Periodic Assessment

The purpose of a periodic assessment is to monitor the general health of the worker at established times during the course of employment. Periodic examinations may be undertaken for three distinct purposes:

  • To evaluate the general health status and lifestyle of an employee as part of a non-specific employment package.
  • To assess the health status of an employee with respect to a specific industry or operation within an industry.
  • To provide ongoing health surveillance of workers for use in epidemiological studies.

Before undertaking any such specific program, the occupational health physician should carefully consider:

  • The needs and objectives of the program.
  • The usefulness of the possible or planned procedures in indicating current disease or forecasting future significant pathological change.
  • The potential benefits to both the individual and the employer.
  • Existing legal requirements to monitor workers periodically and ensure that any program implemented by a company is in compliance with local/national regulations.

At the outset, a procedure should be agreed upon by both management and the employees’ representatives on the action to be taken with respect to those individuals who are found to have problems that render them unsuitable for their current work (e.g., a worker presenting with skin allergies). A single approach may not be applicable to all companies; hence, solutions may need to be tailored to meet the specific needs of a given company and its workers. Any actions taken to remedy a problem should consider the practical consequences of moving a worker, e.g., financial repercussions and job prospects, as well as potential legal constraints such as medical removal provisions of applicable occupational health regulations.

As with pre-placement examinations, plant-specific periodic assessments should examine the general health and lifestyle of a worker, as well as nickel-associated concerns. Such examinations should include a reevaluation of personal habits and recent illnesses, standardized respiratory and dermal symptom questionnaires, a physical examination, and a reevaluation of the worker’s ability to use the types of respiratory equipment that may be required for particular tasks. As noted in the beginning of this Chapter, air monitoring data (discussed further in Chapter 7) needs to be linked to health surveillance data; hence, any personal dust monitoring for nickel data should be kept in the worker’s medical records. Review of these records with the worker should be undertaken at the time that a periodic assessment is conducted.

X-rays and pulmonary function tests are surveillance tools of value to detect the presence of pulmonary abnormalities at a group level. Unless a risk assessment indicates otherwise, measurements of respiratory function and chest X-rays are recommended every five years for surveillance. Depending on the age of the workers (45 years or older), the smoking status, and the job task (nature, duration and level of dust/nickel exposure), more frequent chest X-rays may be appropriate. However, if abnormalities are detected, further tests should be carried out as appropriate, and the frequency of surveillance should be increased. It should be noted that in some countries chest X-rays may be required by law.