UK OH principle — advisory, biopsychosocial, retention-oriented
- OH advises on capability + adjustments — the employer decides reasonableness.
- Biopsychosocial model (FOM) — function and context, not diagnosis labels.
- "Good work is good for health" (Waddell & Burton) — favour adjustments + retention over removal.
- Confidentiality (GMC + UK GDPR): OH record separate from personnel; employer sees outcome + advice, not medical detail.
Healthcare worker — blood-borne virus immunity & EPP
hcw-blood-borne-immunity
Pre-placement + change-of-role + post-exposure Legal basis: Green Book Chapter 12 (HCW immunisation) + Department of Health/PHE 'HBV-infected HCW' guidance + GMC duties + FOM EPP guidance
Immunity status
- ▸ Hep B anti-HBs ≥10 mIU/mL (≥100 ideal); HBsAg + anti-HBc if EPP role
- ▸ Rubella + measles + varicella IgG
- ▸ Tuberculosis: BCG history + IGRA per NICE NG33
- ▸ Anti-HCV / HIV per local trust policy (consent + counselling)
EPP risk assessment
- ▸ Exposure-prone procedure (EPP) role classification
- ▸ If HBsAg+ / HCV-RNA+ / HIV+: assess viral load + EAGA route
- ▸ Restrictions per UKHSA EPP policy if non-compliant
Vaccinations + boosters
- ▸ HBV course completion + 5-yearly review
- ▸ Influenza annual (Sept-Oct)
- ▸ MMR catch-up if <2 doses
- ▸ Pertussis if maternity/paediatric (cocoon)
- ▸ BCG if TB-exposed + IGRA negative
Ongoing surveillance / monitoring
- ●Annual flu campaign coverage
- ●Sharps incident → 1-hr PEP pathway (sprint21 PEP)
- ●EPP HCW: annual viral marker review where applicable
Note: GMC + Faculty OM: HCW with infectious blood-borne virus has duty to seek OH advice. EPP restriction is OH-led with worker consent + employer notified only as required.
LGV / PCV driver — DVLA Group 2 fitness
lgv-pcv-driver
Initial Group 2 medical (D4) + 5-yearly age 45-65 + annual 65+; condition-triggered earlier Legal basis: DVLA 'Assessing fitness to drive' Group 2 standards + LGV/PCV licensing + Working Time (Drivers Hours) Regs
Vision
- ▸ Visual acuity: ≥6/7.5 (better eye), ≥6/60 (worse eye) corrected
- ▸ Visual field: minimum 160° horizontal + 70° each side of vertical
- ▸ No double vision (binocular fields)
Cardiovascular
- ▸ Resting BP <180/100 mmHg (relicense thresholds)
- ▸ ECG if indicated (age + symptoms)
- ▸ Disqualifying: untreated angina, recent MI <6 weeks, NYHA III-IV HF, syncope episodes
Metabolic / endocrine
- ▸ Insulin-treated diabetes: Group 2 specific tightened criteria (no severe hypo last 12 months, awareness preserved, BG monitoring documented)
- ▸ Single severe hypo in last 12 months → barring
Neuro + sleep
- ▸ Seizures: usually disqualifying (10-yr seizure-free + off meds 10 yr for relicense)
- ▸ OSA: untreated moderate-severe disqualifying until treated + adherent
- ▸ ESS / STOP-BANG screening
Substance use
- ▸ AUDIT-C
- ▸ Drug screen if indicated
- ▸ Alcohol dependence → barring until 1-yr sustained sobriety + DVLA review
Ongoing surveillance / monitoring
- ●Drivers Hours Regs compliance review
- ●Periodic vision + CV reassessment per DVLA Group 2 intervals
- ●Self-report obligation: worker must notify DVLA of any new disqualifying condition
Note: Group 2 ≈ US CDL (FMCSA 49 CFR 391.41). DVLA is the licensing authority — OH advises employer on fitness; worker self-notifies DVLA. Distinct lines of duty.
Lead-exposed worker — CLAW 2002 + Appointed Doctor
lead-claw-worker
HSE Appointed Doctor (not all OH physicians qualify) — initial + periodic per exposure level Legal basis: Control of Lead at Work Regulations 2002 (CLAW) + ACOP L132 (3rd ed) + HSE Appointed Doctor scheme
Pre-employment medical
- ▸ History of lead exposure (occupational/environmental/recreational — shooting/lead-glaze)
- ▸ Baseline blood lead (Pb-B) in µg/dL
- ▸ Renal function + Hb (lead anaemia screen)
- ▸ Reproductive history for women of reproductive capacity
Periodic Pb-B monitoring
- ▸ Women of reproductive capacity + young persons (<18): at least every 3 months
- ▸ Other employees: per Appointed Doctor schedule, more frequent if rising trend
- ▸ Suspension thresholds (L132 Table 5): women repro 30 µg/dL · <18 years 50 µg/dL · others 60 µg/dL
Suspension + return
- ▸ Suspension is statutory when Pb-B reaches level above
- ▸ Worker removed from lead exposure on full pay (employer duty)
- ▸ Return when Pb-B falls below resumption threshold + Appointed Doctor sign-off
Ongoing surveillance / monitoring
- ●Health record kept 40 years (COSHH reg 11 + CLAW)
- ●Notify HSE of suspension cases
- ●EU 2024/869 may lower thresholds further to 15 µg/dL — UK post-Brexit adoption pending
Note: CLAW is a SEPARATE regime from COSHH — distinct medical surveillance + HSE Appointed Doctor required. Women of reproductive capacity have strictest thresholds to protect foetus (NOT because women are more susceptible).
Night / shift worker — Working Time Regs + HSG256
night-shift-worker
Pre-placement free health assessment + periodic (worker request or risk-triggered) Legal basis: Working Time Regulations 1998 reg 7 (free health assessment for night workers) + HSE HSG256 (shift work and fatigue)
Baseline assessment
- ▸ Hours pattern (rotation direction, length, rest gaps)
- ▸ Sleep history + Epworth Sleepiness Scale
- ▸ Cardiovascular risk (QRISK3 — sprint23)
- ▸ Metabolic: BMI + glucose + lipids (shift-work metabolic syndrome risk)
- ▸ Mental health screen (PHQ-2/GAD-2)
Risk-specific overlays
- ▸ OSA screen — STOP-BANG (shift workers high prevalence)
- ▸ Pregnancy: medical certificate route to day work (MHSWR)
- ▸ Safety-critical role + night shift = combined risk assessment
Ongoing surveillance / monitoring
- ●Annual self-report worker can request free assessment (Working Time Regs)
- ●Document fatigue management measures (HSG256: shift design, rest, lighting, food access)
- ●Cross-ref to QRISK3 calculator for ASCVD risk re-evaluation
Note: Working Time Regs reg 7 = the only routine health assessment that is statutorily FREE to the worker. Confidentiality: outcome shared with employer only with consent. Pregnancy + night work: MHSWR route to day work via medical certificate.
DSE user — Display Screen Equipment Regs 1992
dse-display-screen-user
Free eye/eyesight test on request + when adjustments suggested + 'reasonable intervals' thereafter Legal basis: Health and Safety (Display Screen Equipment) Regulations 1992 + HSE INDG36 + Equality Act 2010 reasonable adjustments
Workstation assessment
- ▸ DSE risk assessment checklist (INDG36) — chair, desk, monitor, keyboard, mouse, lighting, environment
- ▸ Ergonomic posture (neutral wrist, screen at eye level, feet flat or footrest)
- ▸ Software glare and contrast adequate; document holder if frequent reference
Eye/eyesight test (employer-funded)
- ▸ Vision history + symptoms (headache, dry eye, blurring after sustained DSE)
- ▸ Visual acuity + near vision (DSE working distance 50-60 cm typically)
- ▸ Refer to optometrist if test indicates need — DSE-specific corrective lenses (single-vision intermediate / occupational varifocals) reimbursed by employer per HSE guidance
Musculoskeletal screen
- ▸ Neck, shoulder, wrist, lower-back symptom enquiry
- ▸ Carpal tunnel screen if symptomatic (Phalen / Tinel) — note PD A12 association with vibrating tools, NOT keyboard use alone
- ▸ Refer ergonomics / physio if persistent symptoms despite workstation adjustment
Ongoing surveillance / monitoring
- ●Eye/eyesight test on request — employer pays; corrective lenses for DSE use also employer-funded
- ●Worker can request workstation reassessment whenever role / equipment changes
- ●Equality Act reasonable adjustments for visual impairment / RSI (screen reader, voice recognition, sit-stand desk)
Note: DSE Regs do NOT mandate eye tests at fixed intervals — only on request. Eye tests are NOT a routine occupational health surveillance like CLAW/noise. The pay-for-DSE-glasses rule covers DSE-specific lenses only, not a general prescription.
Asbestos-licensed worker — CAR 2012 + Appointed Doctor
asbestos-car-licensed
Pre-employment + every 2 years while exposed (CAR reg 22) Legal basis: Control of Asbestos Regulations 2012 (CAR) reg 22 + ACOP L143 + HSE Appointed Doctor (asbestos) scheme
Initial medical (Appointed Doctor)
- ▸ Full asbestos exposure history (UK + abroad); smoking status (synergistic lung cancer risk)
- ▸ Respiratory symptoms (cough, breathlessness, chest pain)
- ▸ Chest examination + auscultation
Investigations
- ▸ Spirometry (FEV1, FVC, ratio) — baseline + 2-yearly
- ▸ Chest X-ray at Appointed Doctor's discretion (NOT routinely 2-yearly — radiation balance per HSE guidance)
- ▸ Document baseline for future medico-legal claim purposes
Education + records
- ▸ Worker informed of latency (mesothelioma 30-50 years; lung cancer 15-30 years; asbestosis dose-dependent)
- ▸ Worker advised to STOP SMOKING (synergistic lung cancer ×50)
- ▸ Health record kept 40 years (CAR + COSHH reg 11)
Ongoing surveillance / monitoring
- ●Issue certificate of fitness to continue work — valid 2 years (CAR reg 22)
- ●Notify HSE if asbestosis / mesothelioma diagnosed — RIDDOR + IIDB PD D1/D3 routes
- ●Post-employment: workers entitled to medical surveillance for up to 40 years if previously exposed (Pneumoconiosis etc. (Workers' Compensation) Act 1979)
Note: Asbestos surveillance is SEPARATE from COSHH (CAR is a discrete regime). Only HSE Appointed Doctors can perform — not all OH physicians qualify. The 'every 2 years' frequency is statutory minimum, not maximum.
Work at height — Work at Height Regs 2005
work-at-height-worker
Pre-placement + change-of-role + post-incident; no statutory periodic medical (unless rope access / scaffolding role specifies one via TICA/SIA) Legal basis: Work at Height Regulations 2005 + HSE INDG401 + employer risk assessment + Equality Act 2010 reasonable adjustments
Functional capacity
- ▸ Cardiovascular: BP, exercise tolerance, history of syncope / arrhythmia / ischaemic disease
- ▸ Neurological: vertigo / vestibular history, seizure history, peripheral neuropathy (grip + balance)
- ▸ Musculoskeletal: shoulder ROM, grip strength, lower-limb function (climbing/standing)
Sensory + cognitive
- ▸ Vision: depth perception adequate (binocular)
- ▸ Hearing: communication-relevant (signals + warning sirens)
- ▸ Medication review: sedatives / hypoglycaemics / antihypertensives causing postural drop
Role overlay
- ▸ Rope access (IRATA-certified): more stringent — refer to IRATA medical standard
- ▸ Scaffolding (CISRS): medical declaration via CISRS scheme
- ▸ Lone work at height: combined risk assessment + communication / rescue plan
Ongoing surveillance / monitoring
- ●Re-assess after any condition that affects balance, consciousness, or grip
- ●Worker self-declaration of new conditions or medication changes
- ●Medication-related risks: SSRIs early-onset dizziness, gabapentinoids drowsiness, recent insulin titration
Note: No general statutory 'work at height medical' equivalent to DVLA Group 2 — fitness is role-specific risk assessment. Some industries (rope access IRATA, offshore OGUK) have their own medical standards layered on top.
Confined space — Confined Spaces Regs 1997
confined-space-worker
Pre-placement + change-of-role + post-incident; respiratory equipment users → additional RPE face-fit test annually Legal basis: Confined Spaces Regulations 1997 reg 5 + ACOP L101 + HSE INDG258 + emergency rescue plan duty
Cardiorespiratory
- ▸ Asthma, COPD, fibrosis history — RPE wear adequately?
- ▸ Resting BP + ECG if age >40 or risk
- ▸ Exercise tolerance (escape from confined space may demand exertion)
Neurological + mental
- ▸ Claustrophobia screen (occupational history + brief enquiry)
- ▸ Seizure / syncope history
- ▸ Medication review (sedatives, hypoglycaemics)
RPE compatibility
- ▸ Beard / facial hair: incompatible with tight-fitting respirators — clean-shaven or alternative RPE
- ▸ Face-fit test (Quantitative or Qualitative) — annual minimum
- ▸ Glasses: temple arms break seal — prescription RPE inserts may be needed
Ongoing surveillance / monitoring
- ●Repeat face-fit test annually OR after facial change (weight loss, dental work, scarring)
- ●Asphyxiant / toxic atmosphere risks: cross-ref EH40 WELs + atmosphere monitoring before entry
- ●Emergency rescue plan must be in place BEFORE entry — OH advises but rescue is operational duty
Note: Confined space is not 'one risk' — it includes oxygen deficiency, toxic atmosphere, flammable atmosphere, engulfment, drowning, heat. Pre-entry risk assessment + permit-to-work + rescue plan are mandatory (CSR reg 5).
Food handler — Food Standards Agency 'Fitness to Work' guide
food-handler
Pre-placement health declaration + ongoing self-report duty; no routine periodic medical mandated Legal basis: Food Safety Act 1990 + Regulation (EC) 852/2004 + FSA 'Fitness to Work' guide + RIDDOR food-poisoning duty
Pre-placement declaration
- ▸ History of typhoid, paratyphoid, salmonella, E. coli O157, shigella, Hep A, Hep E, norovirus
- ▸ Recent travel to high-risk area + GI symptoms
- ▸ Skin conditions (open sores, weeping eczema, MRSA) — skin lesions on hands/exposed areas exclude until healed/covered
Active symptoms / acute exclusion
- ▸ Diarrhoea + vomiting: EXCLUDE from work for 48 hours after first symptom-free + formed stool (FSA guide)
- ▸ Confirmed typhoid / paratyphoid / E. coli O157 / Hep A: EXCLUDE until clearance per UKHSA local Health Protection Team
Carrier states
- ▸ Asymptomatic carriers — risk-assess per UKHSA HPT advice
- ▸ Return-to-work clearance: documented + HPT-led, not OH-led alone
Ongoing surveillance / monitoring
- ●Ongoing worker duty to report new GI illness immediately (FSA guide)
- ●Outbreak investigation: notify Environmental Health + UKHSA HPT — RIDDOR if from occupational exposure
- ●No fixed-interval routine examination; surveillance is symptom-triggered + outbreak-triggered
Note: Food handler 'fitness' is NOT a medical certificate — it is a continuous declaration model. Confidentiality matters: a worker disclosing carriage to OH must be supported in conversation with HPT, not penalised. Equality Act applies to chronic / blood-borne carriage routes.
Under the physician's clinical judgement
- These templates are starting points — never substitutes for the clinical assessment of the actual worker.
- OH outcome to employer is a fitness advice statement: fit / fit with adjustments / temporarily unfit / permanently unfit. Medical detail stays in the OH record.
- Where the role requires a regulator decision (DVLA, UKHSA EPP, HSE Appointed Doctor), follow the regulator's route — OH advises but is not the regulator.
- FOM Ethics Guidance for Occupational Health Practice is the canonical reference.