Medical Fitness to Operate

Construction Plant
 Medical Fitness to Operate
Construction Plant

Strategic Forum for Construction

Good Practice Guide

Reference No. CPA 1301

First Published: February 2013
Updated: July 2018
Published by:
Construction Plant-hire Association
27/28 Newbury St
London
EC1A 7HU
Telephone: 020 7796 3366
Email: [email protected]

© CPA Copyright – 2013 & 2018

Medical Fitness to Operate Plant 2 July 2018
Contents
Page

Foreword .....………………………………………………………………......... 4
Executive Summary ................................................................................... 5
1. Introduction and Scope ……………………………………………………....... 6
2. Definitions …………….……………………………………………………........ 7
3. Legislative Requirements ..………………………………………………........ 10
4. Data Protection .......................................................................................... 11
5. Organisation of Medical Fitness Assessments............................................ 13
6. Identifying the Job Characteristics and Assessment Requirements ........... 14
7. Choosing an Occupational Health Service Provider.................................... 16
8. Assessment Process - Initial and Ongoing ................................................ 21
9. Medical Fitness and Recruitment ............................................................... 24
10. Evidence of Medical Fitness for Customers ....………................................ 27
11. Assessment Requirements and Standards ................................................ 28
12. Consultation with Employees ..................................................................... 30
13. Employment Issues .................................................................................... 31
Annex A Example Self Declaration for New Plant Operators ............................... 32
Annex B Example Occupational Health Questionnaire ........................................ 33
Employer's Duties for the Collection and Use of Employees Health
Annex C 37
Information .............................................................................................
Minimum Competency Standards for Occupational Health Service
Annex D 39
Providers to the Construction Industry ...................................................
Annex E Example of a Fitness to Work Certificate ............................................... 42
Annex F Example of Plant Descriptions ............................................................... 43
Seven Core Elements to be Assessed for Individuals Wishing to
Annex G 44
Operate Mobile Plant .............................................................................
Annex H Legal Requirements ............................................................................... 46
Annex I CONIAC Position on Health Risks in Construction ................................ 48
Annex J Further Information and Guidance .………………………………............. 49
Annex K Working Group Membership ………………………………………............ 51
NOTE: This document has been written taking account of UK Legislation, which will not be applicable in other
jurisdictions. Whilst every care has been taken to ensure the accuracy of the material contained within this document, no
liability is accepted by the Construction Plant-hire Association in respect of the information given.
No material from this booklet may be reproduced in any shape or form without the permission of the Construction Plant-
hire Association.

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Foreword
The operators of construction plant play a vital part in the construction process and it is
essential that they are physically and mentally capable of undertaking the tasks they are
required to carry out. Construction plant has the potential to injure or kill both operators
and bystanders if it is operated, installed or maintained by people who are not medically
fit to do so. Employers have a duty to ensure that their employees have the required
level of fitness for their job and this guidance is aimed at providing employers and others
with the tools to do this.
This guidance has been prepared by the industry to provide clarity about the medical
fitness assessment process and outlines the steps that should taken by employers and
others in the construction sector such as Principal, main and sub-contractors, who also
have an interest in ensuring that plant operators have an appropriate level of fitness. In
particular it deals with planning, setting up and implementation of medical fitness
assessment systems, the medical fitness aspects of recruitment and managing those
employees who may develop health problems whilst at work.
The advice in this document is straightforward, comprehensive and easy to adopt. It
represents good practice which may go further than the minimum you need to do in
order to comply with the law.
I thank those who have been involved in its preparation and commend the guidance to
anyone who employs people who operate install or maintain construction plant and
those with an interest in such matters.
Please read the publication and turn the advice into action.

Philip White
HM Chief Inspector of Construction
Chair of the Health and Safety Executive’s Construction Industry Advisory Committee
(CONIAC).

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Executive Summary
People who operate plant have the potential to injure both themselves and other people
in the workplace and the surrounding area. Ensuring that construction plant operators
are medically fit to operate is primarily an issue for their employers, who have a duty to
ensure that any employee is physically and mentally capable of undertaking the tasks
they are required to carry out. Others in the construction sector, such as Principal, main
and sub-contractors, will also have an interest in ensuring that plant operators have an
appropriate level of fitness.
This document provides a step-by-step guide for managers who want to plan, set-up
and implement a system to assess the fitness of their construction plant operators. It
covers the legislation supporting such a system, including the Data Protection and
Equality Acts. The fitness assessment process is described - from identifying individual
job characteristics, which enables fitness assessments to be focused and relevant,
through the initial base line assessment, annual questionnaires and periodic reviews.
Maximum timescales for periodic reviews are also given, as well as guidance on
managing those workers who may develop health problems whilst at work. To assist
with managing and recording the process, examples of forms are provided in the
Annexes.
An essential part of the process is the choosing of an Occupational Health Service
Provider (OHSP), and guidance is given to help those new to this task. In addition the
medical assessment criteria and standards which are relevant to operating mobile plant,
are set out. The aim being to promote consistency across this sector of industry and
between OHSPs.
Particular emphasis is placed on the medical fitness aspects of recruitment and the
need to be fair and objective at every stage to avoid discrimination, even inadvertently,
and ensure that the requirements of the Equality Act are observed.
The assessment of medical fitness to operate mobile plant will have a significant positive
impact on the relationship between an employer and their employees and guidance on
consultation and involvement of employees in the process is given.
All the guidance in this document is aimed at managers of both large and small
organizations and provides information to relevant resources for those without access to
a Human Resources department.

Case Study
An employee worked as a construction plant operator on dumpers and forklift trucks for
six years without any problems. The operator's employer then implemented a company
policy to ensure that all operators’ medical fitness to operate plant was regularly
assessed. During the assessment it was discovered that the operator was being
treated for epilepsy, though he had not been asked to declare this in the past. His
condition and treatment were investigated by the Occupational Health Service Provider
to confirm adequate control and lack of fits. After a management review of the process,
including a full risk assessment on advice from the OHSP and discussion with the
employee, he was assessed as being fit to continue, subject to continuing to take the
medication prescribed.
In addition, an increased monitoring regime was specified by the OHSP. This was
agreed with the employee and carried out by the management.

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1.0 Introduction and Scope
People who operate plant have the potential to injure both themselves and other people in
the workplace and the surrounding area, if they become ill whilst at the controls or have
health related issues which impair their ability to control an item of plant safely. Employers
have a duty to ensure that any employee operating plant is physically and mentally capable
of undertaking the tasks they are required to carry out. The discharge of these duties will
require consultation with specialists.
Employees have a duty to inform their employer of any changes in health or fitness that may
affect their ability to perform their duties safely.
Principal Contractors have a duty to satisfy themselves that the contractors they engage are
competent and adequately resourced. As part of this they should establish that the people
employed by the contractors are physically and mentally capable of undertaking the tasks
they are required to carry out. It does not mean that the Principal Contractor should
undertake assessments of medical fitness but should ensure that their contractors take
adequate steps to ensure that their employees are fit.
The aim of this Good Practice Guide is to provide guidance to those involved in the use of
plant in construction. These include:-
• Employers of people operating plant;
• Principal Contractors;
• Specialist contractors;
• Plant managers;
• Project managers;
• Contractors, site managers and supervisors;
• Anyone else such as employment agencies or self employed operators.
Although the guidance deals primarily with operators of construction plant, it can apply to
other personnel involved with the installation, erection, dismantling and maintenance of
plant.
The Good Practice Guide covers the management of these issues including:-
• Legal duties;
• Steps necessary to introduce, maintain and manage medical fitness;
• Selection of an Occupational Health Service Provider;
• Working with the Occupational Health Service Provider;
• Consultation with employees;
• Relevant employment law issues;
• Assessment process, including frequency and liaison between the employer, the
Principal Contractor and other contractors on site.
The Good Practice Guide does not address the prevention and control of risks to health
created by the work environment. These issues, which are part of an employer’s duties, are
covered by other guidance (See Annex I and Annex J).
This guidance does not cover issues around misuse of drugs and alcohol, including drugs
and alcohol policies and screening. Guidance is available elsewhere (See Annex J).
Statistics indicate that significantly more people die at work in construction from health
related issues than die from accidents at work; consequently there are significant benefits
from monitoring the health of the workforce. The guidance given in this document does not
specifically address these issues, but may well be of assistance in developing such an
approach.
Where local standards are more onerous than those set out in this document, they take
precedence.

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2.0 Definitions of terms applying to this document
2.1 medical fitness
being physically and mentally capable of undertaking the tasks that an individual
is required to carry out
NOTE: Medical fitness does not include assessment of an individual's competence

2.2 clinical medical records

includes confidential medical information on an individual held by a health
professional

2.3 construction plant

construction machinery which is controlled by an operator at all times when in
use

2.4 construction plant operator

person controlling an item of construction plant

2.5 disabled person

a person with a physical or mental impairment which has a substantial and long-
term adverse effect on their ability to carry out normal day-to-day activities
• "Normal day-to-day" means things that people do on a regular or daily
basis, such as reading, writing, using the telephone, having a
conversation and travelling by public transport
• "Long-term" usually means the impairment should have lasted or be
expected to last at least a year
• "Substantial" means not minor or trivial

NOTE: this definition is given in the "Equality Act 2010 - Guidance for employers"
published by the Equality and Human Rights Commission

2.6 fitness for work (task) assessments

specific checks to assess whether an individual is fit to undertake the work they
will be doing without unacceptable risk to themselves or to others

2.7 functional assessment

a health professional’s specific assessment of a worker’s physical and mental
condition and its impact or influence on their ability to operate mobile plant. Four
possible outcomes are (1) fit, (2) temporarily unfit, (3) fit subject to restrictions
and (4) unfit

2.8 health assessment

assessment involving a range of techniques used to determine a worker’s health
status at the time of assessment and to give indications about future fitness

2.9 health monitoring

generic term covering the full range of techniques, statutory and non-statutory, to
monitor the health of individuals during their employment

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2.10 health risk assessment
assessment involving a range of techniques used to determine the hazards a
worker is likely to be exposed to at work and the effect on their health

2.11 health information

2.11.1 partially restricted information
information regarding a person's health which may be accessed by an employer
such as a fitness to work certificate provided to an employee's manager or HR
department (see Annex E)

2.11.2 fully restricted information

information regarding a person's health which may only be accessed by a health
professional

2.12 health surveillance

a statutory process involving a range of techniques used to detect early signs of
work-related ill health among workers exposed to certain health risks; and
subsequently acting on the results

2.13 occupational health

the effect of work on employees’ health and the health of others

2.14 occupational health advisor (OHA)

a registered nurse having a recognised occupational health qualification

2.15 occupational health service provider (OHSP)

an organisation or qualified individual engaged to deliver occupational health
services

2.16 occupational health technicians (OHT)

a person providing technical components of occupational health services working
under professional supervision to established protocols and procedures

2.17 occupational physician (OP)

a Doctor qualified in the specialised field of occupational medicine
NOTE: These are sometimes referred to as Occupational Heath Physicians (OHP)

2.18 operational assessment

a further assessment which takes place when a functional assessment indicates
there is a requirement. It takes place in controlled or test conditions by an
assessor(s) who has (1) knowledge of operating mobile plant and (2) health and
safety. It aims to ensure a worker can demonstrate reliable and safe working of
mobile plant and records outcomes of (1) satisfactory, (2) unsatisfactory or (3)
satisfactory with restrictions.

2.19 signs of disease

objective evidence of ill health (i.e. what a doctor or nurse might find on
examination) (See also symptoms)

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2.20 statutory health records
historical records providing information about an individual’s job, involving
exposure to substances or processes requiring health surveillance and, where
relevant, the conclusions of the person undertaking health surveillance. They
may be kept securely with other confidential personnel records, but must not
contain medical in confidence data

2.21 stress (work related)

the adverse reaction people have to excessive pressures or other types of
demand placed on them at work

2.22 symptoms of disease

subjective indicators of ill health (i.e. what the sufferer experiences, for example
a cough or shortness of breath) (See also 2.19 signs of disease)

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3.0 Legislative Requirements
The Health and Safety at Work etc Act (HSWA) places a duty on employers to ensure
the health and safety of their employees and others who may be affected by their work
activities. This duty includes ensuring that employees and others are physically and
mentally capable of undertaking the tasks they are required to carry out. Regulations
made under the HSWA, including the Management of Health and Safety at Work
Regulations 1999 and the Constructions (Design and Management) Regulations 2007,
place specific requirements on employers for risk assessment and assessment of
competence.
Other legislation with an impact on the assessment of physical and mental capability are
the Equality Act 2010, the Data Protection Act 2018 and the Access to Medical Reports
Act 1988. Further details of the Acts and Regulations are given in Annex H.

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4.0 Data Protection
If employers collect or use information about their employee’s, the Data Protection Act
2018, which incorporates the European General Data Protection Regulation 2016
(GDPR), will apply. The Act replaces the Data Protection Act 1998 and marks a
significant change in data protection obligations for employers in the UK, affecting, for
example, how they handle sensitive information about employee’s physical or mental
health, such as in the context of managing occupational health.
The Information Commissioner's Office (ICO) will be able to impose substantial fines of
up to £1.8 million, or 4 per cent of annual worldwide turnover, for the most serious
breaches of the GDPR – meaning compliance is of high importance. To process
employees’ personal data, employers must comply with the six ‘data protection
principles’. Personal data must be:
• Processed lawfully, fairly and in a transparent manner;
• Collected only for specified, explicit and legitimate purposes;
• Adequate, relevant and limited to what is necessary for the purpose for which it
is collected;
• Accurate and kept up to date;
• Kept for no longer than is necessary; and
• Kept securely.
There is a further overarching ‘accountability principle’ that requires employers to
demonstrate their compliance with the six data protection principles.
For personal data to be processed lawfully, you must establish at least one lawful basis
for the processing. Those that are relevant in an employment context include:
• Consent: the employee has given clear consent for the employer to process their
personal data for a specific purpose;
• Contract: the processing is necessary for the employer to comply with their
contractual obligations to the employee;
• Legal obligation: the processing is necessary for the employer to comply with
their legal obligations;
• Legitimate interest: the processing is necessary for the legitimate interests of the
employer or a third party and is balanced against any impact on the employee's
interests.
This might be the case, for example, when employees are asked to complete a
questionnaire about their health or where they have a consultation with an occupational
health professional.
Information about an employee's health will be ‘special category data’. This is personal
data that the GDPR says is more sensitive, and so needs additional protection. As well
as the above lawful bases for processing, special category data can only be processed
where at least one further condition for processing special category data is fulfilled.
Those potentially relevant in the context of handling information about an employee's
health include where the employee has given explicit consent. However, a problem for
employers in relying on consent as a lawful basis for processing personal data under the
GDPR is that consent must be ‘freely given’ and as easy for the data subject to withdraw
as it is to give. The ICO has stated that it will be difficult for employers to rely upon
consent given the imbalance in the relationship between employer and employee.
Businesses are therefore advised to avoid relying on consent where possible and look
for another legitimate basis for processing.

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Alternative conditions under which special category data can be processed include
where the processing is necessary for:
• the purposes of performing or exercising obligations or rights of the employer or
employee under employment law, such as not to discriminate against an
employee or dismiss them unfairly;
• establishing, exercising or defending legal claims; or
• the assessment of an employee's working capacity, subject to confidentiality
safeguards.
The latter is the condition relating to medical fitness.
Employers must inform their employees of the nature of any processing they carry out –
including the lawful bases the employer is relying on for any processing – in a concise,
transparent, intelligible and easily accessible form, using clear and plain language. This
should be done by way of a privacy notice available to all employees.
Where employers intend to rely on the 'necessary for employment obligations or rights'
or 'assessment of an employee's working capacity' conditions for processing special
category data, employers must have an appropriate policy document in place explaining
their procedures for complying with the data protection principles, and their policies for
retention and erasure of the special category data. Employers must also maintain a
record of their processing activities. These documents may have to be made available to
the ICO upon request.
Further details are given in Annex C.

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5.0 Organisation of Medical Fitness Assessments
Once an employer has recognised the need to carry out medical fitness assessments of
employees operating construction plant, the process requires careful organisation if the
maximum benefit is to be obtained by both the employer and their employees. The steps
required are:-

1. Identifying individual job characteristics to enable fitness assessments to be

focused and relevant;

2. Choosing an Occupational Health Provider who will best suit the size and nature
of the employer's business;

3. Initial assessment of employees to establish a baseline fitness and any

requirement for further action;

4. Ongoing assessment of employees at intervals to determine if there has been

any change and if there is a requirement for further action;

5. Provision of ill health support, including work with restrictions, if a problem is

found;

6. Evaluating medical fitness issues for recruitment of new employees;

7. Provision of evidence of medical fitness for customers of plant hire companies.

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6.0 Identifying Job Characteristics
6.1 Introduction
For the assessment of medical fitness of plant operators to be effective it is essential
that the Occupational Health Service Provider (OHSP) carrying out the assessment is
fully aware of the specific requirements of the job that the individual operator is required
to do. This will enable the assessment to be both relevant and efficient.

6.2 Job analysis

The starting point is analysis of the job to be carried out and the specific requirements
for operating the particular type of construction plant to be operated. A description of the
item of plant should drawn up (See Annex F), together with a list of the characteristics
that are essential to the safe operation of the machine. The list of characteristics will be
made up of core characteristics which apply to the operation of all plant (See Table 1)
and machine/type/task specific characteristics (See Table 2).
NOTE: These "characteristics" are referred to in the Equality Act as "occupational requirements".

1. Operator's ability to get across construction site;

2. Climb steps/ladders to degree required to access/egress
operating positions of plant;
3. Control machine accurately using standard manufacturer-fitted
controls;
4. See with sufficient acuity (with corrected vision if required) to
accurately carry out the range of tasks expected in the time
available (See Annex G);
5. Hear with sufficient acuity (with hearing aids if required) to be
given instructions and react to warnings (See Annex G);
6. Carry out pre-use checks e.g. walking, bending, looking,
accessing covers.

Table 1 - Core Essential Characteristics of Plant Operation

1. Lift and shift heavy loads such as ancillary equipment to

prepare plant for use, to degree required;
2. Comfortable working at height;
3. Comfortable with long periods of isolation and sitting in the
cab;
4. Able to concentrate and stay aware for long periods;
5. Operator ability to exit cab in emergency;
6. Operator ability to exit restricted worksite in emergency;
7. Operator within weight and size parameters specified by
machine manufacturer;
8. Balance.

Table 2 - Examples of Machine/Type/Task Specific

Essential Characteristics of Plant Operation

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6.3 Job Specification
Once the job analysis has been carried out, a job specification should be drawn up. This
will contain both the plant description and the intrinsic functions of operating the specific
item of plant, together with other items such as anticipated working times, need for shift
and/or night work, requirements to be on-call, preparedness to travel between sites,
qualifications such as a training/competence card and required experience. Care should
be taken to ensure that requirements which are unnecessary or seldom used are not
included, as they may well lead to indirect discrimination.
An example of this is where an employer uses a job description for an excavator
operator which says that "employees must be comfortable working at height" when in
fact the job does not require the operator to work at height, other than to climb into the
excavator cab This requirement is unnecessary and could lead to discrimination against
people who suffer from fear of heights.

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7.0 Choosing an Occupational Health Service Provider
7.1 Introduction
Choosing an Occupational Health Service Provider (OHSP) requires employers to
understand their individual company requirements and communicate these to potential
providers. It is important for employers to have a provider they can trust to provide
authoritative and high quality results. It is also important that employees feel able to be
open and frank with the OHSP. This guidance will assist employers to choose an OHSP,
not just when undertaking worker assessment for the operation of plant, but also for
other Occupational Health activities
The range of OH provision is wide but in the main falls into three categories:-
• Commercial providers;
• In-house services;
• The public sector (i.e., the NHS both hospital based services and General
Practitioners).
Depending on the size and needs of the employer, there are three main ways of
engaging with an OHSP. These are shown in Table 3.

OHP Relationship Contract with OHSP Pay as You Go Employee's GP

Advantages Ability to choose Convenient for SME; Convenient for
provider with Costs more easily employee;
appropriate controlled. GP has access to full
occupational health medical records;
expertise;
May be used in
Long term conjunction with an
relationship; OHSP.
Clearly defined
service specification;
Continuity;
Consistent standards.
Disadvantages Costly for SMEs; Possible lack of Dr/Patient relationship
Possible lack of continuity; which is aimed at
flexibility - employees Inconsistent being supportive –
may have to travel to standards. this can put the GP in
assessments. a uncomfortable
position if the
employee is on the
borderline of "fit" or
"unfit";
GP may not have
occupational health
expertise;
Inconsistent
assessments;
Inconsistent
standards.
NOTE: These three approaches may be used in combination if appropriate e.g. OHSP + GP

Table 3 - OHP Relationships - Advantage and Disadvantages

The stages of OHSP selection are illustrated in Figure 1. Depending on the type of
OHSP relationship sought by the employer, not all of these stages will apply.
Medical Fitness to Operate Plant 16 July 2018
The process of choosing an OHSP may be assisted by using an independent consultant
to give impartial advice on the identification of an employer's requirements and the
choice of a suitable OHSP.

7.2 Practicalities
A list of providers who can meet the employer's basic practical requirements should be
drawn up. Points to consider are:
• What size of provider is required – local, national, large regional?
• Is the relationship to be an ongoing one, pay as you go or using employee's GP?
• How many employees are involved and is there a shift pattern to cover? Small
providers might not be able to resource large contracts, while some SMEs can
find large providers too impersonal;
• Who will be making most contact with the service? If there are many line
managers making referrals, a call centre may be preferable. However, if only
one person is liaising with the provider on behalf of the organisation, a dedicated
contact may be preferable;
• Is an on-site service required and, if so, can this be accommodated? For on-site
services, a private room or office is usually all that is required. Some providers
can even offer mobile units, predominantly for health surveillance;
• On some construction sites the Principal Contractor may be able to arrange
medical fitness assessments of sub-contractor's personnel.

7.3 Identifying Employer's Requirements

It is important that before engaging an OHSP employers have clearly identified their
requirements. These should include both general requirements for the type of service
required and identifying the medical fitness aspects of each plant operator's role.
7.3.1 General Requirements
Employer’s requirements for OHSP service should be based on the risks that will have
most effect on the business. These risks should be identified by the employer's Health
and Safety Manager and then checked to ensure that these match with the core
services of the provider.
Employers may find it beneficial to engage an independent Occupational Health
Consultant to help establish requirements and provide independent advice on the
appropriateness of the services being offered by various providers. Independent advice
may also be obtained from NHS Health at Work at https://www.nhshealthatwork.co.uk/
NOTE: This Good Practice Guide does not deal with health surveillance required by specific legislative
requirements such as noise, vibration, radiation or blood lead levels. HSE guidance document HS(G)
61 - Health Surveillance at Work, states that it is the duty of the employer to provide health
surveillance for those employees considered at risk and that it is essential that the people who carry
out health surveillance are competent to do so.
7.3.2 Job Specific Requirements
Identifying the medical fitness aspects of each plant operator's role requires the medical
fitness parameters of the item of plant to be identified (See Annexes F and G) and the
core and machine specific characteristics of the operator to be established (See Table 1
and Table 2). These will help the OHSP understand the employer's specific
requirements.

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7.4 Finding a Provider
The Safe Effective Quality Occupational Health Service (SEQOHS) Accreditation
Scheme is a stand-alone scheme managed by the Royal College of Physicians of
London, which has been selected to lead and manage the process on behalf of the
Faculty of Occupational Medicine and has central government backing. The aim of the
scheme is to ensure, through regular monitoring, that required standards are maintained
by all accredited OH Services. Assessment for accreditation will be against the
SEQOHS Standards, which were developed by the Faculty of Occupational Medicine in
collaboration with a multi-agency, multi-disciplinary stakeholder group.
Further information can be found on the SEQOHS website at https://www.seqohs.org/
Occupational Health organisations are not easily categorised and can be difficult to find.
There are a number of organisations who list Occupational Health providers such as :-
• Faculty of Occupational Medicine - www.fom.ac.uk
• Royal College of Nursing – https://www.rcn.org.uk/
• Society of Occupational Medicine - https://www.som.org.uk/
• Association of National Health Occupational Physicians - https://www.aohnp.co.uk/
• Occupational Safety and Health Consultants Register - www.oshcr.org
• Commercial Occupational Health Providers Association – http://cohpa.co.uk/
• Constructing Better Health - www.cbhscheme.com

Personal recommendations are also a good source.

7.5 Selection Process

It is advisable to talk to a number of providers, setting out the employer's requirements
for medical fitness assessment, and ask each organisation to confirm in writing how they
would meet these requirements and to provide information on their experience,
resources and references from past or existing clients. This should enable the employer
to assess the match with their specific requirements.
When engaging an OHSP for a long term relationship, it is important for employers to
ensure through personal meetings that they can work effectively with the provider and
match in as many ways as possible, since this should be a long-term partnership.

7.6 Competence
The Management of Health and Safety at Work Regulations 1999 (MHSWR) state
that: “employers who appoint doctors, nurses or other health professionals to advise
them of the effects of work on employee health, or to carry out certain procedures, for
example, health surveillance, should first check that the providers can offer evidence
of sufficient level of expertise or training in occupational health”. The competence
required will depend on the tasks performed and specific standards can be found within
guidance associated with regulations. Employers should always be prepared to check
an OHSP's qualifications.

7.7 Service Level Agreements and KPIs

When appointing an Occupational Health Service Provider it is important to agree both
Service Level Agreements and Key Performance Indicators (KPIs) with the OHSP so
that both parties are clear about the level of service expected.

Medical Fitness to Operate Plant 18 July 2018

7.8 Monitoring and Audit
Once the OHSP has been appointed, the employer should ensure that arrangements
are put in place to monitor the OHSP's performance so that any issues can be speedily
identified and rectified. Health assessment should also be included in the employer's
quality assurance system so that it can be subject to audit.

7.9 Further Information

Information on minimum competency standards for occupational health service
providers to the construction industry is given in Annex D.

Medical Fitness to Operate Plant 19 July 2018

 Figure 1 - Choosing an Occupational Health Provider

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8.0 Assessment Process - Initial and Ongoing
8.1 Introduction
The purpose of medical fitness assessment of people operating plant is to ensure that
the operator's health is of an adequate standard to allow them to operate a particular
item of plant safely, thereby reducing the risk of injury or death to the operator or other
persons in the vicinity.

8.2 Assessment Strategy

It is important that the strategy for assessment of fitness for task meets the following
criteria:-
• Assures all parties in the construction process that fitness issues that could lead
to risks to safety for the operator and others, are properly managed by the
Operator’s employer;
• Is sufficiently task specific;
• Is capable of being effectively managed by the employer;
• Is carried out competently;
• Adds value for both the employer and employee.

8.3 Assessment Stages

Assessment of operators will need to be undertaken at various points during their
employment with a specific employer. These are:-
• Initial baseline assessment (See Figure 2);
• Health assessment at periodic intervals (See Figure 3);
• Assessment on change of job characteristics (e.g. moving from mobile cranes to
tower cranes).
NOTE: Assessment on leaving employment may be considered to be of benefit to the employee
and the employer in assessing the effectiveness of health risk management and the medical
fitness assessment process. In addition it may be of benefit in the control of insured risks and the
event of future work related disease compensation claims.

8.4 Assessment Frequency

The frequency of periodic fitness reassessments (See Table 4) is a balance between
ensuring that they are at short enough intervals to ensure that significant changes are
detected, but are not so frequent that they discourage employees or become
uneconomic. A literature survey indicates that age related intervals may be
discriminatory and that a fixed maximum interval of three years for all personnel is
preferable (The OHSP may well recommend a shorter interval, taking account of factors
such as task, fitness and age).
It is therefore recommended that full re-assessment of fitness for people operating plant
is set at a fixed periodic review, after first assessment, of three years, unless otherwise
advised by the OHSP Reassessment of fitness for people operating plant with any
substantial change in medical circumstances is also recommended. Such an
assessment need only address the specific change in those medical circumstances, with
full re-assessment when next scheduled. It is also helpful for employees to fill in a self-
declaration questionnaire every year. These should be reviewed by a competent person
and any concerns raised with the OHSP.

Medical Fitness to Operate Plant 21 July 2018

 Figure 2 – Initial Baseline Assessment Process - Existing Operators

Medical Fitness to Operate Plant 22 July 2018

 Figure 3 – Periodic Assessment

Item Stage Maximum Interval

1. Initial assessment N/A

2. Employee questionnaire 12 months

3. Fitness for task assessment at periodic intervals 3 years

4 Review at change of task As required

Table 4 Maximum Assessment Intervals

Medical Fitness to Operate Plant 23 July 2018

9.0 Medical Fitness and Recruitment
9.1 Introduction
When recruiting plant operators, care must be taken to ensure that enquiries about a
candidate's health during the recruitment process are fair and reasonable and do not
infringe the requirements of the Equality Act 2010. This section provides guidance on
this process.

9.2 Advertising the Job

Advertisements for the job should be based on the job specification, accurately reflect
the requirements of the job and should not contain any unnecessary or spurious
requirements. If candidates are required to take a skills test as part of the interview
procedure this must be stated in the advertisement. The advertisement cannot specify
requirements about health and fitness unless they relate to a characteristic that is
essential to the job (See Section 6.0).
The job should be advertised as widely as possible to avoid discrimination and enable
the employer to select employees from a wide and diverse pool.

9.3 Application Forms

Application forms cannot ask questions about health and fitness unless they relate to a
characteristic that is essential to the job.
An example of this is where a plant company is recruiting tower crane drivers. It would
be lawful under the Equality Act to ask about disability or health on the application form
if the questions related specifically to an applicant’s ability to climb ladders to a
significant height. The ability to climb ladders is intrinsic to the job. However asking
general questions about a candidate's health history would not be lawful.

9.4 Selection for Interview

Processes for selection for interview must be non discriminatory, fair and objective and
ensure that decisions are consistent. Employers should also keep records that will allow
them to justify each decision and the process by which it was reached and to respond to
any complaints of discrimination. If the employer does not keep records of their
decisions, in some circumstances, it could result in an Employment Tribunal drawing an
adverse inference of discrimination.

9.5 Interview
Interviews are the stage of an application process at which judgements may be made
about a candidate based on instant and subjective impressions. Consequently it is
important that interviews are conducted strictly on the basis of the application form, the
job description, the agreed weight given to each criterion and the results of any selection
tests. In this way an employer will ensure that all applicants are assessed objectively,
and solely on their ability to do the job satisfactorily.
With regard to questions on health matters, the same criteria as for application forms
applies.

9.6 Evaluation of candidates

As with selection of candidates for interview, the evaluation of candidates following
interview and any skills testing must be conducted in a consistent and objective manner.
Health issues can only be considered where they have a direct bearing on the intrinsic
functions of the job for which candidates are being evaluated.

Medical Fitness to Operate Plant 24 July 2018

9.7 Job Offers
Once a candidate has been selected and a job offer is made it is permissible to make
enquiries about the prospective employee's general health or to require them to
undertake a health assessment (See 9.8). It is also possible to make the job offer
conditional on the outcome of these enquires or assessment. However employers must
ensure that they do not discriminate against a disabled job applicant, particularly if
reasonable adjustments can be made to the plant and working environment to
accommodate their disability.

9.8 Health Assessment at Job Offer

If a job offer is conditional on the outcome of a health assessment, that assessment will
follow the process outlined in Section 8.0 using Figure 4 in place of Figure 2.

9.9 Induction
If the candidate accepts the job offer, arrangements should be made for their induction
into the company and on the site on which they are to work. This should include the
assessment of any necessary adjustments required to the plant and working
environment to accommodate any disabilities.

9.10 Putting to work

Once the induction process has been completed, and in the case of disabled operators
any necessary adjustments made, the new operator should be put to work.

9.11 Further Information

Further detailed information on ensuring that the recruitment process is fair and non-
discriminatory is given in Equality Act 2010 Code of Practice - Employment Statutory Code
of Practice published by the Equality and Human Rights Commission and downloadable
from:-
https://www.equalityhumanrights.com/sites/default/files/employercode.pdf

Medical Fitness to Operate Plant 25 July 2018

 Figure 4 – Initial Baseline Assessment Process -
New Candidates for Plant Operation

Medical Fitness to Operate Plant 26 July 2018

10.0 Evidence of Medical Fitness for Customers
One of the purposes of medical fitness assessments for construction plant operators is
to be able to demonstrate to those hiring plant and operators that the operators are
medically fit to undertake the tasks they are asked to do. When providing this evidence it
is important that employers ensure that data protection and patient confidentiality
requirements are observed. Any statement of fitness should confine itself to the fact that
the employee has been assessed by the OHSP and found to be medically fit to operate
the specific item of plant.

Medical Fitness to Operate Plant 27 July 2018

11.0 Assessment Requirements and Standards
11.1 Introduction
It is important when medical assessments of people operating plant are carried out that
they are both appropriate and carried out to a recognised and consistent standard. This
will ensure that money and time are not spent on unnecessary tests and that a person's
fitness can be monitored over time.

11.2 Typical Assessments

When assessing the fitness of people operating plant the following typical assessments
should be undertaken. These may be supplemented by addition assessments if
required.
11.2.1 Health Questionnaire
This is aimed at establishing a plant operator’s previous health history, highlighting any
current problems and medication.
11.2.2 Musculo-skeletal Health, Mobility and Coordination Assessment
Ability to access and control the machine effectively and safely e.g. dexterity, head
movement and susceptibility to whole body vibration issues.
11.2.3 Cardio-vascular Health
Provides indications of acute or underlying health problems that may lead to reduced
ability or incapacity.
11.2.4 Nervous System
Ability to control the machine effectively and safely.
11.2.5 Visual Acuity, Colour Perception and Peripheral Fields
Ability to see personnel in danger areas, judge distances and anticipate hazards. Ability
to see warnings and danger signals.
11.2.6 Hearing
Ability to hear warnings from anyone and receive directions from a supervisor.
11.2.7 General Health Assessment
Provides indications of acute or underlying health problems that may lead to reduced
ability or incapacity.
11.2.8 Psychological/Mental Health
Stability for working in isolation (i.e. machine cab), in stressful situations and situations
carrying high responsibility.
11.2.9 Optional Drug and Alcohol Screening
To address specific issues in the workplace after specific incidents and in accordance
with company policy.

11.3 Requirements
The pass/fail requirements for each of the assessments listed in 11.2 should be agreed
between the employer and their Occupational Health Service Provider. Annex G gives
further details of the seven core elements to be assessed for those individuals wishing
to operate mobile plant. These standards have been compiled from the DVLA, CBH,
HSE and Fitness for work - medical aspects guidance.

Medical Fitness to Operate Plant 28 July 2018

References
• At a glance Guide to the current Medical Standards of Fitness to Drive - Driver
and Vehicle Licensing Agency
• Occupational Health Standards for the UK Construction Industry Issue 2 -
Constructing Better Health
• Occupational health standards in the construction industry - HSE Research
Report RR584

Case Study
When setting up a programme to assess fitness to operate construction mobile plant
Company A identified a forklift truck operator who had vision in only one eye. He had
been employed as a forklift truck operator for a considerable time and was considered
a safe and competent operator, despite this restricted vision. As he had compensated
for this defect, he was permitted to continue to operate forklifts. After a period of time, it
was observed that the operator had a number of near misses and his manager put him
forward for a review of his medical fitness to operate the equipment. During this review
it was found that he had developed a neck problem which reduced his ability to look
over each shoulder. As a result of this he was prevented from operating forklift trucks
and provided with other work.

Medical Fitness to Operate Plant 29 July 2018

12.0 Consultation with Employees
12.1 Introduction
All workers have the right to be consulted. Consultation is the process of managers and
workers (or their representatives) jointly considering and discussing issues of mutual
concern. It involves seeking acceptable solutions to problems through a genuine exchange
of views and information.
Consultation is not negotiation and it is not just giving information or telling employees what
the employer has already decided to do. Consultation does not remove the right of
managers to manage – they must still make the final decision – and does not require
managers and workers to agree. It does however, oblige managers to seek and listen to the
views of workers before decisions are taken.
The benefit of consultation is that people's behaviour is more likely to be influenced if they
understand and have contributed to management decisions.

12.2 Legal requirements for consultation

Two principal sets of regulations require workers to be consulted on health and safety
matters. One is for undertakings where trade unions are recognised for collective bargaining
purposes (The Safety Representatives and Safety Committees Regulations 1977), and the
other is for circumstances where this is not the case (The Health and Safety (Consultation
with Employees) Regulations 1996). Other regulations that require consultation of
employees, most of which are sector specific are not considered in detail here (See Table
5).

12.3 Employees duty to inform

Employees have a duty to inform their employers about any changes to their health which
may affect their ability to carry out their work safely.

The Safety Representatives and Safety The Health and Safety (Consultation with
Committees Regulations 1977 Employees) Regulations 1996

“Safety Representatives” “Representatives of Employee Safety”

Appointed in writing by a recognised trade union Elected by the workforce
recognised for collective bargaining purposes
Role Role
• Representation of employees in • Representation of employees in consultation
consultation with the employer on specified with the employer on specified matters
matters • To take up with employers concerns about
• Investigation of workplace incidents, possible risks and dangerous events in the
complaints and potential hazards workplace that may affect the employees they
• Presentation of the findings of such represent
investigations to the employer • Presentation of the findings of such
• Inspection of the workplace; investigations to the employer
• Representation of employees in dealings • To take up with employers general matters
with health and safety inspectors affecting the health and safety of the
employees they represent
• Attendance at health and safety committee
meetings • Representation of employees in dealings with
health and safety inspectors
• Attendance at health and safety committee
meetings

Table 5 - Comparison of functions of Safety Representatives and

Representatives of Employee Safety

Medical Fitness to Operate Plant 30 July 2018

13.0 Employment Issues
The assessment of medical fitness to operate construction plant will have a significant
impact on the relationship between an employer and their employees. At all stages of
the assessment process from the selection of an OHSP, through initial and periodic
assessment, to decisions about an employee's future resulting from assessment
outcomes, employers must ensure that they consult their Human Resources
departments to ensure that employees are treated fairly and that they comply with legal
requirements.
Part of the fair treatment of employees is ensuring that if a problem is found during the
medical fitness assessment process, suitable support is given to assist the employee to
overcome or come to terms with the problem.
In the case of smaller employers who do not have access to in-house Human Resource
departments, advice on employment matter can be obtained from:
• The Advisory, Conciliation and Arbitration Service (ACAS) - http://www.acas.org.uk
• GOV.UK - www.gov.uk/browse/employing-people

Medical Fitness to Operate Plant 31 July 2018

 Annex A - Example Self Declaration for New Plant Operators
Part 1: To be completed by Employer/Company Representative

Surname/Family Name Address Manager contact details:

Forename(s) Location

Postcode
Date of National Insurance Telephone (home) Job Title
birth number
Telephone (work)

State Type of Construction Plant Here:

Evidence of competence

Part 2: To be completed by Employee/Applicant – return the completed form to your Manager or HR

Answer the following questions with either a YES or NO – if you answer NO you will be able to start training
in using Mobile Plant. If you answer YES then an appointment will be made for you to see the
Occupational Health nurse or doctor to discuss your health issues in private.

Please answer the following: Yes No

Do you need any special adaptations/aids to assist you at work, whether or not
you have a disability?
Are you having or waiting for health treatments or investigations of any kind at
present?
Do you or have you ever had any health problems which have been caused or
made worse by your work?
Are you aware of any health issue that may affect your or other's safety when
operating mobile plant?

Signed: Date:

To the employing Manager

If applicant answers ‘yes’ to the above, it is advisable to refer them to Occupational Health Service Provider before
beginning work on Construction Plant. Ask applicants to complete Occupational Health Questionnaire (Annex B)
for review by the Occupational Health Service Provider.
Date & Time of Appointment:
Address of Occupational Health:

Notes:

Medical Fitness to Operate Plant 32 July 2018

 Annex B – Example Occupational Health Questionnaire (See 8.0)
Part 1: To be completed by Employer/Company Representative
Surname/Family Name Address Manager contact details:

Forename(s) Location
Postcode
Date of National Insurance Telephone (home) Job Title
birth number
Telephone (work)
Type of Construction Plant to be Operated:

Approximate date of last health check if applicable ………………………………………………………

Part 2: To be completed by Employee/Applicant – send to Occupational Health Service Provider in the

envelope provided

Complete all parts by ticking the boxes and providing more details where required. At the end you will be
asked to sign a declaration, to say that you have answered the questions truthfully and to the best of your
knowledge. Please be reassured that the medical information you provide will remain confidential to
Occupational Health.

Health history/current condition (since your last health check with an Occupational Health Service
Provider)

If yes, please give details including any

Have you ever had any of the following? Yes No
tests or investigations carried out
1. Anaemia or other blood disorders?

2. Disorders of the nervous system including epilepsy,

balance problems, dizziness or light- headedness?
3. Recurrent or persistent headaches?

4. Psychiatric illness or trouble with nerves, stress,

depression or anxiety, early waking or unpleasant
dreams or difficulty sleeping?
5. Disease of the heart or circulation including angina,
chest pains, palpitations swollen ankles, leg cramps
when walking and high blood pressure?
6. Allergy to any food, drug or other substance at
home or at work? Please describe the effect.
7. Asthma, bronchitis or chest disease such as
persistent cough or breathlessness?
8. Stomach or duodenal ulcer, indigestion, heartburn
or stomach pains?
9. Bowel disorder or problems?

10. Kidney or bladder disorder, pain, blood or frequency

in passing urine?
11. Diabetes or thyroid disease?

12. Hernia or rupture?

Have you ever had any of the following? Yes No If yes, please give details including any

Medical Fitness to Operate Plant 33 July 2018

 tests or investigations carried out

13. Disorder of the back, neck, joints or muscles?

14. Disorder affecting the hands or arm?

15. Skin disease or dermatitis?

16. Ear disease or deafness?

17. Eye disorders including colour blindness? Have you

had laser/corneal surgery?
18. Hepatitis, jaundice or other liver or gall bladder
disease?
19. Disturbed sleep from snoring or breathing difficulty,
daytime sleepiness, or diagnosed with a sleep
disorder
If yes, please give details including any
Other Issues Yes No
tests or investigations carried out

20. Do you take illegal drugs or believe you have an

alcohol problem?
21. Have you ever had a serious injury or broken
bones?
22. Have you ever had an operation?

23. Have you had or are you waiting for any

investigations, tests or treatment?
24. Are you taking any drugs or medicines? If yes,
please list.
25. Have you left a job for medical reasons?

26. Have you ever had an illness caused by your work?

27. Have you been away from work for at least two
weeks due to illness in the past two years?
28. Do you suffer from any other health problem or
disability, which is relevant to your job or the
proposed job?

Notes (more space for any details – continue overleaf if necessary)

Go to next page to sign declaration.

Medical Fitness to Operate Plant 34 July 2018

Please read and sign the following:-
Declaration
I declare that the information I have provided about my health is to the best of my belief true and complete. As a
result of completing this form I understand that I may be asked for clarification of one or more points arising from
the questionnaire, a report may be requested from my GP/Specialist, and/or I may be invited to attend a medical
examination.
I also understand that if, in the event that I am employed, it is subsequently shown that I have knowingly provided
misleading or false information, or knowingly withheld medication information, I may be in breach of my
employment contract.

Print name …………………………………………………… Date ………………………………

Signature ………………………………………………………………………

Data Protection Declaration

I consent to the computer and other processing and use (which may be in any part of the world) by the data
controllers and relevant third parties of: (i) my personal medical details contained in this questionnaire and (ii) all
test results obtained from any periodic medical examination that I may have, for the following purposes:
1. Combining my health data (identified by my name) with data of other employees (identified by name) to
produce, at any time and from time to time, basic and detailed reports of all employees’ health;
2. Forwarding those reports set out in paragraph 1, at any time and from time to time, to my employer so that it
can identify any decline in my, or other employees’, health in order to take appropriate action to comply with its
obligations under any health and safety legislation; and
3. Retaining my health data (identified by name) for the purposes of comparing with more recent data to produce
those reports set out in paragraph 1 above.
For the purposes of this declaration the test results that may be processed and used include, but are not limited to,
tests for eyesight, hearing, cardio-vascular, respiratory, gastro-intestinal, genito-urinary, muscular-skeletal, and
neurological conditions, blood, urine and drug/alcohol tests and tests for vibration related disorders.

Print name …………………………………………… Date ………………………………

Signature ………………………………………………………………………

Medical Fitness to Operate Plant 35 July 2018

Consent to Obtain a Medical Report
Before we can apply for a medical report from a doctor we need your consent, and a declaration for this appears
below. However, you should know that you have certain rights under the Access to Medical Reports Act
1988/Access to Personal Files and Medical Reports Act (Northern Ireland) Order 1991.
The main points of the Act are as follows:
1. If you indicate that you do not wish to see the report we will not notify you if we apply for one. However, if
before such a report is sent to us you write to your doctor requesting to see it, you will have 21 days to contact
your doctor about arrangements for you to see the report.
2. If you indicate that you wish to see the report, we will write to you at the same time as we contact your doctor.
We will indicate that you have asked to see the report and that you have 21 days to contact your doctor to
make arrangements to do so. When you have seen the report the doctor may not send it to us until you have
given your consent to do so. If you do not contact your doctor within 21 days the report will be sent to us.
3. You can ask your doctor if he/she will amend any part of the report which you consider to be incorrect or
misleading. If your doctor is not in agreement you may attach your comments.
4. During the six months after we have received your report you may ask your doctor to see a copy. Should you
ask for a personal copy of the report the doctor can charge you a reasonable fee to cover the cost.
5. In some circumstances the doctor may decide, in the interest of your health, or to respect the interest of other
persons, that you should not see all or part of the report. The doctor will notify you of this and you will have
the right to see any remaining part of the report. If it is the whole of the report which is affected, this will not be
given to us without your consent.
6. You can withhold your consent.

Please read and sign the declaration below.

I have been informed of, and understand, my statutory rights under the Access to Medical Records Act
1988/Access to Personal Files and Medical Reports (Northern Ireland) Order 1991. I hereby consent to
Occupational Health or its agents seeking medical information from any doctor who has attended me for any
periodic medical assessment concerning anything which affects my physical and/or mental health, and that this
information should be passed to the company Occupational Health Department. I agree that a copy of this
consent shall have the validity of the original.
I do/do not wish to see any such report before it is sent to the company.*
*Please delete if you do wish to see a copy of any report.

Print name …………………………………………………Date ………………………………

Signature ………………………………………………………………………

For Office use only

Assessment of current occupational health status

Normal
Unchanged
Changed
Examination by Nurse/Doctor Recommended?

Signature of Examiner ……………………………………………………….. Date……………………

Name of Examiner………………………………………………………………

Medical Fitness to Operate Plant 36 July 2018

Annex C - Employer's Duties for the Collection and Use of
Employee's Health Information
Employers should:-
• Consider why they want to collect and use this information. This might mean
identifying a problem they are trying to solve, for example work that is safety
critical;
• Make sure that they can satisfy a “special category data” condition. This is most
likely to be met if collecting and processing the data is necessary for:-
o the purposes of performing or exercising obligations or rights of the
employer or employee under employment law, such as not to
discriminate against an employee or dismiss them unfairly;
o establishing, exercising or defending legal claims; or
o the assessment of an employee's working capacity, subject to
confidentiality safeguards.
• Bear in mind that if consent is relied upon, it must be freely given. This means an
employee must be able to say ‘no’ without a penalty being imposed and must be
able to withdraw consent once given. A person is more likely to be in this position
at the recruitment stage than when they are employed;
• Be clear that they can satisfy a special category data condition and check that
the collection and use of health information is justified by the resulting benefits;
• Remember that:
o gathering information about their employees’ health may be intrusive;
o employees can legitimately expect to keep their personal health
information private and expect that employers will respect this privacy;
• Consider whether alternative ways of collecting information about their
employee's health would deliver the benefits they want, while being more
acceptable to the employee. For example, a health questionnaires might be used
rather than medical testing or at least a questionnaire used to select those to be
tested;
• Collect health information in areas of significant risk. Consideration should be
given to whether or not just a few individuals whose jobs are safety critical can
be involved;
• Keep information about employee’s health particularly secure. This might mean
allowing only one or two people to have access to it, for example by password-
protecting it, or keeping it in a sealed envelope in an employee's file. Medical
information should only be viewed by Occupational Health Professionals, whilst
Fitness to Work certificates can be accessible to managers;
• Not keep information for longer than necessary or collect more information than
is essential. See Table C1 for suggested minimum retention periods;
• Remember that an employer’s interest is mainly in knowing whether an
employee is or will be fit to work. As far as possible it should be left to doctors
and nurses to access and interpret detailed medical information;
• Ensure that employees are informed that information about their health is being
collected and why;
• Ensure that where a specific action is being taken, for example where an
employee is to undergo a medical test, the employee is made fully aware of
what, why and how much information is to be collected. Care should be taken to

Medical Fitness to Operate Plant 37 July 2018

 ensure that if the employee is referred to a doctor or nurse, they know what type
of information the employer will receive as a result;
• It may be necessary for interpreters to attend medicals in order to ensure that the
person being checked understands the reason for the examination and what the
data is used for. The interpreter is then aware of the medical history of the
individual so they need to be aware of data protection requirements.

Suggested Minimum Reason for Length of

Type of Record
Retention Period Period
Pre-placement health screening During employment plus 3 Ongoing review by
questionnaire and/or Fitness for Work years management + Evidence of
Certificate fair treatment + Limitation
period for personal injury
claims.
Fitness for Work Certificate During employment plus 3 For ongoing review by
years management + Limitation
period for personal injury
claims.
Occupational Health Records where During employment plus 3 Limitation period for personal
reason for termination of employment is years injury claims
connected with health, including stress
related illness

Table C1 – Suggested Minimum Retention Periods for Certain Types of Records

Medical Fitness to Operate Plant 38 July 2018

Annex D – Minimum Competency Standards for Occupational Health
Professionals in the Construction Industry
In addition to the fulfillment of the necessary legal requirements of employment of
clinical staff, the construction industry should apply the following minimum levels of
competence:

Occupational Health Physicians

Occupational health physicians (OHP) are required by law to possess skills and
expertise including an understanding of the health hazards that can arise at work, the
ability to assess risks relating to the health of individuals and groups, knowledge of the
law relating to workplace issues and awareness and understanding of the way business
operates.
There are currently three levels of qualification in occupational medicine for doctors,
• The Diploma in Occupational Medicine (DOccMed.)
• The Associateship of the Faculty of Occupational Medicine (AFOM)
• Membership of the Faculty (MFOM).
In addition, the Fellowship of the Faculty (FFOM) is awarded to those occupational
physicians with MFOM who have made a distinguished contribution to the specialty and
who demonstrate a greater depth of experience and expertise in occupational medicine.
Physicians without these qualifications who rely solely on experience gained in the
workplace may not meet the requirements for competence that are demanded by many
aspects of health and safety legislation. Therefore, the Diploma in Occupational
Medicine has been identified as the minimum standard for the construction industry.
However, all physicians practising in the construction industry should work within the
limits of their competence and be cognisant of the need to have access to a nominated
Accredited Specialist Occupational Physician (Accredited Specialist in Occupational
Medicine who is on the GMC Specialist Register) for advice as needed. The level of
occupational health expertise will need to be commensurate with the level of health risk
identified for the project e.g. for a complex construction project it would be usual for the
occupational health provision to be led by a Consultant Occupational Health Physician.
For a physician led occupational health service (physician led is defined as the situation
whereby the occupational health services are being managed and controlled by a
physician), the lead physician must be either an Accredited Specialist in Occupational
Medicine (Accredited Specialist in Occupational Medicine who is on the GMC Specialist
Register) or have the necessary access to a nominated Accredited Specialist
Occupational Physician for advice as needed.

Occupational Health Nurse Advisors

OHNAs carrying out occupational health surveillance should hold current registration
with the Nursing and Midwifery Council (NMC), as a minimum. They may also hold an
occupational health qualification at Certificate, Diploma or Degree level. If they do not
have an occupational health qualification then they should be working under the
necessary level of supervision of an appropriately qualified clinician (Doctor or Nurse).
Nurses will need to renew their registration every year with the NMC.
For a nurse led occupational health service (nurse led is defined as the situation
whereby the occupational health services are being managed and controlled by a
nurse.), the lead nurse should also be registered as a Specialist Community Public
Health nurse (Occupational Health) with the NMC and have access to a nominated
Accredited Specialist Occupational Physician (Accredited Specialist in Occupational
Medicine who is on the GMC Specialist Register) for advice as needed.

Medical Fitness to Operate Plant 39 July 2018

Occupational Health Technicians
The occupational health technician is a developing role. With the expert supervision of
OH qualified nurses and doctors and the correct training, they may be able to carry out
aspects of health screening required within an OH programme, which in turn frees-up
the OH clinicians for other, more appropriate tasks. Currently there are no minimum
standards available to follow although there are academic organisations currently
looking to develop a training programme for technicians.
Occupational health service providers (OHSP) must hold appropriate business and
professional indemnity insurance, comply with applicable legislation, and should not
undertake work without having seen or had access to the employer’s relevant Health
and Safety policies to determine how Health and Safety is managed.
The Health Professional should be able to demonstrate awareness of legislation,
policies or programs that might interfere with or affect the performance of the health
assessment for example, drug alcohol policy, critical incident management programs,
anti-discrimination legislation, medical ethics and privacy legislation.
Occupational health service providers should have:
• Appropriate quality monitoring processes i.e. a clinical audit programme;
• Clinical training programmes;
• Business and professional indemnity insurance;
• Appropriate registration under the Data Protection Act (1998)
• A health and safety policy for those with five or more employees;
• Access to construction industry occupational health policy and procedures to
which they provide a service.

Construction Industry Knowledge:

The health professional should demonstrate familiarity with Occupational Health
Standards for the UK Construction Industry and working knowledge of Assessment
Procedures and Medical Criteria, including:
• Appreciation of the role of health assessments in ensuring construction safety;
• Familiarity with the risk management approach used to identify the level of health
assessment required;
• Familiarity with the tasks in construction plant operations and with major tasks of
Safety Critical Workers;
• Knowledge of construction safety worker Risk Categories and the rationale for
health assessments applied;
• Knowledge of ability to perform the Safety Critical Worker Health Assessment;
• Understanding of requirements and reporting options for fitness for construction
safety duty;
• Knowledge of the assessment’s administrative requirements, including form
completion and record keeping;
• Understanding of ethical and legal obligations and the ability to conduct health
assessments accordingly, including appropriate communication with the worker
and the employer;
Understanding of ethical issues in relationships with the treating doctor/general
practitioner.

Medical Fitness to Operate Plant 40 July 2018

An OHSP's record keeping should meet the requirements set out the Data Protection
Act 2018 and those of the various regulatory bodies, i.e. The Nursing and Midwifery
Council (NMC), and the General Medical Council (GMC), the OHSP will also be familiar
with the recommendations made by the HSE in relation to the keeping of health records
that form part of a health surveillance programme.
The Faculty of Occupational Medicine’s guidance on ethics for occupational doctors is
followed regarding the provisions for transfer and storage of records and the
confidentiality of health data.
There may be occasions where an OHSP may not meet all the criteria above. However
the OHSP may demonstrate the required knowledge, skills and experience, and have
the relevant procedures in place to enable them to provide an occupational health
service which is at least equivalent to the minimum industry standards.

Medical Fitness to Operate Plant 41 July 2018

 Annex E - Example of a Fitness to Work Certificate from the OHSP to
the Employer

Fitness to Work Certificate for Plant Operator

PERSONAL IN CONFIDENCE

To: Date Screened:

Name: Date of Birth:

Type of Machine Operated

Contracting Company: Location:

Mobile Plant Static Plant Work at Heights Vocational Driver

I have found them to be: - (Please tick)

(Please delete as appropriate)

Fit for purpose / continued employment

Fit to attend Safety Induction Training, but must attend Occupational Health department for medical assessment prior
to commencing work on site.

Fit for purpose/continued employment subject to the following restrictions-

Fit for purpose/continued employment, is likely to be covered under the Equality Act 2010 (Disability Discrimination )

Fit for purpose/continued employment, but requires REVIEW in

I found him/her to be temporarily unfit. REVIEW in

Unable to pass fit for purpose/continued employment and referred to:

Advised to see General Practitioner/Consultant/Physiotherapist

Advised to see Optician

Awaiting information from GP/Consultant

Referred to Occupational Physician

Further Information:

Signed: Occupational Health Advisor

Medical Fitness to Operate Plant 42 July 2018

Annex F - Examples of Plant Descriptions

Machine Type
Telehandler Tower Crane Dumper 360°Excavator
Typical Example

Purpose Transportation of palletised goods Lifting of materials to landing Transportation of loose materials Excavation of material from the
around site and lifting at height points on the structure under around site ground, forming stockpiles, loading
(typically 15 metres) to landing construction. Total lift into transport and backfilling
points on the structure under distance may be in excess of
construction. 100metres
Environmental
Heated cab Heated cab None Heated cab
Protection
Access Distance Typically between 30m and
< 1 metre < 1 metre < 1 metre
(Climb) 100m
Typical Shift
3 hours 4 - 6 hours 3 hours 3 hours
Duration
Maximum Travel
15 mph N/A 12 mph 4 mph
Speed
Communication Direct verbal instruction and hand Verbal instructions via radio Direct verbal instruction and hand Direct verbal instruction and hand
method signals and hand signals signals signals

Physical Operating Operate controls whilst sat on fixed Operate controls whilst sat Operate controls whilst sat on Operate controls whilst sat on fixed
Requirements seating, leaning forward, turning on fixed seating, leaning fixed seating, leaning forward, seating, leaning forward, turning
neck and upper body 180°. Getting forward, turning neck and turning neck and upper body neck and upper body 180°. Getting
down from cab at intervals to shoulders 90° right and left 180°. down from cab at intervals to
change attachments or check change attachments or check
security of connection security of connection

Medical Fitness to Operate Plant 43 July 2018

Annex G – Seven Core Elements to be Assessed for Individuals Wishing to Operate Construction Plant - Guidance
The guidance given below has been compiled from the DVLA, CBH, HSE and Fitness for work – medical aspects guidance. Results of individual tests
should not be taken in isolation in assessing individual fitness but should be used as part of an overall clinical assessment.
Core Elements Assessed Outcome Elements to be Assessed
The combined effect of any physical, medical
or psychological condition is controlled to a
Overall clinical assessment satisfactory level not to interfere with the See Below
activities required of a construction plant
operator.
1. Musculo-skeletal health, No evidence of musculo-skeletal disorder, Full range of movement of the trunk, neck, upper and lower limbs required:-
mobility and co- mobility, balance or co-ordination disorder. a. Chronic pain or restriction of joint movement does not interfere with mobility;
ordination
b. Individual’s with prosthesis require individual operational assessment with OHA,
Manager and operator.
2. Cardio-vascular health a. Normal blood pressure and no cardiac Blood pressure should be controlled:-
symptoms presented or reported; • Diastolic below 95 mmHg;
b. Adequate control of cardio-vascular risk • Systolic below 150 mmHg.
factors.
3. Nervous system No evidence or reporting of neurological Vertigo, giddiness and balance disorders, ataxia, diplopia, significant tremor, paralysis,
disorder. generalised or localised muscular weakness and peripheral/autonomic neuropathy are a
bar to operating construction plant.
Epilepsy which has been controlled, free from fits for 10 years, no anti-epileptic treatment
for 10 years and no continuing liability for seizures, normal EEG. Withdrawal from anti-
epileptic treatment is not considered compatible with mobile plant operating unless cleared
by a Neuro-Consultant.
• Individual functional and operational assessment is required for those employees
post TIA / CVA and with medical problems which restrict capability to stand, walk,
sit for periods of time.
4. Visual acuity, colour a. Uncorrected or corrected vision of an Uncorrected or corrected visual acuity at least 6/9 in one eye and 6/12 in the other. No
vision and peripheral adequate standard; operation of construction plant until corrected vision to the required vision demonstrated.
fields b. No pathological condition of the eyes likely Monocular vision
to cause visual impairment should be • An individual functional and operational assessment with the OHA, Manager and
present; operator.
c. No pathological defect of the visual fields Colour vision
demonstrated;
Has passed Ishihara (24) plates/city test standard for colour perception, no colour
d. No significant pathological colour deficiency noted.
deficiency noted.
• Worker identified as safe where minor degrees of anomalous trichromatism.

Medical Fitness to Operate Plant 44 July 2018

 Core Elements Assessed Outcome Elements to be Assessed
5. Hearing Evidence of adequate hearing to HSE For operating construction plant, hearing loss should not exceed 30dB averaged over 0.5,
category 1 or 2. 1 and 2 kHz in either ear. Where it is difficult to determine the ability of a worker to hear
instructions and auditory warning signals, an operational assessment may be appropriate
– conducted by the manager and safety professional.
Provided the standard is met without the use of an hearing aid, a hearing aid may be used
to improve hearing further.
6. General health No evidence of an uncontrolled or untreated Medical or physical conditions such as diabetes or asthma are not a bar and should be
assessment medical condition which could result in controlled to ensure reduction of sudden collapse. Individual assessment and clinical
impaired cognitive functioning or sudden judgement required on a case by case basis.
incapacity. See CBH and DVLA standard for specific guidance relating to specific medical or physical
conditions.
7. Psychological/mental No evidence of uncontrolled mental ill health Has shown evidence / reported one or more of the following:
heath that is likely to interfere with operation of • Deterioration in behaviour changes;
construction plant.
• Changes in relationships with colleagues;
• Irritability/sudden mood swings/hypermania;
• Reduced performance;
• Inability to make decisions/pay attention to detail/altered perception/short-term
memory problems or concentration difficulties;
• Currently undergoing psychiatric assessment;
• Current symptoms of stress-related illnesses;
• Hypomania;
• Significant intellectual impairment.
Drug maintenance therapy which is not causing side effects will usually be compatible with
operating construction plant providing the individual remains asymptomatic and mental
alertness and concentration should not be impaired.
8. Drug and alcohol No evidence of alcohol or substance misuse in
screening (Optional - relation to operating construction plant at work.
See 11.2.9)

Medical Fitness to Operate Plant 45 July 2018

Annex H - Legal Requirements
H.1 The Health & Safety at Work etc Act 1974 (HSWA)
• HSWA places a duty on employers to ensure the health and safety of employees
and others who may be affected by their work activities;
• Similar duties are placed on the self-employed and persons in control of
premises. Employees, managers and directors also have responsibilities;
• The HSWA also places a duty on employers, where their work activity could
affect the general public.

H.2 The Management of Health & Safety at Work Regulations 1999 (MHSWR)
• Under MHSWR, employers and self-employed people are required to assess
risks to health and safety from their undertaking;
• The risk assessment should identify what measures are needed to comply with
health and safety requirements and control risk;
• The duty holder should then put in place the organisation and arrangements to
ensure that those measures are properly implemented;
• MHSWR also requires employers on multi occupancy sites to co-operate with
each other to ensure that all statutory provisions are complied with;
• Regulation 20 of MHSWR requires employers to "ensure that his employees are
provided with such health surveillance as is appropriate having regard to the
risks to their health and safety which are identified by the assessment".

H.3 The Construction (Design and Management) Regulations 2007 (CDM)

• The Construction (Design and Management) Regulations place duties on duty
holders including clients, designers and contractors for the planning,
management and monitoring of health, safety and welfare in construction
projects and of the co-ordination of the performance of these duties by duty
holders;
• These include a duty on every person working under the control of another to
report anything that he is aware is likely to endanger health or safety;
• The Regulations impose additional duties on clients, designers and contractors
where the project is notifiable, defined as likely to involve more than 30 days or
500 person days of construction work;
• These include the duty of the client to appoint a CDM coordinator and a Principal
Contractor.

H.4 The Equality Act 2010

• The Equality Act became law in October 2010;
• It replaces nine separate pieces of previous legislation (such as the Race
Relations Act 1976 and the Disability Discrimination Act 1995) and ensures
consistency in what employers need to do to make workplaces a fair
environment and to comply with the law;
• The Equality Act covers the same groups that were protected by existing equality
legislation - age, disability, gender reassignment, race, religion or belief, sex,
sexual orientation, marriage and civil partnership and pregnancy and maternity -
but extends some protections to groups not previously covered, and also
strengthens particular aspects of equality law;
Medical Fitness to Operate Plant 46 July 2018
 • The Act places restrictions on pre-employment enquiries about an applicant's
disability or health to those questions which relates to a person's ability to carry
out a function that is intrinsic to that job;
An example of this is where a construction company is recruiting scaffolders. It
would be lawful under the Act to ask about disability or health on the application
form or at interview if the questions related specifically to an applicant’s ability to
climb ladders and scaffolding to a significant height. The ability to climb ladders
and scaffolding is intrinsic to the job.
• Further information can be found on the Government Equalities Offices website
and the Equality and Human Rights Commission website.

H.5 The Data Protection Act 2018

• The Data Protection Act 2018 replaces the previous 1998 Act and incorporates
the requirements of the European General Data Protection Regulation 2016;
• The new Act provides:
o Easier access to an individual’s own data;
o A new right to data portability: it is now easier for an individual to transfer
their personal data between service providers;
o A strengthened right to be forgotten: when an individual longer wants
their data to be processed, and provided that there are no legitimate
grounds for retaining it, the data must be deleted;
o A new right for individuals to know when their data has been hacked;
o Exemptions to support businesses and enable innovation.
• Further information can be found on the Information Commissioner's website
(see Annex J).

H.6 The Access to Medical Reports Act 1988

• The Access to Medical Reports Act 1988 is relevant in the context of recruitment,
health screening during employment, time off for medical reasons and dismissal
for medical reasons;
• The Act itself, sometimes wrongly called the "Access to Medical Records Act
1988", is quite short - only 10 sections in all;
• This Act covers medical records held by employers as well as records held by
doctors. More accurately it gives an individual the right to have access "to any
medical report relating to the individual which is to be, or has been, supplied by a
medical practitioner for employment purposes or insurance purposes";
• It also gives individuals the right to refuse consent for any medical report (as
defined) to be supplied by a doctor to an employer or insurer, plus other rights;
• Employees and prospective employees should not be sent for medical
examination without first being informed of their rights under the Act;
• Rights under the Act are enforceable through the normal courts, not through
employment tribunals
• The Act has been modified by the Data Protection Act 2018 to the extent that the
definition of health professional has been replaced by the definition in the Data
Protection Act.

Medical Fitness to Operate Plant 47 July 2018

Annex I - CONIAC Position on Health Risks in Construction
CONIAC HRWG POSITION ON HEALTH RISKS IN CONSTRUCTION
The Construction Industry Advisory Committee (CONIAC) advises the Health and Safety
Executive (HSE) on the protection of people at work and others from hazards to health and
safety within the building, civil engineering and engineering construction industry.
CONIAC’s membership is tripartite, providing representation from key industry stakeholders,
including small and medium enterprises. The Chair of CONIAC is Philip White, Chief Inspector of
Construction. CONIAC has four sub groups helping to take forward its work, including a Health
Risks Working Group.
A position statement has been agreed and adopted by the CONIAC Health Risks Working Group
as a list of 8 statements setting out its stance on managing health issues in construction.

CONIAC Health Risks Working Group POSITION ON HEALTH RISKS IN CONSTRUCTION

1. Workplace ill health kills and ruins lives in the construction industry. Statistics indicate that a
construction worker is at least 100 times more likely to die from disease caused or made
worse by their work as they are from a fatal accident.
2. Managing workplace health helps employers to retain experienced and skilled workers, and
it helps employees to maintain productive employment.
3. Workplace ill health is preventable - it is possible and practical to carry out construction work
without causing ill health. Risks to health can be managed by modifying the process to
eliminate the risk, controlling and minimising exposure, and taking precautions to prevent
adverse effects.
4. Everyone involved in construction has a responsibility in managing risks to health, and all
parties must take ownership of their part of the process.
5. Planning and working collaboratively will reduce risk throughout the supply chain, and at all
stages of the process. Workers and their representatives must be consulted regarding the
provision of occupational health services and material occupational health issues.
6. Managing health risks is no different to managing safety risks. Assessing hazards and using a
hierarchy of control measures are equally appropriate when applied to health risks.
7. Checking workers’ health is not a substitute for managing and controlling health risks.
Monitoring should not be given priority over managing, or confused with it.
8. Helping workers tackle other “lifestyle” risks to their health is not a substitute for managing
workplace health risks.

____________________________________

2012-03

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Annex J - Further Information and Guidance
Legislation
The Health and Safety at Work etc. Act 1974;
The Data Protection Act 2018;
The General Data Protection Regulation 2016;
The Management of Health and Safety at Work Regulations 1999 as amended (MHSWR);
The Construction (Design and Management) Regulations 2007 (CDM);
The Equality Act 2010;
The Access to Medical Reports Act 1988;
The Safety Representatives and Safety Committees Regulations 1977
The Health and Safety (Consultation with Employees) Regulations 1996.

Other Publications
HSE Leaflet INDG 163 – Five Steps to Risk Assessment;
HSE Leaflet INDG 232 - Consulting Employees on Health and Safety;
HSE publication L73 - A guide to the Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations 1995, HSE Books;
Equality Act 2010 Code of Practice - Equality and Human Rights Commission;
Code of Practice Employment and Occupation - Disability Rights Commission;
Guide to the General Data Protection Regulation (GDPR) - Information Commissioner's
Office;
An Employer's Guide to Engaging an Occupational Health Physician - Faculty of
Occupational Medicine;
Assessing fitness to drive – a guide for medical professionals - Driver and Vehicle Licensing
Agency;
The Health and Work Handbook - Patient care and occupational health: a partnership guide
for primary care and occupational health teams - Faculty of Occupational Medicine;
Sample Alcohol and Drugs Policy - Construction Plant-hire Association.

Medical Fitness to Operate Plant 49 July 2018

Useful Websites

ACAS http://www.acas.org.uk
Association of Occupational
https://www.aohnp.co.uk/
Health Nurse Practitioners
BuildUK https://builduk.org/
Commercial Occupational Health
http://cohpa.co.uk/
Providers Association
Construction Plant-hire
www.cpa.uk.net
Association
CITB: Construction Industry
www.citb.co.uk
Training Board
Constructing Better Health www.cbhscheme.com
Driver and Vehicle Licensing https://www.gov.uk/government/organisations/driver-and-
Agency vehicle-licensing-agency
Equality and Human Rights
https://www.equalityhumanrights.com/en
Commission
Faculty of Occupational Medicine
www.fom.ac.uk
of the Royal College of Physicians
https://www.gov.uk/government/organisations/government-
Government Equalities Office
equalities-office
Health and Safety Executive www.hse.gov.uk
Information Commissioner's Office https://ico.org.uk/
NHS Health at Work https://www.nhshealthatwork.co.uk/
Occupational Safety and Health
www.oshcr.org
Consultants Register
Royal College of Nursing https://www.rcn.org.uk/
SEQOHS Accreditation Scheme https://www.seqohs.org/
Society of Occupational Medicine https://www.som.org.uk/
Strategic Forum for Construction www.strategicforum.org.uk

Medical Fitness to Operate Plant 50 July 2018

Annex K - Working Group Membership

Chairman:
K Minton Construction Plant-hire Association
Members:
M Aldous Constructing Better Health
R Ashcroft Hampton Knight
S Appleyard Select Tower Cranes/CPA
C Bray NCC/CITB-ConstructionSkills
J Coombs Constructing Better Health
M Coyd Skanska
J Dobson Costain/UKCG
N Evans HSE
G Fisher Select Plant/CPA
P Fisher Costain/UKCG
C Haslam Home Builders Federation
E Hunt First Care Limited
H Hurree Duradiamond Healthcare
A Newell NCC/CITB-ConstructionSkills
M O’Connor HSE
T Penketh Vinci/UKCG
A Price Duradiamond Healthcare
V Robins Costain/UKCG
I Strudley HSE
I Watson Lend Lease/UKCG
P Wilson UCATT
M Winstone Segro
J Wood HSE
C Wood CPA

Secretary & Editor:

T P Watson Construction Plant-hire Association

Medical Fitness to Operate Plant 51 July 2018

Reference No. CPA 1301
First Published: February 2013
Updated: July 2018
Published by:
Construction Plant-hire Association
27/28 Newbury St
London
EC1A 7HU
Telephone: 020 7796 3366
Email: [email protected]
CPA Copyright – 2013 & 2018

Medical Fitness to Operate Plant 52 July 2018