purpose of Legislation

One may ask the purpose of legislation or rule. The purpose of the rule is to reduce the
number of job-related fatalities, illness and injuries. The legislation or rule will
accomplish this by requiring employers to establish a workplace safety and health
program to ensure compliance with set standards by Occupational Safety and Health
Administration Act. This act covers all employers except those engaged in construction
and Agriculture. This is the situation in U.S.A.

1. Who wrote an article called “De Re Metalica”?
a. Ramazzini
b. Asogwa
c. Georgius
d. Thachrah
2. Mention the three (3) types of industrial legislation
12.4 Basic Obligations

The basic obligation under this rule is that each employer must set up a safety and health
program to manage workplace safety and health to reduce injuries, illness and fatalities
by systematically achieving compliance with Occupational safety and Health Act
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(OSHA) standards and the General Duty Clause. The set programme must be
appropriate to conditions of workplace such as the hazards to which employees are
exposed and the number of employees there. The rule applies to hazards covered by the
General Duty Clause and by OSHA standards.
The programme must have the following elements:

1. Management leadership and employee participation.
2. Hazard identification and assessment.
3. Hazard prevention and control.
4. Information and training, and,
5. Evaluation of program effectiveness.
It is important to note that the employees who have been operating this programme
before now should continue. The employer should demonstrate the effectiveness of the
employer’s programme that differs from these requirements included under the core
elements of this rule.
12.5 Management, Leadership and Employee Participation:

It is basic obligation that the employer must demonstrate management leadership of the
safety and health program.
The employer can demonstrate this by:-

• Establishing the program responsibilities of managers, supervisors and
employers for safety and health in the work place and hold them accountable for
carrying out those responsibilities.
• Providing managers, supervisors and employers with the authority, access to
relevant information, training and resources they need to carry out their safety
and health responsibilities and;
• Identifying at least one manager, supervisor or employee to receive and respond
to reports about work place safety and health conditions and where appropriate,
to initiate corrective action.
12.6 Employee Participation
The employer’s basic obligation here is that the employees must be provided with
opportunities for participation in establishing implementing and evaluating the
program.
What must the employer do to ensure that employees have opportunities for
participation? The employer must:-
• Regularly communicate with employees about work place safety and health
matters.
• Provide employees with access to information relevant to the program.
• Provide ways for employees to become involved in hazard’s identification and
assessment, prioritizing hazards, training and program evaluation.
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• Establish a way employee to report job-related facilities, injuries, illnesses,
incidents and hazards promptly and to make recommendations about appropriate
ways to control those hazards and provide prompt responses to such reports and
recommendations.
What must the employer do to safeguard employee participation in the programme?
The employer must discourage employees from making reports and recommendations
about fatalities, injuries, illnesses, incidents or hazards in the workplace, or from
otherwise participating in the workplace safety and health programme.
In order to carry out this portion of the rule, the employer must comply with the
National Labour relations Act.
12.7 Hazard Identification

The basic obligation of the employer is that he must systematically identify and assess
hazards to which employees are exposed and assess compliance with the General Duty
Clause and Occupational and Safety Health Act (OSHA).
What must the employer do to systematically identify and assess hazards and asses
compliance? The employer must:
Conduct inspections of the workplace.

1. Review safety and health information.
2. Evaluate new equipment, materials, and processes for hazards before they are
introduced into the workplace.
3. Asses the severity of identified hazards and rank those that cannot be corrected
immediately according to their severity.
4. It should be noted that some OSHA standards impose additional more specific
requirements for hazards identification and assessment. This rule does not displace
those requirements.
How often must the employer carry out the hazards identification and assessment
process? The employer must carry it out:
Initially as often thereafter as necessary to ensure compliance with the General Duty
Clause and OSHA standards and at least two years, and when safety and health
information or a change in workplace conditions indicates that a new or increased
hazard may be present.
When must the employer investigate safety and health events in the workplace? The
employer must investigate each work related death, serious injury or illness or incident
(near-miss) having the potential to death or serious physical harm.
What records of safety and health programme activities must the employer keep? The
employer must keep records of hazards identified and their assessment and the actions
the employer has taken or plans to take to control those hazards.
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Exemption – Employers with fewer than ten employees are exempted from the record
keeping requirements of this rule.
The basic employer’s obligation is to systematically comply with the hazard prevention
and control requirements of the General Duty Clause and OSHA standards.
If it is not possible for the employer to comply immediately, the employer must develop
a plan for coming into compliance as promptly as possible. This includes setting
priorities and deadlines and tracking progress in controlling hazards.
Note
Any hazard identified by the employer’s hazard identification and assessment process
that is covered by an OSHA standard or the General Duty Clause must be controlled as
required by that standard or that Clause as appropriate. Information and training:
(A) What is the employer’s basic obligation? The employer must ensure that:
Each employer is provided with information and training in the safety and health
programme; and
Each employee exposed to a hazard is provided with information and training in that
hazard.
Note
Some OSHA standards impose additional, more specific requirements for information
and training. This rule does not displace those requirements.
(B) What information and training must the employer provide to exposed employees?
The employer must provide information and training in the following subjects:
1. The nature of hazards to which the employee is exposed and how to recognize them.
2. What is being done to control these hazards?
3. What protective measure the employee must follow to prevent or minimize exposure
to these hazards and
4. The provision of applicable standards.
(C) When must the employer provide the information and training required by this rule?
The employer must provide initial information and training as follows: For current
employees, before the compliance date specified in point (i) for new employees, before
initial assignment to a job involving exposure to a hazard.
Note
The employer is not required to provide initial information and training in any subject
in paragraph 3.6.3 (B) for which the employer can demonstrate that the employee has
already been adequately trained.
The employer must provide periodic information and training:

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As often as necessary to ensure that employees are adequately informed and trained;
and
When safety and health information or a change in workplace conditions indicates that
a new or increased hazard exits.
(D) What training must the employer provide to employees who have programme
responsibilities? The employer must provide all employees who have programme
responsibilities with information and training necessary for them to carry out their
safety and health responsibilities.
12.8 Industrial Legislation in Nigeria

Industrial legislation in Nigeria has taken place in two periods; pre-independence era
under colonial administration and the second was after independence.
Before independence, industrial legislation in Nigeria was Workmen’s Ordinance of

1941, Labour Code Ordinance of 1945 and Factories Act of 1955 revised in 1958 were
modeled to all intents and purposes in the same pattern as in Britain since independence;
the situation has not changed but the basic document has changed minimally from
colonial days. From time to time, there had been amendment of one section of the act
after another (Asogwa, 2007).
The most significant change was the coming into law of the Factory Act 1990 on
account of the deficiencies of the Factories Act of 1958 that the new law was enacted
to replace The Factories Act 1990.
The following areas are covered:

Cleanliness: This deal with daily cleanliness of factories washing and painting should
be done at regular intervals.
Overcrowding: Factor building must be 9 feet from the floor and the space available
for each work should be 40 cubic feet.
Light: Lighting of factories must be adequate.

Drainage of floors: Floors construction must be with a slope to aid drainage into
gutters.
Sanitary accommodation: One suitable sanitary convenience should be provided for

every 20 females. One for every 25 males.
Safety
• Safety of prime move.
• Safety of transmission machinery.
• Safety of powered machinery.
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• Safety of other machinery not covered above.
• Provision to unfenced machinery.
• Construction and maintenance of fencing.
• Safety provisions for vessels containing dangerous liquids.
• Safety of self-acting machine.
• Training and supervision of inexperienced workers.
• Safety keeping and maintenance of hoist and lifts.
• Safety rules for chains, ropes and lifting tackle.
• Safety rules for crane and other lifting machines.
• Keeping registers for chain and other lifting machines.
• Safety means of access and safe places of employment.
• Precautions in places where dangerous fumes are likely to be.
• Precautions in respect of explosives or inflammable dust, gas and vapor.
• Construction of steam containers and receivers with sound materials and their
maintenance.
• Safety of air receivers.
• Exceptions as to steam containers and receivers with sound material and their
maintenance.
• Safety of air receivers.
• Exceptions as to steam boilers, steam receivers, steam containers and air
receivers.
• Prevention of fire.
• Power of air inspector to issue improvement notice it any part of work machinery
or plant is in a condition likely to cause injury.
• Power of an inspector to issue prohibition notice as to as factory in a condition
to cause injury.
• Right to appeal against prohibitions notice.
• First aid that is readily accessible.
12.8.1 Welfare
According to Asogwa (2000), the general provisions covered the following areas.
Supply of drinking water, washing facilities, Accommodation for clothing.
First aid: There should be a readily accessible first aid box where more than 150
persons are employed and an additional box or cupboard for every additional 150
persons. Exemption for first aid if ambulance room is provided.
12.3.9 Health Safety and Welfare

Special provisions and regulations are made which include:
Removal of dust or fumes, meals in certain dangerous trades.
Protective clothing and appliances, protection of eyes in certain processes, collection
of samples of a substance suspected to likely cause bodily injury.
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12.3.10 Industrial Health and Welfare Center (IHWC)
Every industry, irrespective of it size should provide as a contiguous unit, if possible
an Industrial Health and Welfare center. This should embody: Occupational Health
Service Unit, Toilet facilities, a restaurant, canteen or snack bar and a resting room.
Workmen’s Compensation Law of 1990

Workmen’s compensation, according to Decree1990, a person shall be deemed a
workman if either before or after the commencement of this Decree he has entered into
or is working under a contact of service or apprenticeship with an employer whether by
way of manual labour, clerical work or otherwise, implied, in oral or in writing.
Under listed are the provisions made:

1. Employer’s liability for compensation for death or incapacity resulting from accident
(not deliberate), which incapacitates the worker for a period of three consecutive days.
2. Compensation in fatal cases – this will be equal to the sum of 42 (forty-two) months’
earnings.
3. Compensation in cases of permanent total incapacity shall be equal to 44 (forty0four)
months’ earnings.
4. Additional compensation of ¼ of 44 months earnings where an injury results in
permanent total incapacity of such a nature that the injured workman must the constant
help of another person.
5. Compensation for permanent partial incapacity. 6. Medical assessors to be appointed
for estimation of degree of disability.
7. Compensation in case of temporary incapacity
Full salary First 6 months

½ salary First 3 months
¼ salary First 15 months
It should be noted that any salary so paid shall be deducted from payable compensation
Method of calculating earnings according to Asogwa (2000, p102) a person entitled to
compensation is the victim in the case of death his partial of complete dependents.
Distribution of Compensation: it is through the court in case of death of a workman.

Among the requirements are notice of accident and application for compensation to be
made within six months of illness or death.
Employer should report the death of a workman to a labour officer with seven days
stating the circumstances of death if known to him.
Medical Examination and Treatment: The employer once notified shall arrange for
the injured workman to have medical examination and treatment free to the workman.
Agreement as to Compensation: This should not be less than amount payable
according to the law.
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Determination of Claims: To be made in a law court in case of disagreement between
workman and employer.
Review of Compensation Paid: This can be made (in case the injury gets worse) with
medical advice.
Medical expenses to be defrayed by the employer include.
Medical, surgical and hospital treatment, shill nursing services and supply of medicines
and surgical dressings.
The supply, maintenance, repair and renewal of non-articulated artificial limbs and
apparatus,
Traveling expenses incurred in the course of receiving medical treatment.
Compensating to include disability caused by occupational diseases.
Compulsory insurance of workman against death or injury arising in the course of his
employment.
12.3.11 Legal Protections in Nursing Practice

Laws and strategies are in place to protect the nurse against litigation. Good Samaritan
Acts- protects the nurse when giving help in the scene of emergency. The nurse practice
Act and standards of practice is a major legal safeguard for nurse. Accurate and
complete documentation is also a critical component of legal protection for the nurse.
According to (Brooke 2000) in a malpractice suit the content and depth of documents
or records can be ones best friends or worst enemy.
12.3.12 Highlights of Pertinent Regulations

The following legislation is available on line in government Health and Safety
executive website at HYPERLINK"http://www.hse.go.uk/ legislation hswa.htm"
www.hse.go.uk/legislation hswa.htm
The Health and Safety at work etc. Act 1974
Health and safety (first Aid) Regulations 1981
Social Security (industrial injuries) (prescribed diseases) Regulations 1985/2005
The Health and Safety Information for Employees Regulations 1989
The Air Quality Standards Regulations 1989
The Control of Noise at Work Regulations 2005
The Electricity at Work Regulations 1989. The Control of Explosives Regulations
1991. The workplace (health, safety and welfare Regulation 1992.
The Health and Safety (display screen equipment) Regulations 1992 The Personal
protective equipment (PPE) Regulation 1992
The Provision and Use of Work Equipment Regulations (PUWER) 1992/1998
The Manual Handling Operations Regulations 1992
The Genetically Modified Organisms (contained use) Regulations 1992
The control of Substances Hazardous to Health (COSHH) Regulation 2002
The construction (Design and Management) Regulation 1994
The Gas Safety (installation and Use) Regulation 1994/1998
Railways (Safety Critical Work) Regulation (SCWR) 1994
The Reporting of Injuries, Diseases and Dangerous Occurrence (RIDDOR) Regulation
1997
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The Health and Safety (Consultation with Employees) Regulation 1996
Confined Space Regulation 1997
Diving at Space Regulation 1997
The Working Time Regulation 1998
The employers’ Liability (Compulsory Insurance) Regulation 1998
The Control of Lead at Work Regulation 1998
Lifting Operations and Lifting Equipment (LOLER) 1998
The Management of Health and Safety at Work Regulation 1999
Quarries Regulation 1999
The Miners (control of ground movement) Regulation 1999
Railway Safety Regulation 1999 (PDF)
The Food Standards Act 1999
The Ionizing radiation (medical Exposure) Regulation 2000
The Chemicals (Hazard Information and Packaging for Supply) Regulation 2002
Control of asbestos at work Regulation 1987/2002
Control of Lead at Work Regulations 2002
Employment Act 2002
The Control of Substances Hazardous to Health Regulation 2002
Gender Recognition Act 2004
Employment Act 2002 (Dispute Resolution) Regulation 2005
The control of Vibration at Work Regulation 2005
Disability Discrimination Act 2005
Control of Major Accident Hazards (COMAH) Regulation 2005
The chemicals (Hazards Information and Packaging for Supply)
Regulation 2005
Restriction of the Use of certain hazards substance in electrical and
Electronic Equipment Regulation 2005
Employment Equality (Sex Discrimination) Regulation 2005
Workplace Exposure Limits 2005
Work at Height Regulations 2005
Control of Noise at Work Regulation 2005
Offshore Installation (Safety Case) Regulation 2005
The Railway and Other Guided Transport System (Safety) Regulation (ROGS) 2006
Coal Miners (Inhaled Dust) Regulation 2006
Employment Equality (Age) Regulation.
12.5.0 SUMMARY
In this unit, we have learnt that industrial legislations were enacted to protect the health
and safety of workers from unhealthy conditions of work environment of industrial
legislation especially in Nigeria was discussed. The provisions of the factories Act and
Workmen’s compensation were discussed. Industrial legislation and governments
inability to enforce the laws was discussed but they should provide necessary modalities
to enhance productivity and a strong labour force that is free from diseases related to
occupations. Industries employing workers sustain costs in the events of accident at
work such as legal fees, fines, compensatory damages, loss of production. Loss of
customer’s good will.
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Achalu E.I. (2000). Occupational Health and Safety. Lagos: Splendid Publishers.
Advanced Learners Dictionary (2001). 6th ed. Oxford University Press.
Asogwa S.E (2007). A Guide to Occupational Health Practices in Developing

Countries. Enugu: Snaap Press Limited.
Allender A. and Bradley B.W (1996). Community Health Nursing’s Concept and
PRACTICE. PHILADELPHIA. Lippincolt Williams and Wilkins.
Kramer S.S (2005). Microsoft Encarta Encyclopedia. Http:
Lucas A.O and Gilles H.M (1984). A Short Textbook of Prevention Medicine for the
Tropics. 2nd ed. London. Hodder and Stoughton. Sation
Ladue J. (2006). Current Occupational and Environmental Medicine. 4th ed. London:
McGraw Hill Professional.
Microsoft Encarta, Encyclopedia Standard 2005.

National Occupational Research Safety and Health. (1999). National Occupational
Research Agenda, Washington D.C.
Rogers B. (1994). Occupational Health Nursing: concepts and practice. Philadelphia:

W.B.Sanders Company.
6.0 TUTOR-MARKED ASSIGNMENT

1. Trace the historical development of industrial legislation in
Nigeria.
2. List and explain 10 provisions of factory acts in Nigeri
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UNIT 13 INDEPENDENT PRACTICE
Module Contents
13.1 Introduction
13.3 INDEPENDENT PRACTICE
13.3.1 Skills and Abilities
13.3.2 Steps to Independence
13.3.3 Service Offering
13.3.4 Important Needs for Effective Practice
13.3.5 Government Registrations, Tax and National Insurance
13.3.6 Finance Management
13.3.7 Business Plan
13.4 General Practice
13.5 Summary
13.1 INTRODUCTION
This unit discusses some general and practical aspects of independent occupational
health nursing. The first issue for anyone considering independent practice is to
recognize what is meant by the term. In the context of this unit it means being self-
employed or:
Someone who uses their skills and abilities to create a successful business while
assuming total responsibility and risk (RCN 2000 p. 5).
It is recognized that being an ‘independent’ can in addition mean working with others
who are also testing the commercial market.
13.2 OBJECTIVES
By the completion of this unit you should be able to:
• Explain the independent Practice
• State the various skills and abilities necessary for practice
• State the various state towards successful independent practice
• State areas of services which would be offered to clients.
13.3 INDEPENDENT PRACTICE
In setting out for independent practice in occupational health sector, there are several
areas the expert involved has to take into critical examination with real self-thought on
how he or she can function with maximize credibility. Some independent practices have
failed because the SWOT analysis proposal was not taken into veritable consideration
with proper planning. Let’s look at various areas where success can be achieved.
13.3.1 Skills and Abilities
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The decision to launch out as an independent can at first glance seem the ideal. The
idealist sees ownership of projects and freedom to choose the clients and work
undertaken. The pragmatist will question what projects, what work and what skills they
will need.
A SWOT exercise is a good starting point. It may be old hat to some but it is a way to
focus on the project of self-employment. The SWOT exercise needs to be specific to
the independent.
The SWOT exercise, if completed objectively, can assist the possible independent to
decide whether self-employment is really a preference or an ability-based option. The
same exercise can be used to assess projects, marketing materials and initiatives.
13.3.2 Steps to Independence

What Do I Want the Business to Be?
There are basically three types of business:
• sole trader,
• partnership and
• limited company.
Sole Trader:
Most independents start out as a sole trader, which is the simplest form of business
structure. Registering the business and, if relevant, obtaining licences is relatively
inexpensive. The sole trader has complete control of finances and can decide when and
how much to take out of or put into the business. Unlike other business structures there
is little government control and there are no reports to be filed with government
agencies or departments. The business and the sole trader are taxed as a single entity,
i.e. the business-generated income is equivalent to the salary.
There is a major risk as a sole trader: personal assets, house, property, car, investments
or other valuables can be seized to pay outstanding debts and other liabilities.
Partnership
A partnership is an association of two or more people to carry on a business with the
aim of making a profit. To enter in to a partnership you need a contract – oral or written
– between all interested parties. The fees and legal expenses are lower than for an
incorporated company but higher than for a sole trader. Being in partnership means
sharing all decisions, profits and unlimited liabilities of the partnership. Changes in
circumstances automatically end the legal identity of the partnership, for example the
death of a partner.
A partnership agreement, sometimes referred to as articles of partnership, is essential.

The larger the partnership becomes the more complex the agreement. When more than
one person is making decisions you need consensus management. A dependence on
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consensus management can lead to difficulties and result in partnership conflict. At the
risk of sounding pessimistic:
A friendship founded on business is better than a business founded on friendship (John

D. Rockefeller, 1874–1960; see Gray 1996).
Dissolving a partnership can result in expenditure of time and legal and administrative
costs, as all partners need to agree the terms, which can result in trading difficulties.
For example, the withdrawal of capital at termination of a partnership can result in the
business being insolvent.
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Limited Company
A limited company is a legal entity, with or without share capital, which can be legally
established by one or more individuals. The shareholders’ (or owners’) personal assets
are separate from the business and cannot be seized to pay outstanding debts incurred
by the business.
It should be noted that there are various tax advantages available to limited companies
that are not available to partnerships or sole traders.
However, expert advice before making the decision is essential. Tax planning and
annual returns will need to be undertaken with the help of a professional and qualified
accountant. The selection of an accountant must be undertaken with care and a decision
based on personal recommendation is advised.
Investors find it more attractive to invest in a company with limited liability than to
invest in a business whose unlimited liability could involve them in financial
responsibility that is greater than the amount of the investment. Long-term financing
from lending institutions is more readily available because lenders may use both
corporate assets and personal guarantees as security.
The limited company continues to exist and operate regardless of any changes in the
shareholders. For example, the death of a shareholder does not mean the termination of
the Company.
There are more regulations affecting a limited company than a sole trader or
partnership. Companies must report to all levels of government. As can be predicted, it
is more expensive to establish and operate a limited company than to operate as a sole
trader or in a partnership, because of the additional documents and forms that are
required.
In general, it is probably better in tax terms to start a small business as a sole trader or
partnership. Once the business is mature and profitable, professional advice may be
sought and the needs and implications of becoming incorporated can be researched.
This delay ensures a better chance of making an informed decision from an experience
base and with some indicators of profit and growth potential.
The choice between setting up as a sole trader or as a partnership is largely dependent

on individual preferences and circumstances. Consultants who start as sole practitioners
may, when they are established, form a partnership with one or more congenial people.
In the final analysis professional advice is required when setting up independent
practice.
13.3.3 Service Offering

A key point when starting out as a self-employed person is to decide what services are
to be offered to clients and whether the services can be offered within current resources.
The range of options is varied and will depend on past experience and the type of work
enjoyed.
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The work of the independent occupational health nurse practitioner seems to breakdown
into several categories. The most popular is providing an independent occupational
health nursing service, usually on a set number of days per week or month to a client or
clients who contract for the service. The work often entails pre-employment and
ongoing health surveillance programmes, training and, in some instances, a treatment
service. Another area of independent practice is consultancy, working with senior
managers to design strategies, policies and procedures and then managing the
implementation of the agreed work. Both elements can be incorporated into a contract
for services but the latter offers a greater opportunity to influence the client at a senior
level and requires a range of management skills.
Some independent occupational health nurses may have a contract to provide full-time
services, which seems to follow a company downsizing or rightsizing. This type of
contract ensures a sustained income but the benefits and security of continued
employment are often less advantageous for the independent than for someone directly
employed. Remember, if the contract is not renewed then the independent practitioner
is unemployed and has to start finding new clients. If self-employment is really a
preferred choice, the pros and cons of being tied down to one client should be
considered carefully – a single contract may be too high a risk.
13.3.4 Important Needs for Effective Practice

An Office and Space
A major decision is whether the office will be in the home or in rented accommodation.
Both have their pitfalls and both need to be well thought out.
To work from home has many advantages, such as no travel and tax relief for a room
used as an office. However, working from home needs discipline – office hours are
office hours. Ideally the office should be a separate room with desk, shelves for
reference books, filing cabinets, computer with broadband Internet access, printer,
telephone and fax/copier.
To rent accommodation means the need for regular income to offset overheads before
making a profit. But the rented office will not intrude on private space. In the end it is
a matter of choice and may be based on projected fee earning. Therefore, another
essential is capital to set up a functioning and efficient office.
Administrative Support
This is another overhead, which would need to be covered on a regular basis before a
profit could be identified. The appointment of an administrative support worker will
depend on the type of services to be offered and the independent’s computer skills. In
consultancy the need is more apparent as there is usually a volume of written
communications. The decision may be based on some or all of the following:
• What is the role of the administrative support worker?
• How much time is spent by the income generator on routine administration, e.g.
accounts, invoicing, chasing payment, writing reports, chasing clients,
marketing, etc.?
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• Could this freed time be used to generate more income?
• Is the independent paid for report-writing time?
• How much of the report writing could be done by a third party?
• Is it nice to have or essential?
• Would it enhance the image of the business?
Computers
Buying the best within budget and with lots of memory will help avoid the need to
upgrade later. Whatever you think you will need, you should get a system that will do
more. Deciding which computer and what programs to buy will depend on your
projected needs: this is not as simple as it sounds so it is essential to do some market
research. The best advice will be from someone doing the type of work being
considered. But remember, everyone has their own favourite. You should identify
computer packages that can be upgraded and are flexible. Monitors are important; the
bigger they are, the easier they are to use. Of course, all independents will complete
their display screen equipment risk assessments and ensure compliance, which is easier
to achieve at the set-up stage. Ensure the programs are user-friendly and buy a virus
and computer systems checking programme.
As the independent will need to prepare reports, and the reports are a window to the
business, a colour printer and a good graphics package are serious considerations.
Seek advice from several Internet suppliers and consider a system, ideally broadband,
that best suits your needs. This can be part of a mobile and TV package – dial-up can
be used in areas where it is hard to get broadband.
There are some very user-friendly computer accounts packages on the market.
Accounts are essential for invoicing clients, for keeping a record of the transacted
business and National Insurance, and for the accountant to prepare tax returns. The
accounts packages will also calculate
VAT and assist in completing the VAT forms. The paperless office is a laudable
objective that is not as easy to achieve as to talk about.
Keeping client files and copies of reports is essential for reference and in case of
complaints. External hard or flash (usually USB) disks have fallen rapidly in price and
provide a good method for backing up the internal drive. Users can use synchronisation
software packages to facilitate backups with the same file structure as the internal drive,
but if a good filing system is used it is easy to back up from the root directory.
This requires an understood and consistent system for directories, folders and files: for
example, a directory may be labelled ‘Clients’, and each folder constitute a named
client, and within the folder the essential files are placed. Retrieving files can be a
nightmare, so consistent titling of files going into the appropriate folder in the right
directory can be a time saver.
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References
Good up-to-date and varied references are essential for the independent. You will need
the latest editions of textbooks, subscriptions to the best occupational health journals
and broadband Internet access for e-mail communications, research, and receipt of e-
bulletins. The risks of making recommendations based on outdated information are real
and can result in clients taking action for loss of or detriment to business. The purchase
of data is a tax-deductible item, as are office equipment and consumables such as paper,
folders, and pens.
13.3.5 Government Registrations, Tax and National Insurance

At a certain level of income a self-employed person must register for VAT. Current
information can be obtained from one’s bank or an accountant, or the local Customs
and Excise office. The advice varies from accountants about when to register but in fact
you can register at any time. The advantages of registering are that you claim back VAT
spent on any purchases that are made solely for business purposes: petrol, stationery,
equipment, etc. A disadvantage is that for non-VAT registered clients you must add
VAT to all invoices, which for some clients such as charities can make the fees seem
high.
The Customs and Excise will issue a refund if you spend more on VAT for the running
of the business than clients pay in VAT for your services, which is likely to be the
situation in the early days of the business.
The basic requirement is to inform the appropriate local Inspector of Taxes of your
intention to be self-employed as soon as the decision has been made. The relevant
notification forms can be obtained from the local tax office. If you are no longer
employed at the time of informing the Inspector of Taxes, the tax office will require the
last P45 provided by your most recent employer
It is imperative to consider the issue of National Insurance (NI). The independent must
notify the Department for Works and Pensions, even if the self-employment is part-
time. If employed while establishing independence you can be designated as employed
and self-employed and the NI contributions can be deferred until you reach a certain
level of income. Up-to-date information can be obtained from the Department for
Works and Pensions.
If the decision is made to employ staff in the business you may have to deduct Pay As
You Earn (PAYE) and National Insurance. In general terms it is better to employ an
accountant to address these regulatory requirements.
Do I Need Business Insurance?

Employer’s liability insurance is a must if staff are employed. A pitfall to be aware of
is when other independent consultants are sub-contracted to fulfil a client’s needs. It is
prudent to check their professional insurance position and to seek legal guidance
regarding the difference between contract for services and contract of services.
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Some client contracts will require the principal independent to obtain insurance for
several million pounds as part of the contract requirements. This is then factored into
the contract price.
The independent professional must have appropriate professional indemnity insurance.

This can be obtained either through the independent’s professional body or from an
insurance company. If private insurance is needed, a reputable insurance broker can
assist.
Car and equipment insurance are also needed and once again insurance brokers are the
best initial contact. It is recommended that several brokers be approached, as the cost
of insurance can vary considerably. One issue that is becoming easier is to insure your
office equipment when the office is home-based. An increasing number of insurance
companies are now providing this cover, often as part of the home contents insurance.
Sometimes there are restrictions to the cover – for example, clients visiting the home
office – so the business plan should reflect this need.
It is essential to notify the insurers that your car will be used for business purposes and
there is merit in asking about cover for car contents, e.g. general equipment for service
provision, laptop, etc.
There are other insurance considerations, such as insurance for life and health, loss of
earnings, cash and cheques, theft, fire and damage to buildings. It sounds a minefield
but a reputable broker can assist, as can the professional bodies. The necessity is to
obtain sound advice, make an informed judgement of actual needs and avoid the trap
of gold star cover if the nature of the client work and services provided can be covered
by professional indemnity and car and equipment insurances. All the overheads mount
up before a profit can be made. It is easier to spend than recoup.
13.3.6 Finance Management and Pension Scheme?

Bank managers can be sympathetic to small businesses and if there is doubt about cash
flow in the first few months it is better to discuss setting up a business account at the
start. Bank charges can be high; for example, for every transaction in or out of an
account there will be a bank charge and so it is worth shopping around. There is merit
in obtaining a business credit card, which will assist in keeping private expenditure
separate from the business and reduce the number of transactions in and out of the
business account. The bank manager may request a business plan.
This is another area where independent financial advice must be obtained. Remember
that banks are likely to recommend to customers their own policies. You will need
advice regarding your existing pension scheme(s). Is it better to freeze an existing
pension or to transfer the cash to a personal pension scheme? The essence is to decide
which of the many options the best one for your particular circumstances is.
If you employ staff you may be required to offer pension advice and to consider whether
the company will offer a pension to staff.
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13.3.7 Business Plan?
A business plan identifies the amount of financing or investment required and identifies
when it will be required. It demonstrates that you have considered all aspects of self-
employment and that you recognize the opportunities and threats to the business. It is
also a means to persuade an investor or bank manager that you are a good risk. In the
longer term, if the objectives identified in the business plan have not been achieved,
you are in a better position to identify the financial needs of the moment and to take
appropriate action. Discussing the business plan with your financial backer or bank
manager will enable focused discussions.
Banks, Chambers of Commerce, Business Link offices and the Internet may provide
templates for use when preparing your business plan. Local Chambers of Commerce
run short courses for people setting up their own business. Some sample topics are:
accounting for small businesses, marketing and basic management skills. Various areas
should be covered in a business plan (see Figure 5.2). Any business plan needs to be
well laid out and cross-referenced for ease of evaluation.
13.4 General Practice

The decision is made, advice has been evaluated and required notifications have been
completed. Now the hard work starts.
What Shall I Call the Business?

What is in a name? Careful thought is required. Is the name of the business to reflect
the independent themself, such as Jane or John Doe, or does the name of the business
reflect that there are associates, such as J. Doe and Associates, or what the business
provides, such as Essential Occupational Health Services (my apologies to all J. Does
and any business of the name used as an example!).
Once the name has been agreed, the question of a logo needs to be considered. It is not
essential but it does give the feel of an established organisation and can be used on
business cards, business headed notepaper and marketing brochures.
What will Be Offered to Clients?

Working as an independent is very different from working as an employed person; the
type of service offered to clients will dictate how different. If providing an occupational
health service such as pre-employment and risk-focused health surveillance
programmes, the expectations of the client will range from sustaining existing
programmes to creating programmes and then implementing them. If the latter work is
required, the independent may have to create, tailor, recommend and then implement
policies and procedures based on statutory requirements, risk or needs assessments and
best practice. This is when the perils of self-employment become more easily
recognised and where references, knowledge and experience come into play.
Training may also be a service that clients require. The trainer is expected to be
knowledgeable not only concerning best practice but concerning the client’s individual
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and specific needs. Prior to embarking on this type of work it is prudent to complete a
training needs analysis – What do they have? Where does the client need to be?
Preparation, supported course notes and lively presentations using computer-generated
graphics are really the norm today.
Remember:
Good teaching is one-fourth preparation and three-fourths theatre (Gail Godwin; see
Kelly and Kelly 1989).
Consultancy is another type of service that can be offered to clients. A consultant is a
person that other people or Organisations ask for advice and look to for guidance,
instruction and/or information. Again, there is a range of consultancy services that can
be offered to clients, from working with company teams to improve the implementation
of policies and procedures of an occupational health department, to assisting the client
to turn the advice into action, to working at a corporate level and facilitating strategic
planning, policy and procedure designs and methods to achieve progress.
Other forms of consultancy are auditing, assessment of needs and helping companies
to managing compliance. The real issue for a consultant is to identify what is needed
and not just accept what the client believes they need; this is a form of specialized
project management.
Project management can be broken down into several steps or phases and each step
should be carefully designed, tested and presented. Once presented, it can constitute a
contract for services. Consider the steps outlined below;
• Define the objectives: what objectives need to be set to meet the needs of the
project and when is the project to be completed?
• Establish terms of reference: how can the objectives be met?
• Construct a realistic and achievable work schedule, breaking the project down
into phases, identifying who will do what and by when, noting resource needs
both hard and soft. Hard needs include computers, facilities, assistance, etc.; soft
needs encompass experience, creative thinking, flexibility, strategic planning,
etc.
• Plan for quality: demonstrable facts are important in every output and activity.
• Plan time scales: each phase of the project will have a time frame for completion.
This is the means to drive the project forward.
• Deliver outputs to client specifications, with regular reports to clients to keep
them abreast of developments.
• Conduct SWOT of project quality of delivery: constant improvement may be
made by learning from success and failures.
• Consider the cost of the project: if the independent needs to provide the hard
resources this will be a cost factor.
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In preparing a proposal, the detail can be broken down into the above elements.
However, it is important to realize that not all elements of the project management list
will be appropriate to all contracts.
How Will the Clients Be Found?

Remember the golden rule: it is easier to spend than to recoup. So be focused and accept
that marketing is expensive, and that general marketing such as a general mailshot is
not usually cost-effective for the small, specialist business.
Contracting a company to call possible clients is expensive and in general does not
generate many leads. However, if a couple of leads are the targets then cold calling may
be a considered approach. Cold calling simply means that you telephone and try to
reach the right person to persuade them that, whatever you are offering, the prospective
client cannot do without. Preparation is needed, such as:
• Identifying the types of companies in the area in which work is sought.
• Going to the library and researching the names and positions of key managers
or directors, purchasing directories of local companies or purchasing lists of
companies of interest from the local Chamber of Commerce, for example.
• Preparing the introduction and sales pitch.
• Ringing to sell yourself and the services to be offered.
• Keeping comprehensive notes.
The aim is to get an appointment to meet. Be prepared for talented blocking maneuvers
by receptionists through to personal assistants.
The business card and headed notepaper are forms of marketing. These tools must be
used, so keep your pockets full of business cards wherever you go. Make sure your
business card states clearly what you do.
A carefully worded advertisement in carefully selected journals can result in leads.

Whichever avenue is selected, it is important to remember that the lead-in time from
contact to work can be months and in some cases years.
Another method of working as an independent is to register with a reputable agency,

which will do the marketing and put you in touch with clients. It is possible to obtain
work from a range of clients, ensuring a full diary with a variety of companies or
involvement in a variety of projects. The agencies must be registered if they are
recruiting or placing nurses, and the agency will pay NI. It can be a low-risk way to real
independence.
How much is to be charged?

If the work is found via an agency they will have a range of fees to offer, so be sure to
negotiate. A golden rule is to remember that the independent is selling a service and
aiming to run a profitable business. Occupational health nurses seem reluctant to be
realistic about the fees to be charged and in essence offer services at a low rate and then
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regret the decision. If the services and the experience are to be valued they must be
realistically cost.
If working as a true independent, it is essential to sit down with a calculator and do

some sums. There are some personally tried and tested golden rules for setting fees
listed below;
• What do you need to generate to ensure the business is solvent? Identify
overheads – rent, insurances, staff costs, telephone, etc.
• Work out a day and hourly rate based on the above, with a profit margin.
Remember just covering costs is no way to run a business and make a profit.
• Find out what other independents are charging in the area (there seem to be
regional variations in fees).
• Decide either to charge expenses separately or to make the fee inclusive (plus
VAT if registered).
Specific Points to Consider
• Is the work occupational health nursing or consultancy? (The latter tends to
generate a higher fee.)
• What does the project management profile identify as the real needs and time
commitments for the practitioner?
• When a contract for services is pending it is also worth considering the client
and the length of the contract. Short-term contracts tend to be costed at a higher
rate, as the independent needs to work and find other clients.
• If equipment is required, the cost of hiring it should also be included in the fees.
How to Keep Clients

An independent must ensure they provide the services agreed to a standard expected by
the client. It is prudent to agree the detail at the start of the contract for services. There
are several issues that need to be considered before entering into an agreement to
provide services, such as:
• The duration of the contract and terms of termination.
• The fact that the independent contractor is not entitled or eligible to participate
in any benefit programmes or tax-withholding obligations on the part of client.
• The detail of the services to be offered.
• Who will do what – ensure both parties agree.
• Confidentiality of information obtained during the term of contract.
• Liability to the business. This can be limited by adding a clause that states
liability for loss or detriment to the client will be equal to the amount of the
contract.
• The period of payment of invoices. Consider charging a penalty for late
payment. Late payment of invoices sent to the client can have a serious impact
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on the business, as there will be companies and people waiting for payment from
the independent.
• Working as an independent occupational health nurse practitioner can be
rewarding and certainly challenging, but it is not for everyone.
REFERENCES/FURTHER READINGS
AOHNP (UK)(1998) Information for Independent Occupational Health Practice,
Leicester: AOHNP (UK).
Gray D.A. (1996) Start and Run a Profitable Consulting Business, London: Kogan
Page.
Kelly F.J. and Kelly H.M. (1989) What They Really Teach You at the Harvard Business
School, London: Piatkus.
RCN (2000) Turning Initiative into Independence, 2nd edn, London: RCN.
RCN (2003) Information forWould-Be Nurse Entrepreneurs: Turning Initiative Into

independence, 3rd edn, London: RCN.
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UNIT 14 EVALUATION OF OCCUPATIONAL HEALTH PRACTICES
CONTENTS
14.1 Introduction
14.3 What to Evaluate
14.4 Working Environment
14.5 Supervision on Correct Use of Protective Clothing and Equipment
14.5.1 Supervision on Correct Use of Safety Materials
14.6 Personal Health of the Workers
14.7 Types of Medical Examination
14.8 Characteristics of Pre-employment Health Assessment
14.8.1 Advantages of Pre-employment Health Assessment
14.8.2 Pre-Placement Health Assessment
14.8.3 Periodic Health Assessment
14.8.4 Pre-retirement Health Assessment/Outcome Evaluation
14.9 Summary
14.1 INTRODUCTION
This unit discusses evaluation of occupational health practices with a view to correct
areas of deficiency or neglect or areas that will have implication(s) on the health of the
people and provide solution. It looks at the meaning of evaluation, types what should
be evaluated and conclusions were drawn.
14.2 OBJECTIVES
By the completion of this unit you should be able to:
• Explain the meaning of occupational health evaluation
• State the types of evaluation
• Explain the aims for evaluating occupational health practices
• State areas of occupational health that should be evaluated.
14.3 What to Evaluation

Evaluation refers to the process by which we can measure the extent to which our
objectives have been met. For evaluation to be effective, the broad and specific
objectives of the programme to be evaluated must have been clearly stated or defined
right from planning stage. Evaluation entails measuring the extent to which these
objectives have been met (Akinsola 1993).
Types of Evaluation
There are two different types of evaluation namely: process evaluation and outcome
evaluation.
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Process Evaluation
Refers to an evaluation of the process by which the programme is being implemented.
This is an examination of the procedures and methods, their merits and demerits.
Outcome Evaluation
It refers to detailed examination or assessment of the achievements of the programme.
Example, what changes have taken place in the rate at which injuries occur in the
factory or industry? Evaluation would be also be categorized as continuous and terminal
evaluation.
In occupational health practice, one can carry out evaluation at the end of a programme
or during the programme; that is, process evaluation. There have been records of several
deaths and injuries in various working environments as a result of failure to either assess
the health of the workers, their environment or the work process. Evaluation of
occupational health practices is concerned with ensuring that both health of the workers
and the working environments are in good conditions in order to avoid recording
casualties at the places of work, and to ensure greater productivity.
Aims of Occupational Health Programme/Practices

The main aims of the occupational health programme include:
i. To protect the workers against any health hazards that may arise out of their work or
the condition in which it is carried out.
ii. To contribute positively towards the workers physical, and mental adjustment and
particularly the adaptation of the work to workers and their assignments to job for which
they are suited.
iii. To contribute to the establishment of jobs to the highest possible degree of physical
and mental wellbeing of workers.
14.4 Working Environment

Things to evaluate are those that can promote the health of workers. They include:
It is the responsibilities of the safety engineer or occupational hygienist where available
to evaluate the working environment. Where these two categories are not available, the
doctor or nurse does it. Treatment services in the industry can be used as an indicator
of problem areas. If many people come with pneumoniocosis, it means something has
to be done about the level of dust to that environment. The dust measurement has to be
taken to know how much of it in the air. Also if workers in the plants with a high
intensity of noise who show by audiometry, evidence of hearing loss, sound level
measurement will be taken to determine their intensities. The doctor must advise the
engineers for reduction of such hazardous elements in the working environment. In
order to be able to give the advice to reduce the level of sound, the doctor must keep
records of annual incidence of the diseases in question in order to discern trends. If in
an industry, accidents rate is high, provision of guard for dangerous machinery and
education of workers result in reduction in the accidents rates (Asogwa, 2007). Aside
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from the level of hazards in the environment, the structures are evaluated. How many
employees are in the employment of the factory or industry? It has to be determined
whether the structure available is alright, and if they are enough, consider the number
of employees it has.
The general condition of the factory has to be evaluated as good or bad. How is the
house keeping on the factory which will include light, heating, ventilation, disposal of
waste and garbage, kitchen facilities for washing, available portable drinking water,
space, cloak room, safety methods organized example machine guard, protective
clothing, masks precaution against fire disasters, hazard encountered example notice of
faulty machines, dust, toxic wastes, health services available. Measurement of acid mist
in electroplating work or the use of gas detector tubes for carbon monoxide, hydrogen
sulphide of methane level. As this evaluation or assessment is going on, actions are
planned and taken to take care of each problem accordingly (Alakija, 2000).
14.5 Supervision on Correct Use of Protective Clothing and Equipment

14.5.1 Supervision on Correct Use of Safety Materials
Ideally, every work process should be designed as to ensure the wearing of protective
equipments such goggles, respirators, gloves. The employee must ensure that the plant
is well designed and meet the safety requirements, specification and makes the work
process safe. In realizing that it is not possible, to make all work process fully safe,
insurance and proper wearing of safety equipment/clothing by the workers is essential.
The nurse will also work in co-operation with other professionals whose function
includes safety in the work place. The nurse may come to realize that some experienced
operators tend to cut corners or may leave out or avoid the use of protective clothing
and equipment during a process thereby exposing themselves and other workers to
avoidable risks. The design of most protective clothing and equipment are meant for
the temperate climates and are sometimes cumbersome for use in the tropical climate.
However, the nurse must encourage the use until more suitable and equally effective
alternative equipment is made. (Akinlolu, 2004)
14.6 Personal Health of the Workers

The medical information needed is recorded in a pre-employment examination form.
The design of the form varies with different occupations and depends on whether the
workers are literate or not, the form is completed. The result of the medical examination
is communicated to the management in terms of whether the work is fit or unfit.
Divulging details of medical finding to management or anybody for that matter is
against medical professional code of conduct. The form of the medical examination
should be stored in a confidential file. If any detailed information is needed by
management about the employee, this should only be provided with prior consent of
the workers.
14.7 Types of Medical Examination

Pre-Employment Health Assessment
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The examination is carried out before employment. A successful medical examination
should be a pre-requisite for employment. The information obtained enables the doctor
(and management also) to know the state of health of the employee. It provided base-
line data, which are invaluable for follow up in subsequent years. However, it has been
found that the majority of people who submit themselves for medical examinations are
sufficiently in good health to be passed as "normal" and consequently, can be first
screened by the nurse. Only those cases requiring more detailed examination should be
left for the doctor. The nurse is therefore, permitted to pass somebody as "fit" but not
"unfit". It is the doctor's responsibility to declare somebody unfit for any particular job
in the organization. The use of the nurse in this way saves doctors valuable time to
attend to more serious problems (Asogwa, 2007).
14.8 Characteristics of Pre-Employment Health Assessment

It must give the indices of health states such as name, age, sex, temperature and blood
pressure, urine analysis, blood profile, chest x-ray results, state of the skin, visual
acuity, and history of previous ill health or surgical intervention. In women the
menstrual history must be taken and recorded for future references.
14.8.1 Advantages of Pre-Employment Health Assessment

i. It provides a base-line data with which the employees' subsequent health record can
be compared.
ii. It is a valuable means for diagnosing and treatment of physical defects as revealed
during the pre-employment evaluation.
The basic purpose of this test is in two folds: to ensure that the employee will not suffer
ill health as a result of the work to be engaged in. Secondly, it helps to ensure that other
workers will not be endangered as a result of any defect in the employment.
14.8.2 Pre-Placement Health Assessment

This type of examination can take the form of the initial pre-employment health
assessment or a special medical examination where the job may require some specific
attributes as regards the mental and physical demand of the job to be performed. If a
person is found during a pre- employment medical examination to be unfit for a
particular job within the Organisation but fit for another job, the doctor should advise
that he be employed and placed in the job he is best suited for. For example, if during
the pre-employment medical examination of unskilled workers seeking employment in
the catering services, one is found to be malnourished he could still be employed, but
instead of doing general duties, he could be kitchen porter.
Pre-placement medical examination could be a special medical examination following

illness or injury when management requests that work men be reassessed for suitability
to return to his previous job. This is often called "request medical". After a worker has
been medically examined, the doctor will be able to advice management on the best
employment for him according to his present state of health vis-à-vis the various jobs
available in the plant.
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The problem that may arise from pre-placement medical examination is failure of either
the worker or management or both to accept the position recommended. The worker
may reject the position on the grounds that he did not initially apply for the position or
because the salary is too low or the working conditions unacceptable. Management may
not have the type of job best suited to the person at the particular time. The issue may
have to be resolved by a discussion between the parties (workers), management and the
doctor to arrive at a mutually accepted solution. Occasionally, inspite of all efforts,
suitable employment cannot be offered to the worker by the organization and he is
therefore, rejected on medical grounds.
14.8.3 Periodic Health Assessment

The period medical examination should be carried out at regular intervals after the
initial medical examination. It is not always necessary to conduct a full-scale medical
examination of workers during these routine periodic tests, especially if there are no
overt signs of illness. The nature of this selective medical examination should depend
on special risks involved and to what extent the worker has been disabled. This
examination is to ensure that the employees working in certain occupation environment
example quarries, mines, oil rigs, those employed in lead industries etc. continue to be
in good health. This is in line with the ILO recommendations of improving the quality
of life by advising on preventive measures to people exposed through their occupation
to physical and psychological risks.
In some occupations or trades, it is mandatory that periodic health assessment is carried

out. The period between each will depend on the type of health risks involved, example,
constant exposure of radiographers to radiation, cement workers to dust and laundry
workers to higher level of noise. People who are exposed to radiation should be
examined every six (6) months or every three months depending on the degree of
radiation hazards to which the worker is exposed. Similarly, those who work in noise
environment such as the engineer's rooms of a ship, require audiometry as the most
important test. Coal miners and others working in organic and inorganic environments
need radiological examination of the chest and lung function test to detect various forms
of obstructive and restrictive lung diseases. They also need special emphasis on the
respiratory system during clinical examination.
If the worker is found to be ill during the period of medical examination, he should be
referred to the doctor for thorough medical examination including laboratory
investigations. A special form needs to be designed with emphasis on the most relevant
aspects. If after the medical examination, the doctor discovers that the worker is no
longer fit for that particular job or should be placed on "light duty", the management
should be informed and they discuss on what should be done to save the life of the
employee.
After the medical examination and the appropriate action, the record should be filed in
the workers confidential file which should be only accessible to the doctor or nurse if
so delegated. Details of the worker's health condition can only be communicated to the
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management on written consent by the worker. High degree of confidence on the side
of both doctor and nurse is very necessary.
Return to Work for Injury or Illness Assessment or Request Medical Examination
From time to time, management requests the doctor to conduct a medical examination
on a worker so as to recommend the best job he is able to do following illness or injury.
This examination has to be conducted by the doctor and not to be delegated to the nurse.
The medical examination should consist of the usual history and physical examination,
laboratory and other investigations including radiography if indicated, may be carried
out. After, the doctor should interview the worker with regards to his job before illness
or injury and what job he would like to do, giving his present limitations.
The doctor has to weigh the possibilities of the workers continuing in his former job by
retaining him against fresh training for a new job. Request medical examination is also
carried out to be certain that a man who has applied to be retired on health grounds
should go. The evaluation will aid the health unit to update its records and will also help
the employee who may be required to be placed in a job that will not endanger or
precipitate other problems. It also helps in planning the rehabilitation of the employee.
14.8.4 Pre-Retirement Health Assessment/Outcome Evaluation

Though very desirable, not all employers of labour subscribe to the assessment. The
assessment is undertaken to measure the health status of a staff that is about to retire.
This information obtained during the preretirement assessment will offer the health care
provider opportunity to counsel the client on maintenance in retirement. The advice
given should include education on adequate diet, exercise in moderation and the
importance of taking prescribed medication. Ailment or disease may be discovered
during the exercise, that client should be referred for expert management.
14.9 SUMMARY
In this unit, we have discussed various types of evaluation and how each can be used in
ensuring effective means of ensuring and protecting the health and safety of workers.
Akinlolu, F.O. (2004). Applied Occupational Nursing in Developing Countries, Lagos:

Folsa Health Consult.
Akinsola, H.H. (1993). A - Z Community Health Social Medicine in Medical and

Nursing Practice: with reference to Nigeria Ibadan. 3 a.m. Communication.

Countries. 3rd Edition. Enugu: Snaap Press Ltd.
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Edmund, G.W. and Edward, S.B. (1995). Annals of American Academy of Political and
Social Sciences 239, the disabled Veteran PP 175 - 181.
14.11 Answers to TUTOR-MARKED ASSIGNMENT

Explain the term evaluation as it relates to occupational health practice.
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UNIT 15 WORKPLACE HEALTH MANAGEMENT
Module Structure
MODULE 3 OCCUPATIONAL SAFETY REQUIREMENT AND PRACTICE
Unit 15 Workplace Health Management
Unit Structure
15.1 Introduction
15.3 Workplace Health Management
15.3.1 The Healthy Workplace setting
15.3.2 The Healthy Community setting
15.4 Changing nature of working life and challenges
15.5 Workplace Health Policies
15.5.1 Key steps in developing workplace health policies
15.5.2 Key steps in implementing workplace health policies
15.6 Key benefits of workplace health management
15.7 The role of the World Health Organization and International Labour Organisation
15.8 Summary
15.0 INTRODUCTION
This unit provides guidance to employers and employees on establishing workplace
health management systems within their own organizations. On how to determine and
develop the role and functions of the occupational health nursing specialist within each
enterprise and where to go for additional help and advice in relation to occupational
health nursing.

By the end of this unit you should be able to:
• Describe the Changing nature of working life and the new challenges.
• Describe he need for improved workplace health management.
• State the role of the World Health Organization and International Labour Organisation
• State various steps of Workplace Health Policies
• State the benefits of workplace health management
15.3 Workplace Health Management

There are four key components of workplace health management:
• Occupational Health and Safety
• Workplace Health Promotion
• Social and lifestyle determinants of health
• Environmental Health Management
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In the past occupational health policy was frequently driven solely by compliance with
legislation. Thus in some countries like the Countries of Central and Eastern Europe
(CEE) or Newly Independent States (NIS) health and safety legislation was very
detailed with an attempt to describe almost every procedure needed for appropriate
health and safety practice. In the new approach to workplace health management, policy
development is driven by both legislative requirements and by health targets set on a
voluntary basis by the working community within each enterprise.
In order to be effective Workplace Health Management needs to be based on

knowledge, experience and practice accumulated in three disciplines: occupational
health, workplace health promotion and environmental health. It is important to see
workplace health management as a process not only for continuous improvement and
health gain within the enterprise, but also as framework for involvement between
various agencies in the community. It offers a platform for co-operation between the
local authorities and business leaders on community development through the
improvement of public and environmental health and contributes towards the
development of social capital. Social capital is understood here as the capacity of the
local community to provide all of its citizens with a good living and working life in a
sustainable way.
Workplace health management implies that industrial enterprises and other

organizations actively manage their health, environment and safety performances.
Efforts involving education, housing, public works and community groups, including
businesses, schools and universities and religious, civic and cultural organizations, are
aimed at enabling people in their communities to ensure sustainable development.
Furthermore, businesses and industries, including transitional corporations, should
recognize environmental management as among the highest priorities and as a key
determinant to sustainable development.
15.3.1 The Healthy Workplace Setting

The Luxembourg Declaration of the European Union Network for Workplace Health
Promotion (WHP) (November 1997) defined WHP as the combined effort of
employers, employees and society to improve the health and wellbeing of people at
work.
This can be achieved through a combination of:

• Improving the work organization and the working environment
• Promoting active participation of employees in health activities
• Encouraging personal development
Workplace health promotion is seen in the EU network Luxembourg Declaration as a

modern corporate strategy which aims at preventing ill health at work and enhancing
health promoting potential and wellbeing in the workforce. Documented benefits for
workplace health programs include decreased absenteeism, reduced cardiovascular
risk, reduced health care claims, decreased turnover, decreased musculo-skeletal
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injuries, increased productivity, and increased organizational effectiveness and the
potential of a return on investment. However, many of these improvements require the
sustained involvement of employees, employers and society in the activities required
to make a difference. This is achieved through the empowerment of employees enabling
them to make decisions about their own health. Occupational Health Nurses are well
placed to carry out needs assessment for health promotion initiatives with the working
populations they serve, to prioritize these initiatives alongside other occupational health
and safety initiatives which may be underway, and to co-ordinate the activities at the
enterprise level to ensure that initiatives which are planned are delivered.
In the past occupational health services have been involved in the assessment of fitness
to work and in assessing levels of disability for insurance purposes for many years. The
concept of maintaining working ability, in the otherwise healthy working population,
has been developed by some innovative occupational health services. In some cases
these efforts have been developed in response to the growing challenge caused by the
aging workforce and the ever-increasing cost of social security. Occupational health
nurses have often been at the forefront of these developments.
There is a need to develop further the focus of all occupational health services in Europe
to include efforts to maintain work ability and to prevent non-occupational workplace
preventable conditions by interventions at the workplace. This will require some
occupational health services to become more pro-actively involved in workplace health
promotion, without reducing the attention paid to preventing occupational accidents
and diseases. Occupational health nurses, with their close contact with employees,
sometimes over many years, are in a good position to plan, deliver and evaluate health
promotion and maintenance of work ability interventions at the workplace.
Health promotion at work has grown in importance over the last decade as employers
and employees recognize the respective benefits. Working people spend about half of
their non-sleeping day at work and this provides an ideal opportunity for employees to
share and receive various health messages and for employers to create healthy working
environments. The scope of health promotion depends upon the needs of each group.
Some of the most common health promotion activities are smoking cession, healthy
nutrition or physical exercise programs, prevention and abatement of drug and alcohol
abuse. However, health promotion may also be directed towards other social, cultural
and environmental health determinants, if the people within the enterprise consider that
these factors are important for the improvement of their health, wellbeing and quality
of life. In this case factors such as improving work organization, motivation, reducing
stress and burnout, introducing flexible working hours, personal development plans and
career enhancement may also help to contribute to overall health and wellbeing of the
working community.
15.3.2 The Healthy Community Setting

In addition to occupational health and workplace health promotion there is also another
important aspect to Workplace Health Management. It is related to the impact that each
enterprise may have on the surrounding ambient environment, and through pollutants
or products or services provided to others, its impact on distant environments. Although
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the environmental health impact of enterprises is controlled by different legislation to
that which applies to health and safety at work, there is a strong relationship between
safeguarding the working environment, improving work organization and working
culture within the enterprise, and its approach to environmental health management.
Many leading enterprises already combine occupational health and safety with
environmental health management to optimally use the available human resources
within the enterprise and to avoid duplication of effort. Occupational health nurses can
make a contribution towards environmental health management, particularly in those
enterprises that do not employ environmental health specialists.
The strengthening of environmental management in enterprises in order to promote a

process of continuous improvement was one of major commitments reached at the
Fourth Ministerial "Environment for Europe" Conference, Aarhus, Denmark, June
1998. As specified in the Policy Statement on Environment Management in Enterprises
in CEEC/NIS prepared by the Environmental Action Plan (EAP) Task Force Secretariat
the commitment should involve all relevant Ministries or preferably the government as
a whole. The governments should invite all relevant stakeholders to commit themselves
to support this process as well as establish a policy framework that provides appropriate
incentives for enterprises to adopt good environment management practices in
enterprises.
The UNEP International Declaration on Cleaner Production in 1998 defines it as “the

continuous application of an integrated, preventive environmental strategy applied to
processes, products and services to produce economic, health, safety and environmental
benefits”. The Declaration promotes the use of sustainable production and consumption
practices. It is certain that workplace health management in enterprises can be used to
help fulfil the above commitments reached in Aarhus and by those who sign the UNEP
Declaration.
Workplace health management, as defined in the new workplace health policies

developed at the enterprise level, are therefore seen to be vital for the improvement of
living and working conditions in Europe, for building human resources, and for the eco-
efficient use of natural resources. Improving and sustaining the use of human and
natural resources and being innovative and competitive, is not only important for the
success of the enterprise itself, but also for the health and safety of its employees, the
quality of working life and for the protection of the local and wider environment.
15.4 Changing Nature of Working Life and Challenges

The world of work has undergone enormous change in the last hundred years. To a
large extent the very heavy, dirty and dangerous industries have gone, and the burden
of disease, which came with them, in most European countries, has declined. However,
the new working environments and conditions of work that have replaced them have
given rise to new and different concerns about the health of the working population.
Exposure to physical, chemical, biological and psychosocial risk factors at work are
now much more clearly linked to health outcomes in the mind of the general public.
Expectations of society in regard to health at work have also changed, with increasing
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demands for better standards of protection at work and for the improvement of the
quality of working life. Employers are also recognizing that health-related issues, such
as sickness absence, litigation and compensation costs, increasing insurance premiums,
are expensive, ignoring them can lead to serious economic consequences. The best
employers' emphasize the important message that good health is good business, and
that much can be achieved in this field simply by introducing good management
practices.
15.5 New Workplace Health Policies

15.5.1 Key Steps In Developing Workplace Health Policies
The direct commitment of senior management and the participation of employees in the
development of workplace health policies are an essential prerequisite to the successful
implementation of policies that are designed to address the real needs of the working
community.
The following main steps and/or activities should be considered in the development and
implementation of workplace health management at the enterprise level:
• Develop a short policy statement from the employer or senior executive that
explicitly states senior management’s commitment to and acceptance of
responsibility for the workplace health management strategy within the
enterprise.
• Educate managers and workers on the impact of environmental, occupational
and lifestyle determinants on their health and social wellbeing and on the
economic situation and competing ability of the enterprise to facilitate their
participation in workplace health management
• Determine the role of the medical, nursing, environmental and safety experts and
other professionals needed to assist in the implementation of the workplace
health management strategy in the enterprise
• Discuss economic appraisal of existing and projected outcomes to health, safety,
and environmental health from the activities of the enterprise (the material flow
analysis guidelines of UNEP may be particularly useful).
• Train staff in quality management principles and standards to be used for the
workplace health management system. These are the same as those applied to
quality assurance in the management of manufacturing, servicing or marketing
operations
• Assure participation of management and employees in the development and
implementation of workplace health management systems in the enterprise
• Develop adequate tools for monitoring and evaluation of health, safety, social,
economic and environmental
• Outcomes (resources used and pollution/waste created = material flow) to
determine the impact on wellbeing of employees and competitiveness of the
enterprise
• Introduce systematic internal auditing and evaluation to be able to make
necessary adjustments to the workplace health management system of the
enterprise.
• External audit by a recognized certifying body, if necessary.
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15.5.2 Key Steps in Implementing Workplace Health Policies
The prerequisite for establishing good practice in workplace health management in
enterprises is the conscious and creative support as well as the fullest possible
participation of senior management, employees and their trade union representatives.
They would co-operate in the development of the workplace health policy and in its
implementation with the assistance of appropriate experts, e.g. from occupational health
services, environmental health services or health promotion agencies, preferably from
multidisciplinary preventive services. Quality management systems and internal and
external auditing is believed to be supportive to the creation and maintenance of a
healthy enterprise.
Leading enterprises are increasingly integrating their health management and

environment management into the overall corporate management system. The health
and environment policy of the enterprise determines targets, define processes, and
assure financial and human recourses necessary to act on the health determinants and
improve social and physical environments in order to:
• Create the greatest gain in health and working ability for the entire staff, and if
possible, also for their families
• Provide a safe and healthy working environment for employees
• While preserving the general environment and health of people living outside
the premises provide healthy and environmentally friendly products and services
• Ensure human rights of the entire staff
• Build up social capital.
15.6 Key Benefits of Workplace Health Management
Economic growth has been fundamental to the general improvement in health in the
Region during the last century. Health gain was achieved within a process of building
up social capital and also as a result of increasing investment in improving the working
environment, housing, nutrition, education, and health care and by addressing the other
needs of the whole population. Economic development has also recently been
associated with increased investments to reduce or eliminate pollution of different
environmental media. However, major differences in health status and economic
development still persist between countries of the European Region, and these
differences are largely associated with the economic and social policies dominating in
a particular country.
The average age of the work force is increasing very rapidly in several European
countries. With the current disability pension systems, a major proportion of the aged
work force fraction will be assumed to leave working life, and this trend will inevitably
be enforced by a higher rate of long-term unemployment amongst the elderly work
force. There is a need for a major reconsideration of the social policy and social
insurance policy in Europe, with an investment in protecting and promoting the working
ability of the economically active working population. The current trends will otherwise
lead to considerable problems in financing social security systems and maintaining the
important safety net that they provide. This will require changes to the social security
systems which operate in Europe to include systems of incentives that reward active
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participation in working life and early return to work following any period of illness or
infirmity. The active participation of employers, and their occupational health services,
will be required to achieve these goals. Occupational health nurses are well placed to
initiate, support and evaluate interventions which can be used to promote early, safe
and successful rehabilitation programs at the workplace. Investment in protection and
promotion of health, may not only support the wellbeing of the individual, but can be
justified on purely economic grounds. The World Development Report indicates that
improved health can contribute to economic growth in four ways.
1. It reduces production losses caused by worker illness;
2. It permits the use of natural resources that had been totally or nearly inaccessible
because of disease;
3. It increases the enrolment of children in school and makes them better able to learn
and increase their opportunity to have higher income in future; and
4. It frees for other uses resources that would be spent on treating illness.
The implementation of the new workplace health management in the enterprises that
respond to national policies in public health, health and safety, workplace health
promotion and environmental health management, as part of a comprehensive
workplace health management system can expect to reap some or all of the following
benefits.
Economic Benefits
• improves sustainable development at a national and enterprise level
• helps to protect the economic independence of the working population
• improved integration of disabled people into the economically active workforce
• increased productivity, competitiveness and profitability
• increased probability of economic investment
• improved self-regulation and adjustment of insurance system to seek benefits of
preventives activities
• increase probability of reduce social insurance premium
• increase probability of reduced costs of health care system
• more efficient use of existing knowledge and skills
• improved economic stability
Health Benefits
• increase life expectancy
• increase disability-free life expectancy
• increase working ability
• increased age of employees’ working potential
• increase proportion of employees free from occupational and work related diseases
and injuries
• increase percentage of employees and pensioners free from serious disability due to
chronic communicable diseases
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• increased proportion of society with healthy lifestyle
• increased equity in health between different professions, economic sectors and
countries
Social and Wellbeing Benefits
• Improved social image of enterprise
• Improved self-esteem of employees
• Increased quality of working life
• Improved compliance with existing legislation
• Increase employment opportunities for people with slight work disability due to
chronic diseases or injures
• Increased participation of employees in organization of their own work
• Increased awareness of society on social. environmental, occupational and lifestyle
health and wellbeing determinants
• Increase knowledge on effective use on natural resources
• Increased professional skills of employees
• Increase managerial skills of employees
• Increase ability of employees to cope with demands of working life
• Increased knowledge of employees on legal requirements and their rationale
concerning health and safety at work and environment management in enterprises
• Increase employability
• Increase potential for social justice
• Increase awareness of characteristics and social value of good enterprise management
• Increased transparency in HESM evaluation and decision making process
• Broader role of enterprise in social capital development
• Increased efficiency in using scientific research results in building up social capital
• Increase society awareness of determinants of sustainable production and consumption
• Increased efficiency of building up social capital through better understanding,
confidence and mutual support of political, social and economic society leaders
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Environmental Benefits
• Increased efficiency in using natural recourses
• Increased number of enterprises with improved pollution prevention mechanisms and
reduced wastes
• Increased number of enterprises managing environmental issue in compliance with
legal requirements
• Increased number of enterprises managing environmental issue using principles and
methods of such strategies as Cleaner Production, Eco-efficiency, Green Productivity,
and Pollution Prevention
Occupational health nurses, working independently or as part of a multi professional

occupational health service can make a significant contribution to the achievement of
these goals. As occupational health nurses are the single largest group of health care
professionals involved in delivering occupational health services in Europe their active
participation in and support of Workplace Health Management is essential if this
strategy is to succeed.
15.7 The Role of the World Health Organization and International Labour
Organisation
th
To assist countries in addressing these problems the 49 World Health Assembly
endorsed the Global Strategy: Occupational Health for All (12). Preventing
occupational accidents and diseases, protecting workers health and improving the
quality of working life is one of the priority objectives of the International Labour
Organisation (ILO). The ILO Conventions, particularly 155 and 161 as well as the
Recommendations and Resolutions in the field of occupational health and safety
represent important agreements between nations on strategies to improve workers
health and safety, and by so doing contribute to sustainable economic and social
development within those nations.
The Twelfth Session of the Joint ILO/WHO Committee on Occupational Health revised
the definition of occupational health in 1995 (previously agreed in 1950) to focus
primarily on three key objectives:
1. The maintenance and promotion of workers’ health and working capacity.
2. The improvement of working environment and work to become conducive to safety
and health; and
3. The development of work organization and working cultures in a direction, which
supports health and safety at work and in doing so also, promotes a positive social
climate and smooth operation and may enhance the productivity of the undertaking.
The concept of working culture is intended, in this context, to mean a reflection of the
essential value systems adopted by the undertaking concerned. Such a culture is
reflected in practice in the managerial systems, personnel policies, and principles for
participation, training policies and quality management of the undertaking.
This change demonstrates a broadening of the concept of occupational health from its
traditional primary role in preventing occupational injury and disease, which is still
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important, to extend further to include both occupational and non-occupational
workplace preventable diseases. Efforts to maintain work ability, prevent disability,
promote early rehabilitation and address all of the factors, which have an impact on the
health of the working population, now fall clearly within the remit of occupational
health.
It is recognized that state authorities, or inspection and enforcement agencies alone
cannot address these problems, but government agencies, industry, trade unions,
employees and health care professionals must be involved in a partnership approach.
By demonstrating that good Workplace Health Management is a key part of good
business management, with many economic, health and social benefits, including
increased productivity, reduced staff turnover, improved attendance and better
motivation within the enterprise, it is hoped that all enterprises will recognize the
important benefits which this approach is intended to achieve.
15.8 Summary
This unit describes the role of the occupational health nurse in workplace health
management, a new and exciting concept designed to improve the management of
health and health related problems in the workplace. Specialist occupational health
nurses can play a major role in protecting and improving the health of the working
population as part of this strategy.
Occupational health nurses can also make a major contribution to the sustainable
development, improved competitiveness, job security and increased profitability in
enterprises and communities by addressing those factors which are related to the health
of the working population. By helping to reduce ill health, occupational health nurses
can contribute to the increased profitability and performance of organizations and
reduce health care costs. Occupational health nurses can also help to reduce the
externalization of costs onto the taxpayer, by preventing disability and social exclusion,
and by improving rehabilitation services at work. By protecting and promoting the
health of the working population, and by promoting social inclusion, occupational
health nurses can also make a significant contribution towards building social capital
in their various place of work.
15.9 References/further readings

Baranski, B. (1999). Towards good practice in health, environment and safety
management in industrial and other enterprises. Copenhagen WHO Regional Office for
Europe.
Cost and Benefits of Occupational Safety and Health. Amsterdam, NIA TNO B.V.,
1998.
Environment 2010: Our Future, Our Choice. The Sixth Environmental Action
Programme of the European Community 2001-2010. European Commission. 2001.
European Commission. The Luxembourg Declaration on Workplace Health Promotion
in the European Union. Luxembourg, Office for Official Publications of the European
Communities, European Network for Workplace Health Promotion/BKK, 1997.
140
Equity in occupational health: report on a WHO meeting. Copenhagen, WHO Regional
Office for Europe, 1996 (document EUR/ICP/EPOL 08/MT01 (A)).
Griffiths, A. Aging, health and productivity: a challenge for the new millennium. Work
& stress, 11: 197-214 (1997).
th
Hunter, D. The diseases of occupations, 6 ed. Sevenoaks, Kent, Hodder & Stoughton,
1978.
Health and safety executive. Successful health and safety management. Norwich, H.M.
Stationery Office, 1998 (ISBN 07176 1276 7)
Healthy employees in healthy organizations : models of good practice in Workplace
Health Promotion (WHP) in Europe. Essen, Federal Association of Company Health
Insurance Funds (BKK Bundesver band), European Information Centre, 1999.
ILO Convention 155 & 161 Geneva, International Labour Organization, 1985
ILO/WHO. Report of the Joint ILO/WHO Committee on Occupational Health, Twelfth

Session. Geneva, International Labour Organization, 1995.
Mossinik, J. & Licher, F. Costs and Benefits of occupational safety and health.
Proceedings of the European Conference on 61
Oxenburgh, M. Increasing productivity and profit through health and safety, Australia,
CCH Australia Ltd. 1991
Occupational health nursing - contributing to healthier workplaces. London, published
jointly by the English National Board for Nursing Midwifery and Health Visiting and
the Department of Health, 1998. (ISBN 1 901697 10 X)
Rantanen, J. et al. ed. New Epidemics in Occupational Health. International
symposium. Helsinki. Finnish Institute of Occupational Health, 1994.
Rossi, K. and Heikkinen, M.R. A view of occupational health nursing practice. Current
trends and future prospects. Changes in society and working life in industrialized
countries. In: Radford. JM. ed Recent Advances in Nursing, Edinburgh, Churchill
Livingstone, 1990.
United Nations Environment Programme: Launch of the International Declaration on
Cleaner Production. Industry and environment, 21 (4): 26-27 (1998). UNEP Cleaner
Production Declaration http://www.unepie.org/Cp2/declaration/
Westerholm, P. & Baranski, B. Guidelines for quality assurance in the management of
multidisciplinary occupational health services. Copenhagen, WHO Regional Office for
Europe, 2000.
World Development Report. Investing in Health. New York. World Bank/Oxford
University Press, 1993.
WHO global strategy on occupational health for all. Geneva, World Health
Organization, 1995.
15.10 Answers
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UNIT 16 WORKPLACE REGULATORY REQUIREMENT
Module Structure
Unit 16 Workplace Regulatory Requirement

Unit Structure
16.1 Introduction
16.3 Workplace Regulatory Requirement
16.3.1 Occupational Safety and Health Act
16.3.1.1 OSHA Standards for General Industry
16.4 Hazard Communication Program
16.5 Chemical Safety
16.6 Emergency Action Plan (EAP) Standard
16.6.1 Walking/Working Surfaces Standard
16.6.2 Medical and First Aid Standard
16.6.3 Machine Guarding Standard
16.6.4 Lockout / Tag out Standard
16.6.6 Electrical Hazards Standard
16.6.7 Personal Protective Equipment (PPE) Standard
16.6.8 Respiratory Protection Standard
16.6.9 Occupational Noise Standard
16.6.10 Confined Spaces Standard
16.6.11 Blood borne Pathogens (BBP) Standard
16.6.12 Powered Industrial Trucks Standard
16.7 Federal Mine Safety and Health Act
16.8 Summary
16.1 INTRODUCTION
There are numerous regulatory concerns that must be taken into consideration that
affect workers and workplaces. Occupational health nurses (OHN) should be keenly
aware of the regulations that affect their specific workplace and strive to assist the
employer in achieving compliance. This chapter provides a summary of some common
workplace regulatory requirements; however this is in no means exhaustive.

At the end of this unit, the learner will be able to:
• describe the occupational safety and health act
• describe the hazard communication program
• state chemical safety measures
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• discuss the various emergency action plan standard
• state the federal mine safety and health act
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19.3 WORKPLACE REGULATORY REQUIREMENT
19.3.1 Occupational Safety and Health Act
The Occupational Safety and Health Act (OSH Act), established in 1970, is intended to
“assure safe and healthful working conditions for working men and women” (OSHA,
2011). The primary intention was to develop and enforce standards that would lead to
safe and healthful working conditions and to provide the mechanism for research,
information, education, and training in the field of occupational health and safety. This
Act led to the development of federal standards, but also allows states to develop and
enforce their own standards as long as they are at least as stringent as the federal
standards. The Act is administered by the Occupational Health and Safety
Administration (OSHA), a division of the U.S. Department of Labor, with leadership
from the assistant secretary of labor. The OSH Act addresses safety and health
conditions in most industries, including some public sector employers. Any employer
covered by the Act must comply with the regulations and standards. The prime principle
of the Act is that employers have a “general duty” to provide workers with a workplace
free from recognized hazards. The provisions of the Act are enforced by OSHA through
inspections and investigations. OSHA, through a consultation service, also provides
proactive assistance to employers to assist in the development of safety programs to
ensure compliance. This consultation is confidential and provided at no cost to the
employer. However, there is a caveat. If the employer does not heed the
recommendations of the consultation and correct serious hazards within the timetable
recommended, the consultation service will report the infractions to OSHA. The
workplace may then be subject to formal inspection. The OSH Act is a comprehensive
law, and it covers most employers.
OSHA’s General Duty Clause states that “no employee will suffer impairment of health
or functional capacity even if such employee has regular exposure to the hazard dealt
with by such standard for the period of his working life.” (OSHA, 2011). The
expectation is that all workers have the right to work in a workplace that is free from
recognized hazards that can cause or are likely to cause death or physical harm. It also
requires that all workers are must be compliant with OSHA standards, along with other
rules and regulations that are applicable to their work actions and job functions. The
OSH Act requires employers to notify workers, through awareness and training
programs, of hazards that exist in the workplace, and the employer is required to
maintain observant awareness of such hazards. Once aware of any hazards, the
employer is required to determine the approach to protect workers
(1) By eliminating the hazard,

(2) By containing the hazard, or
(3) By providing protection for workers.
The employer is then responsible for measuring and monitoring the level of hazard
exposure, as appropriate. The Act also requires the employer to establish a mechanism
for periodic health examinations and testing of workers who are exposed to specific
hazards that could adversely affect their health. These examinations are to be made
available by the employer at no cost to the worker.
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To enforce the Act, provisions authorize an OSHA compliance officer to enter any
workplace at any time to inspect and investigate the conditions and operations of the
workplace and to validate adherence to the applicable standards. The visit from an
OSHA compliance officer may be unannounced, meaning the officer may show up at
the workplace unexpectedly. Visits may also be triggered by notice of or by frequency
of accidents or even upon complaint from a worker. Should the employer attempt to
refuse access to the workplace by the compliance officer, the officer has the right to
obtain a legal warrant to inspect.
After the inspection tour, a closing conference is held between the compliance officer
and the employer and/or the employer representative. This provides an opportunity for
open discussion of findings and identification of any deficiencies, and it is a time for
questions and answers. If the inspection leads to evidence that the employer has violated
any section of the Act, the compliance officer is authorized to issue a citation to the
employer. Each citation is issued in writing and includes a description of the nature of
the violation, with reference to the standard, rule, regulation, or order that has allegedly
been violated. The citation includes a proposed resolution and the reasonable time
frame for compliance. The officer also has the right to levy fines against the employer
for violations. The employer is then required to post a copy of the issued citation in a
prominent location on company premises, thus visible to all workers. The citation
remains posted for 3 days or until the violation is abated, whichever is longer.
Employers have a right to appeal citations to Occupational Safety and Health Review
Commission (OSHRC) and may request an informal meeting with OSHA’s area
director to discuss the case. Workers also have the right to request an informal
conference with OSHA to discuss findings of the inspection, the citation, and notice of
proposed penalty.
The Act also requires employers to maintain accurate records connected to work-related
deaths, injuries, and illnesses that involve medical treatment or for those that result in
modification of the workers’ duties as a result of a work incident. These reports are
submitted to OSHA for the purposes of compiling the data for comparison to industry
standards. OSHA is also authorized to use this data for research purposes and may
publish the findings of any inspection or data from this record keeping.
OSHA also sponsors a Voluntary Protection Program (VPP). This program serves to
recognize the efforts of employers to provide worker protection by exceeding the
minimum standards required by OSHA. There are three VPP categories: Star, Merit,
and Demonstration. These VPP recognitions by OSHA serve to acknowledge
outstanding achievement by workplaces that have incorporated a comprehensive health
and safety approach their total management system through self-initiated efforts and
cooperation, rather than just meeting minimum standards out of regulatory necessity.
This means that the employers have voluntarily invited OSHA to conduct a
comprehensive inspection of their workplace. This inspection consists of a rigorous,
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interactive methodology that includes active participation by not only management, but
also by all workers.
Workplaces that achieve VPP status are recognized at an OSHA award ceremony,
receiving a certificate of approval and a VPP flag that can be proudly displayed at their
worksite and on marketing material. VPP Star sites must apply for recertification every
3 years.
The OSHA Training Institute (OTI) Education Center Program provides support for
OSHA’s training and education mission through a variety of safety and health
programs, including community outreach efforts. These programs are offered through
community-based training and educational institutions and serve to conduct approved
OSHA Training Institute courses. These institutions are selected through a national
competitive process and support OSHA training based on their normal tuition and fee
structures. This program serves as a valuable resource for employers for training
management and workers in the basics of occupational safety and health. Common
courses include training on occupational safety and health standards for general
industry and construction, hazardous materials, machine guarding, ergonomics,
confined space, excavation, electrical safety, and fall protection.
The OSH Act also served to create a National Institute of Occupational Safety and
Health (NIOSH), part of The Department of Health and Human Services (DHHS),
Centers for Disease Control and Prevention. NIOSH is the research body that serves to
provide assistance to OSHA by conducting research on workplace risks and workplace
health hazards. The findings of NIOSH research become the foundation for OSHA
standards, supporting new or revised safety and health standards, and for the
development of criteria for protection against toxic substances and physical agents. The
research conducted by NIOSH is based on findings of investigations and information
from worksites. Workers in certain industrial categories may also be summoned to
participate in NIOSH research efforts through medical monitoring and physical
examination for research purposes. The findings of such research serve to provide
information related to the incidence of work-related illnesses among groups of workers.
NIOSH also provides competitive funding for 17 university-based Education and

Research Centers (ERCs). These centers provide academic programs, continuing
education, training, and research opportunities in the core areas of industrial hygiene,
occupational health nursing, occupational medicine, and occupational safety. The ERCs
serve to educate occupational safety and health professionals in order to provide an
“adequate supply of qualified personnel to carry out the purposes of the Occupational
Safety and Health Act” (NIOSH, 2011).
16.3.1.1 OSHA Standards for General Industry

The following outlines some of the most common OSHA standards for general industry
(29 CFR 1910). OSHA guidelines call for a systematic identification, evaluation, and
prevention or control of general workplace hazards and the hazards involved in specific
jobs and tasks.
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16.4 Hazard Communication Program
This program is designed to ensure that employers and workers are aware of the
hazardous chemicals in the workplace and the protection that is necessary as a safeguard
to avoid exposure to chemicals that may be harmful. The employer is required to
establish and implement a written hazard communication program in order to comply
with the requirements of the standard. The basic concept of the standard is the right to
know, that employees have both a need and a right to know the hazards and the identities
of the chemicals they are exposed to when working. They also have the right to know
what protective measures are recommended and available to prevent adverse health
effects. The Hazard Communication Standard defines requirements for the evaluation
of all chemicals imported into, produced, or used in U.S. workplaces. This information
is to be made available to workers who may be affected by or exposed to these
chemicals. Hazard information must be provided through labels on containers and
through material safety data sheets (MSDSs). The employer is responsible for
awareness and training efforts for workers to inform them about the hazards of specific
chemicals used in their workplace.
16.5 Chemical Safety

Chemicals in sealed containers are required to have affixed labels that must remain
intact. The employer must maintain on file and provide workers access to MSDSs. A
written hazardous chemical program must detail the requirements for labels and other
forms of warning, material safety data sheets, and the process for employee information
and training. The employer’s training for workers must include information on the use
of the chemical and what actions to take in the event of a spill or leak.
The employer should ensure a standard approach to establishing compliance with the
Hazard Communication standard by following these steps:
1. Obtain a copy of the rule

2. Determine if the standard applies to the workplace
3. Identify responsible staff
4. Establish policies and procedures to maintain and evaluate the effectiveness of the
program
5. Identify hazardous substances in the workplace
6. Prepare and implement the program
7. Ensure that all containers are properly labeled
8. Obtain and make available to workers material safety data sheets for each chemical
9. Conduct employee awareness and training
All chemicals have the potential to cause health hazards. Exposures to chemicals may
occur by absorption, commonly through contact with the skin, splashes to mucous
membranes (such as the eye). Exposures may also occur through ingestion, or by
inhalation. Exposures that cause or may lead to acute health issues should be referred
to the OHN or to a healthcare facility immediately. When a worker has a significant
exposure to a hazardous chemical, first aid intervention is critical and the employer is
required to have supplies and equipment available for swift intervention. The second
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step is to retrieve a copy of the MSDS for that particular chemical to see what first aid
interventions are warranted and to identify potential health hazards that may result from
the exposure. If the worker is sent to an outside healthcare facility for further evaluation,
the MSDS should accompany the worker as a resource for the healthcare provider.
Because of the focus on chemical safety within this standard, most exposures are now
prevented by the use of protective clothing or apparatus; such as goggles, respirators,
impervious gloves and aprons, etc. One must remember, however that exposure to
chemicals may also have a cumulative effect and lead to chronic health conditions, such
as cancers, birth defects, blood dyscrasias, liver and lung diseases. Therefore, the
standard calls for routine health monitoring of workers exposed to specific chemicals.
16.6 Emergency Action Plan (EAP) Standard

OSHA recommends that all employers have a plan that addresses emergencies that may
reasonably occur in the workplace. There are also conditions in which an EAP is
specifically mandatory when required by an OSHA standard. An EAP describes the
actions workers should take to ensure their safety in the event of emergencies such as
floods, hurricanes and tornados, fires, release of toxic gases or chemicals, irradiation
accidents, or explosions. Workplaces are also required to have established emergency
action plans in the event of workplace violence.
An EAP is a written document that addresses the procedures for reporting workplace
emergencies. It includes evacuation procedures and emergency escape routes,
assignment of employees who are critical to business operations during evacuation,
procedures to account for all workers after an emergency evacuation, along with rescue
and first aid duties for certain workers.
The emergency escape plan should define who is authorized to order an evacuation and
under what conditions an evacuation would be necessary. The plan should also outline
how workers will evacuate, and what routes they will take. Exit diagrams are typically
used for this purpose.
The plan should also define the workers who are critical to business operations during
and after evacuation. Such workers would be required to operate fire extinguishers or
shut down gas and/or electrical systems. They may also be responsible for operation of
equipment that is critical to business functions or address operational issues that could
create additional hazards during emergency response efforts. The plan should also
include procedures to account for workers after evacuation to ensure that all workers
have safely evacuated. Workers who evacuate should be assigned to specific assembly
areas, and the plan should identify a person responsible for conducting a roll call of
workers. The plan may also outline specific rescue duties of certain workers, those well-
trained in emergency response and first aid, to ensure appropriate triage for workers in
need of further health evaluation.
Additional aspects of the standard require that an alarm system be in place to notify
workers of such an emergency, and to ensure all workers know the actions to take
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should the alarm activate. The standard has provisions for training of all employees on
initial hire and at times when revisions are made to the plan.
Although not specifically defined in the standard, it is prudent for the employer to
ensure provisions are made for workers with impairments or disabilities. Examples
would include evacuation alarm notices that have provisions for hearing-impaired
workers; such alarms would not only be audible, but also visual. Evacuation plans
should include providing support to sight impaired workers and those who are
physically incapacitated.
16.6.1 Walking/Working Surfaces Standard

The OSHA standards for walking and working surfaces applies to all permanent places
of employment The only exceptions are those in which domestic, mining, or
agricultural work is performed. The standard addressed requirements regarding breaks
in elevation and single points of access/egress to allow for ample passage by workers.
The standard also addresses requirements for fall protection for elevated work surfaces,
stairways, and ladders. A requirement for floor guarding for openings and holes in
flooring or ground surfaces is also addressed. The standard also includes
recommendations for the use of mobile ladders, scaffolds, man-lifts, and mounted and
powered platforms.
16.6.2 Medical and First Aid Standard (29 CFR 1910.151)

OSHA requires employers to make provisions for first-aid interventions and health
evaluations of workers. The specifics of a workplace health and first-aid program are
dependent on the unique operations of each workplace, the hazards involved, and its
resources. The aim is to provide prompt attention to workplace incidents and injuries
in order to minimize these events. The employer is required to provide first aid supplies
and equipment that are readily accessible to workers and to first aid providers.
The employer is also expected to establish a relationship with community emergency
medical services (EMS) and local fire rescue. For industries with high risk operations,
it is also prudent to establish relationships with local healthcare providers and
emergency departments. The OSHA First Aid standard also requires “trained first-aid
providers at all workplaces of any size if there is no infirmary, clinic, or hospital in near
proximity to the workplace which is used for the treatment of all injured employees”
(OSHA, 2011). In workplaces where there is risk of extreme exertion, asphyxiation,
electrocution, or other such danger, the OSHA standard requires training of workers in
cardiopulmonary resuscitation (CPR). This requirement specifically applies to
workplaces with confined spaces, logging operations, electric power generation, and
dive operations.
The American National Standards Institute (ANSI, 2011) defines standards for
workplace first aid kits (ANSI standard, Z308.1-2003). Kits sold to and purchased by
employers for use in the workplace must meet the performance standards set forth by
ANSI. There are specific classifications for kits used in the workplace:
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Type I: This kit is intended for indoor use only. It is appropriate for office or service
industries, as well as for light manufacturing settings. The kit is not intended to be
portable and should be place in a fixed location, most likely mounted to the wall.
Type II: This kit, intended also for indoor use, is usually equipped with carrying
handles, thus making it portable and valuable for response to remote locations. This
type is suitable for use in services, light manufacturing, or light industrial settings.
Type III: The kit is appropriate for use in heavy manufacturing, construction,
transportation, and other heavy industrial settings because it is moisture resistant, has
little potential for damage, and is portable.
Recent advances in technology have provided the availability of automated external

defibrillators (AEDs) that can be placed in workplaces. These AEDs are appropriate for
work settings with high potential for sudden cardiac arrest. The presence of an AED in
the work setting is not only a benefit for workers, it is also a benefit for the general
public who frequent that setting. Common settings for AEDs aside from high-risk
industry include shopping malls, public libraries, government or municipal buildings,
theaters, and event locations.
Each workplace should assess its own requirements for an AED program as part of
establishing a first aid response protocol. Issues that should be considered when
implementing a workplace AED program include physician oversight to write the
prescription for the AED and provide medical direction; compliance with local, state,
and federal regulations; location of the AED in the work or public setting; coordination
with local EMSs; a quality assurance program; and medical director review of events
requiring use of the AED.
Additional information and guidance for developing an AED program for the worksite
can be found at the following websites:
• OSHA at www.osha.gov
• American College of Occupational and Environmental Medicine at www.acoem.org
• American Heart Association at www.americanheart.org
• American Red Cross at www.redcross.org
• Federal Occupational Health at www.foh.dhhs.gov
• National Center for Early Defibrillation at www.early-defib.org
16.6.3 Machine Guarding Standard (29 CFR 1910 Subpart O)

Employers with workers who operate machinery (e.g., saws, power presses, moving
conveyors, etc.) are required to comply with the machine-guarding requirements.
Many hazards can be created by moving machine parts, leading to crushed hands and
arms, lacerated fingers, extremity amputations, and other serious injuries. The OSHA
standard for machine guarding requires that “any machine part, function, or process
which many cause injury must be safeguarded. When the operation of a machine or
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accidental contact with it can injure the operator or others in the vicinity, the hazards
must be either controlled or eliminated.” (OSHA, 2011)
There are four strategies to machine guarding:

1. Prevent contact: Protection of hands, arms, and any other part of a worker’s body
eliminates the possibility of the worker or other workers placing parts of their bodies
near hazardous moving parts.
2. Secure: The machine guard should not be able to easily remove or tamper with and
must be firmly secured to the machine.
3. Protect from falling objects: Care must be taken to avoid falling objects that can land
on moving parts of the machinery.
4. Create no new hazards: A safeguard should not create a hazard in and of itself.
5. Create no interference: The safeguard should not impede a worker from performing
the job efficiently. If so, it may provoke the workers to override or disregard the
machine guarding.
6. Allow for safe lubrication of the machine: Maintenance workers should be able to
lubricate the machine without removing the safeguards.
Machine operator training should involve instruction or hands-on training that includes
identification of hazards and their specific safeguards; the purpose of and reasons for
the safeguards; how and for what reasons machine guards can be removed; and steps to
take when a machine guard is missing or when it malfunctions.
16.6.4 Lockout/Tagout Standard

Employers are required to establish measures for controlling hazardous energy
(electrical, mechanical, hydraulic, pneumatic, chemical, thermal, and other energy
sources) as a safeguard for workers. This requires that those servicing machinery or
equipment provide the necessary safeguards against the unexpected startup of the
machinery or equipment. This is done by affixing appropriate lockout or tagout notices
to the device. This standard was established to avoid physical harm as a result of the
discharge of hazardous energy while the machinery or equipment is being serviced. It
also serves as a safeguard to prevent the machine or equipment being turned on by
another worker while it is being serviced. The standard requires that machines or
equipment be de-energized (lockout) or tagged with appropriate notice (tagout) to
provide a level of safety by providing adequate notice to workers. Lockout prevents use
of the machine or equipment by disabling its operations so workers cannot turn on the
machine/equipment. Tagout prevents use by providing appropriate written notice on the
machine that it should not be used. This tag would be located at the area where the
machine could be powered on.
The standard also requires that workers receive training regarding the control of
hazardous energy and avoiding serious physical harm to or death of workers. Workers
must receive training on procedures related to the unexpected energy discharge or
unexpected start-up of the machinery or equipment should it occur. Workers must also
receive training on how to apply the appropriate lockout or tagout devices. Training is
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intended to ensure that workers understand and follow the appropriate provisions for
the lockout/tagout out program.
16.6.5 Electrical Hazards Standard

Electrical and wiring deficiencies are among the most common violations that receive
OSHA citations. OSHA’s Electrical Hazards Standard includes recommendations for
design of electrical systems and safety-related work practices. The standard applies to
engineers, electricians, and other professionals who work with electricity directly,
including those working on overhead lines, cable harnesses, and circuit assemblies. The
standard establishes electrical safety requirements necessary for the practical
afeguarding of employees in their workplaces (OSHA, 2011).
The standard addresses four components for electrical safety:
(1) design safety standards for electrical systems;
(2) safety-related work practices;
(3) safety-related maintenance requirements, and
(4) safety requirements for special equipment.
16.6.6 Personal Protective Equipment (PPE) Standard

The first line of defence in protecting workers from hazards involves engineering
controls physically changing a machine or work environment by removing or
controlling the hazard. The second line of defense, if the hazard cannot be eliminated
or controlled, involves implementing and training workers on ways to perform the job
to reduce their exposure to workplace hazards.
OSHA generally considers PPE to be the third and last option for controlling worker
exposure. If the employer determines that it is necessary for workers to use PPE, the
employer must select the appropriate PPE for the hazard and require its use.
Examples of PPE include, but are not limited to, face shields, safety glasses/ goggles,
hard hats, safety shoes, coveralls, gloves, vests, aprons, earplugs, and respirators.
Employers are required to communicate the requirement for and availability of PPE for
workers; however, this is not enough. The burden is on the employer to routinely
monitor workers’ compliance with the use of PPE and reinforce the standard.
16.6.7 Respiratory Protection Standard (29 CFR 1910.134)

OSHA’s respiratory protection program applies to workers who are exposed to airborne
contaminants at a hazardous level (dust, grains, lead, pesticides, airborne bacteria, etc.)
and for work conditions where the air is oxygen-deficient (mines, confined spaces, fires,
etc.). The standard clearly states that the use of a respirator for protection should be
considered only after exhausting all engineering control efforts, or while these controls
are being instituted. Several other OSHA regulations specifically require the use of
respirators for health hazard protection when workers are exposed to certain health-
compromising contaminants.
The required components of a respiratory protection program include provisions for

selection of the respirator, medical clearance for respirator users, procedures for proper
use, respirator fit testing, and respirator maintenance procedures. In other words, the
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worker must be medically fit to wear the respirator and must wear the appropriate
respirator for the associated work conditions. In order to do so, the worker must undergo
health evaluation and testing to ensure that the respirator is the appropriate fit for
protection. The cost of these evaluations must be covered by the employer. The
employer must also ensure that the worker receives adequate training on the proper use
and Maintenance of the respirator.
Types of Respirators
There are different types of respirators used in the workplace. The first type is the air-
purifying respirator.
• Particulate respirators capture particles in the air, such as dusts, mists, and fumes.
Typically called face-filtering respirators, they do not protect against gases and vapors.
• Gas/vapor respirators are used when there are hazardous gases and vapors in the air.
They contain chemical filters (cartridges or canisters) and are made to protect against
specific gases or vapors.
• Combination respirators have both particulate filters and gas/vapor filters.Another
type of respirator used in the workplace is the atmosphere-supply respirator.
• Air-supplied respirators provide a supply of clean air for long periods of time. They
are lightweight and use a hose to deliver clean air from a fixed source of compressed
air. Use of this type of respirator limits the mobility of the wearer.
• Self-contained breathing apparatus (SCBA) consists of a wearable supply pack of
clean air, and as a result kit does not restrict movement of the wearer. Common use of
SCBA is in firefighting. For work performed underwater, a self-contained underwater
breathing apparatus (SCUBA) should be used.
Combination respirators have an auxiliary wearable supply pack of clean air that can
be used if the primary fixed supply fails. It is typically used for work in confined spaces.
16.6.8 Occupational Noise Standard

Since there are no visible effects of hearing loss, it often goes undetected until it has an
effect on communication and responsiveness on the part of the worker. OHSA’s
Occupational Noise Standard is designed to protect the hearing of workers who are
exposed to significant noise as a part of their work duties.
This standard is based on the principle that the health effects of noise exposure are
dependent on the intensity and duration of the exposure. The health effect is primarily
a loss of or reduction in the worker’s hearing. These effects may be temporary, usually
as a result of short-term exposure, after which normal hearing returns. Or, the effect can
be permanent, usually related to exposure to high-pitched noise over a prolonged period
of time. OSHA requires employers to determine if workers are exposed to excessive
noise in the workplace. If so, the employer may be required to implement a hearing
conservation program.
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The standard requires employers to monitor noise exposure in areas of the workplace
to determine if workers are exposed to noise at or above 85 decibels (dB) over an 8-
hour work shift (8-hour time-weighted average [TWA]).
These work areas are usually in places where noise is generated by machinery, power
tools, or other operational causes. If the noise level exceeds the permissible exposure
limit (PEL), the employer must first consider engineering or administrative controls to
reduce the noise level. If the noise cannot be eliminated or controlled, the employer
must implement a hearing conservation program.
A hearing conservation program consists of worker training, the use of hearing

protection, and periodic audiometric (hearing) evaluations of the workers. The
employer must provide hearing protectors to all workers exposed to an 8-hour TWA
noise level of 85 dB or higher. The protectors must be effective in reducing the workers’
exposure to the noise to 90 dB or lower. The employer must then establish and maintain
an audiometric testing program. The testing program is intended to test all workers at
the time they begin work in the noise-induced area in order to provide a baseline of the
worker’s current hearing. Annual audiograms are performed thereafter, as long as the
worker remains in the noise-induced work area. A comparison of the annual audiogram
to the baseline test is conducted to determine if the worker has incurred hearing loss,
defined as a standard threshold shift (STS), as a result of working in the noise-induced
area. An STS is determined by calculating the results of the audiometric tests at 2,000,
3,000, and 4,000 hertz. If an average shift in either ear of 10 dB or more is identified,
and no other causes of hearing loss can be identified by the occupational healthcare
provider, the worker must receive additional training and counseling on hearing
protection or be removed from the noise-induced area. Workers who terminate
employment or transfer to a non-noise area of the workplace participate in an exit
audiogram to memorialize the hearing of the worker at that time they exit the hearing
conservation program.
The standard requires training, at least annually, of workers who are in the hearing
conservation program. The training includes information on the effects of noise
exposure, the purpose of the use of hearing protectors, the proper selection, fit, and care
of the hearing protectors, and the purpose of audiometric testing. The standard also
requires employers to maintain record keeping of the workplace noise exposure
measurement results for 2 years and must also maintain records of the worker’s
audiometric test results for the duration of the worker’s employment. The employer is
also required to make these records available to current workers, former workers,
representatives of the workers, and to OSHA.
16.6.9 Confined Spaces Standard

Many workplaces contain spaces that are considered “confined” because their
configurations hinder the movement of the worker who must enter, work in, and exit
from them. Examples of confined work spaces would include work in vessels, sewer
lines, mines, containers, crawl spaces, etc. A general principle of a confined space is
that the worker must enter and exit through narrow openings and/or perform work tasks
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while in a limited space, thus preventing free movement. It also takes into consideration
the type of work the worker is performing while in the confined space. Some work
performed in a confined space can lead to the potential for the worker to be exposed to
a variety of hazards, including toxic or flammable gases/vapors, oxygen-deficient air,
and airborne contaminants. The potential for asphyxiation, incapacitation, and the
inability of self rescue, injury, or even death are possible in confined spaces.
If the employer determines that a worker must perform work in a confined space, a
confined space entry permit may be required. Some key principles in evaluating the
workplace to determine if any spaces are permit-required confined spaces include:
1. Is the space large enough that a worker can bodily enter?

2. Is the space configured so that a worker can enter to perform work fully or partially
inside?
3. Does the space in question have limited or restricted means for entry or exit?
If permit spaces are present and workers are required to enter such spaces, the employer
must develop and implement a confined space program, which is an overall plan for
protecting workers. An important element of the requirement is that entry of workers
into confined spaces is allowed only by a written entry permit issued by the employer.
The employer is required to identify confined spaces with signs, and entry must be
limited to only authorized workers. The standard specifies strict procedures for
evaluation and atmospheric testing of a confined space before and during entry by
workers. When workers are performing work in a confined space, the standard requires
that the confined space entry be attended outside the space by an attendant who is
trained and equipped to respond to emergencies that may occur with the worker in the
confined space. Provisions must also be made for rescue of the worker in the event of
an emergency. The standard specifies training requirements and specific duties for
authorized entrants, attendants, and supervisors. Rescue service provisions are required,
and where feasible, rescue must be facilitated by a non-entry retrieval system, such as
a harness and cable attached to a mechanical hoist.
16.6.10 Bloodborne Pathogens (BBP) Standard

Recognizing that exposure to bloodborne pathogens present risk of serious and
sometimes life-threatening illnesses, the BBP standard requires the use of engineering
and work practice controls to eliminate or minimize exposure to bloodborne pathogens.
This standard is applicable to all healthcare and emergency response workers. It is not
only applicable in healthcare-related workplaces, but also applies when workers are
assigned as emergency or first aid responders in the general workplace. In addition, the
standard applies to workers who are not direct caregivers, those who handle potentially
infectious waste (janitors, maintenance workers, medical devise handlers), and those
who may be exposed to risk as a part of other job duties (housekeeping, linen facilities).
The standard requires that such employers establish an exposure control plan, a written
plan intended to eliminate or minimize the risk of be BPP exposures. The written plan
identifies workers in job classifications that would be at risk and a list of job duties
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performed by those workers that might result in exposure. The employer is required to
update the plan annually.
A hallmark of the standard is the use of universal precautions. The key principle of
universal precautions is that all human blood and other potentially infected material is
considered to be infectious and puts the worker at risk for a blood borne pathogen
exposure. As a result, specific procedures must be in place for handling and disposing
of contaminated sharps and medical instruments, handling of specimens, disposing of
contaminated waste, and handling of soiled laundry. The standard has led to the
development of many improvements, such as impervious sharps disposal containers,
safer medical devices and procedures, and self-retracting or self-sheathing needles.
Sharps containers and containers of contaminated waste must be labeled and identified
as communicable hazards. Regulations for the storage, transport, and shipment of
potentially infected material were also established as part of this standard.
The employer must provide personal protective equipment (PPE) to all workers at risk
of exposure. This includes gloves, gowns, eye protection, and masks. The standard also
requires employers to provide training regarding the potential for exposure and the use
of PPE, and to make available hepatitis B vaccinations to all workers with the potential
for bloodborne pathogen exposure. This training and the offer of vaccination must take
place within the first 10 days of initial assignment to a job with potential exposure.
Should the worker decline vaccination for hepatitis B, a signed notice of declination
should be placed in the workers file. Training must also include information on the
possible mechanisms of exposure to blood or other potentially infectious material,
including incidents in which the worker incurs exposures by penetration of the skin and
through splashes onto the skin or into mucous membranes. Workers must receive
training on the appropriate methods of reporting such exposures, and the employer is
required to provide medical evaluation regarding the exposure at no cost to the worker.
The standard requires healthcare employers to maintain a sharps injury log as part of
their record keeping and reporting of occupational injuries and illnesses.
16.6.11 Powered Industrial Trucks Standard

This standard defines powered industrial trucks as anything used to carry, push, pull,
lift, stack, or tier materials. This standard was developed in an attempt to reduce injuries
and illnesses as result of careless use of mobile equipment as part of the worker’s job
duties. Injuries occur not only to the mobile equipment operator, but incidents involving
mobile equipment can also lead to considerable damage to company property and injury
to others. Examples of such incidents and injuries include mobile equipment accidents,
pedestrian incidents as a result of being struck by mobile equipment, material that falls
while being stacked at elevated levels, driving mobile equipment off an elevated
platform or dock, and damage to overhead structures by lift equipment. It is
acknowledged that most incidents and injuries are a result of unsafe use and operation
of the equipment because workers have received insufficient or inadequate training on
mobile equipment safety (OSHA, 2011).
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The standard requires the employer to provide training to mobile equipment operators
on a variety of topics. Among these topics are vehicle inspection and maintenance that
the operator will be required to perform. The standard requires that all mobile
equipment be examined at least daily before being placed in service. Forklifts used on
a round-the-clock basis must be examined after each shift.
• Pre-operation
Workers must be trained on pre-operation inspection of the equipment. This includes
knowing when equipment should be removed from service and when maintenance is
indicated.
• Traveling and maneuvering

Workers must receive training on mounting and dismounting the equipment.
Instructions must be given on starting and stopping, appropriate operating speeds,
audible notice to pedestrians, changes in direction, and parking. Practices for safe
travel, including travel on inclines and on even surfaces must be covered. Procedures
for pedestrian safety and procedures in the event of tip-over must also be covered.
• Load handling
Mobile equipment is most often used to handle product. Training must include
procedures for appropriately positioning the mobile equipment, lifting and lowering the
load, and entry into other vehicles, such as truck trailers and railroad cars.
The employer is required to certify that each mobile equipment operator has received
the appropriate training and has been evaluated and determined competent to operate
the equipment. Although testing is not required, it is prudent for the employer to ensure
the worker has a firm knowledge about the operation of the equipment. A written
training certificate should include the date of the training, the date of the evaluation and
the evaluator’s signature. Annual recertification is not required; however, retraining is
indicated whenever the worker has been observed operating the equipment in an unsafe
manner, when the worker incurs a near-miss incident, or when the worker is involved
in an accident. The worker must also receive training if they are assigned to operate a
different type of equipment or when the workplace conditions change significantly.
Although not required by regulatory statute, it is prudent that the employer establish
that the worker is physically fit and capable of performing the essential functions of
operating mobile equipment on the job. Key aspects of medical evaluation should
include review of a comprehensive medical history to identify any medical conditions
of concern, such as uncontrolled high blood pressure, vision disorders, cardiac
arrhythmias, and neurological disorders.
The examination should include evaluation of the blood pressure and vision, at a
minimum. A sample evaluation form for mobile equipment operator fitness for duty is
provided in Appendix 9.
In addition to the preceding Standards for General Industry, OSHA also publishes a set
of standards specific to the construction, maritime, and agriculture industries. Although
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these industries must also comply with the general industry standards, the industry-
specific standards supersede the rules intended for general industry (Rogers, 2004).
16.7 Summary
The OHN plays a key role in developing health and safety policies and procedures for
the workplace. In order to be most effective in this role, the OHN must know which
specific regulations apply to company operations.
The regulations discussed in this unit all fall under the realm of the OHN in efforts to
establish and maintain mechanisms for regulatory compliance. Management
commitment to maintaining a safe and healthful workplace is crucial, and the OHN
must ensure that management understands their responsibility for protection of workers
through compliance with appropriate regulations. Workplace hazards are identified
through comprehensive hazard assessments and periodic monitoring and plans to
eliminate or control hazards and protect workers should be a priority. Safety and health
training for all workers, including management will not only ensure compliance with
certain regulatory standards, but will also serve to create awareness of the potential
impact of workplace hazards on the health and well-being of workers.
The OHN must strive to stay abreast of any additions or revisions to these laws. In
most cases, these changes will not be published directly to the employer. It is the
professional obligation of those involved in health and safety to proactively stay abreast
of changes through research and professional networking.
16.8 References/further readings/web sources

American Association of Healthplans. HIPAA information. Retrieved from
http://www.aahp.org/Templage.cfm
American Association of Occupational Health Nurses (AAOHN). (2006). Role of

OHNs and NCMs in protecting confidentiality of health information. (Position
Statement). Retrieved from http://www.aaohn.org
American Association of Occupational Health Nurses (AAOHN). (2006). Advisory.

Confidentiality of Employee Health Information. Pensacola, FL: AAOHN.
American College of Occupational and Environmental Medicine (ACOEM). (2000).

Confidentiality of medical information in the workplace. (Position Statement).
Retrieved from http://www.acoem.org
American Heart Association. (2002). Respiratory Protection eTool. Publication 70-

2562. Retrieved from http://www.osha.gov/SLTC/etools/respiratory/ scope.html
American Nurses Association (ANA). (2001). ANA workplace health and safety guide
for nurses: OSHA and NIOSH resources. Washington, DC: ANA Publishing.
159
American Red Cross. (2001). First Aid: Responding to Emergencies. (3rd ed.). Yardley,
PA: American Red Cross.
Americans with Disabilities Act. (2004). Delivery of occupational and environmental

health services. (Position Statement). AAOHN 42 USC §12112(D) (3)(B) (1990).
Center for Democracy and Technology. Health Privacy.: Retrieved from http://
www.healthprivacy.org
Centers for Disease Control and Prevention. HIPAA Privacy Rule. Provisions Relevant
to Public Health Practice Retrieved from http://www.cdc.gov
Centers for Disease Control and Prevention. (2008). Summary of notifiable diseases.
Morbidity and Mortality Weekly Report, 57(54). Retrieved from http://
www.cdc.gov/mmwr/mmwr_nd/
Centers for Disease Control and Prevention. (2010). Our History—Our Story.
Retrieved from http://www.cdc.gov/about/history/ourstory.htm Chalupka, S. (2011).

Lockout and tagout procedures to prevent occupational injury and fatality. AAOHN
Journal, 59(7), 324.
Federal Register. 29 CFR 1910.1020. Access to employee exposure & medical records.
Retrieved from http://www.osha.govealth
Haag, A. B., Kalina, C. M., & Tourigian, R. (2003). Clinical rounds: Case management
update: Short term disability, long term disability, Social Security Disability Insurance,
and Family Medical Leave Act—Relationship to case management practice. AAOHN
Journal, 51(10), 414–417.
Liaison Committee on Resuscitation. (2000). Guidelines 2000 for Cardiopulmonary

Resuscitation and Emergency Cardiovascular Care: International Consensus on
Science, Part 3: Adult Basic Life Support. Circulation.102, (suppl I), 22–59.
Litchfield, S. M. (2009). HIPAA and the Occupational Health Nurse. AAOHN Journal,
57(10), 399.
Medicare and Medicaid HIPAA information: Retrieved from

http://www.cms.gov/Regulations-and-Guidance/HIPAA…/HIPAA101-1.pdf
Occupational Safety and Health Administration (OSHA). (1998). Respiratory
protection standard. 29 CFR 1910.134. Retrieved from http://www.osha.gov/pls/
oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=12716
Occupational Safety and Health Administration. (2011). The Occupational Safety and
Health (OSH) Act. Retrieved from http://www.dol.gov/ compliance/laws/comp-
osha.htm
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Rogers, B. (2004). Occupational health nursing, concepts and practice (2nd ed.).
Philadelphia: W.B. Saunders.
Rogers, B., Meyer, D., Summey, C., Scheessele, D., Atwell, T., Ostendorf, J.,
Randolph, S. A., Buckheit, K. (2009). What makes a successful hearing conservation
program? AAOHN Journal, 57(8), 321–335.
Schuren, W. S., & Livsey, K. (2001). Complying with the health insurance portability
and accountability act privacy standards. AAOHN Journal, 49(11), 501–507.
Sickbert-Bennett, E. E., Weber, D. J., Poole, C., MacDonald, P., & Maillard, J-M.
(2011). Completeness of communicable disease reporting, North Carolina, USA, 1995–
1997 and 2000–2006. Emerging Infectious Diseases, 17(1). Retrieved from
http://www.cdc.gov/eid
Thompson, M. R. (2003). The three Rs of fire safety, emergency action, and fire
prevention planning: Promoting safety at the worksite. AAOHN Journal, 51(4), 169–
179.
Thompson, M. C. (2006). Legislation affecting occupational health nursing: Identifying

relevant laws and regulations. AAOHN Journal, 54(1), 38–45.
U. S. Environmental Protection Agency. 40 CFR. Protection of the Environment.

Retrieved from http://www.epa.gov/lawsregs/index.html
U.S. Department of Health and Human Services, Office of the Assistant Secretary for
Planning and Evaluation. Administrative Simplification in the Health Care Industry.
Retrieved from http://www.aspe.hhs.gov/ admnsimp/
U.S. Department of Health and Human Services. The HIPAA Standards for privacy of
individually identifiable health information. Retrieved from http://hhs. gov/ocr/hippa/
U.S. Department of Health and Human Services (USDHHS). (2003). Privacy rule
preamble. Retrieved from http://www.hhs.gov
U.S. Department of Health and Human Services (USDHHS). (2003). Summary of the
HIPAA privacy rules & frequently asked questions & answers. Retrieved from
http://www.hhs/gov/ocr/hipaa
Mine Safety and Health Administration (MSHA), U.S. Department of Labor. (2011).
Mine Safety and Health Act (MSHA). Retrieved from http://www. msha.gov/
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UNIT 17 WORKPLACE INJURY MANAGEMENT
Module Structure
Unit 17 Workplace Injury Management

Unit Structure
17.1 Introduction
17.3 WORKPLACE INJURY MANAGEMENT
17.3.1 Workers’ Compensation Insurance,
17.3.2 Types of Insurance Coverage
17.3.2.1 Traditional Commercial Plan
17.3.2.2 Guaranteed Plan
17.3.2.3 Retrospective Rating
17.3.2.4 Assigned Risk Pool
17.3.2.5 Self-Insurance
17.4 Benefits for the Injured Worker
17.5 Management of Claims
17.6 Determining Mechanism of Injury,
17.6.1 Defining the Diagnosis
17.6.2 Rendering Opinion of Work-Relatedness
17.6.3 Providing Quality Care
17.6.4 Managing Work Status
17.7 Strategies for Success
17.7.1 Select Key Partnerships
17.7.2 Managing Health and Safety
17.7.3 Assess Effectiveness
17.7.4 Return to Work
17.7.5 Training and Communication
17.7.6 Early Engagement
17.7.7 Responsibility and Reliability
17.8 Summary
17.1 INTRODUCTION
This unit discusses the evaluation of occupational health practices with a view to access
the workplace injury management. There is a significant inverse relationship between
workers’ compensation costs and business success. High injury rates and higher
insurance costs can lead to lower profits. The occupational health nurse plays a key role
in developing a strategic approach to managing workers’ compensation costs, thus
contributing to the profitability of the company.

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• describe the workers’ compensation insurance plan
• state the workplace injury and illness calculation
• state the various benefits for an injured worker
• determine mechanism of injury of workplace management
• state different strategies for success towards workplace injury management
17.3 WORKPLACE INJURY MANAGEMENT
Workers’ compensation laws were enacted in the early 1900s to cover the cost of
medical care and benefits for workers who become injured or ill on the job. As a result,
there are workers’ compensation statutes, regulated by each state, providing rules and
guidance for employers to provide certain benefits to workers when they are injured or
become ill as a result of their jobs. These benefits cover the cost of medical expenses,
death benefits, rehabilitation expenses, and time away from work related to the job
injury. The workers’ compensation statutes vary from state to state, and it is important
for the employer and the occupational health nurse (OHN) to maintain keen knowledge
of these regulations.
Employers with workers in multiple states must abide by the regulations specific to
each state in which workers are employed. These state regulations define specific
criteria that constitute the workers’ rights to the worker’s compensation benefit and also
define the parameters of payment through mandated fee schedules for healthcare
providers who render services for the injured worker. Failure to carry workers’
compensation insurance or otherwise meet a state’s regulatory requirements may
expose the employer to not only paying for these benefits out of pocket, but also to
paying penalties levied by the state. Most state workers’ compensation regulations
require the employer to provide benefits as long as the incident arises out of the
worker’s employment and the injury occurs during the course and scope of performing
job duties. Unlike other types of insurance coverage, such as health benefits or
automobile Coverage that have deductibles and dollar limits, workers’ compensation
insurance does not require the worker to share any cost and does not have a maximum
dollar amount limit. Once a claim is filed, the employer is obligated to cover unlimited
expenses as long as the costs fall under the purview of the state’s requirement for
covered benefits. Income replacement as payment for lost work time under workers’
compensation is usually calculated as a percentage of the average weekly wage and is
not subject to federal income tax for the employer or worker.
A fault of many employers is viewing this benefit as only a regulatory requirement or

as a “necessary evil” and therefore leaving the management of the claims to those they
pay to provide this service. On the other hand, the selection of partnerships with
consultants, insurers’ claims administrators, healthcare providers, and legal counsel is
critical to a successfully executed program. Employers who take an interest in not only
preventing injuries, but also in actively participating in the worker’s recovery and return
to work find, in most cases, a high degree of both worker and employer satisfaction.
The strategy for success, however, starts way before the injury occurs. This chapter
outlines the key components to managing workers’ compensation benefits.
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17.3.1 Workers’ Compensation Insurance
Most employers are required to provide workers’ compensation benefit coverage for
their workers. Employers exempt from this requirement include sole proprietors and
partnerships (unless they have workers who are not owners) and employers whose
workers are paid solely by commission. Some state laws also exempt certain categories
of workers from coverage, such as domestic workers, agricultural workers, and manual
laborers. The burden is on employers to know who is covered under the definition of
“employee” in their specific state’s workers’ compensation regulations. And it is
important to note that employers should be aware of how the state views coverage for
independent contractors and leased workers. Employers must also maintain an
awareness of coverage provided for workers when they establish business relationships
with employee leasing agencies, contractors, and subcontractors. The terms of the
agreement with these types of workers should define the obligations of coverage for
workers’ compensation benefits that is consistent with state regulations, and an astute
employer will not only define the obligation in the contract, but will also require proof
of up-to-date coverage by providing a copy of the coverage certificate that will be kept
on file with the contract.
17.3.2 Types of Insurance Coverage

There are currently three systems in place for states to design their worker’s
compensations programs. Monopolistic states have special legislation that requires
workers compensation coverage be provided exclusively through the state’s workers
compensation funded program. Insurance through private insurance companies is not
permitted, and the workers’ compensation system is administered by the state. This
includes the processes of monitoring data and trends, setting insurance rates, and
sometimes settling disputes. The second system is where states have their own
independent bureau of workers’ compensation rules and regulations that govern
insurance classifications, premium computation, and experience ratings, thus allowing
employers to choose between private insurance companies or a state-administered
workers compensation fund.
Most states, however, manage their workers’ compensation insurance programs based
on data from the National Council on Compensation Insurance, Inc. (NCCI). NCCI is
a national agency that manages the largest database of workers’ compensation
insurance information by analyzing industry trends. The agency also prepares workers
compensation insurance rate recommendations, calculates proposed insurance rates,
develops experience and retrospective ratings plans, analyzes the potential cost of
changes in legislation, and provides a variety of services and tools to maintain an
effective Workers Compensation system (NCCI, 2011).
Employers in non-monopolistic states have the choice of purchasing workers’

compensation insurance in a variety of ways. The insurance may be purchased through
commercial insurance carriers, through a state purchasing fund, or the employer may
choose to set up a self-insured fund. There are certain benefits, risks, and considerations
to each option.
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17.3.2.1 Traditional Commercial Plan
Employers choosing to insure through a commercial insurance product have a variety
of insurance carriers from which to choose. This sets the stage for a competitive market
in that the insurance companies each vie for the opportunity to provide the employer
coverage. In this case, the insurance product or coverage is consistent across insurers
but is dependent on the type of policy selected. Under a fully insured commercial plan,
the insurance company is responsible for the costs of all claims that arise under the
employer’s workers’ compensation benefit in the states covered by the policy.
17.3.2.2 Guaranteed Plan

Under a guaranteed plan, the employer’s premium rate remains consistent and
predictable and is calculated based on the standard classification code (SIC) of the
business, taking into consideration data and an experience modification factor (mod
factor). The employer has no control over the SIC classification since the assignment is
based on the nature and risk of the business operations.
Payroll data is based on the average number of workers and the average wage of all
workers covered under the plan. The mod factor is an equation based on actual claims
versus expected claims for the employer’s industry. The published NCCI data is
typically used to establish the expected claims experience for the employer’s particular
industry. In calculating the mod factor, the expected claims experience (or average) is
factored at 1.0. If the company has more claims than the expected industry standard,
the calculated mod factor will be greater than 1.0, or greater than average. If the
employer has incurred a lower number of claims than expected, the mod factor will be
less than 1.0, or less than average. Therefore, an employer with less experience (i.e.,
fewer injuries or less severe injuries) will be rated at a lower premium cost. Conversely,
an employer with high rates and/or high severity of injuries will be rated with a much
higher premium cost.
17.3.2.3 Retrospective Rating

Employers who focus on controlling claims costs may find retrospective rating to their
advantage. This type of rating takes a look back, usually over a prior 3-year period, at
the volume and cost of claims actually incurred and uses this value as a basis for
establishing premium cost. Since the employer has some control over the mod factor,
this plan provides the employer an opportunity to reduce its premium costs and reap
reward by establishing and maintaining a safe workplace sustained over a longer period
of time.
17.3.2.4 Assigned Risk Pool

An assigned risk pool is designed by each state for those employers who may find the
purchase of an individual commercial product too expensive. Under this premium plan,
the employer joins a pool of other businesses for the purposes of purchasing a more
affordable plan. This approach is sometimes advantageous for small businesses, since
the employer can often purchase the same policy at a more reasonable rate, just by
nature of the fact that they have joined a group purchasing pool. Most times, employers
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in similar industries are assigned to the same purchasing pool since the premium is
gauged on similar industry risk.
17.3.2.5 Self-Insurance
Employers can choose to be self-insured, rather than purchase insurance, which
involves setting aside funds from their operating budget in anticipation of paying
workers’ compensation claims. Each state has regulations through its department of
insurance with established standards for the employer to set aside financial bonds to
assure financial security as a self-insured plan. Under this type of plan, instead of paying
premiums to an insurance company, employers are able to use their own funds to
directly pay claims costs. This self-insured option is also available to small businesses
in the form of a group purchasing pool, where like employers form groups to insure
themselves.
The disadvantage of this approach is that all employers share the risk of every other
employer in their same group. Therefore, if one employer has increased claims
experience, the effect is felt by all members of the group despite the fact that those
employers may have less than average experience strategy, when managed effectively,
can reap a significant return on investment for the business.
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17.4 Benefits for the Injured Worker
The level and scope of benefits provided to injured workers under the workers’
compensation system is guided by state regulations. Changes to these regulations
require statutory reform by the state government, an, as a result, political forces and
lobbying efforts of special interest groups may come into play (Balge & Krieger, 2000).
The workers’ compensation laws provide some protection for the employer by limiting
liability regarding the employer’s responsibility for benefit payment and compensation.
Although regulations are decided at the state level, most are very similar in defining
parameters of coverage. Each state law provides definitions related to compensability
and coverage. If the injury meets the definition of being work related under the state
regulation, medical benefits are covered in full for evaluation and treatment of the
injured worker, without limits and without contribution from the injured worker in the
way of copayments or deductibles. Few states allow the injured worker free choice of
his or her medical provider, while most allow the employer to make the designation or
require selection by the injured worker or employer from a network panel. Covered
medical benefits include office visits, hospitalizations, surgical and interventional
procedures, diagnostic procedures, rehabilitation services, pharmaceuticals, durable
medical supplies, and other support services.
The injured worker is also entitled to wage-replacement benefits for lost work time,
although some states require an eligibility waiting period before wage replacement goes
into effect. The wage-replacement benefits are usually calculated as a percentage of the
worker’s wage; however, this income is not subject to state or federal taxation for either
the worker or the employer. Depending on the worker’s income level, the earnings
under workers’ compensation may be quite comparable to the worker’s regular take-
home pay after taxation.
Injured workers are also entitled to disability benefits based on the level of impairment
as a result of the work injury. If the worker incurs a temporary permanent disability or
impairment, he or she is entitled to financial compensation to replace lost income or to
supplement a reduced earnings capacity. If the worker is unable to return to the same
occupation after maximum recovery, he or she may also be eligible for vocational
rehabilitation benefits for retraining and job placement assistance.
Since benefits under workers’ compensation provide the worker with unlimited medical
care and wage replacement (as long as medically necessary), the employer must be
aware that it may be perceived as a better option for the worker who does not have
healthcare insurance or for those who face copays and large deductibles under their
group health plan. Therefore, incident investigations to assure the validity of the nature
and extent of the injury are of prime importance. Once the incident that contributed to
the worker’s injury has been validated, a structured approach to claims management
will assure the assignment of a fair and balanced benefit for all.
17.5 Management of Claims
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The selection of key partnerships in the management of the workers’ compensation
program is critical to its success. As mentioned earlier, the selection of insurance
consultants, brokers, and advisers sets a foundation for the program. Claims
administrators, such as adjusters and case managers, are on the front lines dealing with
injured workers and coordinating efforts with the healthcare provider managing the
care. A synergy must exist among all individuals, considered stakeholders, who interact
with the injured worker. The company’s workers’ compensation benefits administrator,
along with the OHN, should set the tone for expectation with stakeholders. This
includes department, safety, and human resources managers since interaction with the
injured worker within the company can significantly influence the outcome of the
claim. The employer’s corporate and labor law attorneys must also share the same
philosophy since often other employment-related issues may surface during the course
of the claim. The employer must secure a solid legal workers’ compensation defense
attorney to represent the employer in adjudicating claims and defending the employer’s
stance regarding benefits eligibility and entitlement.
Stakeholders outside the company include any service provider who touches the injured
worker during the course of the claim. These providers should share the philosophy of
providing excellent service and quality care to the injured worker in a cost-efficient
manner. Any opposing force in regard to this philosophy by any stakeholder can have
an adverse effect on the attitude of the injured worker and on the outcome of the claim.
For instance, if the healthcare provider has assigned medically appropriate restrictions
and released the injured worker back to modified duty, the employer should support a
return to work philosophy and provide accommodation for medically appropriate work
restrictions related to the injury. This means they will keep the worker productive and
on the job.
17.6 Determining Mechanism of Injury

There must be a causal connection between injury/illness and employment in order for
the medical findings to be considered work-related. The term mechanism of injury is
used to describe the events or incident that led to the injury or illness. In other words:
How did the injury or illness occur? Was there some risk incidental to or connected
with employment? Did the injury/illness flow from employment as natural result? Did
the injury occur within a period of time when the worker was where they were
reasonably expected to be while performing essential duties related to their work? Was
the worker doing what they were supposed to be doing at the time and place they were
supposed to be doing it? These key questions must be considered in order to determine
compensability of the claim under workers’ compensation. A thorough investigation of
the incident and point of contact with the workers involved in the incident will provide
information regarding the mechanism of injury. Since a thorough interview and
documentation of mechanism of injury can prove valuable in determining
compensability of the claim, these key questions should be addressed during the
interview and investigation process.
17.6.1 Defining the Diagnosis
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It is the responsibility of the healthcare provider to interview and clearly define the
subjective complaints of the worker and to conduct an objective evaluation of the
clinical symptoms and complaints. A thorough, focused, and well-documented
examination of the injured body parts will provide clinical information that supports
medical decision making in regard to work-relatedness. The healthcare provider should
obtain diagnostic tests that are appropriate to the injury or illness, that are widely
accepted among practicing providers, and that are based on scientific criteria. The
injured worker’s subjective complaints should correlate with abnormal anatomical
findings and diagnostic test results. Subjective complaints, in the absence of objective
relevant medical findings, should not be considered the sole criteria for the diagnosis.
The diagnosis and its relationship to the mechanism of injury set the foundation for
determining compensability.
17.6.2 Rendering Opinion of Work-Relatedness

Some state workers’ compensation statutes require the healthcare provider to render
opinion in regard to major contributing cause and work-relatedness. Some states also
require the healthcare provider to render opinion in regard to the influence of any
preexisting, coexisting, and comorbid conditions and their relation to the findings. In
other words, do the clinical findings relate to mechanism of injury and to what degree
do other conditions influence the clinical findings? Determination of causation is
usually straightforward; however, this requires careful analysis of mechanism of injury
and clinical findings. The healthcare provider must weigh all causal or associated
factors and use clearly defined terminology to describe findings as part of the medical
record. The opinion of the healthcare provider is key to the determination of whether
the workplace is the only cause, among other contributing causes, or one of several
possible causes contributing to the injured worker’s symptoms. Healthcare
professionals involved in the care of injured workers have an obligation to the worker,
the employer, the workers’ system, and to their professions to have an astute body of
knowledge related to about state-specific rules on compensability (Foster, 2009).
Questions to consider that support decisions in regard to work-relatedness include: Do
the symptoms fit the injury? Do the physical findings correlate with the injury and
symptoms? Are there preexisting, coexisting, or comorbid conditions that should be
considered?
17.6.3 Providing Quality Care

Any medical service, prescription, or medical supply that is used to treat an illness or
injury must be appropriate to the diagnosis. Ongoing treatment must be based on the
status of recovery and must be supported by applicable practice guidelines. The
healthcare provider must initiate only the medical and pharmaceutical interventions that
are appropriate for the level of injury or illness. Treatment, using a sports medicine
approach of high-intensity and short duration, focusing on early recovery and
restoration of function, is important. The treatment plan must be appropriate and must
match the documented physiological and clinical problem.
17.6.4 Managing Work Status
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Return to work is an integral part of the treatment plan. The assignment of work status
should focus on the worker’s capabilities. Work restrictions should be assigned that
remove essential job functions or physical demands that are appropriate to the injury or
illness and would have an adverse effect on recovery. The role of the healthcare
provider is to determine restrictions that are appropriate to the level of injury.
Advancing work status by removing restrictions and limitations as early as appropriate
should be considered at each visit and should be a part of the treatment plan on a
continuous basis. The assignment of restrictions and limitations should be reviewed
with the injured worker at each visit and upon receipt of new information such as reports
from physical therapy and specialty providers. The healthcare provider must
communicate with the employer and insurance carrier any information regarding the
treatment plan and the injured worker’s work status for the timely and appropriate
management of the workers’ compensation claim. The OHN should assist with the
assignment of modified duty and transition work assignments for the injured worker
compatible with medically appropriate physical restrictions, assuring the restrictions
are based upon the presence or absence of objective relevant medical findings. These
processes are key to managing return to work and to facilitating maximum recovery.
17.7 Strategies for Success

The engagement of all involved to employ SMARTER* strategies help to create an
effective workers’ compensation program that meets the needs of injured workers while
providing a high-quality, cost-effective benefit. By instituting these strategies, the
employer is able to demonstrate value for both the injured workers and for the company.
17.7.1 Select Key Partnerships

It is common to use benefits consultants or insurance agents when securing coverage
for workers’ compensation benefits. The consultant or agent assists the employer in
choosing the appropriate insurance coverage for workers’ compensation. The
consultant/agent should have the employer’s best interests in mind and share the
philosophy of recommending the most cost-effective option for the coverage, based on
company size and history of experience.
The consultant/agent should hold comprehensive knowledge regarding other aspects of

the employee benefits program, such as group health benefits and disability insurance
since there is often significant interplay. Although the calculation of such benefits is
dependent on the makeup of the workforce, work hazards, and wage levels, many other
influences may come into play. Negotiated terms of labor unions may also influence
worker entitlement and coverage under certain benefits. And, decisions to increase
copays and deductibles under the group health benefits may influence workers to
perceive workers’ compensation benefits as a much more attractive benefit. The
consultant/agent must take all influencers into consideration when providing guidance
to the employer.
Performance expectations should be considered during the selection process for the
insurer or TPA. The insurer/TPA must provide the employer with an efficient means
for reporting claims and should also have an efficient internal process for administering
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claims. The adjusters assigned to the claims are on the front lines in regard to
administrative management of the claims, with responsibility for claim investigation by
obtaining information from the injured worker, witnesses, the employer, the workers’
compensation medical providers, and they should obtain information related to the
current and past health history of the injured worker. The claims adjuster also holds the
power to authorize medical treatment and makes decisions related to assignment of
benefits and claims settlements. Case managers may be assigned to certain claims to
direct medical care by developing appropriate recovery plans for the injured worker.
This is of particular value with complex and catastrophic claims or troublesome cases.
Being the prime communicators with other stakeholders, adjusters, and case managers
holds significant potential to influence the outcome of the claim by holding
responsibility for managing claims without harassment, coercion, or intimidation
toward the injured worker, the employer, or the healthcare providers. Therefore, the
selection of adjusters and case managers as key partners, with their agreement to
subscribe to the company’s philosophy related to claims and case management, is of
vital importance.
The selection of key partners who will render care and services to injured workers has
significant positive impact on the outcome of the claim. As long as statutory guidelines
permit, the employer should engage in securing relationships with healthcare providers
who render consistent, high-quality service in an efficient manner. These providers
should be able to articulate a comprehensive knowledge of the state’s workers’
compensation system and execute their services accordingly. Healthcare providers
should render care consistent with that authorized by the adjuster and within the
parameters of care that are medically indicated for the level of the injury or illness,
founded on scientific evidence- based guidelines. Appropriate and timely
documentation of diagnostic results, medical findings, recommended treatment, and the
injured worker’s response to treatment assist the adjuster and case manager in handling
the claim. Of utmost importance, these providers should demonstrate a willingness to
openly communicate with the employer and other stakeholders involved in the claim,
knowing there is always “another side to the story.”
The employer’s workers’ compensation defense attorney plays a key role in providing
advice related to the management and settlement of litigated claims. However, there is
a role for the defense attorney to take a more proactive part as a key partner providing
advice to the employer related to insurance coverage, hazard and risk reduction, and
claims management based on analysis of potential exposure. The
defense attorney should be involved up front in regard to development of the
philosophical decisions related to policies and procedures for the overall workers’
compensation benefit program to assure consistency with their approaches to claims
defense. Of additional value is the integration of philosophical agreement between
defense attorney and the company’s labor law attorney since there is significant
interplay between workers’ compensation and employment labor laws.
Key partnerships must also be engaged within the company. The human resources and
risk managers must work together to assure a firm, fair, and consistent approach to
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investigation of incidents and injury management. Management at all levels of the
company should strive to consistently apply policies and procedures and maintain a safe
work environment. Managers should be well versed in the steps to take when an
incident or injury arises and provide appropriate guidance and intervention. And not of
least importance are the workers. All workers must be made aware of the proper steps
to take to report incidents and injuries that occur in the workplace. Appropriate notice
should be posted to direct workers what to do should they be in need of medical
intervention. Through the engagement of stakeholders at all levels within the company,
acknowledging and understanding the importance of a safe and healthy workplace, the
employer can reap the benefit of support at all levels. Through the selection of key
partnerships, the employer is able to engage a comprehensive philosophical approach
to managing workers’ compensation benefits shared by stakeholders from all
perspectives. By taking charge early in the life of a claim and securing healthcare
services focused on quality, injured workers will receive appropriate and timely
benefits focused on positive outcomes and a swift recovery.
17.7.2 Managing Health and Safety

The employer’s fitness for duty program provides the foundation for the workers’
compensation program. Employers who conduct pre-placement health evaluations gain
benefit from documenting a baseline of the worker’s health history at the time of
placement, as well as assuring that the worker is the right fit for the job. The
establishment of a drug-free workplace also serves to support a safe and healthful work
environment. Health and wellness initiatives, through education, screening, and disease
management assist workers in achieving high levels of safety and health, and as a result
the employer benefits from reduced risks and a more productive workforce.
Philosophical support for developing and maintaining focus on health and safety must
start at the top of the organization. A top-down expectation for reducing hazards and
risks, for regulatory compliance, and for a safety-first management approach is vital. A
focus on incident reporting, rather than just injury reporting, enables the employer to
gain insight into near misses and trends that may prove a threat, thus creating an
expectation for focus on intense investigation aimed at eliminating or minimizing
injuries.
The selection of healthcare providers focused on quality that will provide care to
workers under both group health and workers’ compensation serves to support the
workplace philosophy of good health. Although some employers focus on healthcare
cost containment, an outcome-focused approach for quality care and efficient return to
work will result in improved health and productivity of the workforce.
17.7.3 Assess Effectiveness

The assessment of organization effectiveness focuses on responsibility for health and
safety at all levels. For all stakeholders there should be a keen awareness of the impact
of incidents, injuries, and worker absences on company profitability. All workers
should be knowledgeable about safety procedures, and management must maintain
keen attention to incident and injury reporting, while staying engaged in all cost-
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containment efforts. Chargebacks to the department level for costs related to incidents
and injuries serves to create awareness among managers of the cost implications and
may provide additional motivation for department managers and supervisors to remain
engaged in incident investigation procedures and the return-to-work process for injured
workers.
Program effectiveness is assessed through consistent collection of data aimed at

identifying the true cost drivers and should be coupled with the intent to implement
strategies for potential savings. This can be accomplished through benchmarking the
company’s performance with prior history of claims experience, comparison to industry
standards, and identification of best practices that will lead to improved cost
effectiveness. Establishment of key performance indicators at all stakeholder levels,
such as business units, division, or locations, provides the employer with objective
information on measuring performance and the effect on the workers’ compensation
program.
17.7.4 Return to Work

Keeping workers healthy and on the job should be the focus of any employer wishing
to maintain a productive workforce. Research and experience tell us that injured
workers who remain off work recover less quickly and have poorer clinical outcomes
as compared to those who maintain the social connection with the workplace and with
coworkers (ACOEM, 2006).
The injured worker’s ability to work should be assessed based on three factors
(ACOEM, 2006):
• Functional capacity: What can the injured worker do today?
• Functional impairments or limitations: What can’t the injured worker do now
that he or she normally could do?
• Medically appropriate restrictions: What should the injured worker not do to
avoid more harm?
The employer should strive to have a plan for return to work for all injured workers. A
modified duty or transitional work assignment should be available that supports the
worker’s physical abilities while honoring the medically appropriate limitations or
restrictions. This is accomplished by removing certain essential functions or by placing
the worker in a different job where the limitations can be better accommodated. The
assignment of modified or transitional duty should maintain respect for the worker’s
abilities while also maintaining compliance with regulatory standards and
requirements, company policies, and respect for all safety concerns. Of utmost
importance, in order to maintain a sense of self-fulfillment, the worker should be
assigned to work that is meaningful and contributes to workplace productivity.
A strong return-to-work philosophy supports the employer’s workers’ compensation

program by mitigating loss by keeping the worker gainfully employed and reducing
indemnity benefits. While this is a very positive approach, one must be mindful of
inherent risks as well, such as re-injury of the injured worker, aggravation of the
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condition, and varying attitudes of coworkers. Therefore, the employer must institute
strategies for evaluating the effectiveness of the work assignments and should be aware
of the need to garner support among all stakeholders for this strategy. This can be
accomplished by staying in close communication with the injured worker (even when
he or she is taken off work), the adjusters and case managers, and healthcare providers.
17.7.5 Training and Communication

Safety first. This should be communicated loudly and clearly to all levels of the
organization. The employer must have written policies and procedures for safety and
for incident and injury reporting. This is made clear by using a variety of
communication vehicles, including wall posters, brochures, web messaging, e-mail
messages, company newsletters, and wallet card reminders for those who may work in
remote locations. Communication of expectations cannot be understated and cannot be
overdone. One must only look at how workers’ compensation plaintiff attorneys get
their messages across through the use of billboards, television and radio ads, Web
messaging, and the phone directory. If this is the first message workers remember at
the time they are injured, surely they will be drawn to that resource for direction.
Training for workers must be at the reading level of the user and must be mindful of
language preferences. Training material should also be attractive to the reader in order
to stimulate interest. Efforts should clearly communicate expectations at all levels and
should be reinforced through ongoing training for workers, supervisory staff, and
managers at all levels.
17.7.6 Early Engagement

The RIMS Benchmark Survey (2010) established a direct correlation between early
return to work and lower experience modification factors. Additionally, focus on
prompt attention to the needs of the injured worker and access to appropriate services
in the early part of the life span of the claim have proved successful. Early intervention
at all stages of the claim proves effective: early incident investigation, early medical
attention, early legal intervention.
Early engagement means the employer should make it easy for the worker to access the
workers’ compensation system when needed, for instance, report forms that are easy to
find and easy to complete and communication regarding use of the worker’s system
that is easy to read and understand. Otherwise, the employer fails to obtain the
information it needs regarding incident investigation, and the worker fails to get the
appropriate message regarding his or her rights and responsibilities.
Early engagement also includes getting the injured worker quick and efficient access to
the appropriate healthcare provider. Successful strategies used by employers include
using the OHN as the first point of contact to provide immediate intervention and assess
the need for further evaluation and treatment. Engagement with the OHN or other
telephonic nurse case managers provides an efficient means of triage that gets the
injured worker the care most appropriate for the level of injury. Most often, this serves
to avert costly emergency room charges and avoids allowing the injured worker to
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navigate his or her own way through the system in search for medical care. Once the
injured worker gets lost in the system, the claims most likely will have an untoward
outcome. The engagement of select healthcare providers will lead to better outcomes.
Providers should offer efficient appointments, establish appropriate diagnosis and
treatment plans, and define appropriate apportionment of the injury when necessary.
This leads to a faster recovery for the injured worker and efficient closure of the claim.
With time as the enemy, early engagement by all stakeholders is good for all.
17.7.7 Responsibility and Reliability

All stakeholders hold certain responsibilities under the workers’ compensation
program, and in order to have positive outcomes, everyone must be held accountable
for those responsibilities.
Worker Responsibilities
The worker holds the responsibility to report incidents and injuries in a timely manner,
consistent with company policy. The worker then holds responsibility for following
company policies and procedures, as well as guidelines established by the state’s
workers’ compensation program, in accessing the system for benefit entitlement. Once
the claim is filed, the claims administrator sends the injured workers information
regarding their rights and responsibilities, and the workers hold the obligation to follow
those guidelines.
The injured worker is responsible for open communication with other stakeholders,
providing the claims administrator and medical providers with accurate information
related to the incident. As well, the worker is responsible for accurately describing the
resultant physical complaints or injuries, providing information related to past health
history, and for accurately describing the effects of treatment modalities. The worker is
also responsible for interaction with the employer, following the appropriate steps to
communicate his or her assigned duty status and for returning to work as assigned. Once
returned to work, the worker holds the responsibility for reliably showing up for work
as scheduled and for working at his or her full potential, within the assigned medical
limitations, thus remaining a productive contributor to the workplace.
Employer Responsibility
The employer holds responsibility for posting all notices related to the state’s workers’
compensation system and for communicating and reinforcing all aspects of company
policies and procedures related to incident and injury reporting. The employer is
responsible for ensuring workers know what to do when an injury occurs and must post
the approved workers’ compensation healthcare providers in those states in which the
employer selects the medical provider or noting the workers’ right to select their own
provider if they choose to do so.
The employer is obligated to conduct a full investigation of all incidents, obtaining

written statements from the injured worker, from all witnesses, and from the worker’s
supervisor. The employer is responsible for gathering reliable information that will
assist in claims administration, including copies of any pre-placement health history
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forms; identifying patterns of absences or patterns of other workers’ compensation
claims; and providing the appropriate payroll information.
It is the employer’s responsibility to then file the claim with the insurer/TPA, and there
is usually a state mandate regarding the time frame for reporting. This notice is the
trigger to initiate the injured worker’s access to benefits, knowing that failure to do so
causes delays in authorizations for medical care and treatment.
The employer’s responsibility for communication starts the day of the incident and
continues throughout the life of the claim. The employer should stay in contact with the
injured worker and with the claims administrator. Maintaining communications
provides reliability that the worker is obtaining the appropriate benefits for recovery
and may reduce the risk of the development of any adversarial relationship between
stakeholders, thus reducing the chance the claim will become litigated.
The employer is also responsible for having an effective return-to-work program,

providing modified duty assignments or transitional work plan. Training of supervisors
provides assurance that the injured worker will be welcomed back into the workplace
as a productive contributor, despite having been injured. The OHN is often responsible
for establishing the return to work plan with supervisors and is responsible for
evaluating the effectiveness of the plan. Having more than one option available for the
modified or transitional duty provides reliability that the worker can return to work and
remain productive.
Healthcare Provider Responsibility

Appropriate medical management is crucial to controlling claim costs and effecting
claim outcomes. Appropriate medical management means that the healthcare provider
is responsible for making the correct diagnosis, defining causal relationships, rendering
appropriate treatment, and assigning the appropriate level of impairment or disability,
if indicated. The medical provider is responsible for defining the diagnosis while
addressing coexisting and preexisting conditions that may come into play. This
diagnosis is based on relevant, objective evidence and should be consistent with the
explained mechanism of injury. Treatment should be criteria-based and appropriate to
the work-related injury. The medical provider should focus on returning the worker to
duty on the first visit, unless medically contraindicated. According to ACOEM studies
on preventing needless disability (2006), only a small fraction of medically excused
days off work are medically necessary, and injured workers can generally work at
something productive as soon as there is no specific medical condition to keep them
from working.
The employer and claims adjuster need to know that they can rely on all healthcare
providers to deliver services in an efficient, cost-effective, and consistent manner,
providing injured workers exactly what they need – nothing less and nothing more than
medically necessary. Decision making needs to be consistent and reliable across all
claims to provide a reliable product for the employer that supports the company’s
philosophy. All healthcare providers, including medical, diagnostic, and rehabilitation,
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should support the injured worker’s need for efficient access to services. All providers
should also provide reliable, accurate documentation that will support decision making
for the claim.
Claims Administrator Responsibilities

The claims administrator should be willing to meet face-to-face on a regular basis with
the employer to evaluate the effectiveness of the program and to identify opportunities
for improvement. Quarterly claims reviews with employer should include the workers’
compensation medical provider and defense attorney in this meeting. This sets the tone
for effective interaction and review of open claims while serving to reinforce
stakeholder commitment to the company’s philosophy for treating injured workers and
managing claims.
In managing claims, the adjuster is responsible for initiating a three-point contact,

usually within 24–48 hours from the time of claim notice. Contact is made with the
three primary players that the adjuster will be in touch with during the course of the
open claim: the injured worker, the employer, and the medical provider. Exchange of
information takes place during this contact as the adjuster strives to investigate the
claim in a timely and through manner. The use of consistent intake questionnaires to
gather the same information on each claim provides the adjuster with reliable
information that will assist in setting aside appropriate reserve funds anticipated for the
claim. The adjuster is responsible for identifying workers with preexisting risk factors
for prolonged disability and managing these cases more intensively from the onset
(ACOEM, 2006).
Through the life of the claim, the claims administrator is responsible for maintaining
open communication with stakeholders with the intention of providing the injured
worker with a swift recovery and closing the claim. Reliability is achieved through
consistent handling of every claim, adhering to the steps of the plan.
17.8 Summary
Although employers must assume the costs of injuries, illnesses, and deaths that occur
on the job, without regard to fault, several strategies can be employed to provide a
quality, cost-effective benefit for injured workers. Stakeholder involvement and
commitment at all levels is vital for success.
The employer should have policies and procedures to direct workers on what to do
when an injury or illness occurs as a result of their work, and the procedures should
provide clear direction on how to access healthcare services under the workers’
compensation system. When a worker becomes injured or ill as a result of his or her
work, the employer or insurer should provide authorization for an efficient referral to
the most appropriate healthcare provider as defined in the state workers’ compensation
statute.
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The employer should strive to align incentives for all stakeholders in the system, while
holding them accountable for performance and adherence to expectations. Claims
administrators should be held accountable for managing the finances of the claim in the
best interest of the employer. All must understand that it is the employer’s money that
is being spent, and careless use of financial resources can have a lasting effect on the
employer’s experience modification factor and insurance rating. Additionally, bad
decisions in regard to compensability for claims can have an effect on the company. If
a claim is accepted for one employee for a health condition that is not supported by
scientific evidence or state statute to be work-related, it may cause an epidemic in the
workplace for other workers who perceive entitlement to the same benefit. It must be
clearly acknowledged that workers’ compensation claims can become a contagion in
the workplace, so fair and balanced decision making is required at all levels.
Healthcare providers rendering services under the workers’ compensation system must
have an excellent understanding of the statutory regulations. Being familiar with the
criteria of the workers’ compensation statutes of the state in which the injury or illness
occurs is of vital importance. Besides providing the healthcare services that are
medically indicated, the healthcare provider is often required to render opinion on
whether the injury or illness is related to work. Because healthcare provider decisions
are critical to the quality and cost of workers’ compensation claims, the healthcare
provider must render care in a quality-oriented, cost-conscious manner using cognitive
expertise related to the specialty of workers’ compensation.
On-the-job recovery holds a valuable role by keeping the injured worker engaged and
productive, yet requires a determined commitment by management at all levels of the
company. Supervisors must be held accountable for supporting modified duty
assignments with an attitude of caring for the injured worker. One of the strongest
predictors of untoward outcomes from a workers’ compensation claim is job
dissatisfaction, or a lack of support from coworkers and supervisors. Home and family
considerations are also factors that lead to concern from the injured worker since the
injury may have a significant impact on their personal life, as well. By keeping the
injured worker engaged, the employer is able to identify and investigate workplace and
social issues that may have an impact on the claim and institute appropriate intervention
and support (ACOEM, 2006).
Human reactions will revolve around all aspects of the claim, not just with the injured
worker, but with all stakeholders. For example, if the injury was a result of a safety
violation, supervisors, managers, and even the company can be held accountable. If
company policies define such, workers who are injured as a result of failure to use
proper safety devices can be faced with disciplinary action, up to and including
termination of employment. Some state statutes also allow for a reduction in covered
benefits for the worker under this circumstance. Workers who are found to be under the
influence of drugs and alcohol may face denial of benefits and even termination of
employment. These types of situations set an entirely different set of circumstances that
have profound effects on the claim. The employer needs to address bad behavior at all
levels with issues related to worker performance, attitudes of supervisors and managers,
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issues of professionalism and ethics in regard to claims administrators and healthcare
providers, and even attempted interference from labor union representatives.
Criminal violations up to and including felony indictments can be imposed on

stakeholders for violation of the workers’ compensation statutes. A worker who files
false claims, provides misleading information, or exaggerates injuries can be
considered to have intent to defraud or deceive the employer or insurer and may be
subject to punishment. Employers who knowingly fail to provide workers’
compensation insurance coverage or who intentionally provide inaccurate information
that misclassifies or fails to define accurate payroll or employee information are also
subject to punishment. Healthcare providers who knowingly conspire with or assist
individuals with the intent to commit fraud or those who submit fraudulent billing are
subject to punishment and may lose rights to provide further services under the state’s
workers’ compensation system.
Penalties can be assessed against the insurer for failure to report claims to the state’s
insurance division or to disallow or provide late payment of benefits or fees. Penalties
can be assessed by the state’s division of insurance for untimely reporting, inaccurate
calculation of benefits and payment, or failing to meet audit standards.
Despite every effort by the employer to establish and maintain a quality oriented health
and safety program, workers will continue to get injured on the job. It is expected that
future claims will be driven by three major factors: obesity, the aging workforce, and
distracted driving. Statistics indicate that obese workers are twice as likely to file a
workers’ compensation claim. With individuals working beyond the typical retirement
age, this aging workforce will bring a host of challenges to the workers’ compensation
landscape. Preexisting and coexisting health conditions confound the claims and impact
recovery, having an effect on lost time, claim age, and cost of claim. Highway accidents
and incidents related to the use of mobile equipment continue to create challenges in
regard to safety. Highway incidents are the leading cause of occupational deaths and
also represent a significant risk to public safety (Fuge, 2009).
As the employer strives to establish an effective workers’ compensation program,

decision making should be focused on controlling costs, improving outcomes, and
maintaining productivity. Despite the negative reputation and horror stories conveyed
throughout the workers’ compensation arena, the benefit it brings to the employer and
to injured workers is exceptional. Aligned philosophies are important, and a philosophy
of caring can make the difference.

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MODULE 4: INDUSTRIAL LEGISLATION AND LABOUR ORGANIZATION

Unit 18 Health Professional Involved in Evaluation
Unit 19 Occupational Rehabilitation
Unit 20 International Labour Organisation
UNIT 18 HEALTH PROFESSIONALS INVOLVED IN EVALUATION

CONTENTS
18.0 Introduction
18.2 Learning Outcome
18.3 HEALTH PROFESSIONALS INVOLVED IN EVALUATION
18.3.1 Safety Engineer
18.3.2 Counsellor
18.3.3 Toxicologist
18.3.4 Recreational/Occupational Therapist
18.3.5 Occupational Epidemiologist
18.3.6 Medial Laboratory Scientists
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18.3.7 Laboratory Technicians
18.3.8 Physical Therapists
18.3.9 Industrial Hygienists
18.4.0 Summary
18.5.0 References/Further Readings
18.6 Answers to
18.0 INTRODUCTION
The evaluation of occupational health programme would not be completed if the
functions of some professionals apart from doctors and nurses are not mentioned. These
are professionals who should evaluate at one point or the other.
18.2 Learning Outcome

At the end of this unit, the learner is expected to:
• Identify the professionals involved in evaluation of occupational health
• Describe the function(s) of professionals involved in evaluation of occupational
health.
18.3 HEALTH PROFESSIONALS INVOLVED IN EVALUATION

18.3.1 Safety Engineer
A safety engineer usually heads safety departments and is specially trained in safety
and must ensure that safety of the work, making the worker to be in job best suited to
him and the work environment suitable for the worker. If there is anything that will
constitute a hazard, he is the one that takes care of it. He over-sees general safety in a
plant. He is also a member of the safety committee in any organization. The safety
engineers take record of injuries and investigate accidents which have already occurred.
They use the statistics to advise management on how to avoid the occurrence of such
accidents. They are always available to advice on accident prevention in the plant.
Functions of Safety Engineers

The safety engineer works in the area relating to protection of people, property and
environment.
• Analyses, identify and evaluate hazardous conditions and practices.
• Develops hazard control designs, method, procedures and programmes.
• Implements, administer and advise others on hazard control programmes.
• Measures, audits and evaluates the effectiveness of hazards control programmes.
• Measures, audits and evaluates the effectiveness of hazards control programmes.
• Drafts a future safety plan and statement based on real time experiences and
facts.
.18.3.2 Counsellor
A counselor is one who assists another in making an informed decision concerning a
career. In occupational health, an occupational rehabilitation counsellor helps people or
workers with physical disabilities such as cardiac weakness tuberculosis or structural
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defects produced by any disease condition that are in greater need of counseling because
of greatly restricted range of career open to them. The process of choosing a career calls
for such extensive knowledge about job on the one hand and the extent of ability of the
worker on the other hand in relation to his health.
An occupational rehabilitation counsellor provides five principal types of services

following medical restoration of physical functions:
• Diagnosis of vocational and educational aptitudes and interest by means of
psychological test and other devices.
• Personal assistance and information necessary to the choice of occupational goals and
the making of plans for training and retaining.
• Helps the securing of financial assistance for training and retaining.
Continued counselling and assistance while training is being secured. Special assistance
in finding a job which utilizes the training secured and in which physical disabilities
are minimized with respect to requirements for the job and for the individual's success
and satisfaction. The above description is made in terms of people/workers who find it
necessary to seek counselling again because diseases or accidents have disqualified
them for their former work or job. In a real sense, all clients handled by counselors are
handicapped in one way or the other (Williamson and Bordin 1995).
18.3.3 Toxicologist
Toxicology is the science of adverse effects of chemical substance on living organisms.
Living organisms include the algae in the sea, animal and people. A toxicologist is one
who specialized in toxicology. Toxicological studies aim to assess the adverse effects
related to different drug doses in order to find the "acceptable safe" level of chemicals
or chemical substances. The work is carried out in two phases, first, by collecting data
on the properties of chemicals, results of studies and accidental misuse of chemicals,
second by predicting the effects of chemicals in different situations. To make relevant
predictions there must be information available on:
• The substance and its chemical and physical properties.
• The biological system affected
• The effects or response caused by the substance.
• The exposure (dose, time, situation)
This information is obtained from laboratory test with cells bacteria, animals and
accidents involving the substance. Routes through which toxic substances may enter
the body under normal working condition are: Inhalation, through the skin and
ingestion.
18.3.4 Recreational and Occupational Therapists

Recreational therapy is a planned, organized, and therapeutic recreation programme
designed to help workers develop social skills and learn to participate in leisure group
activities. The focus of recreational rehabilitative programmes for people with
disabilities involves the following,
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• Involving the worker in leisure activities
• Developing or restore social functions
• Preventing loss of physical capacities.
A recreational therapist is the person that specializes on recreational therapy. Functions
of recreational therapist(s) are many. Recreational therapists have learned that play can
heal. They share with occupational therapists view that seemingly ordinary activities
can put a disabled person on the road to recover or lead to improvement, at any rate. It
is also known as therapeutic recreation specialist, a job title that draws attention to the
fact that theirs is a health profession.
They use recreational and leisure activities as a form of treatment, much as other
professionals use surgery, drugs, nutrition, exercise, or psychotherapy. The primary
goal of the recreation therapist to enhance the workers' ability to function in everyday
life. Apart from sheer enjoyment, the activities they devise provide opportunities for
exercise and social participation. Other goals of recreational therapist include relieving
of anxiety, building confidence, and promoting independence. The programmes are
designed to meet the patients' capabilities, needs, and interest. The creational therapist
may guide or instruct patients in several areas such as:
• Relaxation technique such as deep breathing, to help reduce stress or tension.
• Stretching and limbering exercises.
• Individual and group sport activities.
• Leisure activities such as arts and crafts, games or dramatics.
• Special outings such as ball games, sightseeing or picnics.
In general, recreational therapists assess the patients' ability to function, develop a

treatment plan, lead activities, and monitor progress as plan is carried out. During the
initial session with a patient, the recreation therapist might chat for a while with a
worker and family, trying to put them at ease before directing the conversation towards
the worker hobbies or other interests. By discovering what kind of things the patient
likes to do, the therapist will be able to increase voluntary involvement and
participation. The therapist also needs information about the patient's worker mental
and emotional status in order to set realistic goals and recommend suitable activities.
To gather this information, the therapist goes over medical records, talks with other
members of the staff, and observes the patient's behavior.
Having learned what the patient both can do and like to do, the therapist prepares a list
of activities that capitalize on the patient's strengths and interests. While patients engage
in activities, recreational therapists carefully observe their reactions. Observation such
as these provides the basis for the therapist's period review and modification of each
patient's activity programme. Another important function of recreational therapist is
keeping records. Among them are the initial evaluation, memoranda of periodic
reviews, reports of the initial evaluation, memoranda of periodic reviews, reports to the
physician, internal staff notes Medicare records, and discharge evaluations. These
records are used to keep track of the patient's condition, document treatment and
monitor progress (Gamliel, 1985).
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The recreational therapist conducts therapeutic recreational programmes for clients'
families and groups, including but not limited to outdoor adventure/wilderness
programme (ropes course, rock climbing), physical activities programme (sports, group
games, dancing), creative expressive programmes (dramatics, music, arts and crafts),
and special events and programmes. Works intensively with groups and individual
clients as part of their treatment programme, coughing and supervising them in active
sports, grouping games, dancing, dramatics, and related activities, and participates, if
necessary, to encourages participation.
The specifics of the recreational therapist's job vary with the populations served and the
work settling, such as a hospital, nursing, and home, in patient’s rehabilitation centers,
factories and industries:
• Long term are facilities.
• Facilities or company choice
• Residential Facilities
• Schools (U.S. Dept. of Labour 2006).
Occupational Therapist
Occupational therapy is skilled treatment that helps individuals achieve independence
in all facets of their lives. Occupational therapist gives people the "skills for the job of
living" that are needed for independence and satisfying lives. Service typically includes:
• Customized treatment programmes aimed at improving abilities to carry out the
activities of daily living.
• Comprehensive evaluation of home and job environments and recommendations on
necessary adaptation.
• Assessment and treatment for performance skills.
• Recommendation and training in the use of adaptive equipment example wheelchairs
etc.
• Guidance to family members and care givers as well as employees and co-workers.
Occupational therapy practitioners are skilled professionals whose education includes
the study of human growth and development with specific emphasis on the social,
emotional and physiological effects of illness and injury.
Functions of Occupational Therapists

Occupational therapists (OTS) work with individuals who have conditions that are
mentally, physically, developmentally, or emotionally disabling. Occupational
therapists assist individual to develop, recover or maintain daily living and work skills.
They help people improve their ability to perform tasks in their daily living and work
environments. They also help clients not only to improve their basic motor functions
and reasoning abilities, but also to compensate for permanent loss of function. Their
goals are to help clients have independent, productive and satisfying lives. Occupational
therapists assist clients in performing activities of all types, ranging from using a
computer to caring for daily needs such as dressing, cooking and eating. Physical
exercises may be chosen to improve visual acuity and ability to discern patterns.
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Occupational therapists also use computer programs to help clients improve decision-
making, abstract reasoning, problem - solving, and perceptual skills, as well as memory,
sequencing and coordination - all of which are important for independent living.
Therapists instruct those with permanent disabilities, such as spinal cord injuries,
cerebral palsy, or muscular dystrophy, in the use of adaptive equipment, including
wheel chairs, orthotics, and aids for eating and dressing. They also design or make
special equipment needed at home or at work.
Therapists develop computer-aided adaptive equipment and teach clients with severe
limitations how to use that equipment in order to communicate better and control
various aspects of their environment. Some occupational therapists treat individuals
whose ability to function in a work environment has been impaired. These practitioners
arranged, evaluate the work environment, plan work activities, and assess the client's
progress. Therapists also may collaborate with the client and the employer to modify
the work environment so that he works can be successfully completed. Occupational
therapists may work exclusively with individuals in a particular age group or with
particular disabilities. In schools, for example, they evaluate children's abilities,
recommend and provide therapy, modify classroom equipment, and help children
participate as fully as possible in school programs and activities.
A therapist may work with children individually, lead small groups in the classroom,
consult with a teacher, or serve on a curriculum or other administrative committee.
Early intervention therapy services are provided to infants and toddlers who have, or at
the risk of having developmental delays. Specific therapies may include facilitating the
use of the hand, promoting skills for listening and following directions, fostering social
play skills, or teaching dressing and grooming skills. Occupational therapy also is
beneficial to the elderly population. Therapists help the elderly lead more productive,
active, and independence, lives through a variety of methods, including the use of
adaptive equipment. Therapists with specialized training in driver rehabilitation assess
an individual's ability to drive using both clinical and on-the-road tests. The evaluations
allow the therapist to make recommendations from adaptive equipment, training to
prolong driving independence, and alternative transportation options. Occupational
therapists also work with the clients to assess the home and work site hazards and to
identify environmental factors that contribute to falls.
Occupational therapists in mental settings treat individuals who are mentally ill,
mentally retarded, or emotionally disturbed. To treat these problems, therapists choose
activities that help people learn to engage in and cope with daily life. Activities include
time management skills, budgeting, shopping, home making, and the use of public
transportation. Occupational therapists also may work with individuals who are dealing
with alcoholism, drug abuse, depression, eating disorders, or stress related disorders.
Assessing and recording a client's activities and progress is an important part of an
occupational therapist's job. Accurate recording is essential for evaluating clients, for
billing, and for reporting to physicians and other health care providers.
18.3.5 Occupational Epidemiologist

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Epidemiology is the study of the effects of workplace exposures on the frequency and
distribution of diseases and injuries in the population and thus falls into a category of
exposure-oriented sub-discipline. It is the study of factors affecting health and illness
of populations and serves as the foundation and logic and intervention made in the
interest of public health and preventive medicine. An occupational epidemiologist
studies the occurrence of disease symptoms among factory workers.
18.3.6 Medial Laboratory Scientists

Medical laboratory technologists or clinical laboratory scientists play important role in
the clinical laboratory. They are responsible for performing routine as well as highly
specialized tests to diagnose diseases, troubleshooting (preventing and solving
problems with results, specimens, or instruments); and communicating technical
information, including test results to the pathologists or treating physician. They may
also train other personnel (Asaduate Prospects, 2007).
18.3.7 Laboratory Technicians

Scientific laboratory technicians are responsible for laboratory - based tasks, which
include sampling, testing, measuring, recording and analyzing results in biological,
chemical, physical and life sciences. They also provide all the required technical
support to enable the laboratory to function effectively, while adhering to correct
procedures and health and safety guidelines. Scientific laboratory technicians carry out
fundamental tests and part of a scientific team. These tests assist in the advancement
and development of modern medicine and science.
Typical Work Activities

The main function of a scientific laboratory technician is to perform the specific
procedure that allows scientist to perform more complex analytical processes of the
laboratory.
Task Typically Involve

• Carrying out routine tasks accurately
• Performing a limited number of repetitive laboratory tests in order to produce reliable
and precise data to support scientific investigations.
• Following strict methodology to carry out analysis.
• Preparing specimen and samples.
• Constructing, maintaining and operating standard laboratory equipment, for example
centrifuges, tetrapterous, pipetting machines and pH meters. - Recording and
sometimes interpreting results to present to senior colleagues.
• Using computers and performing mathematical calculations for the preparation of
graphs.
• Keeping up to health with technical developments, especially those which can save
time and improve reliability.
• Demonstrating procedures if working in education.
• Conducting searches on identified topics relevant to the research.
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• Following strict safety procedures and safety checks. The actual nature of the work
will depend on the organization. For example:
• With a local authority environmental health development, the work may involve
analyzing food samples to consider prosecution and to protect public health.
• Within the water industry, the work will mainly focus on the collection and analysis
of water samples.
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18.3.8 Physical Therapists
Physical therapy is the planning organizing and implementing programmes for
individuals whose ability to function is impaired or threatened by disease or injury.
Physical therapy focuses primarily on neuromuscular, skeletal, pulmonary and
cardiovascular systems and includes evaluation of the system and selection and
application of appropriate therapeutic procedures to maintain improve or restore
functions. Physical therapists are persons who are specialized in physical therapy. They
prepare patient, treatment area, and/or equipment, implementing the treatment program
and modifying the treatment program as outlined in the plan of care. They perform
therapeutic exercise for individual muscles or muscle groups, including postural
exercise, manual muscle testing and gait analysis, training and balance. They select
exercise for specific results i.e. increasing strength, coordination, endurance, flexibility
and balance. (Wabash Valley College, 2007).
Physical therapists provide treatment to relieve pain, limit or prevent permanent

physical disability, and improve the morbidity of people who have injury, disease, or
disability. These professionals use the properties of heat, cold, exercise, electricity,
ultrasound, massage, and education to relieve pain, promote healing, and improve
function.
Settings for Physical Therapy

• Schools
• Homes
• Factories/Industries/companies.
Physical therapists who work in the schools, work with other members of the special
education team and the family to identify the problems interfering with a students'
education programme. During an assessment of the student, the physical therapist might
measure walking and other mobility skills, daily activities such as dressing and
toileting, and positioning and posture during classroom learning, play, and on the school
bus. The physical therapist will also measure joint range of motion and mobility, muscle
strength, limb length and circumference, and sensor motor performance.
In school settings, physical therapists usually work as a team with occupational

therapists, speech-language pathologists, special education teachers, and other
professionals. In addition to this collaboration treatment, the physical therapist also
serves as a resource to the school faculty. A physiotherapist is a physical therapist.
18.3.9 Industrial Hygienists

Industrial hygienist recognizes evaluates and controls health hazards in the work place
from biological, chemical and physical sources. Industrial hygienists' expertise can be
a vital resource for government agencies, private response organization and local
emergency planning committee when preparing for or responding to emergency
situations. Qualified industrial hygienists can provide effective guidance on methods to
identify, manage, and ultimately control risks associated with natural disasters,
hazardous materials, accidents and terrorist attacks. To help emergency planners,
190
incident commanders and community leaders take full advantages of the experience,
training are education of industrial hygiene professionals. Industrial hygienists are
qualified and able to perform a number of incidence command functions, such as:
• Participating in pre-planning for a major incident.
• Developing and implementing exposure assessment method to identify and prioritize
hazards during the incident response and consequences management.
• Interpret data from sampling activities and direct reading instrumentation
appropriately.
• Advising on, developing, and implementing the appropriate controls for elimination
of chemical, biological and physical hazards.
• Advising on, developing, and implementing appropriate personal protective equipment
(PPE) to minimize exposures.
• Advising on, developing, and implementing personal decontamination procedures.
• Effectively communication risks based on complex scientific and field data (UNA,
2007).
18.4 SUMMARY
The functions of each professional likely to contribute in evaluation of the practice are
highlighted.
Akinlolu, F.O. (2004). Applied Occupational Nursing in Developing Countries, Lagos:

Akinsola, H.H. (1993). A - Z Community Health Social Medicine in Medical and

Nursing Practice: with reference to Nigeria Ibadan. 3 a.m. Communication.

Countries. 3rd Edition. Enugu: Snaap Press Ltd.
Edmund, G.W. and Edward, S.B. (1995). Annals of American Academy of Political
and Social Sciences 239, the disabled Veteran PP 175 - 181.
Graduate Prospects (2007). Registered Office Prospect House, Booth Street, East Man
Chester: MB England and Wales. Southeast Ilion College, Washasha College,
Kastaskia College, Southeast Missouris State University U.S.A.
QQ: Enumerate the roles of four professionals involved in programme evaluation.
191
UNIT 19 OCCUPATIONAL REHABILITATION
Module Contents
19.1 Introduction
19.3 Occupational Rehabilitation
19.3.1 The Concept of Rehabilitation
19.3.2 Access to Health Care and Health Promotion
19.3.3 Nurses Expectations
19.4 Focus of Rehabilitation
19.5 The Rehabilitation Team
19.6 Areas of Special Rehabilitation Practice
19.7 Assessment of Functional Abilities
19.8 Summary
19.10 Answers to Self- Assessment Exercises
19.1 INTRODUCTION
Rehabilitation is an integral part of nursing because every major illness or injury carries
the threat of disability or impairment, which involves a loss of function or an
abnormality. The principles of rehabilitation are basic to the care of all patients, and
rehabilitation efforts should begin during the initial contact with a patient. The goal of
rehabilitation is to restore the patient’s ability to function independently or at a pre-
illness or pre-injury level of functioning as quickly as possible. If this is not possible,
the aims of rehabilitation are maximal independence and a quality of life acceptable to
the patient. Realistic goals based on individual patient assessment are established with
the patient to guide the rehabilitation programme.

• Describe the concept and process of rehabilitation
192
• Identify those involve in rehabilitation
• Identify the principles of rehabilitation.
19.3 OCCUPATIONAL REHABILITATION

19.3.1 The Concept of Rehabilitation
Rehabilitation is a dynamic, health oriented process that assists an ill person or a person
with disability (restriction in performance or function in everyday activities to achieve
the greatest possible level of physical, mental, spiritual, social, and economic
functioning. The rehabilitation process helps the patient achieve an acceptable quality
of life with dignity, self-respect, and independence is designed for people with physical,
mental or emotional disabilities. During rehabilitation, the patient adjusts to the
disability by learning how to use resources and to focus on existing abilities. In
habilitation, abilities, not disabilities, are emphasized.
Rehabilitation services are required by more people than ever before because of
advances in technology that save or prolong the lives of seriously ill, injured, and
disabled patients. Increasing numbers of patients who are recovering from serious
illnesses or injuries are returning to their homes and communities with ongoing needs.
Every patient, regardless of age, gender, ethnic group, socioeconomic status, or
diagnosis, has a right to rehabilitation services.
A person is considered to have a disability, such as a restriction in performance or

function in everyday activities. If he or she has difficulty talking, hearing, seeing,
walking, climbing stairs, lifting or carrying objects, performing activities of daily
living, doing school work, or working at a job. A severe disability is present if a person
is unable to perform one or more activities, uses an assistive device for mobility, or
needs help from another person to accomplish basic activities.
Individuals are also considered severely disabled if they receive federal benefits based
on an inability to work.
19.3.2 Access to Health Care and Health Promotion

For years, people with disabilities have been discriminated against in employment,
public accommodations, public and private services including health care. The needs
of the disabled in health care settings produce many challenges to health care providers:
how to communicate effectively if there are communication deficits, the additional
physical demands for mobility, and time required to provide assistance with self-care
routines during hospitalization. Physicians and nurses may not know the specific needs
of individuals with disability and may fail to provide services for them. For example,
an obstetrician may advise a woman spinal cord injury not to become pregnant because
the physician and nurses caring for an expectant woman with disability may not know
specific transfer techniques to help her unto an examining table or how to advise her on
bowel, bladder, and skin care issues during pregnancy. Before labour and delivery, the
medical team needs to be educated about the special needs of a woman with a cervical
spinal cord injury in regards to management of autonomic hyperreflexia. Often, the
person with disability must educate the health care professionals.
193
Because of unfavorable interactions with health care providers, including negative
attitudes, insensitivity and lack of knowledge, people with disability may avoid seeking
medical interventions or health promotion programme and activities. For this reason,
and because the number of individuals with disability is increasing, nurses must acquire
knowledge and skills and be accessible to assist these individuals in maintaining a high
level of wellness.
Nurses are therefore positioned to influence the architectural design of health care
settings and the selection of equipment that promotes ease of access and health. Padded
examination tables that can be raised or lowered make transfers easier for the disabled.
Birthing chairs benefit women with disability during yearly pelvic examinations and
pap smears and for urologic evaluations. Ramps, grab bars, raised and padded toilet
seats benefit many persons who have orthopedic disabilities and need routine physical
examination and monitoring (e.g. bone density measurements). Just as people without
disability should have regular screening tests, such as mammography or testicular and
prostate examinations, so should people with disability. The health care professionals
who provide these screening and monitoring procedures are in a position to influence
decisions about how equipment and procedures can be adapted to meet the special needs
of their patients, whether these needs are cognitive, motor or communicative.
194
19.3.3 Nurses Expectations
Nurses are expected to provide health promotion education classes that are targeted to
the disabled. Classes on nutrition and weight management are extremely important to
individuals who are wheelchair dependent by adolescents and young adults with spinal
cord or traumatic brain injury, because the threats of acquired immunodeficiency
syndrome (AIDS) and unplanned pregnancy exist for these populations just as they do
for the population in general. Other healthy behaviors about which neurologically
disabled persons need education include avoiding alcohol and non-prescription
medications while taking antispasmodic and anti-seizure medications. Nurses should
teach all stroke survivors and patients with diabetes how to monitor their own blood
pressure or glucose levels. The warning signs and symptoms of stroke, heart attack and
cancer as well as how to access help, should also be taught to all disabled persons.
As active members of the society, people with disabilities are no longer an invisible
minority. An increased awareness of the needs of people with disabilities will bring
about changes to improve their access and accommodate their needs. Modification of
the physical environment permits access to public and private facilities and services,
including health care, and nurses can serve as advocates for the disabled to eliminate
discriminatory practices.
19.4 Focus of Rehabilitation

Disability can occur at any age and may result from an acute incident, such as stroke or
trauma or from the progression of a chronic condition, such as arthritis or multiple
sclerosis. A person with disability experiences many losses, including loss of function,
independence, social role, status and income. A patient and his or her family members
experience a range of emotional reactions to these losses. The reactions may progress
from disorganization and confusion to denial of the disability, grief over the lost
function or body part, depression, anger, and finally acceptance of the disability. The
reactions may subtle over time and may recur at a later time, especially if chronic illness
is progressive and results in increasing losses. Not all patients experience all of the
stages, although most do exhibit grief. Patients who exhibit grief should not be blithely
encouraged to “cheer up.”
The nurse should show a willingness to listen to the patient talk about the disability and
should understand that grief, anger, regret and resentment are all part of the healing
process.
The patient’s preexisting coping abilities play an important role in the adaptation
process: one patient may be particularly independent and determined, while another
may be dependent and seem to lack personal power.
19.5 The Rehabilitation Team

Rehabilitation is a creative, dynamic process that requires a team of professionals
working together with the patient and the family. The team members represent a variety
of disciplines, with each health professional making a unique contribution. Each health
195
professionals assess the patient, identifies patient’s needs within the discipline’s
domain and sets rehabilitative goals. Team members hold group sessions at frequent
intervals to collaborate, evaluate progress, and modify goals as needed to facilitate
rehabilitation and to promote independence, self-respect, and an acceptable quality of
life for the patient.
The Rehabilitation Team includes:

• The patient
• Patient’s family
• The rehabilitation nurse.
The patient is the key member of the rehabilitation team. He or she is the focus of the
team effort and the one who determines the final outcomes of the process. The patient
participates in goal setting, in learning to function using remaining abilities and in
adjusting to living with disabilities.
The patient’s family is also incorporated into the team. The family is a dynamic
system. So disability of one member affects the other family members. Only by
incorporating the family into the rehabilitation process can the family system adapt to
the change in one of its members. The family provides ongoing support, participates in
problem solving and should learn to provide necessary ongoing care.
The rehabilitation nurse develops a therapeutic and supportive relationship with the
patient and the family. The nurse always emphasizes the patient’s assets and strengths,
positively reinforcing his or her efforts to improve self-concept and self-care abilities.
During nurse patient interaction, the nurse actively listens, encourages and shares the
patient’s successes.
Using the nursing process, the nurse develops a plan of care designed to facilitate
rehabilitation, restore and maintain optimum health and prevent complications. The
nurse helps the patient identify strengths and past successes and develop new goals.
Coping with the disability, self-care, mobility, skin care and bowel and bladder
management are frequently areas for nursing intervention. The nurse assumes the roles
of caregiver, teacher, counselor, patient advocates and consultant. The nurse is often
the case manager responsible for coordinating the total rehabilitative plan, collaborating
with and coordinating the services provided by all members of the health care team
including the home care nurse who is responsible for directing the patient’s care after
return to the home.
Other members of the rehabilitation team may include: a physician, nurse practitioner,
psychiatrist, physical therapist, occupational therapist, speech-language therapist,
psychologist, psychiatric liaison nurse, social worker, vocational counselor, orthotics
or prosthesis, rehabilitation engineer and sex counselor or therapist.
19.6 Areas of Special Rehabilitation Practice
196
Although rehabilitation is a component of every patient’s care, there are specialty
rehabilitation programs established in general hospitals, freestanding rehabilitation
hospitals, and outpatient facilities. The Commission for the Accreditation of
Rehabilitation Facilities (CARF) sets standards for these programs and monitors
compliance with them.
Special rehabilitation programs often meet the needs of patients with neurological
disabilities. Stroke recovery programs and traumatic brain injury rehabilitation
emphasize cognitive remediation: assisting patients to compensate for memory,
perpetual, judgment, and safety deficits as well as teaching self-care and mobility skills.
Other goals include assisting patients to swallow food safely and to communicate
effectively. In addition to stroke and brain injury, other neurological disorders treated
include multiple sclerosis, Parkinson’s disease, amyotrophic lateral sclerosis and
nervous system tumors.
The number of spinal cord injury rehabilitation programs has increased since World
War II. Integral components of the programs include understanding the effects and
complications of spinal cord injury; neurogenic bowel and bladder management;
sexuality and male fertility enhancement; self-care including prevention of skin
breakdown; bed mobility and transfers; and driving with adaptive equipment. The
programs also focus on vocational assessment, training and reentry into employment
and the community.
Orthopedic rehabilitation programs provide comprehensive services to traumatic or

non-traumatic amputee patients, patients undergoing joint replacements, and patients
with arthritis. The goals of the programme include: pain management, learning to be
independent with prosthesis or a new joint, energy conservation and joint protection.
Patients with myocardial begins rehabilitation during acute hospitalization and

continues on an outpatient basis. The goals are on monitoring, progressive exercise,
nutritional counseling; stress management and sexuality.
Others are simplified in this table:
Cases Rehabilitative Goals of rehabilitation

programme
Patient with Pulmonary Effective breathing
restrictive or patterns; energy
chronic conservation, self-
obstructive medication and home
pulmonary ventillatory mgt.
disease
197
Chronic pain Alternative Exercise, supportive
pain counselling and vocational
Treatment evaluation
modalities
Burn Intensive Joint mobility, self-care
rehabilitation burn care and counselling
Nurses Responsibilities towards all rehabilitation cases
• Skilful and knowledgeable about patients case

• Assessment of actual or potential substance abuse
• Thorough physical and psychological evaluation
• Detoxification
• Counselling
• Medical treatment
• Psychological assistance for the patient and family
• Treatment of any coexisting psychiatric illness
• Referral to community resources for social, legal, spiritual or vocational
assistance.
• Encourage self-help groups
• Application of nursing process in rehabilitation.
19.7 Assessment of Functional Abilities
Comprehensive assessment of functional capacity is the basis for developing a

rehabilitation programme. Functional capacity measures a person’s ability to perform
activities of ADLs and IADLS. ADLs include activities performed to meet basic needs,
such as personal hygiene, dressing, and toileting, eating and moving. IADLs include
activities that are necessary for independent living such as the ability to shop for and
prepare meals, use the telephone. Clean, manage finances and travel.
The nurse observes the patient performing specific activities (e.g. eating, dressing) and
notes the degree of independence; the time taken; the patient’s mobility, coordination,
endurance and the amount of assistance required. Good joint motion, muscular strength,
cardiovascular reserve and an intact neurological system are also carefully assessed,
because functional ability depends on these factors as well. These tools provide a way
to standardize assessment parameters and supply a scale or score against which
improvements may be measured. They also clearly communicate the patient’s level of
functioning to all members of the rehabilitation team. Rehabilitation staffs use these
tools to provide an initial assessment of the patient’s abilities and to monitor the
patient’s progress in independence.
One of the most frequently used tools to assess the patient’s level of independence is
the Functional Independence Measure (FIM). The FIM is a minimum data set,
measuring 18 items. The self-care items measured are eating, bathing, grooming,
198
dressing upper body, toileting, bladder Management, and bowel management. The FM
addresses transfers and the ability to ambulate and climb stairs and also includes
communication and social cognition items.
A WeeFIM instrument is used for children. For both children and adults, scoring is
based on a seven-point scale with items used to assess the patient’s level of
independence.
The PULSES profile is used to assess the following
• physical condition(e.g. health/illness status)

• upper extremity functions (e.g. eating, bathing)
• lower extremity functions (e.g. transfer, ambulation)
• sensory function (e.g. vision, hearing, speech)
• excretory function (i.e. control of bowel or bladder),
• situational factors (e.g. social and financial support
Each of these areas is rated on a scale from one (independent) to four (greatest
dependency).
The Barthel Index is used to measure the patient’s level of independence in ADLs
(feeding, bathing, dressing, grooming), continence, toileting, transfers and ambulation
(or wheelchair mobility). This scale does not address communicative or cognitive
abilities.
The Patient Evaluation Conference System (PECS) contains 15 categories. This

comprehensive assessment scale includes such as medications, pain, and nutrition, use
of assistive devices, psychological status, vocation and recreation. There are many other
assessment tools designed to evaluate function in persons with specific disabling
conditions.
In addition to the detailed functional assessment, the nurse assesses the patient’s
physical, mental, emotional, spiritual, social and economic status. Secondary problems
related to the disability such as muscle atrophy and deconditioning are assessed as are
residual strengths unaffected by disease or disability.
Other areas that require nursing assessment include:

• potential for altered skin integrity
• altered bowel and bladder control
• sexual dysfunction
19.8 SUMMARY
The goal of rehabilitation is to help the patient gain a positive self-image through
effective coping. The nurse must recognize different coping abilities and identify when
the patient is not coping well or not adjusting to the disability. The patient and family
may benefit from participating in a support group or talking with a mental health
professional to achieve this goal.
199
19.9 REFERENCES/ FURTHER READINGS
Akintolu, F.O. (2004). Applied Occupational Nursing in Developing Countries. Lagos:
Akinsola, H.H. (1993). A-Z Community Health Social Medicine in Medical and Nursing
Practice: with reference to Nigeria, Ibadan, 3 a.m. Communication.

Countries, 3rd edition Enugu: Snaap Press Ltd.
Edmund, G.W. and Edward, S.B. (1995). Annals of American Academy of Political and
Social Sciences 239, the disabled Veteran PP 175-181.
Graduate Prospects (2007). Registered Office Prospect House, Booth Street, East
Manchester: MB England and Wales.
Southeast Ilion College, Washasha College, Kastaska College, Southeast

Missouri State University, U.S.A
19.10 Answers to TUTOR-MARKED ASSIGNMENT

Describe the nurses’ role in rehabilitation.
UNIT 20 INTERNATIONAL LABOUR ORGANIZATION
CONTENTS
20.1 Introduction
20.3 International Labour Organization
20.4 How International Labour Organization Works
20.4.1International Labour Conference
20.4.2 The Governing Body
20.4.3 The International Labour Office
20.4.4The International Labour Organization (ILO) and contributions to United
Nations Agency for International Developments (UNAIDS)
20.5 Summary
20.1 INTRODUCTION
200
The International Labour Organization (ILO) was created in 1919 by Part XIII of the
Versatile Peace Treaty ending in World War 1. It grew out of nineteenth century labour
and social movement which culminated in widespread demands for social justice and
higher standards for the world’s working people. In 1946, after the demise of the League
of Nations, the ILO became the first specialized agency associated with the United
Nations. The original membership of forty-five countries in 1919 has grown to 121 in
1971.

At the end of this unit you are expected to:
• Describe the structure of International Labour Organization
• State how ILO works
• Examine the contributions of ILO to United Nations AIDS.
20.3 INTERNATIONAL LABOUR ORGANIZATION

The annual International Labour Conference, the ILO supreme deliberative body, is
composed of four representatives from each member country: two government
delegates, one worker and one employer delegate, each of whom may speak and vote
independently. Between conferences, the work of the ILO is guided by the Governing
Body, comprising twenty-four government, twelve worker and twelve employer
member twelve deputy members from each of these three groups. The International
Labour Office in Geneva, Switzerland, is the organization’s secretariat, operational
headquarters, research center and publishing house. Its operations are staffed at
headquarters and around the world by more than 3,000 people of some 100 nationalities.
Activities are decentralized to regional, area and branch offices in over forty countries.
The ILO has three major tasks, the first of which is the adoption of International Labour
Standards called conventions and recommendations for implementation by member
states. The convention and recommendations guidelines contain guidelines on child
labour, protection of women workers, hours of work, rest and holidays with pay, labour
inspection, vocational guidance and training, social security protection, workers’
housing, occupational health and safety, conditions of work at sea and protection of
migrant workers.
They also cover questions of basic human rights, among them, freedom of association,
collective bargaining, the abolition of forced labour, the elimination of discrimination
in employment and the promotion of full employment. By 1970, 134 conventions and
142 recommendations had been adopted by the International Labour Organization.
Each of them is a stimulus, as well as a model for national legislation and for practical
application in member countries.
A second major task which has steadily expanded for the past two decades is that of
technical cooperation to assist developing nations. More than half of ILO’s resources
are devoted to technical cooperation programme carried out in close association with
the United Nations Development Programme and often with other UN specialized
201
agencies. These activities are concentrated in four major areas: development of human
resources through vocational training and management development, employment
planning and promotion; the development of social institutions in such fields as labour
administration, labour relations, cooperatives and rural development; conditions of
work and life – for example, occupational safety and health, social security,
remunerations, hours of work, welfare, etc. Marking the beginning of its second half-
century, the ILO launched the World Employment programme, designed to help
provide employment and training opportunities for their swelling populations. The
World Employment programme will be the ILO’s main contribution to the United
Nations Second Development Decade.
There are some 900 ILO experts of fifty-five different nationalities work on more than
300 technical cooperation projects in over 100 countries around the world.
Third, standard setting and technical cooperation are bolstered by an extensive research,
training, education and publication programme. The ILO is a major source of
publications and documentation on labour and social matters. It has established two
specialized educational institutions: the International Institute for Labour Studies in
Geneva and the International Centre for Advanced Technical and Vocational Training
in Turin, Italy.
Since its inception the ILO has had six Directors-General: Albert Thomas (1919-1932)
of France: Harold B. Butler (1932-1938) of the United Kingdom: John G. Ireland;
David A. Morse (1948-1970) of the United States; Wilfred Jenks (1970) of the United
Kingdom
3.1 How International Labour Organization Works

3.1.1 International Labour Conference
The member states of the ILO meet at the International Labour Conference in June of
each year in Geneva. Two governments delegated, an employer delegate and a worker
delegate represent each member state. Technical advisors assist the delegations which
are usually headed by Cabinet Ministers who take the floor on behalf of their
governments.
Employer and worker delegates can freely express themselves and vote according to
instructions received from their organizations. They sometimes vote against each other
or even against their government representatives.
The Conference establishes and adopts International Labour Standards and is a forum
for discussion of key social and labour questions. It also adopts the organization’s
budget and elects the governing body.
3.1.2 The Governing Body
The Governing Body is the executive council of the ILO and meets three times a year
in Geneva. It takes decisions on ILO policy and establishes the programme and the
budget which it then submits to the Conference for adoption. It also elects the Director-
General.
202
The ILO Governing Body is composed of 28 government members, 14 employer
members and 14 worker member states of chief industrial importance permanently hold
ten of the government seats. Government representatives are elected at the Conference
every three years, taking into account geographical distribution. The employers and
workers elect their own representatives respectively.
3.2 The International Labour Office

The International Labour Office is the permanent secretariat of the International Labour
Organization. It is the focal point for ILO’s overall activities, which it prepares under
scrutiny of the Governing Body and under the leadership of a Director-General, who is
elected for a five year renewable term. The office employs some 1,900 officials of over
110 nationalities at the Geneva headquarters and in 40 fields around the world. In
addition, some 600 experts undertake missions in all regions of the world under the
programme of technical cooperation. The office also contains a research and
documentation centre and a printing facility, which issue many specialized studies,
reports and periodicals.
3.3 The International Labour Organization (ILO) and contributions to United

Nations Agency for International Developments (UNAIDS
The International Labour Organization (ILO) is the United Nations Agency with special
responsibility for the world of labour.
The ILO’s goal is productive and remunerative employment for all based on the
principles of social justice and equality.
The epidemic is a threat to all of the organization’s four strategic objectives:
fundamental principles and rights at work: employment, income generation and skills;
social protection and social dialogue.
Worldwide, at least 26 million workers in their productive prime are infected with HIV.
The epidemic is a labour and workplace issue because it threatens livelihoods,
productivity, rights at work and economic growth. It also worsens existing problems of
inadequate social protection, gender inequalities and child labour.
AIDS is a development crisis that can only be resolved with a multispectral response.
The ILO’s particular contribution to UNAIDS includes:
1. A tripartite membership encouraging the mobilization of governments, employers
and
workers against HIV;
2. Direct access to the workplace with its opportunities for HIV prevention as well as
care,
support and treatment;
3. long- standing experience in framing international standards to protect the rights of

workers;
4. A global network of field offices and technical cooperation projects and substantial
capacity for research, information sharing and training.
203
5.0 SUMMARY
In structure, the ILO is unique among world organizations in that the representatives of
the workers and of the employers have an equal voice with those of governments in
formulating its policies.

“Fifty Years in the Service of Social Progress, 1919-1969”, ILO Panorama, 37 (July-
August, 1969) 1-88.
The ILO in the Service of Social Progress: A Workers’ Educational Manual, Geneva,
ILO, 1969.
Jenks, Wilfred. (1960). Human Rights and International Protection of Trade Union
Freedom, London: Stevens,
Jenks, Wilfred. (1960). The International Protection of Trade Union Freedom, London:
Stevens, 1960.
Johnston, G.A. The International Labour Organization: Its work for Social and
Economy Progress, London: Europa Publications, 1970
Landy, Ernest A., The Effectiveness of International Supervision: Thirty Years of ILO
Experience.
Morse, David A., The Origin and Evolution of the ILO and its Role in the World
Community. Ithaca, N.Y., Cornell University, New York State School of Industrial and
Labour relations, 1969.
Nobel Lectures, Peace 1951 – 1970, Editor Fredrick W. Haberman, Elsevier Publishing
Company, Amsterdam, 1972.
Phelan, Edward J., Yes and Albert Thomas. London, Cresset Press, 1936.
The Story of Fifty Years, Geneva, ILO, 1969.
Valticos, Nicholas. (1969) Fifty Years of Standard-Setting Activities by the ILO,

International Labour Review, 201-237.
6.0 TUTOR-MARKED ASSIGNMENT

Describe the structure of International Labour Organization and explain its mode of
operation.
204

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NATIONAL OPEN UNIVERSITY OF NIGERIA

COURSE CODE: NSC512

COURSE TITLE: OCCUPATIONAL NURSING

Course Reviewer: Dr (Mrs) Akon Emmanuel Ndiok, Department of Nursing Science

Faculty of Allied Medical Sciences, University of Calabar

3.0 Course learning Outcome

On successful completion of the course, you should be able to:

4.0 Working through This Course

5.0 Study Units

6.0 References and Further Readings

7.0 Assignment File

How to get the Most from the Course

8.0 Tutor Marked Assignment (TMA)

9.0 Final Examination and Grading

Course Marking Scheme

10.0 Course Overview

Module 2 Occupational Health Problems

12.0 Tutors and Tutorials

UNIT 1 HISTORICAL DEVELOPMENT OF OCCUPATIONAL HEALTH

1.2 Learning Outcomes

1.3 Historical Development of Occupational Health

1.3.1 Occupational Health Development in Ancient Times

1.3.2 Occupational Health Development in Britain

Lord Cooper, an aristocrat, as a member of the British Parliament helped to promote

1.3.3 Development of Occupational Health in United State of America

1.3.3.1 Early Research in Occupational Health in USA

1.4 Development in Developing Countries

1.5 Development in Nigeria

Modern occupational health, reported Achalu, (2000, p. 25) started as a result of

1.6 International Occupational Health

1.7 International Labor Organization

The International Programme for the Improvement of Working Conditions and

Self- Assessment Exercise 2

1.8 The World Health Organization

Occupational health, as in other areas of Public Health, lays emphasis on preventive

1. Analysis of trends (health promotion, risk reduction and health expenditures).

Self- Assessment Exercise 3

1.11 References/Further Readings/Web Sources

1.12 Possible Answers to Self-Assessment Exercises

Answers to Self-Assessment Exercise 2

Answers to Self-Assessment Exercise 3

2.2 LEARNING OBJECTIVES

2.3 BASIC CONCEPTS IN OCCUPATIONAL HEALTH

1.3.1 Aims and Objectives of Occupational Health

2.3.2 Rationale for Occupational Health

2.4 Benefits of Occupational Health Promotion

1. Improvement of worker's health behaviour due to relaxed atmosphere in the work

2.5 Occupational Health Benefits to Industries and Other Occupations

2.6 Relationship between Work and Health

2.7.1 Negative Effects of Work on Health

2.9 Needs for the Maintenance of Health in Industrial Communities

Asogwa, S.E. (2007). A Guide to Occupational Health Practice in Developing

Rogers, B. (1994). Occupational Health Nursing: Concepts and Practice. Philadelphia:

1.12 Possible Answers to Self-Assessment Exercises

3.2 Learning Outcomes

3.3 Roles of Occupational Health Nursing Practices in Organizations

Self – Assessment Exercise 1

They hence may comprise the following: