Microsoft word - fitness guidelines_2003.eng.doc

A Guide for Examining Physicians
Adapted from the United Kingdom Offshore Operators Association Limited (UKOOA) Medical Advisory
Committee (2003)
Guidance of Specific Conditions which May Affect Medical Fitness to Work

The term "work" or "employment" in this document refers to any professional activity taking place in
remote locations, offshore rigs, ships or in high health risk conditions (extremes in climate, living
conditions, isolation, etc.).

Diseases of Blood or Blood Forming Organs 10. Endocrine and Metabolic Disorders 11. Genitourinary System 12. Respiratory System 13. Ear, Nose and Throat 14. Eyes 15. Dental Health 16. Medications 17. Pregnancy
1. Objectives of the Medical Assessment
The worksite exists in a remote and potentially hostile environment, which may be isolated from qualified medical assistance. Adverse weather may cause long delays in medical evacuation, and thereby exacerbate a minor medical problem. In conducting the medical assessment, the examining physician is responsible for carefully assessing the physical and mental health of employees in order to: • Anticipate and, where possible, prevent the avoidable occurrence of ill-health which could place the individual, their colleagues and the emergency rescue services, at undue risk. • And Ensure that so far as is reasonably practicable, designated location personnel are medically fit to work at a remote and isolated location. 2. The Working Environment
The examining physician should conduct the assessment in accordance with recognized occupational health standards. In common with good occupational medicine practice, the examining physician must ensure that the medical assessment of a prospective employee relates to the particular work factors and environment of the worksite. The examining physician should, therefore, have an appropriate knowledge of these factors, which include, but are not limited to the following: • Physical exertion (climbing walkways, stairs, work tasks, etc.) and exposure to heights. • Shiftwork, with long hours, eg 12-hour shifts, and changes in routine. • Absence from home for prolonged periods, which may be up 2 or 3 weeks or more in duration. • Potential involvement in emergency situations, which may involve the individual being exposed to extremes of physical exertion, to thermal and smoke exposure as well as cold water immersion. • Certain categories of personnel, such as offshore personnel must undergo training in firefighting and sea survival/helicopter escape training which simulate the situations and conditions described above. • Claustrophobia, eg in relation to helicopter travel or in a totally enclosed motor-propelled • The need for the physical and mental health of an individual to be such that it does not cause an additional hazard, whether to the individual or his or her colleagues, in an emergency situation • Adverse weather conditions, which may prohibit or delay medical access to or evacuation from These factors combine to distinguish the workplace. Episodes of ill-health or disability which may be wholly compatible with “normal” employment may debar the individual from work for Schlumberger – either temporarily or permanently, where the condition places the affected individual, and/or his/her colleagues at risk. 3. The Medical Examination Process
Age should not be a bar to fitness to work for Schlumberger, but must be taken into account with all the other findings in the assessment. If a disability as defined within the Disability Discrimination Act (U.K.) is identified at the examination, the examining doctor should ensure that the actual or potential employer is in a position to consider reasonable workplace accommodation prior to the final fitness assessment. However, consideration of the person’s ability to undertake the necessary actions to evacuate and escape from an installation in an emergency situation is of paramount importance. Workplace safety should not be compromised when considering reasonable accommodation. 1. Infectious Diseases
Active infectious disease is unacceptable. Re-examination following successful resolution of infection may be
appropriate if there is significant impact on capacity for work or there are any public health considerations.
Catering staff require special examination to exclude acute or chronic disease involving gastrointestinal tract,
chest, ear, nose, throat and skin.
Screening for tuberculosis is not required unless clinically indicated. If, clinically, this is considered a possibility
then necessary screening examinations in accordance with current advice from public health authorities should be
completed and confirmed negative before an individual is certified as fit to work.
2. Malignant Neoplasms
Frank malignant disease is usually unacceptable for work. Each case should be considered individually and the
natural history and prognosis of the neoplasm taken into account. In reaching a recommendation, the impact of
the condition, the treatment and the ability to function normally must be considered.
Where appropriate, relevant medical information should be requested from the individual's general practitioner
and/or specialist before making a final decision.
Individuals taking cytotoxic drugs, immunosuppressants and/or steroids in acute phases of illness or for relapse
should be considered unsuitable for employment until the condition has been resolved or is in complete remission.
3. Diseases of Gastrointestinal System
Clinical assessment of any gastrointestinal system disturbance should consider the impact of the condition on an
individual's function as well as any medication taken. Reference should be made to the individual's specialist
where appropriate.
Peptic ulceration. Active peptic ulcer disease is unacceptable. Where there is a past history of ulceration, a
person may be acceptable provided that the examining physician is satisfied that the risk of recurrence or
complications is reduced to a minimum by the use of appropriate treatment. An employee should not be allowed to
work until asymptomatic and on acid suppression therapy and/or they have undergone successful helicobacter
eradication therapy. Proven active gastric ulceration is unacceptable and individuals should only be allowed to
work once asymptomatic and they have had a negative endoscopy.
Oesophagitis and gastritis are unlikely to cause severe symptoms and individuals are acceptable on appropriate
treatment. Other non-specific upper gastrointestinal disorders including "dyspepsia" and diaphragmatic hernia are
acceptable provided they are non-disabling and the physician is satisfied they are not indicative of a more serious
underlying disorder.
Inflammatory bowel disease is unacceptable in the acute phases until individual is stable and controlled on
medication compatible with work. Where the condition is in remission and symptoms are under control, a case can
be made for return to work following consultation with appropriate specialist advice.
Hernia is usually unacceptable until satisfactorily surgically repaired. Those with hernia employed in non-manual
work should not normally be considered fit for work until repaired.
Hemorrhoids, fistulae and fissures causing intractable pain or recurrent bleeding are unacceptable until treated.
Abscess and fistulae are unacceptable until treated.
Uncomplicated stoma is usually acceptable but the examining physician should be satisfied that the underlying
cause is compatible with work and that the personal management of the condition is acceptable within the confines
of the work community.
Liver Diseases are unacceptable where the condition is serious or progressive and/or where complications such
as esophageal varices or ascites are present. Those with chronic active hepatitis requiring Interferon are
unacceptable due to the potential side effects of treatment. Assessment of all individuals with a significant history
of liver disease should include an update from their clinical specialist and a recent (within 3 months) prothrombin
Chronic or recurring pancreatitis is unacceptable.
4. Cardiovascular System
The cardiovascular system should be free from acute or chronic disease that causes significant symptoms,
incapacitation or interference with function.
Congenital Heart Disease. Other that atrial septal defects or small ventricular septal defects with no
haemodynamic significance, all congenital heart disease should be individually assessed by a cardiologist and the
resulting report used in the decision process. Where the risk of complication is low and the individual can meet the
physical demands of work and emergency response in work, they may be acceptable.
Valvular Heart Disease with significant haemodynamic change, as assessed by a cardiologist, is unacceptable.
An individual who has undergone successful cardiac surgery for valvular or congenital heart disease may be fit for
employment, if free of all symptoms and off all therapy. It should be noted that patients who remain on Warfarin are
at significant risk related to prolonged bleeding time associated with trauma.
Ischaemic Heart Disease. A history of myocardial ischaemia may be considered acceptable, but certain
conditions must be applied in considering suitability for work :
• All patients with documented coronary artery disease and not treated surgically should be taking optimal medication and must have been symptom-free for at least 6 months, • They must be able to complete a Bruce Protocol exercise test and complete Stage III without cardiac symptoms or signs of reversible ischaemia. Those who exhibit changes above Stage III should undergo further assessment by a cardiologist. Those individuals who wish to return to work but who do not meet the above (eg persistent symptoms despite medication, or those with signs of reversible ischaemia) must undergo formal assessment by a cardiologist on occupational grounds. A decision to return the individual to work should then be taken following discussion with the company's medical advisor. Annual reassessment by a consultant in cardiology should take place in these cases and each review should include successful completion of a symptom minuted Bruce Protocol exercise test. Myocardial Infarction. An individual may be considered fit to return to work 4 months after myocardial infarction
providing at cardiologic assessment he/she :
• Has no evidence of reversible ischaemia by successful completion of a Bruce Protocol exercise test to Stage III without cardiac symptoms or ischaemic changes. If in addition for clinical reasons additional invasive cardiac investigations have been completed, then for these the individual must demonstrate a left ventricular ejection fraction of at least 40% and non-threatening coronary vascular anatomy on coronary angiogram. (Threatening anatomy includes 50% or more proximal left anterior descending disease before the first septal branch and left main stem stenosis as well as 3 vessel disease). Note : Angiography should be pursued only where clinically indicated and there is no need in a post MI
candidate who is symptom-free and meets the exercise tolerance test criteria to proceed to angiography for work
certification purposes.
Following angioplasty or coronary bypass surgery (CABS), an individual may be considered fit to return to work
4 months after the procedure has been successfully completed, and after consultant reassessment, providing they
can complete Stage III of the Bruce Protocol without evidence of ischaemia and remain symptom-free.
Myocardial infarction and CABS Follow-up. A restricted certificate for one year and annual reassessment by a
consultant in cardiology should take place in all post MI cases and each review should include successful
completion to Stage III of the Bruce Protocol exercise test. In addition, steps should be taken to ensure compliance
with currently agreed good clinical practice relating to general measures, eg smoking cessation, BMI, cholesterol
lowering medication. All candidates in this group are still required to complete survival training but will not be
suitable for firefighting or emergency response team duty. (This should be confirmed to the employer before
embarking on any investigative procedures).
Cardiac transplantation. Individuals with cardiac transplants will not usually be acceptable due to the nature of
the associated medication required to suppress tissue rejection.
Cardiac Arrhythmias. If these produce symptoms, interfere with function or cause temporary incapacitation, then
expert cardiac opinion should be sought. Individuals on anti arrhythmic medication may be acceptable following a
cardiologist's assessment and report.
Pacemakers. The presence of a permanent pacemaker should not preclude employment. However, assurance
from a cardiologist should be obtained, that the patient is free of syncope or pre syncope as a result of the
pacemaker insertion and that he is experiencing no complications related to its insertion. Employees with
permanent pacemakers require, and would normally undergo, annual cardiological review.
Employees with pacemakers who are pacemaker dependent, and who may come into contact with powerful
electromagnetic fields, need to demonstrate that their pacemaker generator is not inhibited by electromagnetic
energy before being certified to work.
Patients with overdrive anti-tachycardia pacemakers or implantable defibrillators should not be employed as their
condition may involve syncope.
Hypertension. As a general rule, hypertension is acceptable provided it is uncomplicated and well controlled by
treatment. The British Hypertension Society Guidelines are a useful reference for this condition and should be
consulted for further guidance on management.
In respect of employment, the following guides appropriate course of action
• > 220/120 - not fit for work, refer for immediate treatment. • 200/110 to 219/119 - decline certificate and refer to GP for investigation and treatment. Full certificate may be issued once stabilized on any required medication. • < 200/110 but > 140/85 - issues fitness for work certificate but refer to general practitioner for lifestyle advise and investigation if above desired level of 140/85 (particularly important if there is any evidence of end organ damage). • < 140/85 - optimal blood pressure control, fit for work and no further action required. Peripheral circulation. Conditions of the peripheral circulation should be actively
sought and particular note taken of the following :
• Current or recent history (within 3 months) of thrombophlebitis or phlebothrombosis (DVT) with or
without embolisation are not acceptable. Recurrent conditions are not acceptable without further investigation. • Varicose veins are acceptable other than when associated with varicose eczema, ulcers or other
Arteriosclerotic or other vascular disease with evidence of circulatory embarrassment, for example
intermittent claudication, or thoracic or aortic aneurysm are all unacceptable. Symptomatic peripheral vascular disease is unacceptable. • Carotid disease if detected should be fully investigated to assess the extent of the disease and Pulmonary circulation. A history of more than one pulmonary embolism is normally
unacceptable and requires full investigation. A single episode requires careful assessment
and specialist report.
Cerebro-vascular disorders. Any untreated cerebrovascular disorder including history of CVA, transient
ischaemic attack or evidence of general cerebral arteriosclerosis, including dementia, is unacceptable. Treated
cerebrovascular disease with no increased risk of recurrence or residual functional deficit may be acceptable after
suitable assessment and report.
5. Diseases of Blood or Blood Forming Organs
Due to the complex nature of hematological disease, certifying physicians should consider obtaining a specialist
opinion before issuing or refusing certification. In some cases, it is inappropriate to issue a certificate of normal
duration and the use of restricted duration certificates is encouraged to permit active monitoring of the individual's
condition and continuing fitness for work.
Anemia severe enough to cause symptoms is unacceptable until satisfactorily investigated and treated. Mild,
asymptomatic anemia may be acceptable provided the cause is known and any appropriate treatment is in place.
Thalassaemia trait and Sickle Cell trait should not disbar an individual from employment. The symptoms
associated with Thalassaemia Major and Sickle Cell disease and complications arising from the treatment of
Thalassaemia Major are likely to render an individual unfit for work.
Polycythaemia. Primary polycythaemia (Polycythaemia Rubra Vera) is acceptable provided treatment is not
interrupted by the work cycle and blood indices are within the normal range. In secondary polycythaemia the
causative condition is likely to be the limiting factor and full assessment of this should be made.
Coagulation disorders. An individual with a low platelet count is at increased risk of hemorrhagic problems
following trauma and, in severe cases, spontaneous hemorrhage can occur. This would disbar an individual from
employment. Specialist advice should be sought where appropriate. Hemophilia and related bleeding disorders
are not acceptable.
Malignancy of the blood forming organs. Individuals with leukemia are unlikely to be fit to work while
undergoing treatment or while receiving immunosuppressive therapy. If in remission, (no signs of active disease
detected clinically or by laboratory methods) an individual may be considered fit to work. In Hodgkin's Disease an
individual may remain fit enough to work during treatment - a detailed clinical assessment of the case with
specialist input is required.
In Non-Hodgkin's Lymphoma it is unlikely that an individual will be fit to work during treatment.
Chemotherapy schedules may make it difficult to maintain a regular work cycle. The side effects, actual or
potential, of any treatment should be considered carefully along with the frequency of administration and
monitoring of chemotherapy before allowing an individual to work.
Any medication which is likely to significantly inhibit or increase blood coagulation will render an individual unfit
for work for the duration of treatment and for a period following this until it can be demonstrated that the individual
is no longer at significant risk of bleeding/thrombosis.
Any medication which causes significant immunosuppression will render an individual unfit for work for the
duration of treatment and for a period following this until it can be demonstrated that the individual is no longer at
significant risk of infection.
6. Mental Disorders
Mental disorders are amongst the most commonly encountered conditions in those presenting for work. If a
condition is identified an assessment should be made of the current mental state, the impact of medication and the
impact on effective functioning in the work environment. Where appropriate, specialist advice should be sought
from the individual's specialist and/or general practitioner.
Depressive disorders in the acute phase will normally render an individual unsuitable for work but in the absence
of any psychotic features or an increased risk of self harm, individuals may be able to return to work once the
mental state has improved, particularly in respect of sleep disturbance, attention and concentration. Tricyclic and
other sedative antidepressants should be avoided but those stabilised on SSRI or SNRI type medication may
return to work when considered symptomatically well enough. Those with a recurrent or chronic depression should
not normally be considered suitable for work.
Anxiety disorders will in the short term prohibit working but an isolated episode which has resolved is not a bar.
Those with recurrent or chronic anxiety disorders will not normally be suitable.
Psychoses - including mania, hypomania, depressive and schizophrenic disorders are very rarely
compatible with work. Exceptions to this may only be made on the basis of a detailed specialist clinical assessment
following a sustained period (minimum of 3 years) of stable good health off all medication. In any such case where
a return to, or a first employment is being considered, formal referral to the company's medical advisor will always
be required.
Personality disorders, particularly those characterised by antisocial behavior are unacceptable for employment.
Drug abuse will debar an individual from employment whilst active and for a minimum period of 3 years.
Thereafter a subsequent favorable consultant report and negative testing for substance abuse will be required
before returning to work.
Alcohol dependence will debar an individual from employment for a minimum period of one year at the end of
which time they should be able to demonstrate normal biological parameters. (Compliance with the guidelines for
alcohol-induced epilepsy is also required for those who have had alcohol relates seizures - refer to paragraph 7).
Other psychological disorders including eating disorders, stress, phobias and childhood behavior disorders
need not be a bar to employment unless there is evidence of continued dysfunction or vulnerability, likely to impact
on health and well-being in the work environment. Where reasonable doubt exists, the assessing physician should
consider the option of a specialist report and opinion.
7. Diseases of the Nervous System
Organic or functional neurological disorder causing, or likely to cause, any significant defect of consciousness,
cognitive function, muscular power, balance, mobility, sensation or coordination is likely to significantly and
adversely affect both capability to undertake work and safety of the individual and others. Detailed assessment
including, where considered appropriate, specialist referral, should be made.
Epilepsy. The diagnosis of epilepsy with persisting epileptic seizures (one or more per year) of any type is
incompatible with work. Those with a history of epilepsy but who are able to meet the criteria below may be
considered for work. In all cases, an assessment needs to be made by the examining doctor to determine the
likelihood of a seizure occurring and the likely consequences to the individual and others should they have a
seizure whilst working.
Doctors will require reports from the examinee's GP and/or specialist in order to verify the medical history, and
establish facts on which the individual risk assessment can be based :
• Increased risk occupations (such as crane operators, work at height, scaffolders, drill crew, emergency response teams) require the individual to have been seizure free for the last 10 years, have not taken anti-epileptic medication during that period and not to have a continuing liability to epilepsy. • Other occupations - an individual with a history of epilepsy or a single unexplained seizure may only work when a consultant neurologist is able to confirm that their risk of further seizure on or off medication is equivalent to that of the general population. The holding of a group one driving licence does not equate to this and a specialist neurological opinion is required in all cases where this is being considered. • Following significant head injury or cranial surgery, and when there have been no epileptic seizures, the risk of post-surgical or post-injury epilepsy must be below 2% in increased risk occupations (see above). For other occupations a minimum period seizure free by day and night of one year is normally required. Specialist neurological opinion should be obtained in all cases. • For alcohol relates seizures, the individual must be seizure free (by day and night) for at least one year and off all medication before returning to any employment. Those in increased risk occupations must be seizure free for a minimum period of 5 years by day and night and off all medication. Multiple Sclerosis. Those with mild or predominantly sensory symptoms will be fit for
work. A reduced periodicity of medical review may be appropriate given the nature of
this condition. Individuals with significant and progressive multiple sclerosis will not be
suitable for work.
Migraine. The majority of cases are straightforward in symptomatology and treatment, and should not result in
unfitness for work. Some more severe cases may result in episodic protracted incapacity or unusual neurological
features. Such cases should be referred for a neurological opinion and on optimum treatment aimed at minimising
these features, before a decision to refuse a certificate of fitness is made.
Narcolepsy/Sleep Disorders. In view of the increased risk of accidents due to inattention or inability to
concentrate sufficiently on the task at hand, individuals suffering from such disorders should be carefully assessed.
It is likely that individuals with unpredictable drowsiness during periods of normal wakefulness, consequent on
narcolepsy/sleep disorders, will not be fit for work.
8. Musculoskeletal System
In assessing disorders of the musculoskeletal system, a careful assessment should be made of the impact on the
individual's functional capacity, not only to complete their intended work, but also activities which are an essential
part of work-related life, including mobilisation by helicopter wearing a survival suit, ability to move up and down
flights of stairs easily and repetitively as necessary, emergency response musters and other related drills.
Functional assessments of mobility should be supplemented where necessary by a specialist report of the current
stability and future prognosis of the condition.
• Conditions significantly affecting locomotor function or balance to the point that an individual could not self rescue during a muster will normally be unacceptable. • The medication used to treat symptoms musts also be considered. Significant immunocompromise will Chronic musculoskeletal disease which is prone to remission and relapse need not
immediately disbar from work but an appropriate and, if necessary, shortened review
cycle should be employed. Where medivac is required following a relapse of any such
condition then re-examination will be mandatory before a return to employment is
Limb prostheses are acceptable where an individual can meet the mobility requirements of for his work.
9. Skin
Skin disorders should be assessed for suitability and any task-specific requirements. A detailed understanding of
the specific task is required before declining certification for work related skin disease. The probability of exposure
to substances which may act as allergens or irritants should be understood and taken into account when making
the assessment.
Psoriasis controlled by topical medication is acceptable. More serious disease requiring inpatient treatment and
chemotherapy should be carefully assessed, including the compatibility of rotational duties with treatment regimes.
Specialist advice should be sought. Skin disease complicated by joint disorder should be carefully assessed.
Eczema of a mild local nature is acceptable, but extensive disease requiring complex treatment regimes is
generally not acceptable.
Allergic dermatitis should be carefully assessed with specialist referral and patch testing as indicated. Where
avoidance is practicably possible, working will be possible.
Irritant dermatitis can usually be treated and prevented but, if persistent, may not be compatible with work.
Infectious skin disease, including scabies and impetigo, is unacceptable until successfully treated.
10. Endocrine and Metabolic Disorders
All cases of endocrine and metabolic disorder require comprehensive investigation prior to assessment of fitness
to work.
Non Insulin Dependent Diabetes Mellitus (Type II). Stable well-controlled cases (6 months or more) of NIDDM
will normally be acceptable providing that there are no complications causing other restrictions on capacity or
safety. Of particular importance is visual acuity which must meet the standard in Paragraph 14. An increased
frequency of medical examination may also be appropriate to ensure regular review and continuing fitness to work
(at least annually).
Insulin Dependent Diabetes Mellitus (Type I). Individuals with IDDM will not be accepted for unrestricted fitness
to work. However, those who can demonstrate long established good control (at least 6 months), who can self
manage their insulin requirements and have no secondary complications of their illness may be considered on a
case-by-case basis and, with the explicit agreement of the company's medical advisor, may be issued with a
restricted certificate. This must not be for a period greater than one year and must stipulate the location/type of job
which the individual may work on. Unrestricted certification is unacceptable in these cases but, when managed
appropriately, well-controlled individuals can operate safely in some locations. All such cases will require a report
from the specialist or general practitioner. Those with IDDM are not considered suitable for fire or emergency
response duty. Anyone with IDDM must be reviewed at least annually to ensure control remains acceptable.
Thyroid Disease. All cases of thyroid disorder require careful individual assessment. Inadequately controlled
thyroid disease is unacceptable but those who are stable on long-term medication will be considered fit. More
frequent review will be appropriate and annual review is likely to be appropriate.
Other Endocrine Disorders such as Addison's disease, Cushing's syndrome, acromegaly, diabetes insipidus and
hypoglycemia, either functional or due to pancreatic or adrenal pathology, are likely to be unacceptable but should
be individually considered and carefully assessed. Specialists' reports should be used where appropriate.
Other metabolic disorders such as inborn errors of carbohydrate of amino acid metabolism, amyloidosis and
porphyrias are likely to be unacceptable but should be individually considered and carefully assessed.
Obesity. All cases of gross obesity require careful individual assessment. Those in whom exercise tolerance,
mobility or general health is adversely affected or whose obesity is likely to impair safe performance are
unacceptable. Individual decisions regarding fitness for work in the overweight should be made on a case-by-case
basis. As a guide :
• BMI 25 to 30 - Fit for work, counsel about weight management • BMI 31 to 35 - Consider other risk factors, mobility and general health. Usually fit for work. Consider restricted period of certification if appropriate. • BMI 36 to 40+ - Consider other risk factors, mobility and general health. Individuals in this category are normally not fit for work because of the impact on mobility and general health. Physicians should only certify anyone in this category fit for work after carefully considering all pertinent risk factors. Restricted certification not exceeding 6 months will always be appropriate. 11. Genitourinary System
Genitourinary disease should be carefully assessed. A history of a short-term illness will usually present no
difficulties for work but chronic or recurrent disease should be carefully considered with referral, as necessary, to
appropriate specialists.
Renal Calculi. The presence of renal, ureteric or vesical calculi is generally unacceptable until successfully treated
by surgery or lithotripsy. Recurrent renal colic without demonstrable calculi requires careful assessment.
Recurring Urinary Infections are unacceptable until investigated, and treated.
Renal Failure. Any renal disease which could lead to acute renal failure, ie nephritis, nephrosis, is unacceptable.
Polycystic disease, hydronephrosis or unilateral nephrectomy with disease in the remaining kidney, is
unacceptable, unless otherwise indicated by a nephrologist. Patients using ambulatory peritoneal dialysis are not
normally suitable for work.
Renal Transplant is usually unacceptable because of the level of immunosuppression normally required.
Enuresis, recent or active, is unacceptable. Mild post-operative incontinence which can be managed by the
individual may not pose significant problems but those with more significant incontinence will normally be
unsuitable for work.
Prostatitis where active is unacceptable until successfully treated.
Prostatic hypertrophy, or urethral stricture interfering with adequate bladder evacuation is unacceptable until
successfully treated.
Gynecological disorders, such as menorrhagia, disabling dysmenorrhoea, pelvic inflammatory disease or
prolapse, are unacceptable until successfully treated.
Hydrocele, or painful conditions of the testicles, require careful assessment but unless disabling may be
considered fit.
Sexually transmitted disease where active is unacceptable until treated.
HIV and AIDS. A diagnosis of "HIV positive" need not debar from employment. Such employees should receive
regular surveillance. Persistent Glandular Lymphadenopathy and AIDS related illnesses with a decreased CD4
count will normally be unacceptable.
12. Respiratory System
Assessment of the respiratory system can normally be made on clinical grounds alone unless there is a history of
specific respiratory illness in which case some limited respiratory function testing should be conducted. Where the
need for investigation is beyond that available to the examining physician, specialist reports should be obtained.
Pneumothorax. A history of spontaneous pneumothorax is generally unacceptable, except for a single episode
without recurrence for one year, or after a successful surgical procedure.
Obstructive or restrictive pulmonary disease, such as chronic bronchitis, emphysema, and any other
pulmonary disease causing significant disability or recurring illness, such as bronchiectasis, is unacceptable. The
severity of chronic conditions should be assessed using standard spirometry measurements using the following
guidance :
• FEV1 between 60 and 80% predicted - mild disease with minimal symptoms likely to be considered fit. • FEV1 between 40 and 59% predicted - moderate disease may be fit for sedentary duties but with ability to respond to an emergency compromised. Consider very carefully especially if FEV1 is less that 50% predicted. • FEV1 less than 40% predicted - severe disease with significant reduction in pulmonary reserve. Not likely Open Pulmonary tuberculosis is unacceptable until treatment is concluded and the
attending physician has certified that the patient is no longer infectious. Foreign nationals
should be assessed and screened in accordance with the British Thoracic Society
Guidelines on the Control and Prevention of Tuberculosis. Routine chest radiography is
not required by UKOOA, NOGEPA or OLF guidelines unless clinically indicated.
Asthma. As a clinical entity, asthma has a wide spectrum from infrequent mild episodes causing little if any impact
on functional capacity through to major life threatening events. In assessing an individual's suitability for work, a
number of factors must be considered and a risk-based approach adopted. The British Thoracic Society guidelines
provide detailed guidance on the management of asthma and may also assist with the assessment of fitness for
work. In assessing the degree of impact of the condition, reference should be made to control over the last 2 years
or more and the frequency of complications or functional limitation during that period.
• Resolved childhood asthma does not prevent successful employment. • Mild asthma (Level 1 or 2 on the BTS scale) is usually compatible with work (unless there is a specific occupational exacerbating factor). Mild asthma is characterised by : Good knowledge and awareness of illness with ability to modify own treatment as necessary Symptoms do not require high dose inhaled or oral steroids • Moderate or severe asthma (Level 3, 4 and 5 on the BTS scale) are normally incompatible with work. Specialist referral may assist in the decision-making process. Those with mild asthma who are considered suitable for work may also be required to wear breathing apparatus during emergencies. The exercise, dry nature of the air breathed and environmental conditions can all cause an exacerbation of asthma. In general terms, only those with mild asthma requiring only infrequent use of a bronchodilator should normally be considered for breathing apparatus work (refer to Section 3, Paragraph 6). 13. Ear, Nose and Throat
Conditions of the ear, nose and throat if chronic, can impact on an individual's ability to perform safely in a working
environment. The functional impact on the individuals' ability to hear and communicate, as well as any impact on
balance, must be carefully assessed in addition to considering any underlying pathological process.
Hearing. Where the average hearing loss at low frequencies (O.5, 1, 2kHz) is documented at greater than 35dB in
the better ear then the individual may have difficulty hearing safety warnings, and further assessment to confirm
their ability to hear a safety announcement should be conducted. Where it is established by practical field-testing
that the individual can hear such warnings then they may be certified fit. An intrinsically safe hearing aid may be
used to improve hearing but the individual must not be dependent upon it to achieve these standards.
Hearing conservation. Where an individual may be exposed to noise in excess of the HSE second action level
then under the Management of Health and Safety at Work Regulations 1999, the employer of that individual should
arrange for periodic assessment of their hearing as a health surveillance measure. The responsibility for this rests
with the employer. Experience has shown that the UKOOA medical examination offers a convenient opportunity to
conduct necessary hearing examinations to meet this legislation, and it is recommended that audiometry to the
appropriate standard (refer to Addendum 4) is conducted at each UKOOA medical examination or more frequently
as clinically indicated.
Balance. Where an individual has a chronic history of a balance disorder, they should be considered unfit for work
until such time as symptoms have resolved or have been controlled for a minimum period of 3 months on
medication. Any precipitant factors must also be considered when addressing a return to work, including flying and
transfer by boat.
Chronic suppurative ear infections will normally be unacceptable until adequately treated. particular care must
be taken in respect of food handlers.
Motion sickness where recurrent and incapacitating may be reason to restrict from work.
Acute and chronic sinusitis causing discomfort during flying may be a reason to restrict from certain work
environments until adequately resolved.
14. Eyes
Visual acuity adequate to permit the individual to mobilise and work safely is essential and should be confirmed at
each medical examination. Any eye disease or visual defect rendering, or likely to render, the applicant incapable
of carrying out job duties efficiently and safely, is unacceptable.
Visual acuity. Visual acuity in the better eye should be at least 6/12 using corrective lenses as necessary. Higher
standards of visual acuity are required for some specific roles, including crane operators and certain emergency
response roles. An uncorrected visual acuity of 6/60 is recommended to permit emergency mobilisation around a
location without corrective lenses if necessary. Individuals who require lenses to meet the visual standard should
be encouraged to carry two pairs.
Monocular vision is acceptable provided the above minimum standard of acuity is met and the individual shows
appropriate adaptation to the loss of binocular vision. Special attention should be given to protecting the monocular
eye from high hazard operations.
Diplopia, if persistent, poses a safety hazard and is unacceptable for working.
Visual Fields should be full und unrestricted, and should be tested by confrontation. Where this suggests a deficit
then referral for mapping may be necessary. Significant field deficits as a result of progressive eye disease,
diabetes, or cerebrovascular events should be referred for a specialist opinion.
Colour vision is only required for specialist tasks such as electrical work and need not be assessed unless
specifically required for this purpose or a similar colour dependent task.
Stereoscopic vision is not required for normal tasks unless the individual is also required to operate cranes.
Glaucoma which is adequately controlled and has not compromised visual acuity may be acceptable but specialist
referral and restricted periods of certification not exceeding one year will normally be required.
Uveitis. Acute cases usually resolve and need not restrict employment once resolved. Chronic uveitis will normally
cause significant impact on vision and will normally prevent working.
15. Dental Health
Whilst the company does not wish to impose a mandatory dental certification process on employees, experience
has shown that dental problems continue to be a frequent cause of medivac. Consequently a dental screening
process is an important part of the fitness for work certification process. The examining physician should take
reasonable steps to assure that an examinee's dental health is adequate for work. As a minimum, it should be
established that the candidate is free from :
• Bleeding gums or periodontal disease If the examiner thinks that there is sufficient dental pathology present, then certification of fitness for work should be withheld pending a dental opinion and treatment if necessary. Patients medivaced for dental reasons must have a letter from a treating dentist confirming resolution of the dental
pathology before they are allowed to return to work.
16. Medications
Any medication taken by an individual on a prescribed or self-medicated basis should be carefully assessed prior
to certifying an individual fit to work. The medication may :
• Indicate serious underlying pathology incompatible with work (although care must be taken where medication is used for multiple conditions eg prochlorperazine) • Have a side effect which may seriously compromise an individual's health and/or safety in a work environment eg methotrexate or benzodiazepines • Have significant interactions with other medications eg macrolide antibiotics. In some cases, more • Have serious side effects if the medication were suddenly to be withdrawn in the event of delays, eg oral 16.1 Restricted Medications
All cases must be assessed on an individual basis. However, those who require the following medications for an
underlying medical condition will not normally be suitable for unrestricted work.
Proposed exceptions to this rule must be considered in detail with appropriate specialist reports and should normally entail a discussion with the company's medical advisor. 16.2 Other Medication
Other medication may potentially cause significant side effects and applicants for work should be specifically
questioned about this at screening medical examinations.
16.3 General Considerations for Medication
• All medication must be reported to the location's company approved health professional (eg, medic) on • All workers must take sufficient medication for their requirements for the duration of their trip plus a small contingency supply in the event of a delay in leaving the location. • Unidentified substances such as Chinese herbal medications, dietary supplements or similar are liable to confiscation by security under the industry substance abuse control measures. Where these substances are being legitimately used, the individual should carry appropriate identification and prescription details to verify legal and appropriate use thereof. 17. Pregnancy and Work
The purpose of these medical guidelines is to protect individuals and employers from predictable medical emergencies which may arise in an isolated location. Schlumberger clearly recognizes that pregnancy is not a medical condition and is a normal physiological state. It is, however, appropriate to consider any additional medical risks faced by the pregnant employee in a remote or high risk environment. Contraindications to working in remote or high risk locations whilst pregnant include: • Active complication of current pregnancy, including threatened miscarriage, hyperemesis, and multiple • Previous obstetric history, particularly any risk factors or history of ectopic pregnancy, hyperemesis, pre eclampsia, premature labour or pregnancy induced diabetes. • Any relevant medical conditions which may complicate pregnancy, including particularly endocrine disease, cardiovascular disease or epilepsy. Schlumberger recommends that pregnant women do not normally work in remote or high risk locations and that , where appropriate and possible, suitable work in a suitable location be offered. Following the medical examination and discussion with the employee and her manager, and after a proper risk assessment, it may be reasonable to consider work in a remote or high risk location, but in all cases the following must be satisfied: • The pregnancy has been assessed by a physician as low risk and confirmed at ultrasound as intrauterine • The employee understands and accepts the additional risks entailed in working in a remote or high risk • The Schlumberger approved health advisor has been informed and agrees to remote or high risk location Under no circumstances should any pregnant women work on or visit a remote or high risk location beyond 24 weeks’ gestation.


Microsoft word - a-1-8-rasoanaivo

11th NAPRECA Symposium Book of Proceedings, Antananarivo, Madagascar Natural Products and Drug Discovery through a Network of Partnerships Philippe Rasoanaivo, David Ramanitrahasimbola, Dina Rakotondramanana, Voahangy Ramanandraibe, Suzanne Ratsimamanga Institut Malgache de Recherches Appliquées Abstract We present here relevant result obtained from a network of collaborations. Mala


SAFETY DATA SHEET Date of issue: 26.11.2009 Updating date: 26.11.2009 1. IDENTIFICATION OF THE SUBSTANCE/MIXTURE AND OF THE COMPANY/UNDERTAKING 1.1 Identification of the product: METAL BOX – REPAIR BOX WITH ALUMINUM NET 1.2. Use of the substance/mixture: 2-component putty based on unsaturated polyester resin with aluminium net. Used for filling up the holes in a car body. 1.3. Manufacturer/supp

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