INTERNATIONAL

HEALTH AND SAFETY

A course book for the NEBOSH International General Certificate
in Occupational Health and Safety

Series Editor:
Paul Randall
Authors:
Dr Luise Vassie
Tony Morriss
Dr Mark Cooper
Caroline Copson
Dr David Towlson
INTERNATIONAL
HEALTH AND SAFETY
A course book for the NEBOSH International General Certificate
in Occupational Health and Safety

Series Editor:
Paul Randall
Authors:
Dr Luise Vassie
Tony Morriss
Dr Mark Cooper
Caroline Copson
Dr David Towlson
Editorial and project management by Haremi Ltd. (www.haremi.co.uk)
Typesetting by York Publishing Solutions Pvt. Ltd., INDIA
Cover design by Kamae Design

Edition: 1
Version: 1

Contains public sector information published by the Health and

Safety Executive and licensed under the Open Government Licence

Every effort has been made to trace copyright material and obtain
permission to reproduce it. If there are any errors or omissions,
NEBOSH would welcome notification so that corrections may be
incorporated in future reprints or editions of this course book.

© 2022 NEBOSH
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form, or by any means, electronic, electrostatic, mechanical
photocopied or otherwise, without the express permission in writing from NEBOSH.
 CONTENTS

Introduction 5

Element 1: Why we should manage workplace health and safety 7

1.1: Morals and money 7
1.2: The force of law – punishment and compensation 12
1.3: The most important legal duties for employers and workers 23

Element 2: How health and safety management systems work

and what they look like 36
2.1: Health and safety management systems and their benefits 36
2.2: What good health and safety management systems look like 49

Element 3: Managing risk – understanding people and processes 61

3.1: Health and safety culture 61
3.2: Improving health and safety culture 69
3.3: How human factors influence behaviour positively or negatively 84
3.4: Assessing risk 96
3.5: Management of change 118
3.6: Safe systems of work for general work activities 125
3.7: Permit-to-work systems 135
3.8: Emergency procedures 144

Element 4: Health and safety monitoring and measuring 152

4.1: Active and reactive monitoring 152
4.2: Investigating incidents 164
4.3: Health and safety auditing 174
4.4: Review of health and safety performance 184

Element 5: Physical and psychological health 190

5.1: Physical and psychological health hazards and risk control 190
5.2: Vibration 202
5.3: Radiation 209
5.4: Mental ill-health 221
5.5: Violence at work 231
5.6: Substance abuse at work 237

International Health and Safety 3

Contents

Element 6: Musculoskeletal health 243

6.1: Work-related upper limb disorders 243
6.2: Manual handling 256
6.3: Load-handling equipment 267

Element 7: Chemical and biological agents 280

7.1: Hazardous substances 280
7.2: Assessment of health risks 291
7.3: Occupational exposure limits 303
7.4: Control measures 307
7.5: Specific agents 322

Element 8: General workplace issues 335

8.1: Health, welfare and work environment 335
8.2: Working at height 346
8.3: Safe working in confined spaces 362
8.4: Lone working 376
8.5: Slips and trips 387
8.6: Safe movement of people and vehicles in the workplace 398
8.7: Work-related driving 411

Element 9: Work equipment 428

9.1: General requirements 428
9.2: Hand-held tools 438
9.3: Machinery hazards 445
9.4: Control measures for machinery 459

Element 10: Fire 468

10.1: Fire principles 468
10.2: Preventing fire and fire spread 478
10.3: Fire alarms and firefighting 492
10.4: Fire evacuation 501

Element 11: Electricity 510

11.1: Hazards and risks 510
11.2: Control measures 518

4 International Health and Safety

 INTRODUCTION

This International General Certificate in Occupational Health and Safety coursebook has been designed
to support learner development. A variety of topics will be covered, of which risk assessment is central.
It is a measure of the work undertaken in recent decades by bodies such as the International Labour
Organization and the EU, together with various professional, standards and trade bodies, that an
International Certificate qualification, relevant to all countries, has become possible. And here it is.
As you will learn, the harmonisation of scientifically based exposure limits for noise and hazardous
chemicals and the worldwide adoption of the Plan, Do, Check, Act health and safety management
system have all contributed to our core body of workplace health and safety knowledge.
Consistent use of the terminology ‘Risk’, ‘Hazard’, ‘Danger’, ‘Practicable’ and ‘Reasonable’ is now well
established.
This introduction has been written by someone who has spent the last 40 years teaching and promoting
workplace health and safety. I have never been on the staff of NEBOSH but have, over the years, done
much work for them, and with them. My background is in materials research and, for me, workplace
health and safety provides a rich combination of engineering and human behaviour. Over the years, the
syllabus has seen the balance between these two (ie engineering and human behaviour) evolve, partly
to reflect the changing nature of workplaces. It is now widely recognised that issues such as bullying,
exhaustion, lone working, mental ill-health, etc impact on workers as much as traditional safety or
health issues.
The early ‘pioneers’ in occupational safety and health tended to come from industrial backgrounds,
such as engineering, mining and so on. Their work in the 1950s onwards laid the foundations for the
various professional bodies and the qualifications that we have today. I look back with great pride and
affection having known many of these (very!) stubborn people who worked so hard to ‘make things
better’ (that seems to have been the unspoken motto for all of them).
A huge thanks needs to go to those who have contributed to the making of this coursebook, especially
Dr Luise Vassie, Tony Morriss and Dr Mark Cooper. The three authors have worked together with
NEBOSH in creating this content to make it as accurate and knowledge-inducing as possible.
I hope this coursebook plays a part in guiding you towards achieving your qualification.
Paul Randall

International Health and Safety 5

ELEMENT 1
WHY WE SHOULD MANAGE
WORKPLACE HEALTH AND SAFETY

1.1: Morals and money

Syllabus outline
In this section, you will develop an awareness of the following:
• Measuring the cost of poor health and safety management
• Society’s expectations of good standards of health and safety
• Financial costs of incidents

The reasons for managing health and safety in workplaces fall into two broad
categories – moral and financial. Both categories can be used to describe reasons
for, or benefits of, managing health and safety, but can equally be used to explain
the costs of getting it wrong.
Moral reasons are concerned with our judgement about what is right and wrong.
This reflects society’s view that it is wrong for anyone to be injured or made ill by
their work, and that there should be good standards of health and safety in all
workplaces. In most countries, these expectations have led to the enactment of laws
that regulate health and safety. This means that moral reasons are often split into
societal and legal expectations.
Financial reasons are concerned with the costs of health and safety incidents, and
also the costs of trying to prevent them. The organisation must invest in health and
safety to protect its workforce. This investment will obviously have a financial cost
for the organisation but a lack of investment could have a bigger financial impact
if things go wrong. After an incident, an organisation could incur both direct and
indirect costs. For example, there could be fines from enforcement actions; in such
cases the organisation would also be expected to put right the original cause of the
accident. While investing in health and safety measures is a cost to the employer, it
has the benefits of reducing the costs of failure and protecting the workforce. This
means not investing in health and safety could be seen as ‘false economy’.
The individual and their family will also face costs, such as loss of income and
medical bills. Additionally, wider society also faces costs resulting from, for example,
dependency on the state’s benefits system for people who are no longer able to
work due to their injuries or ill-health.
We start by considering the scale of the issue.

International Health and Safety 7

Why we should manageworkplace health and safety

1.1.1 Measuring the cost of poor health and

safety management
Every day, across the world, people die because of occupational accidents or
work-related diseases. Latest estimates are that there are more than 2.78 million
deaths per year. Work-related diseases account for 2.4 million (86.3%) of the
estimated deaths, and fatal occupational accidents account for the remaining
380,000 (13.7%). Additionally, there are some 374 million non-fatal work-related
injuries each year that have resulted in each injured person taking more than
4 days of absence from work. Respiratory diseases, circulatory diseases and cancers
contributed more than three-quarters of the total work-related mortality.1
In one report, Asia was the highest contributor and constituted about two-thirds
of the global work-related mortality, nearly six times that of Africa at 11.8% and
Europe at 11.7%.2
Statistics on occupational accidents and diseases are often incomplete because
under-reporting is common and official reporting requirements frequently do not
cover all categories of workers – those in the informal economy, for example. Other
indicators, such as compensation data, disability pensions and absenteeism rates,
could also be considered, although these too provide incomplete data. Hence the
statistics do not truly reflect the scale of poor health and safety management.
For example, in Great Britain, each year there are approximately 130 fatal accidents
at work. However, this figure is a small proportion of the true toll of health and
safety failure. It does not include those who were killed in work-related traffic
accidents (which are not separately recorded in Great Britain). It is estimated that
between a quarter and a third of road fatalities involved someone driving for work.
Those who died from cases of disease such as asbestos-related cancer, which claims
over 5,000 lives per year in Great Britain, are also not included.
We all know that it is not just the injured person who is affected, it is their families
and friends and work colleagues. Multiplying the 2.78 million cases by the number
of people affected, we can readily see that the impact of poor health and safety
standards goes far beyond the global estimates. From a financial perspective, the
economic burden of poor occupational safety and health practices is estimated at
3.94% of global gross domestic product each year.

1.1.2 Society’s expectations of good standards of

health and safety
Understandably, many societies take the view that suffering as a result of poor
health and safety standards is unacceptable and should be prevented wherever
possible. Put simply, society expects that workers should leave work at the end
of the day in the same condition as when they arrived to start their work –
being injured or becoming ill as a result of your work or workplace is morally
unacceptable.
Unfortunately, societal expectations are not quite enough to motivate employers to
improve standards of safety management. Some employers will want to prioritise
profit over health and safety. Therefore, most countries have enacted laws to help
improve standards of health and safety management.

8 International Health and Safety

 1.1 Morals and money

Many countries which have enacted health and safety legislation have based this
on recognised international standards. An example of this is the International
Labour Organization’s (ILO) occupational Health and Safety Convention (C155) and
Recommendation (R164). Organisations in countries that have not enacted specific 1
legislation may use the convention and recommendation as ‘good practice’ to
protect their workforce. Although obligations and standards vary, it is usually true to
say that a failure to follow these obligations will leave an organisation liable to legal
action. Society will expect to see organisations (or individuals) penalised for breaches
of health and safety law – especially where a worker has been injured or killed as a 2
result of obvious breaches.
Workers and others have some health and safety obligations (to be discussed later
in the book) but most of the obligations are placed on the employer. As moral
standards are often enshrined in laws, there is a considerable overlap between moral 3
and legal obligations.
There are many international standards, such as the ILO conventions as well as
national laws, codes, decrees, etc, but they all have certain common requirements.
These include obligations for the employer to: 4
• provide a safe place of work;
• provide safe plant and equipment;
• provide safe systems of work; and
• ensure competence of workers. 5
Legal obligations will be discussed in 1.2.

1.1.3 Financial costs of incidents 6

The social and legal reasons for managing safety and health have been briefly
outlined above. At the very least, an employer should have a sufficiently well-
developed social conscience not to unnecessarily place workers at risk. However,
what might really motivate employers to focus on health and safety is that accidents
7
and ill-health cost an organisation money in terms of financial losses resulting from
a failure to manage risk. Therefore, employers are often more likely to provide safe
systems if these costs, and ways to avoid incurring them, are made clear.
8
Direct and indirect costs
There are two broad types of accident costs – ‘direct’ and ‘indirect’. These may also
be referred to as ‘tangible’ and ‘intangible’ costs.
9
Direct costs
Direct costs are those that come directly from an accident. They are measurable and
quantifiable and include such things as fines paid following conviction of a criminal
offence, the cost of first-aid treatment, sick pay, payments for medical treatment,
equipment repairs and replacement costs, the value of lost and damaged product,
10
lost production time, and overtime for workers who are having to cover the injured
worker’s job as well as their own.

Indirect costs 11
Costs arise indirectly because of an accident and cannot really be said to be a direct
consequence of it. Nevertheless, they can be traced back to the event. So, if the
event never occurred, these costs would not have been incurred. They are hard to
quantify, not just because of the less direct relationship with the cause, but also

International Health and Safety 9

Why we should manageworkplace health and safety

because they may be incurred a considerable time after the event. Examples include
workers being taken from their normal duties to take part in an investigation, loss
of goodwill, reputational damage, a reduction in workforce morale that could lead
to lower production rates, activation of penalty clauses for failing to meet delivery
dates, cost of recruitment of replacement labour, increased insurance premiums, and
loss of experienced, competent workers that will result in recruitment and training
costs for replacement workers.

Insured and uninsured costs

Some of the costs, whether direct or indirect, are insured; many are not. It
is therefore important to understand the relationship between ‘insured’ and
‘uninsured’ costs.

Insured costs
In some cases, it is possible to take out insurance cover that will pay out in the event
of a loss, provided all the relevant terms of the contract of insurance have been met.
Examples include coverage for equipment damage and medical costs.

Accident Iceberg

£1 Insured costs
Medical costs
Equipment repairs

£8-£36 Uninsured costs

Reputational damage
Legal costs
Increased insurance premiums
Cleaning up site
Production delays
Recruitment and training costs
Lost orders
Investigation time
Fines
Loss of expertise

Figure 1: Insured and uninsured costs

In many countries, employers are required to take out compulsory employers’ liability
insurance, which ensures that there will be money available to meet compensation
claims should they arise. If such insurance was not in place, workers might win their
claim against the employer but find that the employer has no money to meet the
judgement sum or cover legal costs. Personal injury costs are therefore ‘insured’.

Uninsured costs
In most cases, the employer will find that ‘uninsured’ costs exceed those for which
an insurance claim may be made. This means that the organisation will lose money
as these types of loses cannot be reclaimed through insurance. Uninsured costs can
be more than ten times greater than the insured ones.

10 International Health and Safety

 1.1 Morals and money

Losses may be uninsured for two main reasons – either it is impossible to get
insurance for them (eg the payment of a fine levied by a criminal court) or because
the employer has not taken out insurance cover for a specific loss. In addition, the
small size of an individual loss may mean that the employer does not bother to 1
make a claim, even if there is insurance in place that theoretically covers it. In any of
the above situations, the costs will have to be met straight from company profits.
Alternatively, the amount being claimed may be less than the policy excess amount,
which is set by agreement with the insurer to reduce premiums. In such cases, 2
the employer agrees to meet the cost of the first $x of a claim, beyond which the
insurance takes over. This means that, if individual claims are less than the ‘excess’
amount, the employer will need to pay these claims and the insurer is not involved.
Examples of ‘uninsured’ costs include:
3
• time spent investigating accidents, ie lost production time due to workers being
taken away from their normal jobs;
• fines from criminal courts;
• cost of overtime; 4
• recruitment costs;
• costs associated with downturns in morale that affect productivity; and
• costs associated with reputational damage, eg loss of orders if customers switch
to buying goods and services from other suppliers with a better reputation.
5
Preventing workers being killed, injured or made ill by their work is not only morally
the right thing to do, but it also makes good business sense. The direct and indirect
costs associated with accidents and incidents are prevented, and it can also mean
the employer pays lower insurance premiums. However, investing in health and
safety has additional benefits, such as raised productivity levels, increased staff
6
motivation and improved reputation.

KEY POINTS 7

Nearly 3 million people each year die from occupational accidents and
diseases, costing approximately 4% of GDP. So, there are moral and
financial drivers for managing health and safety. 8
The moral reasons can be split into societal and legal expectations.
From a financial perspective, accident costs are direct and indirect.
Insurance may cover some but not all the costs associated with
accidents. 9
Investing in health and safety is associated with raised productivity,
increased worker motivation and improved reputation.

References 10
1
Hämäläinen, P, Takala, J and Kiat, T B (2017) Global Estimates of Occupational Accidents and Work-
related Illnesses 2017. Workplace Safety and Health Institute: Singapore Report Global Estimates of
Occupational Accidents and Work-related Illnesses 2017 rev1.pdf (icohweb.org)

See note 1.
11
2

International Health and Safety 11

Paul Randall
Paul Randall studied Materials at Imperial College in the 1960s, qualifying with a
BSc and a PhD. Aside from time spent working in record shops, he has spent his
working life teaching at schools and universities and through his own company. For
the last 40 years he has been delighted to be working with occupational health and
safety, a subject which has its roots in both human behaviour and engineering.

Dr Luise Vassie
Luise is a consultant and trustee/NED assisting organisations with governance,
health and safety risk management, and assurance. Luise has extensive experience
in developing the evidence base for health and safety practice and in assessment
of health and safety management learning. Luise is a Chartered Fellow of the
Institution of Occupational Safety and Health.

Tony Morriss
Tony has devised and presented H&S training courses for more than 25 years,
including provision of NEBOSH Certificate and Diploma courses for further
education in colleges. He has also provided a H&S consultancy service during this
time to private companies and national organisations such as the British Printing
Industries Federation. His qualifications are BSc; MSc; CMIOSH(ret): MIIRSM(ret).

Dr Mark Cooper
Mark has been a postgraduate Admissions Tutor at the Health and Safety Unit,
Aston University, Birmingham. He also has extensive experience in providing
foundation training for health and safety professionals from the UK and overseas.

Caroline Copson
Caroline Copson is Head of Assessment Development at NEBOSH. She has been
involved in both qualification and assessment development for over 10 years. She
gained the NEBOSH National Diploma in Occupational Health and Safety in 2012
and has been a Chartered member of IOSH since 2015.

Dr David Towlson
David initially trained as a physical chemist (that’s applying physics to chemical
systems), working in the industrial chemical process sector for large multi-nationals.
His current role is to make sure NEBOSH’s products (including assessments,
qualifications, courses and publications) are designed, developed and maintained to
be fit for purpose.