Occupational medical examination

What is a workplace medical examination?

Law 31/1995 obliges employers to guarantee workers periodic health surveillance based on the risks inherent to their work. Medical examinations are the most visible aspect of this surveillance, but not the only one: health surveillance also includes the collective analysis of results, epidemiological interpretation, assessment of damages, and the proposal of preventive measures. Royal Decree 39/1997 (Article 37.3) requires that surveillance be carried out by healthcare personnel with accredited technical competence, training, and capacity (occupational medicine and nursing), that it be specific to the risks, that it use the protocols of the Ministry of Health, and that it respect confidentiality and dignity.

The assessments are carried out at specific times: initial, after joining the job or after being assigned tasks with new risks; periodic, with the frequency determined by the protocol and the risk; after a prolonged absence for health reasons, to detect the possible occupational origin and recommend actions; and in the cases provided for by specific regulations, such as exposure to carcinogenic, biological agents, noise, vibrations or radiation, where monitoring acquires its own rules and very long periods of record preservation.

Generic or company-wide assessments, unrelated to job risks, do not fulfill the legal obligation nor can they replace specific monitoring; nor is it acceptable to use them for selection or control purposes unrelated to prevention.

Principles governing medical examinations

• Voluntariness. It can only be carried out with the consent of the worker. Exceptions, after consultation with the representatives, are: when it is essential to assess the effects of working conditions on health, when the state of health may constitute a danger to the person, to other people or to third parties, or when established by a legal provision for specific risks and especially hazardous activities.
• Proportionality. Tests should be those that cause the least discomfort and be proportionate to the risk; examinations unrelated to the risks of the position cannot be included without justification and consent.
• Specificity. Content defined by the specific health surveillance protocols of the Ministry of Health (noise, visual display screens, handling of loads, chemical agents, awkward postures, among others) and by the risk assessment of the position.
• Confidentiality. The results are communicated to the employee; the employer and those with preventive responsibilities only receive the conclusions in terms of fitness (fit, fit with restrictions, unfit) and the need to introduce or improve measures. Access to medical information is limited to healthcare personnel and health authorities.
• Free of charge and working time. The cost is borne by the employer and the time spent is considered working time.
• Extension. When the risks justify it, the right to surveillance extends beyond the termination of the employment relationship, under the terms established by the regulations.

Content and results

• Clinical-occupational history. Anamnesis, history of exposures and positions, relevant habits and background, complemented with the description of the position and the risks.
• Exploration and tests. According to protocol: audiometry in noise, spirometry in respiratory agents, musculoskeletal examination in loads and postures, visual control in screens, biological markers in chemical agents, among others.
• Conclusions. Report to the worker with complete results and recommendations; certificate of fitness to the employer with any necessary restrictions or adaptations, without clinical data.
• Preventive use. Collective analysis of the results, with epidemiological criteria, to detect patterns of harm and propose modifications to the risk assessment and measures.
• Documentation. Records kept by the prevention service within the time limits required by the specific regulations and health legislation.

Organizational application: how to manage medical examinations

1. Define with the prevention service, based on the risk assessment, the protocol applicable to each position and the frequency of the examinations.
2. Identify the positions where surveillance is mandatory by specific regulations and document the report of the representatives in the exceptions to voluntariness.
3. Inform each person of the content, purpose and voluntary nature, and obtain written consent or waiver.
4. Plan appointments within the day, with initial medical examinations before exposure and periodic ones within the protocol’s deadlines.
5. Receive and manage fitness-for-work certificates, applying restrictions and adaptations in the position and communicating them to those who need to know them.
6. Request the prevention service to conduct a collective analysis of results and incorporate its conclusions into the evaluation and planning.
7. Ensure confidentiality: separation between health data (prevention service) and fitness data (company), with restricted access.

Preventive management software allows scheduling assessments by position and protocol, controlling expiration dates and consents, recording fitness and restrictions with limited access, and tracing the relationship between collective results and preventive measures.

Limits and common mistakes

1. Perform generic assessments not related to job risks and consider the obligation fulfilled.
2. Treating a voluntary medical examination as mandatory without proving the legal exception or the report of the representatives.
3. Communicate clinical or diagnostic data to the employer instead of fitness.
4. Not applying fitness restrictions to the position or doing so without adapting the tasks.
5. Omitting medical examinations after prolonged absence for health reasons and post-employment surveillance when appropriate.
6. Do not use collective outcome analysis to improve risk assessment.

The content of each assessment is determined by the healthcare staff in accordance with current protocols; this form is for informational purposes only.

Regulatory framework in Spain

• Law 31/1995, article 22. Health surveillance: voluntariness, exceptions, confidentiality and communication of fitness.
• Royal Decree 39/1997, article 37.3 . Health surveillance and control functions by health personnel and times of surveillance.
• Royal Decree 843/2011, of June 17. Basic criteria on the organization of resources for the health activity of prevention services.
• Law 41/2002, of November 14. Patient autonomy, information and clinical documentation.
• Organic Law 3/2018, of December 5. Protection of personal data, applicable to health data.

Directive 89/391/EEC, Article 14, establishes the right to adequate health surveillance based on risks. In Colombia, occupational medical assessments are regulated by Resolution 2346 of 2007 and the Occupational Health and Safety Management System (SG-SST) of Decree 1072 of 2015.