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ABU DHABI NATIONAL OIL COMPANY

ABU DHABI NATIONAL OIL COMPANY HEALTH SAFETY AND ENVIRONMENTAL MANAGEMENT MANUAL OF CODES OF PRACTICE VOLUME

HEALTH SAFETY AND ENVIRONMENTAL MANAGEMENT MANUAL OF CODES OF PRACTICE

VOLUME 3 : OCCUPATIONAL HEALTH

CODE OF PRACTICE ON OCCUPATIONAL HEALTH RISK MANAGEMENT - GENERAL ADNOC-COPV3-03
CODE OF PRACTICE ON
OCCUPATIONAL HEALTH RISK MANAGEMENT -
GENERAL
ADNOC-COPV3-03
VOLUME 3 : OCCUPATIONAL HEALTH CODE OF PRACTICE ON OCCUPATIONAL HEALTH RISK MANAGEMENT - GENERAL ADNOC-COPV3-03
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RECORD OF REVISION

Revision No. Date Section / Page Reason
Revision No.
Date
Section / Page
Reason

Copyright

The copyright and all other rights of a like nature in this document are vested in Abu Dhabi National Oil Company (ADNOC), Abu Dhabi, United Arab Emirates. This document is issued as part of the Manual of HSE Codes of Practice (the “Manual”) and as guidance to ADNOC, ADNOC Group Companies and independent operators engaged in the Abu Dhabi oil & gas industries. Any of these parties may give copies of the entire Manual or selected parts thereof to their contractors implementing HSE standards in order to qualify for award of contracts or for the execution of awarded contracts. Such copies should carry a statement that they are reproduced by permission of ADNOC, and an explanatory note on the manner in which the Manual is to be used.

Disclaimer

No liability whatsoever in contract, tort or otherwise is accepted by ADNOC or any of its Group Companies, their respective shareholders, directors, officers and employees whether or not involved in the preparation of the Manual for any consequences whatsoever resulting directly or indirectly from reliance on or from the use of the Manual or for any error or omission therein even if such error or omission is caused by a failure to exercise reasonable care.

All administrative queries should be directed to the Manual of HSE Codes of Practice Administrator in:

Environment Health & Safety Division (SPC), Abu Dhabi National Oil Company, P.O. Box : 898, Abu Dhabi, United Arab Emirates. Telephone : (9712) 6023782 Fax: (9712) 6668089 Internet site: www.adnoc.com E-mail: hse@adnoc.com

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TABLE OF CONTENTS

PAGE

 

I. PURPOSE

 

4

II. DEFINITIONS

4

III. EXISTING LAWS

9

1. INTRODUCTION

10

2. HEALTH RISK ASSESSMENT

12

3. HEALTH SURVEILLANCE

14

3.1 Health Surveillance Activities

14

3.2 Purpose of Health Surveillance

15

3.3 When is Health Surveillance Required?

15

3.4 Competency Requirements

15

3.5 Health Surveillance Records

16

4. OCCUPATIONAL HEALTH AUDITING

18

4.1 Audit Plan

 

18

4.2 Conducting the Audit

18

4.3 Audit Completion

19

4.4 Audit Report

 

19

5. ENGINEERING & NON-ENGINEERING CONTROLS

20

6. EXPOSURE MEASUREMENT/SAMPLING, MONITORING & INSTRUMENTATION

21

7. PERFORMANCE REPORTING GUIDELINES

22

7.1

Annual HSE Report

23

8. MEDICAL EMERGENCIES: PLANS, FACILITIES & TRAINING

24

8.1 Medical Emergency Response Plans

24

8.2 General Principles of Effective Medical Emergency Management

24

8.3 Documentation Requirements

25

8.4 Facilities and Personnel for Medical Emergency Response

25

 

8.4.1

Competence of Emergency Response Personnel

26

9. BIOSTATISTICS & EPIDEMIOLOGY FOR OCCUPATIONAL HEALTH

27

10. TOXICOLOGY FOR OCCUPATIONAL HEALTH

28

10.1 General Concepts in Occupational Toxicology

28

 

10.1.1 Toxicity versus Hazard

28

10.1.2 Routes of Entry into the Body

28

10.1.3 Dose Response Relationships

29

10.1.4 Threshold Concepts

29

10.1.5 Indicators of Toxicity Derived From Animal Toxicity Studies

29

10.1.6 Action of Toxic Effect

30

10.2 Effects of Inhalation Exposure to Airborne Contaminants

30

10.3 Neoplasms and Congenital Malformations

31

REFERENCES

 

32

APPENDIX 1 BIOSTATISTICS & EPIDEMIOLOGY FOR OCCUPATIONAL HEALTH

34

APPENDIX 2 TOXICOLOGY FOR OCCUPATIONAL HEALTH

37

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I. PURPOSE

The ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1], establishes the framework for ensuring occupational health matters in Group Companies are effectively managed and health risks are controlled to as low as reasonably practicable. This Code of Practice supports the Framework document in specific technical areas and is complementary to other Codes of Practice/Guidelines concerned with occupational health management.

II. DEFINITIONS

ACGIH American Conference of Governmental Industrial Hygienists. This is a standards setting body that recommends occupational exposure limits for a wide range of agents. It also provides recommended good practice in the field of occupational and environmental hygiene.

Audiometry The measurement of an individual's hearing acuity using an audiometer.

Biological Agents Any micro-organism, cell-culture or human endoparasite, including any which have been genetically modified, which may cause any infection, allergy, toxicity or otherwise create a hazard to human health.

Biological Effect Monitoring Biological effect monitoring is the measurement of a reversible biochemical change caused by the absorption of the substance; the degree of change being below that associated with toxic injury and not associated with a known, irreversible pathological effect.

Biological Monitoring Biological monitoring involves the measurement of a hazardous substance or its metabolites* in body fluids, usually blood, urine or exhaled breath.

* A metabolite of a substance is either a breakdown product or modified (more soluble) form suitable for excretion by the kidney in the urine or by the liver into the intestine.

Biostatistics and Epidemiology Disciplines in the study of the distribution and determinants of disease and other health-related states in human populations.

Engineering Controls The control of exposure to a hazardous agent by the design of plant and equipment, e.g. containment, exhaust ventilation, mechanical aids.

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

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Epidemiology Epidemiology is the study of the occurrence of disease in human populations. Epidemiological studies in industry enable us to establish the relationship between work environment and the health, type of illnesses and ultimate causes of death of working people.

To be effective, epidemiology must be based on accurate data on the occurrence of disease, types of jobs and exposures. The quality of the statistical analysis, and therefore the information produced, improves with (i) larger number of people and (ii) longer follow-up periods. Some diseases, particularly cancers, may take several decades to appear.

Ergonomics Ergonomic is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimise human well-being and overall system performance. Ergonomics draws together the disciplines of occupational physiology, psychology and design. Physical stresses on the body may result in acute (short term) and chronic (long term) damage (musculoskeletal disorders) and lowering of performance (e.g. fatigue). The mental demands of work may cause psychological stresses. Ergonomics seeks to recognise and evaluate these factors. Control can then be achieved by fitting the task to the individual. Where ergonomics has not been taken into account in the design of workstations and tasks, personnel may suffer, for example, discomfort, musculo-skeletal disorders, psychological stress.

Exposure Limit (EL) The airborne concentration of chemical agents and levels of physical agents to which workers may be repeatedly exposed, day after day, without adverse effect.

Exposure Monitoring Measurement, sampling and analysis of exposure to hazardous agents for exposure assessment or other occupational health management purpose.

* Exposure monitoring must be conducted by a suitably qualified competent person e.g. an Occupational Hygienist, using equipment suitable for taking measurements of the required accuracy.

Health Controls See 'Hierarchy of Health Control Measures'.

Health Hazard This is an agent with potential to cause harm to health. These agents may be biological, chemical, physical, ergonomic or psychological in nature. ‘Health hazards' are also known as 'agents hazardous to health' and 'hazardous agents'. These terms are interchangeable.

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Health Risk Health risk is the combination of likelihood that harm to health may occur (which is related to exposure) multiplied by the severity of health effects (hazard).

Health Risk Assessment (HRA) The systematic identification of health hazards in the workplace and subsequent evaluation of health risks. This process takes existing control measures into account and identifies and recommends further preventive or control actions where appropriate.

Health Surveillance Measures for monitoring the health of the workforce if risk to health cannot reasonably be excluded.

Hierarchy of Health Control Measures The means of controlling exposure to health hazards, listed in preferential

order as follows: -

Elimination

- Substitution (alternatives)

- Engineering (plant and equipment)

- Procedural

- Personal protective equipment

(The) HSE As in “The Health and Safety Executive”, which is the enforcement and standards setting agency in the United Kingdom. The HSE has developed a range of Occupational Exposure Limits (MELs and OESs) and exposure evaluation methods.

Maximum Exposure Limit (MEL) * MELs are UK exposure limits provided for substances that are particularly hazardous or difficult to control. These limits recognise that health-based OELs may not be technically or economically achievable. These levels denote that the value is the maximum exposure concentration to which personnel are allowed in the workplace. The onus is placed on the employer to reduce exposure below this limit as far as reasonably achievable. These limits are listed in HSE Guidance Note EH40.

* Note: This definition is for general reference only – ADNOC does not use MELs but only TLV data as provided by ACGIH.

Medical Surveillance Medical surveillance is defined as an assessment of an employee's health using medical or biological procedures (biological effect monitoring) to identify any significant abnormalities attributed to exposure to hazardous agents, at as early stage as possible.

The procedures used should be of acceptably high sensitivity, specificity and predictive value in detecting abnormalities related to the nature and degree of exposure. The criteria for interpreting the data should be known and the

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procedures should be safe, easy to perform, preferably non-invasive and acceptable to employees. Surveillance should only be undertaken if the possible detected changes are reversible or measures are available to prevent their further development.

Occupational Exposure Limit (OEL) * The airborne concentration of chemical agents and levels of physical agents to which workers may be repeatedly exposed, day after day, without adverse effect. OELs are based on the best available information from industrial experience, from experimental human and animal studies, and when possible, from a combination of the three. The basis on which the values are established may vary from agent to agent; protection against impairment of health may be a guiding factor for some, whereas reasonable freedom from irritation, narcosis, nuisance or other forms of stress may form the basis for others. OELs are guidelines or recommendations in the control of potential health hazards. They are not fine lines between safe and dangerous concentration nor are they a relative index of toxicity.

* Note: This definition is for general reference only – ADNOC does not use OELs but only TLV data as provided by ACGIH.

Occupational Hazard

A hazard with the potential for causing ‘Occupational Accidents’ through slips,

trips, falls, crushing, drowning, electrocution etc. Unlike a ‘Major Accident

Hazard’, an Occupational Hazard does not have the potential for the loss of control and escalation that could lead to further major consequences. Occupational Hazards are identified and either eliminated, controlled or mitigated by the use of best practice HSE management systems, procedures, methods and techniques.

Occupational Health (OH) The promotion and maintenance of the physical, mental and social well-being

of the workforce.

Occupational Health Hazard This is an agent with potential to cause harm to health. These agents may be biological, chemical, physical, ergonomic or psychological in nature. Hazards are normally classified according to the severity of their adverse health effects.

Occupational Health Management This is a discipline concerning the organized use of corporate resources to prevent or minimize the adverse health impact of work on personnel and contractors.

Occupational Health Management System Part of the overall management system that facilitates the management of the OH risks associated with the business of the organization. This includes the organizational structure, planning activities, responsibilities, practices, procedures, processes and resources for developing, implementing,

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achieving, reviewing and maintaining the organization’s OH policy. In ADNOC Group, the OH Management System is integrated with Group Company HSEMS.

Personal Protection Equipment (PPE) The collective term describing clothing and equipment used to protect the individual against agents hazardous to health.

Physical Agents For example, noise and vibration, ionising and non-ionising radiation, extreme temperatures, humidity.

PPE Personal Protective Equipment

Qualified Person

A health care professional who is qualified to carry out certain medical checks

for the purpose of health surveillance or fitness for employment

Responsible Person

A ‘Responsible Person’ is someone, having received appropriate training, who

undertakes the non-invasive examination of employees for the detection of adverse reactions to hazardous substances/agents used in the workplace

Risk Risk is the product of the measure of the likelihood of occurrence of an undesired event and the potential adverse consequences which this event may have upon:

- People – injury or harm to physical or psychological health

- Assets

(or

Revenue)

damage

to

property

(assets)

production

or

loss

of

- Environment – water, air, soil, animals, plants and social

- Reputation – employees and third parties. This includes the liabilities arising from injuries and property damage to third parties including the cross liabilities that may arise between the interdependent ADNOC Group Companies.

Risk = Frequency x Consequences.

Severity The degree to which an agent hazardous to health can cause harm.

Standard A prescribed set of rules, conditions or requirements. Standard is an all- inclusive term denoting specifications, recommended practices, procedures, guidelines, philosophies and handbooks.

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TLV – Threshold Limit Value ACGIH term for OEL. These values are assigned based upon evidence of the level (i.e. the threshold) at which an adverse health effect may occur in the vast majority of the population. TLVs are not restricted to chemical agents. ACGIH defines three categories of TLVs as follows (* see note):

a) Threshold Limit Value - Time-Weighted Average (TLV-TWA): the time- weighted average concentration for a conventional 8-hour workday and

a 40-hour workweek, to which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse effects.

b) Threshold Limit Value – Short-Term Exposure Limit (TLV-STEL): the concentration to which it is believed that workers can be exposed continuously for a short period of time without suffering from:

1) irritation, 2) chronic or irreversible tissue damage, or 3) narcosis of sufficient degree to increase the likelihood of accidental injury, impair self-rescue or materially reduce work efficiency, and provide that the daily TLV-TWA is not exceeded.

A STEL is a 15-minute TWA exposure which should not be exceeded at

any time during a workday, even if the 8-hour TWA is within the TLV- TWA.

c) Threshold Limit Value –Ceiling (TLV-C): the concentration that should

not be exceeded during any part of the working exposure. Note: The above are abbreviated versions of the ACGIH definitions [Ref. 21].

Toxicology The study of the adverse effects of chemicals (poisons) on living organisms and biological systems.

Further detail on definitions is provided in the document ADNOC Manual of Codes of Practice ‘Guideline on HSE Definitions and Abbreviations’ [Ref. 20].

III. EXISTING LAWS

Occupational Health matters in the Emirate of Abu Dhabi are regulated by:

Federal Law Number 8, Year 1980: Regulation of Labour Relations and Order Issued in implementation thereof.

Ministerial Order No. (32), 1982.

UAE Federal Law No. 1, 2002.

UAE Federal Law No. 3, 1978.

UAE Federal Law No.24, 1999.

Ministerial Decree 50/2003

[20] ADNOC Manual of Codes of Practice: ‘Guideline on HSE Definitions & Abbreviations’’, ADNOC-COPV1-05. [21]American Congress of Governmental Industrial Hygienists (ACGIH), Threshold Limit Values (for Chemical Substances and Physical Agents) and Biological Exposure Indices (booklet). ACGIH (American Congress of Governmental Industrial Hygienists) Cincinatti, USA. (Updated annually) (www.acgih.org).

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1.

INTRODUCTION

This Code of Practice sets out essential general requirements for Group Company occupational health risk management, not covered by other specific ADNOC Codes of Practice/Guidelines. It is designed to complement or, where necessary, to supplement other ADNOC Guidance documents and Codes of Practice, in particular the ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1].

The requirements of this Code of Practice apply to all Group Companies and others who may have access to or work at Group Company sites, including contractors. The areas of occupational health risk management covered by this Code of Practice are:

Health Risk Assessment (Section 2).

Health Surveillance (Section 3).

Occupational health auditing (Section 4).

Engineering and non-Engineering controls (Section 5).

Exposure measurement/monitoring (Section 6).

Performance reporting (Section 7).

Medical emergencies (Section 8).

Biostatistics, epidemiology and toxicology in occupational health risk assessment (Sections 9 and 10).

Some of the roles and responsibilities as described in this document can only be performed meaningfully by or with support from professional medial personnel i.e. those employed in hospitals and clinics. Practices throughout the ADNOC Group of Companies vary considerably i.e. some Group Companies have own hospitals/clinics, some use facilities by others Group Companies, some use Government facilities and lastly, some use facilities in the private sector. As such, this document cannot provide a precise generic definition of where and by whom the ADNOC standards are to be met. As a general principle, the Group Companies, regardless of how medical and occupational health services are provided, remain ultimately responsible for complying with the ADNOC standards for Occupational Health Risk Management (OHRM), as laid down in this and other COP documents. ADNOC expects the Group Companies to arrange for these standards to be met in any way suitable to their specific circumstances.

Related Codes of Practice and Guideline documents which complement this document are:

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

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Codes of Practice

COP-OHRM: Physical Agents [Ref. 3].

COP-OHRM: Chemical and Biological Agents [Ref. 4].

COP-OHRM: Ergonomic Factors [Ref. 5].

COP-OHRM: Food Safety and Welfare [Ref. 6].

COP-OHRM: Human Factors and Personnel Related Aspects of HSE [Ref. 18].

Guidelines

ADNOC Group Guideline on Health, Safety and Environmental Management Systems [Ref. 7].

ADNOC Manual of Codes of Practice: Guideline on Exposure Monitoring [Ref. 8].

ADNOC Manual of Codes of Practice: Guideline on Health Risk Assessment [Ref. 9].

ADNOC Manual of Codes of Practice: Guideline on Chemical Use [Ref.

10].

ADNOC Group Guideline on Health Performance Reporting [Ref. 11].

[3] ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Physical

Agents’, ADNOC-COPV3-05.

[4] ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Chemical and

Biological Agents’, ADNOC-COPV3-04.

[5] ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Ergonomic

Factors’, ADNOC-COPV3-06.

[6] ADNOC Manual of Codes of Practice: Code of Practice on Occupational Health Risk Management - Food Safety and

Welfare’, ADNOC-COPV3-07.

[18] ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management - Human Factors and Personnel Related Aspects of HSE’’, ADNOC-COPV3-02. [7] ADNOC Group Guideline ‘Health, Safety and Environmental Management Systems’, January 2002.

[8] ADNOC Manual of Codes of Practice: ‘Guideline on Exposure Monitoring’, ADNOC-COPV3-11. [9] ADNOC Manual of Codes of Practice: ‘Guideline on Health Risk Assessment (HRA)’, ADNOC-COPV3-08. [10] ADNOC Manual of Codes of Practice: ‘Guideline on Chemical Use’, ADNOC-COPV3-12. [11] ADNOC Group Guideline ‘Health Performance Reporting’, August 2001.

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2. HEALTH RISK ASSESSMENT

Health Risk Assessment (HRA) is the systematic identification of health hazards in the workplace and subsequent evaluation of health risks. The process takes existing control measures into account and identifies and recommends further preventive or control actions where appropriate. HRA is the primary method for classification of the level of occupational health risk and for setting of control implementation priorities.

Health Risk Assessments must be conducted for all operations and activities carried out by Group Companies that may have adverse health impacts on personnel. The HRA must address the risks to health from all types of occupational hazard (physical, chemical, biological, ergonomic, psychological). Details of each of these hazard types can be found within the relevant Codes of Practice.

HRA must be conducted in accordance with the ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1] and the ADNOC ‘Guideline on Health Risk Assessment’ [Ref. 9].

A suitable and sufficient HRA must identify the following:

Health Hazard (i.e. anything with the potential to cause harm to health.)

Control measures (i.e. anything designed to reduce or mitigate risk e.g. engineering controls, substitution of substance with a less hazardous form etc.)

The HRA must be conducted prior to the commencement of work activities. Consideration must be given to the risks of all personnel who might be exposed to an occupational health hazard. This includes:

Personnel directly involved in the activity.

Personnel conducting other activities in the work area who may be affected.

Contractor personnel.

Ancillary personnel.

Maintenance Personnel.

Members of the public.

Findings of the HRA must be communicated to the workforce, along with details of any control measures required. Records of training must be maintained. The HRA must be accessible to all personnel.

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

[9] ADNOC Manual of Codes of Practice: ‘Guideline on Health Risk Assessment (HRA)’, ADNOC-COPV3-08.

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All HRAs documents must be reviewed at least annually, or sooner where one of the following has occurred:

An incidence of ill-health, or other adverse effects thought to be connected to workplace hazards.

A change in legislation or guidance.

A change in the control measures.

Any significant change in the activity (including new equipment, personnel, change of environment, working conditions etc.).

Audit findings that require an immediate assessment.

A complaint has been made.

Results from routine Health Surveillance (see Section 3) indicate control measures may not be adequate or working correctly.

In any other situation where doubt has been cast on the validity of the risk assessment.

In addition, periodic reviews of the control measures must be conducted by a competent person(s) to ensure control measures are still effective and are being used correctly.

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3. HEALTH SURVEILLANCE

Health Surveillance is defined as ‘measures for monitoring the health of the workforce if risk to health cannot reasonably be excluded’. Health surveillance requires an assessment of an employee's health, using medical or biological procedures to identify any significant abnormalities.

Group Companies must establish procedures for Health Surveillance of all employees who might be exposed to harmful physical, chemical or biological agents which could lead to an identifiable disease or adverse health effect.

Consult the ADNOC Group Guideline on ‘Occupational Medicine’ [Ref. 2] and the ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1] for further information.

3.1 Health Surveillance Activities

Health Surveillance involves a number of interrelated activities including:

Where a Responsible Person examines employees with the objective of detecting any adverse reactions to hazardous substances or agents used in the workplace. This could involve, for example, checking for skin damage in persons who are exposed to solvents in the workplace, or asking employees to complete questionnaires on symptoms from which they may have suffered. This role of ‘responsible person’ will usually be taken by an individual approved by the person with responsibility for Occupational Health within individual Group Companies.

Where a Qualified Person questions employees about symptoms of ill health they may have suffered, or examines individuals for signs of ill health. Examples include audiometry testing or lung function testing. This role will usually be carried out by an occupational health nurse.

Medical Surveillance by a doctor or qualified nurse or medic, which can include clinical examinations (e.g. checking for signs of an adverse reaction to chemical exposure).

Biological and Biological Effect Monitoring involving blood, urine or breath testing to measure and assess the effects of exposure to hazardous substances such as lead.

Self checks by employees

Baseline health assessment or pre-employment medicals conducted when an employee takes up or changes job functions.

The Provision of health information to employees and referrals to an Occupational Health Professional as required.

Maintaining Records of all health surveillance carried out.

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

[2] ADNOC Group Guideline ‘Occupational Medicine’, November 2000 (Under revision).

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3.2 Purpose of Health Surveillance

The main purpose of Health Surveillance is:

To detect harmful health effects on personnel at an early stage, and confirm whether affected employees are fit to continue working.

To evaluate health risks.

To check that control measures are working as intended, and to determine if any further controls may be required.

To provide data in the form of health records.

To inform trainers what they should be focussing on in workplace health and safety training.

To give employees the opportunity to raise any concerns they might have about the effect of their work on their health.

3.3 When is Health Surveillance Required?

Health Surveillance is required when all of the following apply:

The work involves a recognised risk to health.

There are valid practicable techniques for detecting the disease or condition.

It is reasonably likely that damage may occur to health under the particular conditions of work.

Health Surveillance is likely to benefit the employee.

Health surveillance will always be appropriate where:

There have been cases of work-related ill-health in the workplace.

Personal Protective Equipment (PPE) (e.g. gloves or respirator) is heavily relied upon as an exposure control measure.

There is evidence of ill health where similar jobs are performed in other organisations.

3.4 Competency Requirements

Health Surveillance must only be carried out by suitably experienced and competent persons. The level of competency required is dependent upon the particular aspect of health surveillance being considered. Basic competency requirements are as follows:

Self-Checks - Self-checks can be carried out by employees exposed to hazards at work, as long as they have been properly trained. Training should include information on how to recognise signs and symptoms of disease and who to contact if they have concerns about their health.

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Basic checks for signs of disease - Personnel such as managers, supervisors or first aiders may be designated the workplace ‘Responsible Person’, with responsibility for conducting basic, non- invasive examinations of employees for signs of work-related illness (e.g. skin examinations where employees work with detergents). The Responsible Person must be adequately trained by an Occupational Health Nurse or Group Company Medical Professional, so that they know exactly what signs or symptoms to look out for and when, how and to whom they should refer employees where necessary. A ’Responsible Person’ is not expected to diagnose the possible causes of symptoms.

Enquiries about symptoms, or more detailed health inspection or examination - The only people considered ‘competent’ to deal with such enquiries, or to undertake specialist health examinations, are properly qualified health professionals. An examination for possible occupational illness must be done by an Occupational Health Nurse or Group Company Medical Professional, as appropriate. Alternatively, or in addition, the expertise of someone with specialist technical knowledge may be required, such as an audiologist, who carries out hearing tests.

Clinical examinations - should always and only be conducted by a qualified Doctor, nurse or medic.

Biological monitoring and biological effect monitoring - In general, these should only be conducted by, or supervised by, a qualified Doctor.

The frequency of health surveillance will depend upon the level of risk identified during Health Risk Assessment.

3.5 Health Surveillance Records

Health Surveillance programmes must include the keeping of Health Records for each employee. Group Companies must establish appropriate record keeping procedures for health surveillance records. They should contain as a minimum:

Historical records of all jobs undertaken by that employee that involved exposure to hazardous substances or processes.

A record of the outcome of previous health surveillance procedures (including details of the employee’s fitness-to-work, any workplace restrictions required etc).

Personal details of the individual (name, sex, date of birth, address, employee number, date started present job etc.).

Conclusions of health surveillance, with the date and the name of the person who carried out the surveillance.

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Health Surveillance Records should not contain any confidential clinical details, and they can therefore be held in the workplace together with other types of confidential personnel records. Clinical details noted during health surveillance must be held in the employees medical records, in confidence, by the Company Doctor, Nurse or other Occupational Health Professional, and may only be released to someone else with the employee’s written consent or where there is a legal requirement to do so.

As general rule, the time frame for keeping Health Records should be agreed as per best industrial practice and should take account of the type of work performed by individual workers. It should be noted that there are occupational health diseases with prolonged latent period e.g. upon exposure to asbestos, naphtylamine 10 years or longer may pass between first exposure and the development of the malignancy. ADNOC Medical Division should be consulted for detailed guidance on keeping health records for such special circumstances and/or work conditions.

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4. OCCUPATIONAL HEALTH AUDITING

Group Companies must establish procedures for periodic auditing of their occupational health management programme, to ensure that it remains effective, is fit for purpose, and that all legislative and other requirements (including ADNOC Codes of Practice) are being fulfilled. Audits must be conducted by individuals who are independent of the operational area that is being audited and using industry standard audit protocols.

An audit schedule must be prepared which details the time frame for conduct of audits for each operational area. The interval between repeat audits must not exceed 12 months.

Key requirements for occupational health audits are outlined below.

4.1 Audit Plan

An annual Audit Plan must be developed for each Group Company operational activity, which defines the following:

Area/activity to be audited.

Relevant auditing procedures.

Who shall conduct the audit.

Proposed date of audit.

As part of their Annual HSE Letter [Ref. 22], Group Companies should submit copies of their annual audit plans to ADNOC EH&S Division for record purposes.

4.2 Conducting the Audit

The audit must be performed by an auditor who has sufficient experience of the audit process. An audit checklist approach is recommended to help determine whether planned arrangements for controlling workplace health and safety are being followed. The audit must include sampling documented evidence of an activity/process to confirm (or otherwise) that the system is functioning as intended. It is also important for the auditor to speak to relevant personnel to establish whether they fully understand and use the correct occupational health protection procedures.

As a minimum, the auditor must check that:

Health Risk Assessments have been completed for all work activities.

Personnel have been trained in the risk assessment procedure.

Control measures are still in use and are effective.

All procedures implemented as a result of the Risk Assessment are being followed.

[22] ADNOC Manual of Codes of Practice: ‘Directions for Preparing the Annual HSE Letter’, ADNOC-COPV1-07.

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Remedial action has been undertaken as the result of any illnesses or adverse health effects detected by health surveillance or occupationally related ill-health detected by sickness absence monitoring.

4.3 Audit Completion

On completion of the audit, the auditor must compile his findings and where necessary, raise non-conformances. The findings and any non-conformances must be discussed with the auditee (usually the Area Supervisor/Manager) at the close out meeting and timescales agreed on remedial action for non- conformances must be recorded.

4.4 Audit Report

The auditor must complete an Audit Report, in which he documents all the audit findings, along with details of any non-conformances raised. The report must be issued within 14 days of the audit. The report must include the following information as a minimum:

Details of audit location, date, time and person(s) consulted.

Summary of audit findings.

Details of audit findings.

Details of non-conformances, and any remedial action agreed, including names of individuals responsible for corrective actions.

Details of follow-up audit, where necessary.

On completion and issue of the audit report, the auditor should update the audit schedule. The auditor is responsible for following up on any corrective measures identified by the audit, and ensuring they are implemented within the agreed timescale. Any failures to implement corrective actions within agreed time scales should be reported to Group Company Senior Management.

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5. ENGINEERING & NON-ENGINEERING CONTROLS

Where the need for control measures has been identified through risk assessment or health surveillance, the use of engineering controls should only be considered when options for eliminating the hazard or substitution with a less hazardous substance/procedure have been reviewed.

There are usually many ways of controlling exposure to hazardous agents, the selection of which method to use depends on a number of factors including:

Route of exposure.

The hazard under consideration.

Existing control measures.

The level of exposure and assessed risk.

The anticipated duration of exposure.

The nature of the work activity and practicability of control options.

Some of the control methods are more effective in practice than others. For any particular hazardous agent, controls should be selected and arranged from a list (the ‘hierarchy of control’) with the most effective methods of control at the top of the list (see ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1] for further information on control strategies).

By far the most effective methods of control are to eliminate the hazard (e.g. the removal of noisy machinery) or to substitute the hazardous agent with a less hazardous one. However where elimination and/or substitution are not possible, other means of control must be used. Other possible methods are (in order of most to least effective):

I. Total enclosure of the hazardous process.

II. Segregation of the hazardous process from the workforce.

III. The use of engineering controls (e.g. Local Exhaust Ventilation, silencers on noisy machinery etc.)

non-

IV. Reducing

the

number of

essential

employees,

and

excluding

essential employees.

V. Reducing duration of exposure to hazardous agent.

VI. Information, instruction and training of employees.

VII. Use of suitable PPE.

Any control measures put in place must be subject to regular inspection and maintenance to ensure their continued effectiveness.

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

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6. EXPOSURE MEASUREMENT/SAMPLING, MONITORING & INSTRUMENTATION

This section provides a brief overview of the requirements and standards for exposure measurement and sampling. More detailed guidance on exposure monitoring is provided in the ADNOC ‘Guideline on Exposure Monitoring’, [Ref. 8]

All measurement and sampling for exposure assessment or other occupational health management purpose, must only be conducted by a suitably qualified, competent person e.g. Occupational Hygienist, using equipment which is suitable for taking measurements of the required accuracy. Further details on competency requirements are provided in the ADNOC ‘Code of Practice on Framework of Occupational Health Risk Management’ [Ref. 1]

When selecting measurement techniques and equipment, consideration must be given to the following:

The nature of the substance/agent to be measured/sampled (noise, vibration, dusts, vapours, gases, fumes, humidity etc.)

The environment in which measurement/sampling will take place (e.g. there may be harsh environmental conditions, such as extremes of temperature or humidity).

Whether the measurement/sampling to be done is of the personal exposure experienced by individual employees, or ambient readings taken in the work environment.

The accuracy required (for example, indicator tubes will give a basic reading, whereas a personal sampling device will give more detailed information).

The battery life of the equipment (will it last for the duration of the measurement/sampling?).

Calibration techniques and standards.

The bulkiness and portability of equipment (this is especially important when conducting personal exposure measurements/sampling).

Any analytical techniques required. The results produced by some equipment may require laboratory analysis. It is important that laboratories contracted to carry out such analysis are suitably competent and accredited.

All equipment must be suitably calibrated before and after use, in accordance with manufacturer’s instructions.

During measurement/sampling, continuous checks should be made to ensure that the equipment is operating correctly.

[1] ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’,

ADNOC-COPV3-01.

[8] ADNOC Manual of Codes of Practice: ‘Guideline on Exposure Monitoring’, ADNOC-COPV3-11.

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7. PERFORMANCE REPORTING GUIDELINES

Health performance reporting is an essential part of occupational health management. It is fundamental for measuring achievement of targets and plans, confirming compliance with regulatory standards, including ADNOC Codes of Practice/Guidelines, highlighting areas where performance improvements may be required and quantifying failures in performance.

Health performance reporting fulfils two basic requirements:

1. It provides data at Group Company level for Management information, and

2. It provides a method of measuring the rate of success in implementing health strategies and plans. All ADNOC Group Companies are required to establish procedures for health performance reporting, consistent with the requirements detailed in the ADNOC Group Guideline on ‘Health Performance Reporting’, [Ref. 11]. Health performance data that must be reported includes:

Statistics on exposure to health hazards.

Statistics on occupational illness.

Statistics on lost workdays, restricted workdays, permanent partial total disabilities and fatalities resulting from occupational illness.

The categories of occupational illness which are required to be reported on are:

Infectious and parasitic diseases.

Skin diseases.

Poisoning.

Disorders due to physical agents (other than noise and toxic materials).

Disorders due to repeated trauma.

Cancers and malignant blood disorders.

Disorders due to mental stress.

Noise induced hearing loss.

Other illnesses and disorders.

There is also a specific requirement to report on noise exposure of personnel

In addition to Group Company employees, it is recommended that Group Companies also report on contractors’ health performance. Separate sets of data should be compiled for employees and contractors, so that any specific concerns with either group are identifiable.

[11] ADNOC Group Guideline ‘Health Performance Reporting’, August 2001.

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7.1 Annual HSE Report

ADNOC EH&S Division is responsible for collating health performance statistics from all Group Companies and preparing the annual HSE Report for Management. Regular and consistent reporting is needed to facilitate the preparation of meaningful Group-wide information, and to allow assessment of overall performance. All health performance data must be reported in the standard format defined in the ADNOC Group Guideline ‘Health Performance Reporting’ [Ref. 11]

[11] ADNOC Group Guideline ‘Health Performance Reporting’, August 2001.

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8. MEDICAL EMERGENCIES: PLANS, FACILITIES & TRAINING

Group Companies must ensure suitable arrangements are in place for dealing with medical emergencies. This includes suitable emergency response procedures, medical and first aid facilities, equipment, and provision of trained personnel (See the ADNOC ‘Code of Practice on Occupational Health Risk Management - Food Safety and Welfare’ [Ref. 6] for further details on first aid requirements).

8.1 Medical Emergency Response Plans

Facility specific response medical emergency response plans are required as part of the facility emergency response plans. These are detailed in ADNOC Code of Practice on Crisis and Emergency Management’ [Ref. 19].

Group Companies must develop and implement Medical Emergency Response Plans that detail employees’ responsibilities in medical emergencies, and the resources required for management of all foreseeable medical emergencies. Plans must be regularly tested and reviewed to ensure they remain fit-for-purpose.

Medical and first aid emergency procedures must be described and documented in the Medical Emergency Response Plan. Procedures must be comprehensive and cover the range from basic first aid administered on the work site, to the evacuation of a patient to hospital.

8.2 General Principles of Effective Medical Emergency Management

The guiding principles of effective medical or first aid emergency management are to:

Create awareness of emergency situations and of their potential for escalation.

Develop an integrated approach to the management of emergencies, allowing for several levels of expertise to function in a co-ordinated manner.

Ensure that every worker understands how the system operates, and the part they play in it.

Have a good system of communication between all levels of the health care team so as to provide continuous medical and first aid support from immediate on the spot care through to treatment in hospital.

Provide the resources and equipment required to run the system effectively, and ensure they are regularly inspected and maintained.

Conduct regular training in how to locate and use the resources and equipment. Hold regular emergency drills to improve the effectiveness of procedures, and encourage feedback from personnel.

[6] ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management - Food Safety and

Welfare’, ADNOC-COPV3-07.

[19] ADNOC Manual of Codes of Practice: ‘Code of Practice on Crisis and Emergency Management’’, ADNOC-COPV5-

02.

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Evaluate the effectiveness of Medical Emergency Response Plans as part of incident investigation, audit and review of the HSE Management System.

8.3 Documentation Requirements

Medical Emergency Response Plans must be clearly documented. Line Managers must participate in the development of the plan, and ‘own’ the plan relevant to their operation. The Medical Emergency Response Plans must contain details of the following:

Resources (including which ones are needed, where are they kept etc.)

Particular tasks and responsibilities of personnel in an emergency situation.

Training contents and schedules.

The emergency call-out scheme (e.g. who calls whom, and in which circumstances).

Emergency telephone numbers (these, as well as the call-out scheme, should also be available in the form of separate cards, which are prominently displayed at appropriate locations on site).

The contents and location of first aid kits, stretchers, eye wash stations, MSDSs, etc.

The inspection schedule for emergency equipment.

Emergency drills.

A list of external service providers with contact points, emergency telephone numbers (e.g. local/regional and international Medevac providers).

Information on insurance cover.

Emergency procedures covering visitors, and other third parties.

Emergency procedures for employees working off-site.

Emergency drill reports must also be documented, and a process put in place to correct any deficiencies identified during the drills.

8.4 Facilities and Personnel for Medical Emergency Response

Facilities and personnel for medical and first aid emergencies must include:

Properly trained first aid personnel, first aid kits and suitable facilities for treatment at the workplace.

Access to paramedics, an occupational health nurse or doctor, or an offshore medic as required.

Access to medical/surgical specialists, (usually in the local hospital) as required.

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Adequate facilities and number of First Aiders and other medical/first aid emergency response personnel required in the workplace must be identified during the Health Risk Assessment. The following factors should be taken into account:

The number of employees.

The occupational health and safety hazards, (taking into account the physical environment (offices, industrial plant, exposure to local weather conditions), the type of activities performed, and degree to which the hazards are controlled).

The situation of the facility (e.g. a remote facility may have different requirements from one in the middle of a city).

The quality and response times of local medical support systems.

Lessons learned from incident investigation, and emergency drills, and training exercises.

Legal and other national requirements.

8.4.1 Competence of Emergency Response Personnel

The following defines minimum levels of competence and training for emergency response personnel:

All Employees and Supervisors must be instructed in emergency response action, so they know who to contact and where to find facilities and equipment.

Designated First Aiders must have Basic Life Support, and life and limb saving first aid knowledge and skills. These include:

Non work-specific: cardio-pulmonary resuscitation, control of bleeding, care of the unconscious (including maintaining an open airway, expired air resuscitation and spine protection).

Work-specific: e.g. first aid for chemical & heat burns, eye injuries, heat-stress, gassing, etc.

First Aiders must also have a working knowledge of MSDSs.

Paramedic/Emergency Technician, Offshore Medic, Nurse, Site Doctor – These persons require Advanced Life Support knowledge and skills, including experience in the use of resuscitation equipment, automated external defibrillator equipment and administration of appropriate medications and supplies. Good communication skills are also essential, including language skills.

Medical/Surgical Specialists – They should be certified as competent specialists by a recognised professional institution, and be in current, skills maintaining practice.

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9. BIOSTATISTICS & EPIDEMIOLOGY FOR OCCUPATIONAL HEALTH

Assessment of occupational health risks requires information from a wide range of scientific and medical disciplines, including biostatistics and epidemiology. An explanation of these terms and their importance in HRA is provided in Appendix 1.

Group Companies must ensure that the HRA team has access to suitable and sufficient biostatistics and epidemiology expertise to assess the findings of occupational Health Risk Assessments, where required.

Epidemiology and biostatistics involve the study of the distribution and determinants of disease and other health-related states in human populations. In occupational health, epidemiology is used to study how workplace exposures and practices influence the health of persons at work. Thus the ‘populations’ studied are groups of people connected by a common type of work or process.

Epidemiology cannot be used by itself to identify the causes of disease as disease can rarely be attributed solely to one factor. The investigation of the effects of any particular factor is often prejudiced by the influence of other factors. Epidemiological investigations are also hampered by the difficulty of obtaining reliable information (e.g. in historical studies), pressure to provide ‘quick’ answers, and by economic considerations.

Epidemiological evidence on the cause of ill health is therefore often incomplete and circumstantial. However epidemiology and biostatistics are useful in the assessment of hazards and in identifying the need for workplace control measures.

Epidemiology is necessarily a quantitative subject, requiring an understanding of statistical methods. As such, the skills of a trained epidemiologist are essential in the interpretation and use of epidemiological research and biostatistics.

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10. TOXICOLOGY FOR OCCUPATIONAL HEALTH

Toxicology is the study of substances and their effects on biological systems. Natural and synthetic chemicals are many and varied. As a rough estimate, there are some seven million chemicals known to man, of which approximately 150,000 are in regular industrial use. Only a small proportion of these have been fully evaluated by modern toxicological screening techniques. It is worth noting that “everything is a poison, it is only the dose which makes it not a poison” (Paracelsus 1493 to 1541).

Toxicity can be described as the harmful or undesirable effect(s) of a substance. The toxic effects which chemical substances can have on the human body are also highly variable, ranging from minor health problems to

potentially life threatening conditions, depending on the substance in question and the received dose. Toxicological studies, therefore, are important in understanding the health significance of chemical substances and what levels

of exposure are acceptable.

Exposure Limits (EL) are designed to restrict the exposure of workers to

substances to a level below which toxicological effects do not occur. These limits are regularly reviewed and modified to reflect the findings of new toxicological research. ADNOC has adopted the findings as published by ACGIH as its regulatory limits (see Section 10.1.4). Group Companies must ensure that only the latest sources of ACGIH EL data are used in HRA studies. Group Companies must also ensure that the HRA team has access

to suitable and sufficient toxicology expertise for the purposes of occupational

Health Risk Assessment when required.

10.1 General Concepts in Occupational Toxicology

10.1.1 Toxicity versus Hazard

A substance’s toxicity is its capacity to induce injury. For most types of

chemical agents the level of hazard of the substance (its intrinsic ability to cause harm) has a direct relationship to its toxicity. That is, if a person is exposed to a quantity of a medium toxicity substance, the harmful effect will be less severe than if he were exposed to the same quantity of a substance of high toxicity.

10.1.2 Routes of Entry into the Body

The main routes of entry for hazardous substances are as follows:

Inhalation – substances are inhaled through the nose and mouth into the respiratory tract. Some substances exert a local effect on cells of the respiratory tract, others cross from the respiratory tract into the bloodstream and hence onto their target organs. Others can have a combination of the two effects.

Skin Absorption – skin contact with some substances can result in them being absorbed through the skin and into the bloodstream to

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cause system wide effects. A direct action at the site of contact may be seen which is known as local effect.

Ingestion – substances can gain access to the body through the mouth and, by swallowing, into the digestive system. In some cases local effects can occur - causing damage to the cells of the mouth, throat and digestive system. Some substances can cross the gut wall into the bloodstream where they can exert their systemic effects. Although ingestion can occur via contact with splashes and sprays of hazardous substances, it occurs more commonly in an occupational setting through transfer from contaminated hands to the mouth during eating, drinking and smoking.

Direct injection – this is a relatively uncommon but potentially extremely hazardous route by which people may be exposed to hazardous substances. Substances may be directly injected into the body from high-pressure sources (such as high-pressure grease guns) that have sufficient energy to puncture the skin. The other method of direct injection is via “needle stick” injury, where a hypodermic syringe containing a hazardous substance may be accidentally injected into the body.

10.1.3 Dose Response Relationships

Relationships between the dose, often based on an "administered dose" (i.e. exposure) rather than absorbed dose, and the extent of toxic injury produced by that chemical (the response) are known as a Dose-Response relationship. Responses commonly increase with greater doses and can be expressed either as the severity of injury or proportion of exposed subjects affected.

10.1.4 Threshold Concepts

The threshold of a substance is the dose or exposure at which a specific adverse health effect begins to be produced. The threshold dose is the smallest amount of toxic substance that can produce the first recognisable adverse health effects (e.g. tissue irritation).

The threshold limit value or TLV is a value that refers to airborne concentrations of substances and reflects concentration to which the majority of workers may be exposed on a daily basis for a working lifetime without adverse health effects occurring. A table of these values is produces annually by ACGIH, which are adopted by ADNOC as regulatory limits. Group Companies must ensure that only the latest sources of ACGIH TLV data are used in Health Risk analyses and studies.

10.1.5 Indicators of Toxicity Derived From Animal Toxicity Studies

The indicator of Lethal Dose of a substance in toxicological studies is the LD 50 test – the Median Lethal Dose. This is the dose of the substance that results in the death of 50 percent of the animal population on which the test was

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carried out. The dose of the substance under test is normally administered in a single dose through a specified route.

The indicator of Lethal Concentration via the inhalation route of a substance is the LC 50 test – the Median Lethal Concentration. This is the concentration of aerosol or vapour of a particular substance that results in the death of 50 percent of the animal population on which the test was carried out.

10.1.6 Action of Toxic Effect

Acute Toxic Effects – are those adverse health effects that arise quickly and have a relatively short, severe course.

Chronic Toxic Effects – are those effects that may persist over a long time period. Depending upon the agents involved, they may arise after a period of months or years after a single exposure. Alternatively, for some agents, consistent exposure over an extended time period may be required to trigger the health effect. For others, it may arise immediately after exposure. The effects may have symptoms ranging from relatively mild to severe.

10.2 Effects of Inhalation Exposure to Airborne Contaminants

Exposure to airborne contaminants can produce a variety of toxicological effects, depending on the substance and the exposure concentration.

Irritation – this is a local, rather than systemic effect. Some substances (e.g. irritant gases like Sulphur Dioxide and Chlorine) have a directly irritating effect on the respiratory tract. Inhalation in high enough quantities can lead to death through severe irritation leading to respiratory distress and pulmonary oedema.

Narcosis – this is a systemic effect. Inhalation of narcotic substances (such as many chlorinated solvents) results in the agents being absorbed from the lungs into the bloodstream. From there, the solvents can impair the cognitive functions of the central nervous system. Symptoms may progress from giddiness and light-headedness through lassitude to unconsciousness. In extreme circumstances, death may occur if the individual is not removed from exposure and suitably treated.

Asphyxiation – is denial (or interference) of oxygen flow during breathing. There are two types of asphyxiants – simple and chemical.

Simple asphyxiants - are inert gases that remove oxygen through displacement.

Chemical asphyxiants – act in one of two major ways. Some prevent uptake of oxygen in the blood. Carbon monoxide, for example, binds more strongly to hemoglobin in the blood than oxygen does. This binding leaves insufficient hemoglobin available for oxygen uptake into the blood and transport to the tissues. A second type of chemical asphyxiant inhibits normal oxygen transfer either from the blood to the tissues or within a cell. Hydrogen cyanide is an example of this type. It interferes with electron transport within cells during aerobic respiration.

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Allergic – This is an over-reaction of the immune system and can be a local effect (eg rhinitis, asthma) or a widespread systemic effect (anaphylaxis). Severe allergic reactions can lead to death.

10.3 Neoplasms and Congenital Malformations

Carcinogenesis –the action of certain chemicals (carcinogens) may result in the development of cancer in a living individual. A cancer is a malignant tumour resulting from a change in the normal growth and development pattern of cells. Malignant tumours have the tendency to invade surrounding tissues and spread to other sites in the body. This spread is known as metastasis.

Mutagenesis – the action of certain chemicals (mutagens) may result the formation of changes (mutations) in cellular genetic material (DNA) that can be passed on to subsequent generations of cells. When these occur in germ cells (i.e. sperm or ova) the mutations can be passed on to offspring.

Teratogenesis - the action of certain chemicals (teratogens) may result in the occurrence of physical defects in the developing embryo or foetus when a pregnant female is exposed to that substance.

For further information on toxicology for occupational health see Appendix 2

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REFERENCES

1. ADNOC Manual of Codes of Practice: ‘Code of Practice on Framework of Occupational Health Risk Management’, ADNOC-COPV3-01.

2. ADNOC Group Guideline ‘Occupational Medicine’, November 2000 (under revision).

3. ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Physical Agents’, ADNOC-COPV3-05.

4. ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Chemical and Biological Agents’,

ADNOC-COPV3-04.

5. ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management – Ergonomic Factors’, ADNOC-COPV3-06.

6. ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management - Food Safety and Welfare’, ADNOC-COPV3-07.

7. ADNOC Group Guideline ‘Health, Safety and Environmental Management Systems’, January 2002.

8. ADNOC Manual of Codes of Practice: ‘Guideline on Exposure Monitoring’,

ADNOC-COPV3-11.

9. ADNOC Manual of Codes of Practice: ‘Guideline on Health Risk Assessment (HRA)’, ADNOC-COPV3-08.

10. ADNOC Manual of Codes of Practice: ‘Guideline on Chemical Use’, ADNOC-

COPV3-12.

11. ADNOC Group Guideline ‘Health Performance Reporting’, August 2001.

12. Federal Law Number 8: Regulation of Labour Relations and Order Issued in implementation thereof. ILO 1980.

13. Foundations of Epidemiology, Third Edition. Lillienfeld, D.E. and Lillienfeld, A.M. New York: Oxford. University Press, 1994.

14. Intuitive Biostatistics, Motulsky, H. Oxford University Press, 1995 (ISBN -

0195086074).

15. Research Methods in Occupational Epidemiology, Checkoway, H., Pearce, N. E., and Crawford-Brown, D.J. New York: Oxford University Press, 1989.

16. An Introduction to Epidemiology, Alderson, M. (1980): MacMillan, London.

17. An Introduction to Epidemiology at the Work Site: Searching for Causes of Work-Related Diseases. Olsen, J., Merletti, F., Snashall, D. and Vavlsteek, K:

Oxford Medical Publications. 1991.

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18. ADNOC Manual of Codes of Practice: ‘Code of Practice on Occupational Health Risk Management - Human Factors and Personnel Related Aspects of HSE’, ADNOC-COPV3-02.

19. ADNOC Manual of Codes of Practice: ‘Code of Practice on Crisis and Emergency Management’’, ADNOC-COPV5-02.

20. ADNOC Manual of Codes of Practice: ‘Guideline on HSE Definitions & Abbreviations’, ADNOC-COPV1-05.

21. American Congress of Governmental Industrial Hygienists (ACGIH), Threshold Limit Values (for Chemical Substances and Physical Agents) and Biological Exposure Indices (booklet). ACGIH (American Congress of Governmental Industrial Hygienists) Cincinatti, USA. (Updated annually) (www.acgih.org).

22. ADNOC Manual of Codes of Practice: ‘Directions for Preparing the Annual HSE Letter’, ADNOC-COPV1-07.

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APPENDIX 1 BIOSTATISTICS & EPIDEMIOLOGY FOR OCCUPATIONAL HEALTH

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APPENDIX 1:

EPIDEMIOLOGY AND BIOSTATISTICS

Epidemiology uses techniques to study the distribution of occupationally induced diseases and physiological conditions in work places and the factors that influence their frequency. This includes concepts, prospective and retrospective studies, morbidity and mortality and animal experimental studies and the distribution of data.

The epidemiological approach to health is distinguished from the clinical approach as it is concerned with ‘populations’ as opposed to ‘individuals’. For example, while clinical studies focus their attention on the treating sick individuals, epidemiologists seek to relate individual cases to the population to which they belong. On a simple level, this is done by calculating the rate of disease in a given population. Thus, epidemiological research must always begin with a definition of the population concerned. Again, the population definitions offered by clinician and epidemiologist may differ. The population of interest to an occupational physician would be those employees for whom he is directly responsible. However the epidemiologist is concerned with a much wider population. For example, if it is shown that a particular workforce has a higher rate of cancer than expected, an epidemiologist will seek to discover whether it is fair to infer that this will be the case for all workforces with similar exposures.

For the epidemiologist the ‘target population’ is “all workforces with similar exposures”. The population actually studied, (the ‘study population’), may constitute only a small proportion of the target population.

Types of Epidemiological Study:

Descriptive study a study that tries to reveal patterns associated with a specific disease, without an emphasis on pre-specified hypotheses. Sometimes these types of studies are called hypothesis-generating studies (to contrast them with hypothesis testing studies). Generally, in a descriptive study, the emphasis is on estimation rather than testing. Some of the quantities someone carrying out a Descriptive Study might want to estimate include:

1. The prevalence of an occupational illness.

2. The natural history of an illness.

3. The resources required to treat the condition.

4. Attitudes and perceptions about the condition.

Retrospective Study - a study that looks backwards in time. This type of epidemiological study would cover the statistical analysis of workforce personnel who have been already been made ill or who have died. The epidemiologist then tries to establish whether or not there is any (causal) link between the illness (morbidity) and death (mortality) and agents to which the personnel were exposed in the workplace.

Prospective Study - a study that projects ahead in time. In a Prospective Study, the epidemiologist selects a group of subjects and observes them over an extended time period (in many cases over 10 years). Statistics on illness

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and death in the study group can then be studied in relation to the agents to which the personnel are exposed.

For further information on the use of epidemiology and biostatistics in occupational health management, consult references [Ref. 13] to [Ref. 17].

[13] Foundations of Epidemiology, Third Edition. Lillienfeld, D.E. and Lillienfeld, A.M. New York: Oxford. University Press, 1994. [14] Intuitive Biostatistics, Motulsky, H. Oxford University Press, 1995 (ISBN - 0195086074). [15] Research Methods in Occupational Epidemiology, Checkoway, H., Pearce, N. E., and Crawford-Brown, D.J. New York: Oxford University Press, 1989. [16] An Introduction to Epidemiology, Alderson, M. (1980): MacMillan, London. [17] An Introduction to Epidemiology at the Work Site: Searching for Causes of Work-Related Diseases. Olsen, J., Merletti, F., Snashall, D. and Vavlsteek, K: Oxford Medical Publications. 1991.

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APPENDIX 2 TOXICOLOGY FOR OCCUPATIONAL HEALTH

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APPENDIX 2: TOXICOLOGY FOR OCCUPATIONAL HEALTH – FURTHER INFORMATION

Often one or more organs in the body (the ‘target organs’) are particularly vulnerable to the toxic effects of certain hazardous substances. The toxic effect may produce symptoms noticed by the affected individuals, or other signs observed by other people. Detection of ill health caused by toxic substances is done by pathological tests (x-rays, chemical tests and other tests of abnormal function).

Examples of target organs/systems & signs of toxicity are shown below:

Liver

Enzyme Inhibition Or Stimulation

Necrosis or Apoptosis (Two Mechanisms Of Cell Death)

Cirrhosis/Fibrosis (tissue destruction and scarring of the liver)

Hepatitis (Inflammation)

Cholestasis (Blocked Bile Flow)

Kidney

Failure Of Resorption Mechanisms In Proximal Tubule

Obstructive Uropathies (damage that may cause obstruction to urine flow)

Bladder Cancer

Lungs

Inflammation (Bronchitis, Alveolitis, Pneumonitis)

Allergic Reactions (Rhinitis, Asthma)

Fibrosis (Silicosis, Asbestosis Etc.)

Cancer

Skin

Irritation

Allergy

Ulceration or Corrosion

Increased Cell Turnover

Dermatoses

Cancer

Cont’d

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Blood

Blockage of Oxygen Transportation (e.g. CO poisoning)

Haemolysis (destruction of blood cells)

Inhibition of Haemopoiesis (i.e. production of blood cells)

Cancer (e.g. Leukemias)

Alterations In Haemoglobin Synthesis and Breakdown

Nervous System

Narcosis

(slowing

and

unconsciousness)

impairment

of

cognitive

functions

Peripheral Neuropathy (nerve damage)

leading

to

Reproductive System

Ovulatory Disturbances

Foetal and Prenatal mortality

Congenital Malformations

Genetic Material

Cancer

Transgenerational Reproductive Defects

Infertility

Immune system

Hypersensitivity

Allergy

Toxicokinetics

This is the study of the behaviour of toxic chemicals within the body in terms of absorption, distribution, retention, biotransformation (process by which substances are changed to facilitate elimination from the body) and excretion. The most important factors requiring evaluation are:

The distribution of the chemical within the various tissues, relative to exposure.

The amount of the toxic chemical absorbed.

The studies of bi-transformation and excretion are next most important.

The effect the toxic chemical has on the body is determined by how much of the substance gets into the tissue compartment. Toxicokinetics provides an estimate of the effect a particular dose is likely to have on the body.

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Knowledge of toxicokinetics and particularly of biotransformation, is important in risk assessment when extrapolating from the effects of a high dose to those of a low dose, or trying to make predictions about human health effects from animal testing data. For ethical reasons, human experimentation, even at low doses, is difficult to carry out, and as a result, the ability to extrapolate accurately from animal models is important.

Biotransformation

Biotransformation is a form of metabolism, whereby the original structure of a substance is modified within the body. This often aids detoxification and excretion, thus giving protection form the effects of the parent molecule, although the metabolite (the substance in its modified form) itself will still have to be excreted or further metabolised. Some products of biotransformation can themselves adversely affect health.

Toxicity Tests

The introduction of chemicals into industry without prior toxicological assessment would subject the human population to unknown, and therefore unacceptable risks. The use of animal testing for identifying and assessing chemical hazards is therefore standard practice. Today, such tests are obligatory, and no company can sell a new chemical without first complying with the statutory test requirements. Techniques are well established for predicting the likely toxic effects on man.

These techniques include the consideration of:

Physico-chemical properties

Structure-activity relationships

Tests on biological systems (bacteria, cell cultures, animals)

Experience gained from human volunteers and/or workers exposed to the chemical during development.

Experimental toxicological protocols are standardised and can be divided into the following groups:

Short-Term Toxicity Tests:

Acute toxicity (by inhalation, dermal administration, oral administration)

Skin irritation

Skin sensitisation

Eye irritation

Short-term repeated dose (28 day) toxicity

Delayed peripheral neurotoxicity in hens (for organophosphorous compounds used as pesticides)

Longer-Term Toxicity Tests:

Sub-chronic (3 months repeated dosing)

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Chronic (2 year or lifetime repeated dosing)

Genotoxicity (mutagenicity):

Ames test (bacterial mutations)

Point mutation in mammalian cells (e.g. HGPRT assay)

In-vitro cytogenetics

In-vivo cytogenetics

Carcinogenicity:

Life-time study

Reproductive toxicity:

One generation study

Developmental toxicity (teratology)

Multi-generational study