Health surveillance

Frequently Asked Questions

Health surveillance

employees possibly exposed to:
- chemical risks (for example solvents);
- biological risks (for example hepatitis B or tuberculosis);
- physical risks (for example noise, vibration, radiation);
- physical risks (for example working with computer screens or manual handling of loads);
- psychosocial stress (for example stress, team and night work);
- mental stress (for example call centres).
employees with a function involving increased vigilance;
employees with a safety related function;
employees coming into contact with unpacked food.

In addition, there are specific categories of employees that need medical follow-up, such as:

pregnant and/or breastfeeding employees who might be exposed to risks.
employees underage (under 18);
apprentices and job students;
handicapped employees;
temporary workers.
(top)

What are the various examinations forming part of the health surveillance?
An employee can be subject to the following examinations:

a previous health assessment,
a periodic health assessment,
an examination when resuming work,
a visit prior to resuming work,
a continued health assessment,
a health assessment concerning a permanently disabled employee in view of his reintegration,
an extension of the health surveillance.
(top)

What is a previous health assessment?
Any previous health assessment is done prior to the employee being employed in a risk function.
The following employees are subject to a previous health assessment:

Any employees who are being employed or
who are already employed and who are assigned to another function due to which they are exposed to other risks than in their previous function.

The following functions or activities are involved:

a safety related function;
a function involving increased vigilance;
any activity with a certain risk;
any activity connected with food.

The previous health assessment will take place either prior to the employment or during the trial period, providing this period does not exceed one month. (top)

What is a periodic health assessment?
Employees who are exposed to risks, should regularly undergo a medical examination. This examination is called periodic health assessment.
The employer must submit the subject employees to a periodic health assessment.

The periodicity is once a year, unless otherwise stipulated: for example 3 or 5 times a year for working with computer screens, lifting loads,… Another periodicity may also apply according to the employee’s age.

The prevention consultant/occupational physician may also increase or decrease the intervals in function of the risk analysis and following the previous advice of the medical inspection and the Committee for Prevention and Protection at Work.

The prevention consultant/occupational physician shall propose appropriate individual and collective protection measures based on his examination. (top)

What is an examination when resuming work.
After at least four weeks of absence due to any illness, disorder or accident or after childbirth, every subject employee will be obliged to undergo an examination before resuming work. This has to be done within eight working days after the work resumption.

Any employee, subject or non-subject, has the right on his/her initiative to demand the prevention consultant/occupational physician a consult during his/her sick leave, in order to further his/her resumption of work (= the right to visit prior to resuming work). (top)

What is a visit prior to resuming work?
Any employee, either subject or not to the obligatory health surveillance, has the right to consult the prevention consultant/occupational physician in case of health complaints he/she attributes to working factors or which might have an influence on his/her employment.

Every sick employee may on his own initiative demand a prevention consultant/occupational physician consult during his/her sick leave in order to further his/her resumption of work. The prevention consultant/occupational physician may then propose a work adjustment. (top)

What is a continued health assessment?
Any employees exposed to biological, physical or chemical agents, must be enabled to make use of the continued health surveillance. In fact, exposure effects sometimes become manifest at a later time than the exposure time.
The surveillance is done within the enterprise as long as the employee is employed there. Any costs are on the account of the employer.

When the employee concerned is no longer employed by the company where he was exposed, the continued health surveillance is ensured by the Funds of Occupational Diseases. The Funds of Occupational Diseases also bears the costs thereto. (top)

What is a health assessment of a permanently disabled employee in view of his reintegration?
When the attending physician declares the employee permanently unable to carry out the agreed work, the employee concerned is entitled to a procedure of reintegration, regardless of the fact that he/she is subject or not to the health surveillance.

The employee shall demand his employer this type of examination by registered mail, for example through the personnel service. The latter will then contact the external service. Following the examination, the prevention consultant/occupational physician shall formulate an advice. In consultation with the employer the possibilities for a mutation to another function will be looked into. If no suitable work can be found, this may result in dismissal for medical reasons. (top)

What is an extension of the health surveillance?
Upon the request of the prevention consultant/occupational physician, the employer, the employee representatives, or upon the advice of the Committee for Prevention and Protection at Work, and based on the results of the risk analysis, the health surveillance may be extended to all employees working in the immediate surroundings of the workplace of an employee who is subject to the obligatory health surveillance. (top)

Who draws up the name list of employees in relation with the health surveillance?
Every employer is obliged to carry out a risk analysis. After that, he/she will decide in consultation with the prevention consultant/occupational physician and the Committee for Prevention and Protection at Work who is to be put on the name list for the health surveillance. The prevention consultant/occupational physician will have a consulting role in this matter. The final responsibility rests with the employer. (top)

What is involved in a medical examination (=health assessment)?
At the time of employment, every employee will receive a personal medical questionnaire from his/her employer. This questionnaire must be filled in completely. Do not forget to fill in your state register number. Also mention any vaccination data (tetanus, hepatitis A and/or B,…).

During the examination by the nurse:

data regarding the identity of the employer are collected;
the eyesight is tested;
the urine is checked for the presence of sugar, albuminoid and blood.
the employee is measured and weighed;
it is checked whether the employee is smoking;
it is checked whether the employee is doing any sports;
it is checked whether the employee has been absent due to illness or an accident.

Depending on the risks the employee might be exposed to, the following examinations may be carried out:

a tuberculin test (in case of tuberculosis risk) if need be, the employee will be sent for a lung radiography;
an vaccination (tetanus, hepatitis,…);
a lung function rest (blowing test);
a hearing test.

During the examination by the prevention consultant/occupational physician:
The prevention consultant/occupational physician will examine the individual medical questionnaire together with the employee. Any occupational accident or occupational disease shall also be discussed.

In addition, the prevention consultant/occupational physician shall examine the employee. The examination may vary according to the health situation and the risks the employee is exposed to during work.

So, the prevention consultant/occupational physician may

listen to the lung function;
measure blood pressure and pulse;
listen to the heart;
detect any skin diseases;
do a back examination;
if needed, carry out a breast examination.

Sometimes, the prevention consultant/occupational physician may contact the employee’s attending physician – providing he/she gives permission thereto - to:

ask or give additional information;
demand an additional examination;
propose a further treatment (the occupational physician will never start any treatment);
prescribe a temporary disability to work.

The prevention consultant/occupational physician may also refer the employee for information and/or additional examinations. Any required information or examination results should be sent to the prevention consultant/occupational physician as soon as possible. (top)

Is it permitted for the GP to carry out the medical examination (=health assessment)?
No. The medical examination is carried out by the prevention consultant/occupational physician and a nurse. Both the prevention consultant/occupational physician and the nurse have followed a specific training. They are allowed to carry out medical examinations related to occupational medicine providing they have acquired the specific diploma. (top)

What is the form of the preventive health assessment to be used for?
At the end of the medical examination, the prevention consultant/occupational physician will complete a form in which he will indicate whether the employee is able to work or not. The form has to be drawn up in three copies. One copy is intended for the health records (medical records), one for the employer and one for the employee. The latter will keep this certificate.

The prevention consultant/occupational physician may formulate an advice and/or stipulate (binding) conditions regarding the employment. (top)

Has the prevention consultant/occupational physician the right to declare the employee unable to work?
Yes, but he is obliged to follow strict rules. In case of a temporary or permanent disability to work, he will propose the employee a change of work. Only secondly, when no suitable work is found, the prevention consultant/occupational physician will declare the employee unable to work.

The employee is entitled to lodge an appeal against the decision of the prevention consultant/occupational physician. This procedure is extensively explained on the reverse side of the form regarding the health assessment.

Furthermore, the employee who has been declared permanent unable to carry out the agreed work by the attending physician, will have the right to lodge a procedure concerning reintegration, regardless of the fact whether he/she is subject or not to the medical health surveillance. During this type of medical examination, the employee may be declared permanent unable to work. (top)

Has the employer the right to discharge the employee for medical reasons?
Yes, but he is obliged to follow strict rules. Furthermore, the employee who has been declared permanent unable to carry out the agreed work by the attending physician, will have the right to lodge a procedure concerning reintegration, regardless of the fact whether he/she is subject or not to the medical health surveillance.

The employee shall demand his employer this type of examination by registered mail, for example through the personnel service. The latter will then contact the external service. Following the examination, the prevention consultant/occupational physician shall formulate an advice. In consultation with the employer the possibilities for a mutation to another function will be looked into. In case no suitable work can be found, this may result in discharge for medical reasons (=medical reasons beyond one’s control). (top)

Is an employee on sick leave obliged to go to the planned medical examination?
Only if the employee demands to do so using a written request. The employer will ask you to sign a request for medical examination. (top)

Has an employer the right to test an employer for use of drugs?
Under certain circumstances (for example for safety related functions, the prevention consultant/occupational physician has the right to test the employee for use of drugs. However, he is obliged to inform the employee thereof, and he may not disclose the result to the employer (the prevention consultant/occupational physician is bound by the professional secret). (top)

Has an employer the right to view an employee’s medical records? Has an employer the right to view the health assessment?
The prevention consultant/occupational physician only tells the employer whether the employee is able to carry out the function or not. He can only give advice on the health assessment form concerning the work or the workplace. He can also provide conditions for the employment (for example an adjustment of the workplace). All the rest is to strictly remain confidential and subject to the professional secret. (top)

Who shall determine the frequency of the medical examination (= health assessment)?
The frequency of the medical examination depends on the risks the employee is exposed to. The applicable stipulations are formulated by law. The prevention consultant/occupational physician has the right to increase or decrease the frequency. The employer too has the right to demand to change the frequency of the medical examination.
Other factors may also play a role, such as for example the employee’s age. (top)

Who is paying for the medical examination (=health assessment)?
The employer pays an annual contribution to IDEWE (the External Service for the Prevention and Protection at Work). A part thereof is used to pay for the medical examination. The rest is used for company visits and attendance of the Committee for Prevention and Protection at Work. (top)

Are the remarks made by the prevention consultant/occupational physician binding?
Yes and no. The prevention consultant/occupational physician may formulate an advice. In addition, he may provide conditions for the employment, which might be binding in some cases. For example when employing an employee in a safety related function, or a pregnant or breastfeeding employee. The employee has the right to lodge an appeal against these binding conditions.

The employer is not bound by the advice given by the prevention consultant/occupational physician and can ignore it. But in case of a serious accident at the employer’s due to not following the advice, the cause of the accident shall be investigated. The report by the prevention consultant/occupational physician with remarks regarding the risk management may form a negative element for the employer. (top)

For any further information, please contact your prevention consultant-occupational physician or your regional IDEWE-IBEVE secretariat.