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Transcript of Health and Safety Upper Limb Disorders
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Health and Safety
Executive
Upper limb disorders in the
workplace
This is a free-to-download, web-friendly version of HSG60
(Second edition, published 2002). This version has been adapted for online
use from HSEs current printed version.
Youcanbuythebookatwww.hsebooks.co.ukandmostgoodbookshops.
ISBN 978 0 7176 1978 8
Price 9.50
Whereveryouworkthereisachancethatupperlimbdisorderscouldaffectyou.
Theycancausepainandevenpermanentinjurytotheneck,shoulders,arms,
wristsorhands.Inmostcasestheyarepreventableandthisbookshowsyouhow
toassessandminimisetherisksthroughpositiveaction.Itshouldhelpyouto
complywiththelawandmakeyourworkplacesafer.
HSE Books
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Crown copyright 2002
Firstpublished1990
ISBN9780717619788
Allrightsreserved.Nopartofthispublicationmaybereproduced,storedin
aretrievalsystem,ortransmittedinanyformorbyanymeans(electronic,
mechanical,photocopying,recordingorotherwise)withoutthepriorwritten
permissionofthecopyrightowner.
Applicationsforreproductionshouldbemadeinwritingto:
TheOfficeofPublicSectorInformation,InformationPolicyTeam,
Kew,Richmond,SurreyTW94DUore-mail:[email protected]
ThisguidanceisissuedbytheHealthandSafetyExecutive.Followingtheguidance
isnotcompulsoryandyouarefreetotakeotheraction.Butifyoudofollowtheguidanceyouwillnormallybedoingenoughtocomplywiththelaw.Healthand
safetyinspectorsseektosecurecompliancewiththelawandmayrefertothis
guidanceasillustratinggoodpractice.
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ContentsPreface 5
Introduction 6
Upper limb disorders: Understand the issues and commit to action 8
Understandtheissues 8
Committoaction 11
Create the right organisational environment 13
Participationandinvolvement 13
Communication 14
Competence 14
Allocationofresponsibilities 14
Assess the risk of ULDs in your workplace 15
Whatisanergonomicsapproach? 15
Identifyingproblemtasks 15
Riskassessment 16
ULDriskfactors 17
Reduce the risk of ULDs 24
Lookingforhigherordersolutions 24
Usinganergonomicsapproach 24
Basicprinciplesinimplementingsolutions 25
Individualdifferences 25
Suggestionsforreducingtherisk 25Otherguidanceonsolutions 25
Afterimplementation 26
Educate and inform your workforce 27
Trainingasacontrolmeasure 27
Whoshouldreceiveeducation? 27
Whatshouldtrainingcover? 27
Makingtrainingmoreeffective 28
Evaluationandfollowup 28
Manage any episodes of ULDs 29
Reportingandrecording 29
Referral 29Diagnosisandreturntowork 30
Surveillance 31
Carry out regular checks on programme effectiveness 32
Whymonitororreview? 32
Monitoring 32
Approachestomonitoring 32
Examplesofpassiveandactivemonitoring 33
Monitoringoutcomes 33
Reviewing 34
Appendices 35Appendix1: Casestudies 35
Appendix2: RiskFilter,RiskAssessmentWorksheets,suggestionsforreducing
therisk 46
Appendix3: Medicalaspectsofupperlimbdisorders 68
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Appendix4: Legalrequirements 76
References 81
Further information 89
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PrefaceTheHealthandSafetyCommission(HSC)hasastrategyfortackling
musculoskeletaldisorders(MSDs)*includingupperlimbdisorders.Thestrategy
adoptstheprinciplesofSecuringHealth Together: A long-term occupational
health strategy for England, Scotland and Wales.1Thisformsanintegralpartof
Revitalising Health and Safety.2
Governmentdepartmentsinco-operationwithemployers,employees,tradeunions,
employersorganisations,healthprofessionalsandvoluntarygroupshaveset
severalchallengingtargetsaspartof Securing Health Together.Thesehavebeen
usedinestablishinganHSCpriorityprogrammeformusculoskeletaldisorderswith
thefollowingtargets,tobeachievedby2010:
n 20%reductioninincidenceofwork-relatedillhealthcausedbyMSDs;
n 30%reductioninthenumberofworkingdayslostduetoMSDs.
Thepriorityprogrammeaimstoimprovecompliancewiththelaw,topromote
continuousimprovement,andtodevelopthenecessaryknowledge,skillsand
supportsystemstoachievetheMSDtargets.Thisguidanceformsonestrandof
thesupporttobeprovidedforemployers,employeesandthosewhoadvisethem.
Itaimstoensurethattheyhavetherightinformationandadvicetopreventand
manageupperlimbdisordersintheworkplace.
* Thetermmusculoskeletaldisorders(MSDs)referstoproblemsaffectingthemuscles,tendons,
ligaments,nervesorothersofttissuesandjoints.UpperlimbdisordersareasubcategoryofMSDs.
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1 Thisdocumentdescribeshowmanagers,togetherwiththeiremployees,can
cooperatetominimisetherisksofupperlimbdisorders(ULDs)througha
positivemanagementapproach.Itgivesgeneralguidanceontheprocesses
involvedandincludesariskassessmentfilterandworksheetsaswellas
informationonthemedicalaspectsofULDsandthelegalrequirements.
2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nerves
orothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,
arms,wrists,handsandfingers.ULDscanoccurinalmostanyworkplaceand
theycanusuallybeprevented.Whenpreventionhasnotworked,systems
areneededtomakesuretheyarepromptlyreported,properlydiagnosedand
treated.Employerslegalresponsibilitytopreventwork-relatedaccidentsand
illhealthalsoappliestoULDs.
3 ThisguidancereplacesWork-related upper limb disorders: A guide to
preventionandreflectsthechangesinourunderstandingofriskfactors
andcontrolstrategieswhichhaveemergedfromresearchoverthelastdecade.Thishasshowntheimportanceofpsychosocialriskfactorsacting
inconjunctionwithphysicalriskfactors.Ithasdemonstratedtheneedfor
anintegratedapproachtothemanagementofULDriskswhichaddresses
bothorganisationalandphysicalaspectsoftheindividualstaskandwork
environment.
4 Thisguidancepresentsanapproachwhichisbasedonsevenstagesina
managementcycle.Thestagesare:
n understandtheissuesandcommittoaction;
n createtherightorganisationalenvironment;
n
assesstheriskofULDsinyourworkplace;n reducetherisksofULDs;
n educateandinformyourworkforce;
n manageanyepisodesofULDs;
n carryoutregularchecksonprogrammeeffectiveness.
5 Eachstageisconsideredinaseparatesectionoftheguidance.Anoverview
oftheapproachisshowninFigure1.(seealsoparagraph30)
6 Appendices1-4includethefollowing:
n Appendix1:illustratesreallifeexampleswheretherisksofULDshave
beenmanaged.
n Appendix2:providespracticalhelpwithriskassessmentandcontainsaRiskAssessmentFilterandWorksheetsandsuggestionsforreducingthe
risk.
n Appendix3:givesbackgroundinformationonmedicalaspectsofULDs.
n Appendix4:setsouttherangeoflegaldutieswhichapplytothe
preventionofULDs.
7 Vibrationisincludedinthisdocumentwhereitcontributestothedevelopment
ofULDs,buttheguidancedoesnotcoverallaspectsofthepreventionof
vibration-inducedillnesses,suchasvibrationwhitefinger. 3,4Inaddition,the
risksofupperlimbdisordersduetoDisplayScreenEquipment(DSE)useare
coveredbytheDSEregulations,andseparateHSEguidanceisspecifically
availableonthistopic.5,6
DutyholdersmustcomplywiththeDSEregulations;howeverthisULDguidancemaybeusedtoprovidesupplementary
information.
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Upper limb disorders: Understand
the issues and commit to actionn IstheriskofULDsrecognisedinyourworkplace?
n IsmanagementcommittedtopreventingorminimisingtheriskofULDs?
n Arethereadequatemanagementsystemsandpoliciestosupportthe
commitment?
Understand the issues
Whatareupperlimbdisorders?
8 Thephraseupperlimbdisordersisagenerallabelwhichisusedtorefertoarangeofmedicalconditionswhichcanbecausedormadeworsebywork.
Therearea numberofcommontermswhicharealsoinusetodescribethe
sameconditions,ofwhichthemostwellknownisrepetitivestraininjury.
Otherlesserknowntermsarecumulativetraumadisorder,oroccupational
overusesyndrome.Thesecommontermscanbemisleadingwithregardto
themanyfactorswhichcancontributetotheonsetoftheconditions,andfor
thisreasonthemoregeneraldescriptionofupperlimbdisordersisusedin
thisguidance.
9 Thetermupperlimbrefersto:
n
thepartofthebody:thearmandhand,coveringaregionextendingfromthetipsofthefingerstotheshoulderandextendingintotheneck;
n thetissues:thesoft-tissues,musclesandconnectivetissues(tendons
andligaments)andthebonystructures,aswellastheskin,alongwiththe
circulatoryandnervesupplytothelimb.
10 Thetermdisorderreferstotheclinicaleffectsproducedbyunderlying
changesinthetissues.Thesecomprisesymptomssuchaspain,experienced
bytheperson,andsignswhichareabnormalities,egintheappearanceof
thelimb,whichmaybeapparenttothepersonormayonlybefoundon
examinationbyadoctor.Theseclinicaleffectsareaccompaniedbyfunctional
changes,egareductionintheabilitytousetheaffectedpartofthelimband
areoftenassociatedwitharestrictionintherangeorspeedofmovement.
Strengthandsensationmayalsobeaffected.Althoughtheclinicalandfunctionaleffectsareconfinedtothelimbitself,theirpresencewilloftenlead
toareductioninanindividualsassessmentoftheirgeneralhealthandtoa
reductionintheirqualityoflife.
Figure 2
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11 Upperlimbdisorderscanbedescribedbythepartofthebodyaffected,orby
thepresumedpathologicalmechanism.Therearecommontermsformany
oftheindividualconditions,suchastenniselbowandfrozenshoulder.
Asimpleguidetothemorecommonupperlimbdisordersiscontainedin
Appendix3.
12 PainisacommonsymptomofULDsbuttheexperienceofpainintheupper
limbisalsocommonamongstthegeneralpopulation.Therefore,feelingpain
intheupperlimbisnotinitselfanindicationofthepresenceofanULD,and
suchsymptomsmaybedifficulttoattributetoworkwithanycertainty.
13 Paincanalsobeexperiencedintheformofstiffnessorsorenessof
themusclesaccompaniedbytemporaryfatigue.Thesesymptomsare
comparabletothosefollowingunaccustomedexertionwherenopermanent
pathologicalconditionresults.Fullrecoveryusuallyoccursafterappropriate
rest.
14 Atanyonetimeitispossibletoexperiencesymptomsintheupperlimbwhich
resultfromanumberofdifferentcauses.Thisguidanceisprimarilyconcerned
withULDsforwhichthereisevidencetobelievethattheconditionscanbe
causedby,ormadeworsebyworkactivity.
Areallupperlimbdisorderswork-related?
15 Thesimpleanswerisno,butexperiencehasshownthatULDsareoften
directlylinkedtoworkplaceactivitiesorifduetoanon-workcause,made
worsebywork.
16 Itisimportanttorecognisethatthemusculoskeletalsystemiswellsuitedtoproducingrepeatedmotionsatlowforcelevels.Undesirableforcesmay,
however,beimposedonmuscles,tendonsandjointsbysomejobdemands
andworkingpractices.Suchstressesareusuallywithinthephysicalcapability
orstrengthofthetissues,providedtheforcesareofshortdurationandrest
periodsareadequate.Prolongedtissueloadingcausedbystaticpostureor
performanceofveryfrequentexertionscan,however,beharmful.
17 ThereareestablishedassociationsbetweenmanytypesofULDsandwork
tasks,orspecificriskfactorswithinthesetasks. 7Evidencecomesfrom:
n anecdotalreportswhichhavehistoricallylinkedspecificoccupationsand
particularconditions;8
n clinicalcasestudiesandreportingschemesforoccupationaldiseases; 9,10n workplacesurveysofsymptoms;11
n epidemiologicalreviews7,12andpopulationsurveys;13,14
n laboratorystudiesofthephysiologicalimpactofexperimentallyimposed
physicalstresses.15,16,17
18 Thereviewsoftheepidemiologicalliterature7,18providegoodevidenceofthe
associationsbetweenworkplaceriskfactorsandULDs,particularlywhere
workersarehighlyexposedtotheseriskfactors.
19 Non-workactivities,suchasdomesticactivityandhobbies,maycontain
similartypesofriskasarefoundinworkactivities.Thesetasksaregenerally
notasrepetitive,forceful,orprolongedasareworktasks.Also,theindividualhasahighdegreeofcontrolastowhentheactivitycanbetemporarily
stoppedorabandonedaltogether.
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Howbigistheproblem?
20 Musculoskeletaldisordersarethemostcommonworkrelatedailment
afflictingthegeneralpopulationinGreatBritain.Theyaccountformorethan
halfofallself-reportedoccupationalillhealth(morethan1millioncases). 13
Theseproblemsarenotconfinedtoparticularjobsorsectorsandarefound
throughoutmostmanufacturingandserviceindustries.
21 Basedonahouseholdsurveydonein1995,anestimated506000people
weresufferingfromamusculoskeletaldisorderwhichaffectedtheupperlimbs
orneck.
22 Anestimatedminimum4.2millionworkingdayswerelostinBritaindueto
musculoskeletaldisordersaffectingtheupperlimbsorneckin1995,with
eachaffectedemployeetaking,onaverage,13daysoffwork. 14Coststo
employersofmusculoskeletaldisordersoftheupperlimbsorneckwere
estimatedtobeatleast200million.
Whattypesofjobcarryparticularrisks?
23 EvidencegatheredoverrecentyearsshowsthatULDsarenotconfinedtoany
oneparticulargroupofworkersorindustrialactivity,butarewidespreadinthe
workforce.Thefollowinglistofgroupswhichhavereportedhighlevelsofarm
painillustratesthispoint.Acommonfeatureofthejobsisthattheirtaskshave
recognisedriskfactors:
n assemblylineworkers;
n cleaninganddomesticstaff;
n constructionworkers;
n garmentmachinists;
n
hairdressers;
24 Thislistisnotexhaustive,andtherearemanyotherjobsthatcarryariskof
ULDs.Similarly,thepresenceofjobsonthislistdoesnotimplythattheriskof
injurytotheseworkerscannotbeadequatelycontrolled.
WhyshouldIbeconcerned?
25 IfworkwhichcarriestheriskofULDsisnotmanagedproperlythenthe
consequencesareseenin:
n thehumancostofpainandsufferingexperiencedbyemployeesandtheir
familiesthroughillhealth;
n lossofearnings;
n lossoftheabilitytowork;n problemsinqualitycontrolandproductivity;
n decreaseinefficiency;
n sicknessabsence;
n costsofstaffreplacementandtraining;
n theriskoflitigation;
n theriskofbadpublicity;
n ariseininsurancepremiumsandcostsofcompensationtoinjured
workers.
26 Anywarningsignsmaybethetipoftheiceberg.Onepersonwithsymptoms
maymeantherearenumerousotherworkersalsoexposedtoriskfactors,
andwhoareintheprocessofdevelopingadisorder.
Whataremylegalresponsibilities?
27 TherearegeneraldutiesonallemployersundertheHealthandSafetyat
WorketcAct197419andtheManagementofHealthandSafetyatWork
n meatandpoultryprocessors;
n mushroompickers;
n potteryworkers;
n secretaries/temps;
n
textileworkers.
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Regulations199920whichrequiretherisksofULDstobeaddressed.These,
andotherlegalresponsibilitiesareoutlinedinAppendix4.
28 ULDshavealsobeenthesubjectofmuchcivillitigationoverthepasttwenty
years.21Althoughthelegalprocesshassometimesappearedinconsistent
thereisnodoubtthattheemployersdutyofcaretowardstheiremployees
withrespecttoULDsisnowwellestablishedinthecivilcourts.Thiscivillaw
dutyrunsparalleltotheemployersstatutoryresponsibilityunderhealthand
safetylegislation.
Commit to action
29 RealisingthatULDsmaybeariskwithin,andto,yourbusinessisnotenough.
Itisessentialtoturnthatawarenessandunderstandingintoacommitment
totakeactiontomanagetherisks.TheframeworkinFigure1outlinesseven
stageswhichformasoundbasisfordevelopinganeffectiveprogrammeforthemanagementofULDrisks.
30 Thestagesareasfollows:
n Understand the issues and commit to action:Managementand
workersshouldhaveanunderstandingofULDsandbecommitted
toactiononprevention.Thiscommitmentmaybeexpressedthrough
positiveleadershiponthetopic,bygeneratinganeffectivehealthand
safetypolicyonULDsandbyhavingappropriatesystemsinplace.These
actionswillhelptopromoteapositivehealthandsafetycultureinthe
workplace.
n Create the right organisational environment:Theorganisational
environmentshouldfosteractiveworkerparticipationandinvolvement,
haveclearandopenlinesofcommunicationandencouragepartnership
workinginthenextfivesteps.Thiswillinvolvedevelopingthe
competenciesofworkers,supervisorsandmanagersfortheirdiffering
roles.
n Assess the risks of ULDs in your workplace:Acorefeatureofthe
managementprogrammeistoassesstheriskofULDs.Itneedstobe
doneinasystematicwaybymanagersandworkerssothatthemainrisks
intheworkplacecanbeidentifiedandprioritisedforaction.Asrisksare
potentiallywidespread,simplechecks,includingafilterquestionnairecan
beusedtoidentifyjobswhichrequireamoredetailedassessment.
n Reduce the risks of ULDs:Onceriskshavebeenassessedand
prioritisedacoherentprocessofriskreductionshouldbeundertaken
usinganergonomicsapproach.Possiblerisksshouldbereduced
oreliminatedatsource.Implementationshouldincludeworkforce
participationasthisisknowntoleadtobettersolutionsandmore
effective,sustainedchanges.
n Educate and inform your workforce:Toenableparticipationand
involvementoftheworkforceandforindividualstoassumetheirproper
responsibilities,provisionofeducationandinformationisvital.Training
willsupportallaspectsofthemanagementprogramme,andshouldbeconsideredasanongoingactivityandnotasaone-offtask.
n Manage any episodes of ULDs:Itisimportanttohaveasystemto
manageanyepisodesofULDs.Employeesshouldbeencouragedto
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identifyanysymptomsandtoreportthembeforetheybecomepersistent.
Managersneedtorespondquicklybyreviewingrisksandintroducing
moreeffectivecontrols,ifnecessary.Theyalsoneedtoreassure
employeesthatreportingofsymptomswillnotprejudicetheirjobor
position.Earlymedicalmanagementcanstopestablishedcasesfrom
deterioratingandalsohelptheprocessofreturntowork.
n Carry out regular checks on programme effectiveness:Toensure
thatthisprogrammecontinuestoworkproperlyovertimeregularchecks
ofeffectivenessshouldbecarriedout.Thiswillhelptoensurethat
controlsonULDrisksremaineffectiveandwillallowyoutoprogressively
improvetheireffectiveness.
Managementcommitment
31 Ifthisprogrammeofcontrolistoworkeffectivelythenitisimportantto
demonstratemanagementcommitmenttothewholeprocess.Effective
managementofoccupationalhealthrisksischaracterisedby:
n visibleseniormanagementinvolvement;
n openmanagementstyle;
n goodcommunicationswhichengenderownershipofproblems(ie
personalresponsibilityandparticipation);
n anappropriatebalancebetweenhealthandsafetyandproductiongoals.
Supportingpoliciesandsystems
32 AclearpolicyforthemanagementofULDssetsthedirectionforthe
organisationandmeansthatpeoplethroughouttheorganisation,however
largeorsmallitis,willknowthatthepreventionofULDsisanissuewhich
hastobeaddressedinallstagesofbusinessplanning,bothforday-to-dayoperationsandinthelongerterm.
33 TheframeworkinFigure1andtheguidanceinthefollowingsectionsarea
meanstoturnyourintentionsintorealityandtokeeptheseintentionsunder
scrutiny.
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Create the right organisational
environmentn Isworkerparticipationactivelysoughtandvalued?
n Aresafetyrepresentativesinvolved?
n Arealldepartmentsawareofthecontributiontheycanmake?
n Iscompetenceensured?
n Haveyouallocatedresponsibilities?
34 TheeffectivemanagementofULDsrequiresseniormanagementcommitment.
Inaddition,itneedsthepresenceintheorganisationofsharedandinterlinked
beliefs,attitudesandbehavioursthatallowthemanagementofrisksto
proceedeffectively.Theseelementsmakeupwhathasbeenreferredtoasthehealthandsafetyclimateorculture.Keyfeaturescrucialtodevelopinga
positiveenvironmentfordealingwithULDproblemsinclude:
n participationandinvolvement;
n communication;
n competence;
n allocationofresponsibilities.
Participation and involvement
35 Involvingstaffintheplanningandorganisationalprocessescanbean
importantwayofincreasingthelikelihoodofsuccessofyourriskcontrol
strategy.Workershavefirst-handknowledgeandanalmostunique
understandingaboutparticularaspectsofthetaskstheyperform.Itmay
howeverbeimportanttoprovideeducationandtrainingonULDsbefore
expectingemployeestocontributefullytotheprocessofassessmentand
control.KeyindividualsareSafetyRepresentativesastheyprovideaneffective
channelforcommunicationwiththeworkforcetheyrepresentandtheycan
usetheirfunctionstoprovidearealitychecktoensurethattheproposed
controlmeasuresmightactuallywork.TheHealthandSafety(Consultation
withEmployees)Regulations1996, 22SafetyRepresentativesandSafety
CommitteesRegulations1996, 23andtheOffshoreInstallations(Safety
RepresentativesandSafetyCommittees)Regulations1989 24requireyoutoconsultwithyouremployeesontheirhealthandsafetyatwork.Thiswould
extendtoactionsyouintendtotaketotackleULDs.Furtherinformation
aboutemployeeparticipationcanbefoundin Development of a framework
for participatory ergonomics25andalso Handle with care - assessing
musculoskeletal risks in the chemical industry.26
36 Asupportivecompanycultureandopennesswillbeimportantfactorsin
ensuringthattheadverseeffectsofULDsarenothiddenfrommanagement.
Encouragingearlyreportingofworkrelatedachesandpainstosupervisors
orlinemanagers,andinturntotheoccupationalhealthservice(ifyouhave
oneavailable)canprovidesignificantbenefitsforboththeemployeeand
thecompany.Oneofthemaindifficultieswithreportingisthefearoftheoutcome,egpossiblybeingdeclaredunfitforwork.Thisiswhereanopen,
positiveculturebecomesimportant.Employeesoughttofeelsafetoreport
achesandpainsearlyintheironset.
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Communication
37 Goodcommunicationwillensurethatstaffmembersineverydepartment
ofyourbusinessareawareoftherisksofULDsandwhattheycando
tohelpreducethem.Productdesignstaffwillinfluencethedetailsofthe
manufacturingprocessandthedecisionsofmarketingstaffwilldetermine
thenatureofthepackagingrequired.Purchasingdepartmentswillcontrol
thesourcingoftheequipmentusedandgeneralmanagementwilldetermine
termsandconditionsincludingworkingschedules.Insomecases,factors
whichinfluencetheserisksmaybecontrolledatadistanceinaparent
organisation.Arangeofmethodsshouldbeusedtoensurethateveryoneis
keptinformedofhowtheirrolescanimpactonotherworkersandalsothe
companysprogrammeonthepreventionofULDs.Thesearelikelytoinclude
seminars,meetings,postersandarticlesinthehousejournalornewsletter.
Theinternetalsoprovidessomeusefulwebsites,someofwhichareincluded
intheFurtherInformationsection.
38 Anopensystemofcommunicationshouldprovideopportunitiestodistribute
informationtoemployeesandalsoopportunitiesforfeedback.Thiscanbe
informal(egtosupervisors)ormorestructured,forexamplethroughregular
surveys.Ifcomplaintsoccurtheyshouldbeinvestigated.
Competence
39 ItisimportantthatpeoplearecompetenttopreventULDswithintheir
technicalareasofresponsibility.Healthandsafetytrainingisimportant,
payingparticularattentiontotheriskfactorsforULDsandhowthesemay
beavoided.Somegroupsofstaffmayrequirespecialisedtraining,eginthe
applicationofergonomicprinciples,evaluationofworkplacechangesorthe
recognitionofupperlimbhealthcomplaints.
40 Theneedforcompetencealsoextendstoareassuchastheoperationof
recruitmentandplacementproceduresandsystemstoidentifytrainingneeds
whenworkpracticesandtechnologieschange.Staffdevelopmentsystems
canbeusedtoensurethatindividualshaveaccesstothetrainingthey
require,andtheiroperationcanformpartoftheregularchecksonprogramme
effectiveness.
Allocation of responsibilities
41 AsmanypeoplewillhavearoleinyourprogrammetopreventULDs,it
isimportanttobeclearaboutwhoisresponsibleforwhatfunctions.For
example,supervisorswhounderstandtheriskscantakeanactiverolein
helpingtocontrolthem,andinencouragingstafftoreportanyproblems.You
mayneedtosetupsystemstodealwithanyproblemswhichmayoccur,to
ensureanearlyresponsetothem.
42 Settingobjectivesforyourorganisation,withclearrolesandaccountabilities
willhelpkeepyouontarget.Youmaybeabletousebenchmarkingasa
wayofcheckingprogress,egbetweendepartmentsorwithneighbouring
businesses.
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Assess the risk of ULDs in your
workplacen AreanyULDhazardsidentifiedthroughsimplechecks?
n AreriskfactorsforULDspresent?
n Repetition,workingposture,force,durationofexposure,working
environment,psychosocialfactors,individualdifferences,
43 AssessingtheriskassociatedwithULDsinvolvestwomajorstepsnamely:
n identifyingproblemtasks;and
n riskassessment.
44 Anexampleofamethodfortacklingtheabovetwostepscanbefoundin
Appendix2.
45 Inordertobeabletogetthemostbenefitfromtheprocess,youandyour
workforceneedtobeabletoworktogethertoidentify,assessandcontrol
theriskofULDs.Thisprocessshouldinvolveanergonomicsapproachand
shouldincludetheparticipationofworkers.
What is an ergonomics approach?
46 Ergonomics(orhumanfactors),isconcernedwithensuringworkisdesigned
totakeaccountofpeople,theircapabilitiesandlimitations.Itsobjectiveisto
optimisehealth,safetyandproductivity.Anergonomicsapproachisthemost
effectivewayofdealingwithULDproblems.Thisisbecauseitencourages
youtotakeaccountofalltherelevantpartsoftheworksystemandrequires
workerparticipation.
Identifying problem tasks
47 Therearetwomainapproachesyoucanusetoidentifyifyouhaveaproblem
inyourworkplace.Firstlymanagersandworkerscanlookforanysignsof
problemsorsymptomsamongsttheworkforce.Secondly,youcanobserveworktasksthemselvestoseeifriskfactorsforULDsarepresent.Thiscanbe
doneusingasimpleinitialassessmentofriskssuchastheriskfilterapproach
foundinAppendix2.Sourcesofinformationthatmayhelpincludeexpert
advice,industrystandardsandlegislativestandards.
Warning signs
48 WarningsignscanindicatethepresenceofhazardsrelatingtoULDs.Signsof
existingULDproblemscaninclude:
n injuryandillnessrecords;
n jobswhichworkersarereluctanttodo;
n jobswhereworkerscomplainofdiscomfort;n workershavingmadeadaptationstoworkstations,toolsorchairs;
n workersrequestingtobere-deployedortakenoffajob;
n splintsorbandagesbeingworn,and/or;
n useofpainkillers.
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Figure 3
49 Paragraphs120-128outlineotherwaysofmonitoringthenumberofworkers
whoareexperiencingupperlimbpainordiscomfort.
Risk Filter
50 Adetailedassessmentofeveryjobcouldbeamajorundertakingand
mightbeanunnecessaryeffort.Tohelpidentifysituationswhereadetailed
assessmentisnecessary,aFilterforaninitialscreeningoftaskshasbeen
devised.WheretheFilteridentifiesseveralriskfactorsincombination,theriskofULDsislikelytobegreater.AcopyoftheRiskFilterandinstructionsfor
usecanbefoundinAppendix2.
Risk assessment
51 OnceyouhaveidentifiedthatcertaintasksmaybecreatingariskofULDs(by
lookingforsignsandsymptomsandusingtheriskfilter),amoredetailedrisk
assessmentshouldbeconducted,involvingmanagersandworkers,inorder
toascertainthelikelihoodandseverityofrisk.ULDassessmentworksheets
thatcanassistinrecognisingandrecordingriskfactors,canbefoundin
Appendix2.
The risk assessment process
52 Ajoboftenconsistsofseriesoftasks.Performingyourriskassessmentcan
besimplifiedbythinkingintermsofthesetasksandtheirsubsidiaryelements.
Toillustratethispoint,Figure4describesthejobofaprocessworkerthat
consistsofthreedifferenttasksonanassemblyline:
n station1:attachingahandle;
n station2:grinding,and;
n station3:packing.
53 Ascanbeseeninthisexample,thesetaskscanalsobefurtherbrokendown
intoelements,whicharedistinctsequencesofmovementwithinthetask.
54 Lookingattaskelementscanhelpbothinidentifyingthecausesofrisks
andindevisingpotentialsolutions.Forexample,inthecaseoftheprocess
workertheriskfiltermightidentifythetaskofattachingahandle(station1)as
posingapossiblerisk.Themoredetailedassessmentusingtheworksheet
wouldidentifyrepeateduseofapinchgripwhenpickingupandpositioning
thescrews(elements1and2),andawkwardarmpostureouttothesideof
thebodywhendrilling(element3).Whenconsideringthetaskinthiswayit
iseasiertolinktheriskstoparticularactionsoroperations,whichthenhelps
whenconsideringriskreductionmeasures.
55 Inthiscasebetterpositioningoftheassemblylineinrelationtotheworker,andre-orientatingtheobjectswillreducetherisktotherightarmand
shoulder.Reducingthedurationspentonthetaskandintroducingmore
frequentbreakswillreducetheriskassociatedwithusingthepinchgrip.
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Figure 4 Thetasksandelementsofaprocessworkersrole
56 Remembertoconsiderwhetherworkersperformanumberofpotentiallyrisky
tasks(iethathavebeenhighlightedbytheriskfilter),inagivenshift.Ifthisis
thecase,itisessentialthatyourriskassessmentconsiderstheoverallimpact
ofperformingthecombinationoftasksinyourriskassessment.Inpractice,
thiswouldusuallymeanthataseparatefilterandriskassessmentworksheet
wouldbefilledoutforeachtask,andthatthecompletedworksheetswouldbeconsideredincombinationwhendecidingontheoveralllevelofriskfor
thoseworkers.Detailedinstructionsfortheriskfilterandriskassessment
worksheetscanbefoundinAppendix2.
57 Otherriskassessmenttoolsareavailable.27,28,29,30Theserangefrom
standardisedorquantitativetoolsthatareusuallyrequiredtobeundertaken
byacompetentperson,tosimplechecklists.Engagingacompetentperson
maybeappropriateformorecomplexriskassessments.
ULD risk factors
58 Riskfactorscanbethoughtofastask,environment,orworker-relatedwithin
anergonomicapproach.TheprincipalULDriskfactorsare:
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59 Eachoftheseriskfactors,includingtheirdefinitionsandwhytheycreatethe
riskofULDs,willbediscussedinmoredetailinthefollowingparagraphs.
60 Riskfactorscommonlyinteractwitheachotherincreatingtheoverallrisk
ofULDs.Forexample,thetaskofgrippingaheavypowertoolwithalargehandleforsixhourswouldresultinanawkward,forcefulgrippingpostureand
exposuretovibrationoveraprolongedperiod.Thereforeworkingpostures,
duration,forceandworkingenvironmentareallriskfactorsforinjuryinthis
task.
61 Incontrast,ifthistaskwasonlydoneforashortperiodineachshift,the
riskofinjurymaynotbehigh.Thisisdespitethefactthattheriskfactorsof
workingpostures;forceandvibrationarestillpresent.
62 Generally,thereisanincreasedriskofinjurywhenthereareanumberof
riskfactorsactingincombination.However,oneriskfactoractingalonecan
createanunacceptableriskofinjuryifitissufficientlygreatinmagnitude,
frequencyorduration.
Repetition
63 Workisrepetitivewhenitrequiresthesamemusclegroupstobeused
overandoveragainduringtheworkingdayorwhenitrequiresfrequent
movementstobeperformedforprolongedperiods.
64 Rapidorprolongedrepetitionmaynotallowsufficienttimeforrecovery
andcancausemusclefatigueduetodepletionofenergyandabuildupof
metabolicwastematerials.Repeatedloadingofsofttissuesisalsoassociated
withinflammation,degenerationandmicroscopicchanges.Fastmovements
andaccelerationrequirehighmuscleforces.
Figure 5
Taskrelatedfactorsn repetition;
n workingpostures;
n force;
n durationofexposure.
Environment-relatedfactorsn workingenvironment;
n psychosocialfactors.
Worker-relatedfactorsn individualdifferences.
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Workingposture
65 Workingposturescanincreasetheriskofinjurywhentheyareawkwardand/
orheldforprolongedperiodsinastaticorfixedposition.
Figure 6
Awkward postures
66 Anawkwardpostureiswhereapartofthebody(egalimbjoint)isused
wellbeyonditsneutralposition.Aneutralpositioniswherethetrunkandheadareupright,thearmsarebythesideofthebody,forearmsarehanging
straightoratarightangletotheupperarm,andthehandisinthehandshake
position.Forexample,whenapersonsarmishangingstraightdownwiththe
elbowbythesideofthebody,theshoulderisinaneutralposition.However,
whenemployeesareperformingoverheadwork(egrepairingequipmentor
accessingobjectsfromahighshelf)theirshouldersarefarfromtheneutral
position.
67 Whenawkwardposturesareadopted,additionalmusculareffortisneededto
maintainbodypositions,asmusclesarelessefficientattheextremesofthe
jointrange.Resultingfrictionandcompressionofsofttissuestructurescan
alsoleadtoinjury.
Static postures
68 Staticposturesoccurwhenapartofthebodyisheldinaparticularposition
forextendedperiodsoftimewithoutthesofttissuesbeingallowedtorelax.
Whenholdingabox,forexample,itislikelythatthehandsandarmsareina
staticposture.
69 Staticloadingsrestrictbloodflowtothemusclesandtendonsresultinginless
opportunityforrecoveryandmetabolicwasteremoval.Musclesheldinstatic
posturesfatigueveryquickly.
70 Inboththeabovetypesofposture(awkwardandstatic),theriskofULDs
willberelatedtothenumberoftimesthepostureisrepeated,theamountofforcerequired,and/orthelengthoftimeitisheld.Aswithalltheriskfactors
forULDs,theimpactoftheworkingpostureneedstobeunderstoodin
relationtootherriskfactors.
Force
71 Forcecanbeappliedtothemuscles,tendons,nervesandjointsoftheupper
limbby:
n handlingheavyobjectswhenperformingtasks,ieanexternalload;
n fastmovementorexcessiveforcegeneratedbythemusclesofthebody
oftentobetransmittedtoanexternalload,egtryingtoundoastiffbolt;n localforceandstressfromitemscomingintocontactwithpartsofthe
upperlimb,suchasthehandleofapairofpliersdiggingintothepalmof
thehand.
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Figure 7
72 Thelevelofforcethatisgeneratedbythemusclesisaffectedbyanumberof
factorsincluding:
n workingposture:thelevelofmusculareffortrequiredincreaseswhena
partofthebodyisinanawkwardposture;
n thesizeandweightofobjectsbeinghandled;n thespeedofmovement:asextraforceisneededatthebeginningand
endoffastmovementssuchashammering;and
n vibratingtoolsorequipment:asoperatorsneedtouseincreasedgrip
forceinworkingwithvibratingequipment.
73 Useofexcessiveforcecanleadtofatigueandifsustained,toinjury,either
throughasingle-eventstraininjuryorthroughthecumulativeeffectofthe
repeateduseofsuchforce.Localforceandstresscanalsocausedirect
pressureonthenervesand/orbloodvesselsandincreasetheriskof
discomfortandinjury.
Force in gripping74 Theneedtogriprawmaterials,productortoolsisapotentialriskfactor
ifexcessiveforceisused.Theamountofforcerequiredtogripcanbe
influencedbythetypeofgripused,thepostureofthewrist,exposuretocold
andvibrationandtheeffectsofwearinggloves.
75 Theforcerequiredtogripobjectsisalsodependentuponthematerialoritem
beinggripped.Forexample,ascrewdriverhandlewithaflexiblegriprequires
lessforcewhenbeingusedthanonewithaharderhandle.Thesizeofthe
objectbeinggrippedcanalsoaffecttheforcerequired.Forexample,pliers
withtoowideortoonarrowaspanwillbemoredifficulttogrip.
76 Muscleforceisgreatestwhenapowergrip(eggrippingahandleinthepalm
withfingersandthumb)isusedas,thisallowsalargesurfaceareaofthehandtobeutilised.Thestrongestgripstrengthoccurswhenthewristisclose
tothehandshakepositionandisslightlybentupwards.
Durationofexposure
77 Durationreferstothelengthoftimeforwhichataskisperformed.It
includesthelengthoftimethatthetaskisundertakenineachshift,plusthe
numberofworkingdaysthetaskisperformed(egfourhoursperday,five
daysperweek).Durationisanimportantconceptinassessingtheriskof
musculoskeletaldisorders.
78 Itisgenerallyacceptedthatmanytypesofupperlimbdisordersare
cumulativeinnature.Therefore,whendurationtimeisincreasedtheriskofinjuryisincreased.Thisisbecausewhenpartsofthebodyundertake
workforperiodswithoutrest,theremaybeinsufficienttimeforrecovery.
Consequently,timefortheindividualsbodytorecoverfromaspecifictaskor
tasksisimportant.
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79 Shortexposuresareunlikelytocreatesignificantriskofinjury,exceptwhere
thetaskisexceptionallydemandingand/ortheworkerhasnotbeenallowed
tobuilduptoitsdemandsoveraperiodoftime.Thiscanoccurafterreturnto
workfromholidaysorwithanincreaseinworkpace.
Figure 8
Workingenvironment
80 Workingenvironmentreferstoaspectsofthephysicalworkenvironmentthat
canincreasetheriskofULDs.Thisincludesfactorssuchasvibration,cold
andlighting.
Vibration
81 Exposuretohand-armvibrationresultsfromtheuseofhand-held/guided
powertoolsandequipmentorfixedmachinerysuchasbenchgrinderswhere
theworkpieceisheldbytheworker.VibrationcanincreasetheriskofULDs
andisknowntocausevibrationwhitefingerandcarpaltunnelsyndrome,
lossofsenseoftouchortemperature,painfuljointsandlossofgripstrength.Informationaboutthedose(ievibrationmagnitudeandexposuretime)of
vibrationisneededinordertoaccuratelyassesstherisk.Furtherinformation
onvibrationcanbefoundin Hand-arm vibration3,ISO5349-24andAppendix
3.
Figure 9
Cold
82 Workingincoldtemperatures,handlingcoldproductsorhavingcoldair
blowingonpartsofthebodycanplaceadditionaldemandsonthebodyas
wellaspossiblyrequiringtheuseofpersonalprotectiveequipment(which
cancompoundtheriskbyrequiringadditionalforcetogrip).Exposuretocold
canresultindecreasedbloodflowtothehandsandupperlimbs,decreased
sensationanddexterity,decreasedmaximumgripstrengthandincreasedmuscleactivity(whichispartofthebodysnaturalresponsetobeingcold).
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Figure 10
Lighting
83 Thevisualdemandsofthetaskareanimportantconsideration,sincea
workersposturecanbelargelydictatedbywhattheyneedtosee.Dimlight,
shadow,glareorflickeringlightcanencourageworkerstoadoptabentneckandpoorshoulderposturesinordertoseetheirwork,therebyexacerbating
theeffectsofotherriskfactors.Furtherinformationonlightingcanbefoundin
Lightingatwork.31
Figure 11
Psychosocialfactors
84 Physicalriskfactorsexerttheirharmfulinfluencethroughphysiologicaland
biomechanicalloadingoftheupperlimb.Ofequalimportanceisthelarge
bodyofworkshowingthataworkerspsychologicalresponsetoworkand
workplaceconditionshasanimportantinfluenceonhealthingeneraland
musculoskeletalhealthinparticular;thatis,workasexperiencedbyworkers.
Thesearereferredtoaspsychosocialriskfactors.Theyincludethedesign,
organisationandmanagementofworkandtheoverallsocialenvironment
ingeneral(thecontextofwork)andalsothespecificimpactofjobfactors
(thecontentofwork).Itisverylikelythatphysicalandpsychosocialrisk
factorscombineandthatthegreatestbenefitwillbeachievedwhenbothare
identifiedandcontrolled.Manyoftheeffectsofthesepsychosocialfactors
occurviastress-relatedprocesseswhichincludedirectbiochemicaland
physiologicalchanges.Alsoincludedareinstanceswhereindividualstryto
copewithstressfuldemandswithbehavioursthat,inthelongterm,maybe
detrimentaltohealth.Anexamplewouldbewhereanindividual,because
ofhighworkloadordeadlines,foregoestherestbreakstowhichtheyare
entitled.
85 Psychosocialriskfactorsarecommoninsectorswhereupperlimbdisordersoccur13.Importantaspectsofworkdesignincludetheamountofcontrol
peoplehaveintheirjobs,thelevelofworkdemands,thevarietyoftasksthat
theyhavetocarryoutandthesupporttheyreceivefromsupervisorsand
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co-workers.Manyjobsarenotwelldesignedandincludesomeorallofthe
followingundesirablefeatureswhere:
n workershavelittlecontrolovertheirworkandworkmethods(including
shiftpatterns);
n tasksrequirehighlevelsofattentionandconcentrationespeciallyin
conditionswheretheworkerhaslittlecontrolovertheallocationofeffort
tothetask;
n workersareunabletomakefulluseoftheirskills;
n theyarenot,asarule,involvedinmakingdecisionsthataffectthem;
n theyareexpectedtocarryoutrepetitive,monotonoustasksexclusively;
n workismachineorsystempaced(andmaybemonitoredinappropriately);
n workdemandsareperceivedasexcessive;
n paymentsystemsencourageworkingtooquicklyorwithoutbreaks;
n worksystemslimitopportunitiesforsocialinteraction;
n highlevelsofeffortarenotbalancedbysufficientreward(resources,
remuneration,self-esteem,status);
Aswithphysicalriskfactors,psychosocialissuesarebestaddressedwithfull
consultationandinvolvementoftheworkforce.
Individualdifferences
86 Allindividualsaredifferentandforbiologicalreasonstheremaybesome
peoplewhoaremoreorlesslikelytodevelopanULD.Individualdifferences
mayalsohaveimplicationsforemployeesreportingULDtypeconditions.
Whereanergonomicapproachisfollowed,thisshouldensurethattasksare
withinthecapabilitiesoftheentireworkforce.Somefactorsmayincreasethe
riskofdevelopingsymptomsandshouldbeconsideredinthemanagement
programme.Theseinclude:
n newemployeesmayneedtimetoacquirethenecessaryworkskillsand/
orrateofwork;
n differenceincompetenceandskills;
n workersofvaryingbodysizes,ieheight,reachetc.Thiscanleadto
adoptingpoorpostureswhenworkingatsharedworkstations;
n vulnerablegroups,egolder,youngerworkersandneworexpectant
mothers;32
n healthstatusanddisability;
n individualattitudesorcharacteristicsthatmayaffectcompliancewithsafe
workingpracticesorreportingofsymptoms.
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Reduce the risk of ULDs
n HaveyouprioritisedyouractionstocontroltherisksofULDs?
n Haveyoulookedforhigherordersolutions?
n Haveyouutilisedanergonomicsapproach?
n Haveyouimplementedsolutions?
87 Havingassessedtheworktodeterminethelikelihoodandscaleoftherisks
associatedwitheachoftherelevanttasks(andthetasksincombination
whereapplicable),youmustimplementcontrolsinordertoreducetheserisks
asfarasisreasonablypracticable.
88 Prioritiseactionssothat,forexample,seriousrisksaffectinganumberof
employeesaretackledbeforeanisolatedcomplaintofminordiscomfort.
Look for higher order solutions
89 Ahierarchicalapproachtoriskreductionandcontrolshouldbefollowed
wherepriorityisgiventoeliminationofriskatsource.Firstly,considerifitis
reasonablypracticabletoeliminatethehazard,egbyredesignofthework
task,bysubstitutionorreplacementoftoolsorcomponents,orthrough
automationofthetask.Insomecasesitmaybepossibletoisolatetherisks
atsourcebyengineeringcontrolsorprotectivemeasures,egbyshieldingthe
workerfromdraughtsorbypreventingexposuretovibration.Wheretheseare
notviable,thelowestorderinthehierarchyofcontrolsistominimiseriskby
designingsuitablesystemsofwork,usingPPEifappropriateandtoprovide
training.
Using an ergonomics approach
90 Asinriskassessment,anergonomicsapproachisimportantindeveloping
yourinterventionstoreducerisk.Aparticipativeapproachtosolutionfinding
isconsideredtobethemosteffectivemethodforinterventiondevelopment. 18
Interventionsmayinvolvechangestothetask,theworkingenvironment,or
theindividual(orworkgroup)ortoallofthese.Researchhasshownthat
interventionsthattakeaccountofalltheseaspectsaremoreeffectivein
reducingrisk:
n Changestothework task(s)mayincluderedesignoftheworkstation
andworkequipment.Itmayincludetheprovisionofappropriatefurniture,
equipmentortoolsthathavebeenmatchedtotheneedsoftheworkers
andthetask.Jobrotationorautomationmaybebeneficialinreducing
ULDrisks.
n Changestotheenvironmentcouldincludemodificationstothethermal
conditions,vibrationexposureorlightinglevels.Changestoinfluence
psychosocialfactorsmayberequired.Areviewoftheworkorganisation
andstructuresuchasreductionofworkhoursorchangestoscheduling
ofbreaks,ormodifyingpacingorincentiveschemesmayalsobehelpful.
n Trainingandprovisionofinformationto individualsorworkgroupsmayalsobeneededtosupportotherchanges.
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Basic principles in implementing solutions
91 Riskscanberemovedorreducedthroughsystematicattentiontosomeorall
ofthefactorsmentionedpreviously.Somehelpfulprinciplesare:
n greatbenefitoftenresultsfromsimpleandlowcostinterventions(eg
changesinworkingheight)whicharegenerallymorepracticalandeasier
toimplement;
n consideranumberofpossiblesolutions,preferablytryingthemoutona
smallscalebeforedecidingononetoimplement;
n employeescanbeespeciallygoodatdevisingeffectiveandpractical
improvementmeasures;
n checkthatanychangesdonotcreatenewhealthandsafetyrisks
elsewhere;
n successfulimplementationoftenrequirestheinvolvementofallemployees
fromthetopleveldownwards.Evensoundergonomicsolutionsmay
notbesuccessfuliftheyareimposed.Involvingworkersinproblemsolvingandtheimplementationprocesses,givesanenhancedsenseof
ownershipofthesolutionsandmaycreateagreatercommitmenttotheir
effectiveimplementation;
n inlarge,geographicallyspreadorganisations,incorporateshort-termlocal
initiativesintothecompanysoverallhealthandsafetystrategy;
n refertocasestudiesfromothersources,egfromtradeassociationsorthe
Internet,forideasconcerningbestpracticesolutions.
Individual differences
92 Alltasksshouldbedesignedsotheycanbeundertakenwithoutcreatinga
riskofULDs.Thereisnoscientificallyvalidscreeningtestwhichcanpredict
thefuturedevelopmentofULDsinanindividual.Placementprocedures
shouldtakeaccountoftheriskassessment,jobrequirementsandthe
individualdifferencesoutlinedintheprevioussection.
93 Newemployees,particularlyyoungworkers,andthosereturningtoworkfrom
aholiday,sicknessorinjury,mayneedtobeintroducedtoaslowerrateof
productionthantheexistingworkforce,followedbyagradualincreasein
pace.Thisworksbest,forexample,byonlyworkingforalimitedtimeperday
atproductionspeed,increasingasappropriate.Introducingnewcomersat
aslowerpaceenablesthemtodevelopgoodworkpracticesbeforehaving
toconcentrateonworkingfastandhelpsthemtoassimilatetrainingmore
effectively:ideally,earlytrainingshouldbedoneoff-line.Regulation12intheManagementofHealthandSafetyatWorkRegulations1999 20details
requirementsconcerningnewemployees.
Suggestions for reducing the risk
94 Someexamplesofapproachesthatmaybeusefulforreducingtheriskof
ULDsarelistedinAppendix2.
Other guidance on solutions
95 HSEhasproducedanumberofpublicationsthatprovideguidanceon
reducingworkplacemusculoskeletaldisorders.Thisincludesguidancebased
oncasestudies33,34aswellassomethatisindustry-specific.Informationcan
alsobefoundontheHSE,andsomeotherwebsites.Seefurtherinformation
forsources.
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96 Ifyouareunsureofhowtoapproachimplementingchangeswithinthe
workplace,youmaywishtoconsiderseekingspecialistadvicefroman
ergonomistorotherworkplacehealthandsafetyconsultant.
After implementation
97 Finally,itisimportanttomonitorthesituationtomakesuresolutionsarestill
effectiveatalaterdate(particularlywheretheirsuccessdependsonsome
formoflearningorbehaviourchange).Keepabreastofnewdevelopments(eg
whennewmachineryorstaffareintroducedintotheworkplaceorwhenother
alternativeriskcontrolmeasuresaredeveloped).Monitoringandreviewingare
explainedinparagraphs120-132.
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Educate and inform your
workforcen Haveyoueducatedandinformedyourworkforcetohelpprevention?
n Haveyouinvolvedsafetyrepresentativesincommunicatinginformation
aboutULDriskfactors?
n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworking
practicesandcontrolmeasures?
98 Educationandtrainingarecomplementarytoallotheraspectsofyour
programmeforthepreventionofULDsandindeedarecriticaltoitssuccess.
InformingstaffaboutsignsandsymptomsofULDs,riskfactors,controlmeasuresandtheneedforearlyreportingandactionwillimprovetheoverall
effectivenessofyourprogrammeandwillencourageemployeestobecome
activelyinvolvedinidentifyingandcontrollingULDrisks.
Training as a control measure
99 Trainingshouldnotbereliedonastheprimarymeansofcontrollingtherisk
ofULDs.Influencingthewayworkersperformtasksthroughtrainingisan
essentialpartofriskcontrol,butrelyingonthisalonehasbeenshownto
havelimitedsuccessinprevention.Trainingshouldideallycomplementother
higherordercontrolsthathavealreadybeenimplemented(ieredesignofthe
worktask,substitutionorreplacementoftoolsorcomponents,isolatingthe
riskatthesourceetc).Itcanbeverybeneficialtoinvolveemployeesinthe
developmentandpresentationoftraining.
Who should receive education?
100 Allworkers,supervisorsandmanagersshouldreceiveeducationonULDsto
enablethemtoidentifytheearlywarningsignsofpotentialULDriskfactors.
Educationshouldalsoextendtopurchasingstaff,engineers,maintenanceand
supportstaff,particularlywheretheyareinvolvedinspecifying,designingor
modifyingworkequipmentinordertoincreasetheirawarenessofergonomic
issuesandULDriskfactors.
What should training cover?
101 TrainingcanbedesignedbothtoraisegeneralawarenessofULDissues
andtoaddressthespecificneedsofaparticularjobortask.Generaltraining
shouldaimto:
n increaseawarenessandknowledgeofULDissues/problemsinthe
workplace;
n reducethelikelihoodofULDproblemsbyprovidingadequateinformation:
recognitionofsymptomsofULDs(seeAppendix3); riskfactorspresentintheworkplace;
safeworkingmethods;
correctoperationofcontrolmeasures;
theimportanceofproceduresfortheearlyreportingofULDsymptoms.
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102 Task-specifictrainingshouldconsiderULDriskfactorsassociatedwiththejob
ingreaterdetail.Suchtrainingshouldincludeareviewofriskfactorsrelatedto
tasksandsafeworkingmethodsforthatparticulartask.Anyspecificcontrol
measuresassociatedwiththejob,includingpersonalprotectiveequipment
shouldalsobecovered.
Making training more effective
103 Trainingthatinvolvesnomorethansittingwithanexperiencedemployeewho
doesnothaveappropriateunderstandingofULDsisunlikelytobesatisfactory
sincebadhabitsandpracticescaneasilybepassedontothenewemployee.
Whenattemptingtoalterworkerbehaviour,programmeswillneedto
consider:
n adversetraditionalmethodsandingrainedhabits;
n productionpressures;n anyperceptionthatnewmethodsaredifficultortimeconsuming;
n anylackofunderstandingofriskfactorsforULDs;
n situationswhereimprovementsinjobmethodsmaybeconstrainedby
poorworkplacelayout,materials,equipmentand/orjobdesign;
n employeeinvolvement.Thisisfundamentaltothesuccessofanytraining
programme.Employersshouldpromoteparticipationbyencouraging
discussion,askingemployeesforsuggestionsandcommentsontraining
issuesand,whereappropriate,involvingemployeesinthepresentationof
trainingmaterial;
n theroleofsafetyrepresentativesinpromotingsafeworkingpracticesand
reinforcingtrainingmessages;
n
theneedtoprovideopportunitiesforimmediatepracticeandfeedbacksoastocorrectperformanceandtoensurethatskilllevelscanbe
maintainedfollowingtraining.Principlescoveredintrainingsessions
shouldbereinforcedbysupervisors,safetyrepresentativesandpeerson
aregularbasis;
n theneedforperiodicrefreshertrainingforallemployees.
Evaluation and follow up
104 Periodicevaluationofyourtrainingprogrammesshouldbeundertakenaspart
ofageneralreviewofyourULDpreventionprogramme.Employeesshouldbe
involvedinthisprocess,particularlysafetyrepresentativesandsupervisors,
whocanassesstheimpactandeffectivenessofthetrainingoffered.Trainingshouldalsobereviewedwhentherearechangesin:
n workplacelayouts,taskdesignorworkorganisationortheintroductionof
newworkequipment;
n workpracticesorcontrolmeasures;
n reportedinjurylevelsinotherworkplacesintheindustry,orinworkplaces
withsimilarjobs.
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Manage any episodes of ULDs
n Haveyouimplementedandsupportedasystemforearlyreportingof
ULDs?
n DoyouactivelylookforsymptomsofULDs?
n Haveyouarrangedforoccupationalhealthprovision?
n Doyouhavesystemsinplaceforemployeesreturningtoworkafteran
ULD?
105 Adequatecontrolofriskfactorswillgoalongwaytopreventtheoccurrence
ofULDs.Duetoindividualdifferencesinthebodysresponsetostressesit
isnotpossibletoensurethateverypossibleepisodeofULDswillalwaysbe
prevented.Itisnecessary,therefore,tohaveasysteminplacetomanage
anyreportsorcasesofULDsthatariseintheworkforce.Theapproachtomanagingthesecomplaintsisbroadlysimilarwhethertheyarethoughtto
havebeencausedbyworkactivity,beenmadeworsebytheworkorare
largelyunrelatedtoparticularworktasks.
Reporting and recording
106 IndividualswillvaryintheirwillingnesstoreportearlysymptomsofULDs.
Itisimportanttomaintainaclimateinwhichearlyreportingofsymptoms
isregardedpositivelyandthiswillbeencouragedifmanagersandsafety
representativesbothemphasisethebenefitsofsuchearlydetectionof
possibleharm.Educationonpossiblesymptomsandsigns,whotoseein
thecompanyandwhathelptoexpectshouldbeprovidedtoallemployees
wherethereisaresidualriskofULDs.Employeesshouldbeadvisedtohave
anyrelevantsymptomsrecordedinthecompanyaccidentbook.Anyfirstaid
providedshouldalsobedocumented.
107 Ifsymptomsaresuchthatcontinuingtoworkdoesnotmakethemworse,
thenitmaybeenoughtoprovidetheworkerwithreassurance,adviceonrisk
factors,andtoreviewtheindividualsworktaskswiththem.
108 Ifcontinuingtoworkatthesamejobcausessymptomstogetworseor
becomeprolonged,orifthepersonwasconcernedaboutthenatureofthe
symptomsthenitwouldbeappropriatetoobtainfurtheradvicebymeans
ofareferraltoahealthprofessional.AdiagnosticsupportaidforULDshasbeendevelopedandislikelytobeofbenefittoGeneralPractitioners(GPs)
andotherhealthprofessionals.35Ifsymptomsareaggravatedbyapersons
currentjobitisadvisabletolookforalternativeworkthattheycando,evenif
thisisquitedifferentfromtheirnormalduties.Thiscanpreventtheneedfor
sicknessabsenceandallowforrecoverytimebeforereturntotheirnormal
duties.
Referral
109 Onewaytoobtainhealthadviceisbyreferraltoanoccupationalhealth
service,eitheronoroffsite.Appendix3containsmoreinformationonthescopeofoccupationalhealthprovisionandhowtoaccessthis.Accessto
anoccupationalhealthservicewillusuallyallowboththeworkerandtheir
managertobegivenappropriateadvicewithminimaldelay.Theindividualwill
beadvisedonthenatureoftheircomplaintandanyappropriatetreatment
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andthemanagercanbeadvisedwhetherthecomplaintsarelikelyto
havebeenrelatedtoworkandtheshorttermimplicationsforcontinuing
employment.
110 IfanemployeeisoffsickwithwhatisbelievedtobeaULDthenitisusefulto
makeearlycontactwiththeperson,forexampleatelephonecall,toseewhat
youcandotohelptheirreturntowork.Appendix3listsanumberofspecific
medicaldiagnosestolookoutforifyouareconcernedaboutcomplaintsof
ULDs.
111 Ifyoudonothaveaccesstoanoccupationalhealthservicethen,withyour
employeesagreementandwrittenconsent,youcanwritetotheirGPasking
forareportwhichmayhelpyouinmanagingtheabsence.However,anysuch
communicationhastocomplywiththeprinciplesdetailedintheAccessto
MedicalReportsAct,1988. 36,37Thefollowingpointscouldberaised:
n thenatureoftheillness;n whetherthedoctorthinksitisrelatedtowork;
n iftreatmentwillbenecessaryandtimerequiredtoaccesstreatment;
n whenareturntoworkmaybeexpected;
n whetheractivitywillneedtobelimitedforaperiodafterreturningtowork;
n ifanylongtermeffectsaretobeexpectedfromtheillness.
112 Appendix3providesfurtherinformationonarangeofpossibletreatmentsfor
ULDs.
Diagnosis and return to work
113 Receiptofawrittendiagnosisofanupperlimbdisordermaytriggera
requirementtomakeareporttotherelevantenforcingauthorityunderThe
ReportingofInjuries,DiseasesandDangerousOccurrencesRegulations
(RIDDOR).38,39,40ThisrequirementappliesonlytoasmallnumberofULDs
whichariseinthecourseofspecifiedworkactivities.Appendix4provides
furtherdetails.
114 AnumberofULDsarealsoprescribedundertheSocialSecurity(Industrial
Injuries)(PrescribedDiseases)Regulations1985. 41Atthetimeofwriting,the
listofULDswhicharePrescribedDiseasesisthesameasthosewhichare
reportableunderRIDDOR.Individualsdiagnosedwithsuchdisordersshould
beadvisedthattheymightbeentitledtobenefitundertheIndustrialInjuries
Scheme.
115 ConfirmationofacaseofanULDshouldbetakenasaprompttoconsider
whetherexistingriskassessmentsandcontrolsareadequate.Thisis
especiallyimportantifthereareotherpreviouslyreportedcases.
116 Theexacttimingofanindividualsreturntoworkwilldependonthemedical
advicewhichtheyreceivewhichinturnwilldependonthenatureofthe
underlyingdisorder.Itisoftenpossibletoreturntoworkbeforesymptoms
haveresolved,and,insomecasesthismaybeadvantageous.
117 Youmayalsoneedtoreviewyourarrangementsforoccupationalhealth
advicetoassistwiththemanagementofanyfurthercaseswhichmayoccur.Thisisparticularly importantinworkwherethereisalreadyexistingevidence
ofupperlimbcomplaints.
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Surveillance
118 Healthsurveillancecanbeundertakenoneitheravoluntaryorastatutory
basis.TheApprovedCodeofPracticefortheManagementofHealth
andSafetyatWorkRegulations 20recommendsthathealthsurveillanceis
undertakenwherecertaincriteriaaremet.Oneoftheseisaccesstoavalid
meansofdetectingthediseaseorconditionofconcern.Atpresentitisnot
consideredthatvalidtechniquesexistforthedetectionofchangeswhich
reliablyindicatetheearlyonsetofspecificupperlimbdisorders.
119 Valuableinformationcanhoweverbeobtainedfromlessprecisemeasures
suchasreportsofsymptoms.Itisgoodpracticetoputinplacesystems
whichallowindividualstomakeearlyreportsofupperlimbcomplaints.Where
appropriatethesecanbesupplementedbyregularsurveysofsymptoms.
Furtherinformationcanbefoundin Health surveillance at work.42
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Carry out regular checks on
programme effectivenessn Doyouhavesystemsinplacetomonitorandreviewyourcontrolsfor
ULDs?
n DoyouhavesystemsinplacetomonitorandreviewyourULD
managementprogramme?
n Areyouawareofnewdevelopments/information?
n Doyouaimforcontinuousimprovement?
Why monitor or review?
120 Inanymanagementsystemitisimportanttochecktheeffectivenessofyour
actions,andthisisnolesssointhepreventionofULDs.Thesecheckscan
beconsideredattwolevels:
n monitoring:whichistheongoingandregularappraisaloftheprocedures
andsystemswhichyouhaveinplacetocontrolrisk;and
n reviewing:whichisalessfrequentbutmorestrategicactivitywhich
considershowwelltheoverallcontrolsareworkingandwhetherany
changesmightbebeneficialandreasonablypracticable.
Monitoring
121 Monitoringisanintegralpartofmanagementandrequirescommitment,
consultationandparticipationatalllevelsintheorganisationinordertobe
fullyeffective.MonitoringgenerallyinvolvesrecordingtrendsinULDsymptoms
andriskfactorsovertimeinordertoassesstheperformanceofexisting
controlmeasuresandtoplanandimplementnewinterventions.
122 Factorstoconsiderinplanningmonitoringandreviewingsystemsinclude:
n method;
n frequency;
n whentomonitor;
n costsandbenefits.
123 Themethodandfrequencyofmonitoringshouldbeconsideredwheninitially
planningandimplementingcontrolmeasures.Thescaleandextentof
monitoringrequiredwilldependonthedegreeofriskandtherelativecosts
andbenefitsofavailablemethods.Itisimportantthatthereisconsultation
withemployeessothattheyarefullyawareofthemonitoringprocedures
whichareinplace.
Approaches to monitoring
124 Therearetwobroadapproachestomonitoringsystemspassiveandactivemonitoring.Table1comparesthegeneralfeaturesofeachapproach.
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Table 1 Generalfeaturesofpassiveandactivemonitoring
125 Someinitialvaluecanbegainedfrompassivemonitoringbutactive
monitoringbuildsonthisinformationandenablesanin-depthlookatrisk
factors,signsandsymptomsinaspecificworkplace.Consultationwith
employeesisparticularlyimportantsincethereareethicalconsiderations
relatingtothehandlingofpersonalhealthinformation.
Examples of passive and active monitoring
Someexamplesofpassiveandactivemonitoringmethodsaregivenin
Table2.
Table 2 Passiveandactivemonitoringmethods
Monitoring outcomes
126 Ininterpretinginformationobtainedfrommonitoringitisusefultolookfor
consistentpatternsin:
n commentsfromemployees;n symptomsreported;
n existingriskfactors;
n resultsofsurveys.
Passive Active
Usesexistinginformationsourcesand
methods
Activeseekingofinformationaboutsigns,
symptoms,riskfactors
Usuallyinexpensive Generallyinvolvesadditional costs
Usuallyundertakenfirst Usuallyundertakenasafollow-uptopassive
monitoringbutmaybethefirstlineapproach
wherethereisasignificantULDrisk.
Datacodingandanalysisisusuallysimple Indepthdatacodingandanalysisrequire
specialistassistance.
Non-clinical Non-clinicalandclinicalindicatorsincluded
Readilyestablishedasinformationsources
usuallydesignedforotheradministrative
purposes.
Recommendedwhenfacedwithanoutbreak
ofULDs
Passive Active
Accidentbook/Firstaidrecord
Compensationdata
Workplacewalkthroughs
Bodymapping
Statutoryreportingsystems(RIDDOR)38 Taskanalysis
Medicalretirementreports Confidential questionnaires
Symptomsreported Healthinterviews
Sicknessabsencerecords Healthexaminations
Productionproductivityandqualitymeasures Exposurechecklist27
Staffturnover
Healthandsafetymeetings
Moraleandemployeesatisfaction
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127 Comparisonsbetweengroupsofemployeesindifferentlocationswithin
theorganisationmaybehelpfulparticularlywheresimilarworkisbeing
undertaken.Wherepracticable,comparingyourexperienceswithother
companiesinyoursectormayalsoassistinevaluatingtheperformanceof
yourcontrolmeasures.42,43
128 Whereproblemsareidentified,actionshouldbetakentorevisethemeasures
inyourmanagementpolicytoimprovecontroloftherisk.Employeesshould
beadvisedofthesituationandanyappropriatemedicalmanagementmade
available.Furthermonitoringwilldetermineiftheserevisedmeasureshave
beeneffective.
Reviewing
129 Reviewingprovidesanopportunitytolookattheoverallperformanceofyour
systemsformanagingULDrisksandshouldbeconsideredasanintegralpartofthemanagementprocess.Itshouldbeundertakenwhenmonitoring
suggeststhatthecurrentpolicy/programmeisnotadequatelycontrollingthe
risksorwhentechnicaldevelopmentsororganisationalchangesareplanned
whichmayalterthelevelsofrisk.
130Reviewingrelieslargelyontheuseofexistingmanagementinformationand
mayoftenbeincorporatedinaperiodicreviewofbusinesseffectiveness,eg,
aspartofaqualityprogramme.
131 Reviewing:
n
needstobesystematicinapproach;n makesfulluseofexistingmanagementresources;
n isanopportunitytolearnfromexperiencesgainedinmanagingULDrisk
factors,signsandsymptoms;
n determineswhetherinterventionscontinuetobeeffective;
n establisheswhetherriskshavebeencontrolledwherereasonably
practicable;
n providesanopportunitytoassesswhetherimprovedcontrolmeasures
shouldbeintroduced.
132 Asystemshouldbeinplacetoensurethattheoutcomesfromtherevieware
actedupon,feedingbackintothemanagementsystemasshowninFigure1.
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Appendices
Appendix 1: Case studies
Thesecasestudieshavebeendividedintothestagespresentedinthe
managementmodelshowninFigure1.Thishasbeendoneretrospectively
soallstagesofthemodelarenotalwaysfullyrepresented.
Case study A: Easter egg and chocolate box packing
Background
1 AlargefactoryidentifiedanumberoftasksthatcreatedariskofULDs:
n Task 1: Easter egg packingForpackingEastereggs,eightseparatecomponentswereassembledbyhand.Mostofthesecomponentsarrived
asflat-packswhichthenhadtobefoldedandbentintothecorrect
shape.Theoperatorsonthistaskwerepaidpieceworkratesdependent
uponthenumberofeggstheyassembledinaworkday.
n Task 2: Chocolate box packingDuringtheproductionofboxesof
chocolates,twolayersofchocolatesinaplasticmouldedtray,apadof
corrugatedcardboard,andtheunitkey(ietoidentifythefillinginthe
chocolate)wereneededtobepackedintodifferent-sizeboxes.Theboxes
werepresentedtotheoperatoronamovingconveyor,and,astheywent
past,differentoperatorshadtoputdifferentcomponents(thechocolates,
themouldingsinwhichtheysit,thecardboardpad,andinformation
leaflets)intotheboxesinaflowassemblyoperation.
Understandtheissuesandcommittoaction
2 Thecompanyphysiotherapistandothermedicaldepartmentstaffwereseeing
peoplefromtheeggandchocolatepackagingdepartmentwithULDs.With
thepermissionoftheemployeesconcerned,managementhadbecomeaware
ofULDreferralsandhaddirectedactionontheissue.
Createtherightorganisationalenvironment
3 Thecompanydoctor,theoperationsmanagerandtheindustrialengineerfor
thesiteworkedwithemployeesthroughouttheprocessofassessment.Trials
ofsolutionstoreducetheriskswerealsodoneinaparticipativemanner.
AssesstheriskofULDsinyourworkplace4 Ariskassessmentoftask,environmentandindividualfactorsforULDs
identifiedthefollowingriskfactors:
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5 Ifworkerswererotatingbetweenthetwotasks,theymayhavebeenatan
increasedriskofULDs.BothtaskspresentverysimilarriskfactorsforULDs
(repetitionofsimilarupperlimbposturesforlongperiods)andincombination,
furtherincreasetheriskofULDs.Thisexamplehighlightstheimportanceof
lookingattheriskassessmentsoftasksincombinationwhereworkersare
performingmultipletasksduringtheshift.
ReducetheriskofULDs
6 Aftertheassessmentwascompleteditwasdeterminedthatcertainelements
neededtoberedesigned:
n thepackingoperationwasredesignedtoremovetheriskelementof
cardboardbendingandthesnappingshutoftheplasticmould.This
reducedthenumberofuncomfortablewristandhandmovements;
n thepaystructurewaschangedfrompieceworktosalariedwork;n forchocolateboxassembly,engineersdevelopedamock-upworkstation
totrialwithoperatorsinwhichtherateofcompletionofthetaskwas
determinedbytheoperator,notbytheconveyor;
Task 1: Easter egg packing
Task-relatedfactors
Repetition: Thistaskwashighlyrepetitivewithworkers
performingthesamefinger,wrist,armandshouldermovementsmanytimesperminute.
Working posture: Thetaskrequiredmanymovementsofthehand
andwrist,egsidewaysbendingandbendingthe
wristsupanddownwhilefoldingthecardboard
andsnappingaplasticcoverovertheeggs.The
elbowwasoftenheldandmovedinpositionsaway
fromthebody.
Force: Snappingoftheplasticcoverovertheeggs
requiredforcewithpinchgrip.
Duration of exposure: Workersconductedthistaskforprolongedperiods
eachday.
Environment-relatedfactors:Psychological factors: Workerswerepaidonapieceworkbasiswhich
mayhaveencouragedthemtopushthemselves
beyondthepointatwhichtheyexperienced
discomfort.Thismayalsohaveinfluenced
theworkerswillingnesstoreportupperlimb
discomfortforfearofreducedworkinghours/
speedetc
Task 2: Chocolate box packing
Task-relatedfactors
Repetition: Thistaskwashighlyrepetitivewithworkers
performingthesameupperlimbmovementsmany
timesperminute.Theoperatorsworkratewasdeterminedbytheconveyorspeed.
Working posture: Theboxdesignmadeitdifficulttoplacethe
componentsaccuratelyintheboxeswhenthe
conveyorwasmovingquickly.Thismeantthat
workersassumedawkwardposturesofthe
shoulderandwrist.
Duration of exposure: Workersundertookthistaskforprolongedperiods
eachday.
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n asingleoperatorundertookthewholeassemblytaskratherthanputting
onecomponentinthebox(iejobenlargement);
n engineersworkedoutthebestangleforviewingthecomponents,for
takingthemofftheconveyor,andforassemblingthemwithouttwisting
andturning;
n aftertestingoutthisdesignwiththeparticipationoftheoperatorsthenew
linewasbuiltandinstalled.
ManageanyepisodesofULDs
7 Thecompanyemploysaphysiotherapistandothermedicaldepartmentstaff
inordertomanageanyepisodesofULDsandfacilitaterehabilitationand
returntoworkwherepossible.
Carryoutregularchecksonprogrammeeffectiveness
8 ForEastereggpacking:
n fewercasesofwristandhandproblemsarenowreportedtomedicalstaff;
n overallefficiencyoftheproductionlinehasimproved;
n thenumberofunitsdamagedhasdecreased,andthevisualqualityofthe
finishedproducthasimproved;
n theamountofmaterial(chocolate,plastic,cardboard)wastedhas
decreased;
n staffmoralehasimproved;
n theeggproductionworkflowiseasiertomanageandregulate;and
n thereneedstobelessstaffrotationbecausethenatureofthejobhas
improved.
9 Forthechocolateboxpacking:
n operatorcomforthasincreased,astheadjustabilityineachworkstation
canbeusedtomeeteachoperatorsneeds;
n assemblyqualityhasimproved,astheoperatorsarenolongertryingto
putthecomponentsintoamovingbox.
10 Packingoperationsareperformedmanuallyinarangeofdifferentindustries.
Asthiscasestudyillustrates,theoperatorisoftenrequiredtousepositions
ofthehandandwrist,whichcanleadtoupperlimbdisorders,especially
whencombinedwithhighforceand/orrepetition.Thecompanyhasbenefited
inbothproductionefficiencyandstaffwellbeingandhealthbyrecognising
riskswithinthetask,andinvestinginergonomicchangestothetasksand
packagingmaterials.
Case study B: Computer use in news media organisation
TheworkcoveredbythiscasestudywassubjecttotheDisplayScreen
EquipmentRegulations.Thiscasestudyshowshowthestructuredapproach
intheguidancecanhelpcomplywiththeRegulationsinanunusualsituation
withcomplexchallenges.
Background
11 Formanyyearsalargenewsmediaorganisationhadusedacomputer-basedsystemtostoreandtransfernewsstories.Thiswasgraduallybecoming
outdatedandrequiredupgradingduetodevelopmentsintheelectronic
transferofstoriesandtheneedforafastermoreefficientsystem.
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12 Anewoff-the-shelfpackagebasedonanexistingandwidelyusedsystem
waschosen.Someadaptationsweremadeforthecurrentorganisation
anditwasinstalledinthenewsroomandelsewhere.Accompanyingthe
rolloutwasaprogrammeofchangemanagementthatincludedadviceon
implementation,installationandtrainingforusersincludingworkstation
adjustmentandposture.
Understandtheissuesandcommittoaction
13 Theuseofthenewsystemledtounanticipatedconsequencesbecauseit
wasbeingusedforataskforwhichitwasnotdesignedthepreparation
ofsometimeslengthy,in-depthnewsstoriesratherthanshortbulletin-style
pieces.
14 Priortotheintroductionofthenewsystem,comparativelyfewcasesofULDs
hadariseneventhoughcomputerisedtechnologyhadbeeninuseformany
years.Therethenfollowedarapidsurgeinnewcasesintheorderofathree
tofourfoldincreaseoverthepreviousyears.
Createtherightorganisationalenvironment
15 Rightfromthebeginninganopen-mindedpolicywasadoptedsothatallstaff
couldbekeptfullyinformedoftheextentoftheproblemanditsprogress.
AssesstheriskofULDsinyourworkplace
16 Assessmentoftask,environmentandindividualfactorsforULDsrevealedthat
thesoftwaredidnotcopewithpagebreaks,spellchecking,cut-and-paste
editingfacilitiesandtheneedforthenewsorganisationtocopewithnon-
Englishmaterial.Thetaskoftextinputandeditingagainstconstantdeadlines
wasnowmuchmoreonerousthanwithastandardwordprocessingstyle
package.Unfortunatelytheimplementationofthisnewsystemcoincidedwiththeoutbreakofamajorinternationalnewseventnecessitatinganenormous
increaseinworkload.Inaddition,organisationalchangeswerebeingmadeto
thebusinessinfrastructureincommonwiththosebeingmadeelsewhereat
thetime.Thisinevitablyledtouncertaintyaboutthefuture,insecurityonthe
partoftheworkforce,andtohigherlevelsofstress.
17 IdentifiedriskfactorsforULDsincluded:
Task-relatedfactors
Repetition: Staffwereperformingmultiplemouseclicksas
wellashighlyrepetitivekeying.
Working posture: Positionofthekeyboard,mouseandmonitormeantthatstaticcontractionoftheshoulder
andneckmuscleswasoccurringwhen
workerswereusingtheinputdevicesand/or
lookingatthescreen.Wristpostureswerealso
problematicforsomeworkers.
Duration of exposure: Textinputandeditingtaskswereperformedfor
prolongedperiodseachday.Theoutbreakof
themajorongoingnewseventmeantthatmany
workerswereworkinglongerhours.
Environment-relatedfactors
Psychosocial factors: Organisationalchanges,strictdeadlinesand
workloadassociatedwiththemajornewsevent
wereallidentifiedaspsychosocialriskfactors.
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ReducetheriskofULDs
18 ControlstoreducetheriskofULDswereimplementedasfollows:
n computerrelatedequipmentwhichincludedhardware,softwareand
furniturewasreviewedbythesafetymanager;
n changestoworkstationlayoutweremadetoimproveworkingpostures,
particularlyinrelationtotheupperlimbandmouseandkeyboarduse.
n Thisfocusedontheriskfactorofworkingposture;
n changesweremadetothesoftwaretoreducerepetition;
n themanageralteredtheworkorganisationincludingworkpatternsand
shifts.Thisrectifiedanyadverseworkpracticesandincludedcontrolover
workqualityanddeadlines.Thesecontrolsfocusedontheriskfactorsof
durationandpsychosocialfactors.
ManageanyepisodesofULDs
19 Earlyreportingofindividualcasestotheoccupationalhealthdepartmentwasencouragedsothatstepscouldbetakenbymanagerstominimisetheimpact
ofsymptoms.Threemainroutesofmanagementweredrawnup:
n aself-helprouteincludingarangeofphysicaltherapiesandrelaxation
exercises;
n atherapeuticroutetoinvestigatesymptomsandsigns,carryout
diagnosticandotherinvestigationsandrefer,asappropriate,fortreatment
optionsdonebytheoccupationalhealthdepartment.Treatmentcould
includemedication,onwardreferraltoGPorspecialist,physiotherapyor
counselling;
n frominitialonsetorreportingofsymptoms,acycleoffourweekswas
allowedfortheabovetobeaccomplished,afterwhichacaseconference/reviewmeetingwouldtakeplacetodetermineiftheindividualwasnow
fitandcouldreturntowork,wasimprovingandcouldreturntomodified
workorwheretheprogrammehadfailedandajobchangewasrequired.
Carryoutregularchecksonprogrammeeffectiveness
20 Afterseveralyearsfromtheinitialoutbreakthenumberoforiginalcaseshad
halved,ofwhichmorethan60%weredeemedtobecuredordormant.
21 Thisstudyshowsthattheoutlookforthemajorityofcasesshouldbegood
solongasaprogrammeisadoptedwhichencouragesearlyreportingand
managementofcaseswithoutfearofprejudice,inanenvironmentofmutual
co-operationbetweenemployees,managers,unions,safetyofficers,IT
specialistsandoccupationalhealthprofessionals.
Case Study C: Healthcare product packing
Background
22 Alargemanufacturingcompanywithseveralfactorysitesproducesand
packsawiderangeofcosmeticandskincareproducts.Theseoftenhave
shortpackingruntimes,andsomeproductlinesaredifficulttoautomate.The
companyrecognisedthatthehighlymanualpackagingtaskspresentedarisk
ofULDsandtookmeasurestotacklethese.
Understandingtheissuesandcommittoaction23 ThecompanyidentifiedtheneedtotakeactiontoreducetheriskofULDs
andforaproactivesystemtomanageULDreferrals/casesacrossthedifferent
factorysites.ThiswasmetthroughthedevelopmentofacompanyULD
policy.Acompanyergonomistwasalsorecruitedtodevelopandfacilitatean
ergonomicsprogramme.
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Createtherightorganisationalenvironment
24 ManagersandoperatorshadbeenawareofreportedsymptomsofULDsand
weresupportiveofmeasurestoreducethese.Fromthestarttheergonomist
workedcloselywithoccupationalhealthstaffandmanagement.
25 Packingteamleadersandseniorteammemberswithresponsibilityforthe
healthandsafetyoftheirparticularareaweretrainedinsafetyriskassessment
andtheidentificationofpossibleriskreductionmeasures.
AssesstheriskofULDsintheworkplace
26 Athree-stageriskassessmentprocesswassetup:
n detailedriskassessmentsofthepackagingtaskswereundertaken
usingtherapidupperlimbassessment(RULA)method 28andabody
partdiscomfortandpsychosocialsurvey.Theseformedthebasisfor
prioritisingriskreductionrecommendations;
n seniorteammembersregularlyassesstheriskofULDsduringroutineriskassessmentsoftheirpackinglines.Theyareencouragedtoidentify
andimplementriskreductionmeasuresandcanseekadvicefromthe
companyergonomist;
n whenanewproductistobeintroducedtoaline,achangecontrol
assessmentisundertakentoidentifyanyspecificproblemswhichmay
relatetothepackingofthatproduct,andpossiblesolutions.
Anexampleofataskidentifiedduringapackingtrialriskassessmentas
posingaULDriskwassealingatwo-pieceglassjarusingawiremetalclasp.
Thetaskrequiredrepetitiveactivityandtheapplicationofforcetoclosethe
clasp.Therewasalsotheriskofpressurepointsonthepalmfromthewire.
TheriskofULDsassociatedwiththetaskwasreducedbyencouragingoperatorstostandratherthansittomakeiteasiertoapplyforce;providing
aleatherpalmprotector;ensuringtwopeopleundertookthetasktoreduce
durationofexposureandincreaserecoverytime;andprovidingguidanceon
taskprocedure.Afterimplementation,noULDsymptomswerereportedfrom
thispackingoperation.
ReducetheriskofULDs
27 Thefollowingmeasuresapplytoallpackinglines:
n allpackingemployeesrotatetoadifferenttaskevery30minutes.Where
possible,rotatedtasksaresignificantlydifferentintermsofupperlimb
movementsrequired;n increasedautomation,standardisationofpackaging,andwaysofreducing
repetitivemovementsaresoughtatthedesignstage(egreducingthe
numberofturnsrequiredtofastenalid);
n developmentofproceduresthatencourageoperatorstoadoptgood
posturesandmovementsonpackingtasks;
n thedevelopmentandavailabilityofriskreducingaids(egtoolsand
equipment);
n increasedawarenessofULDissuesamongtheworkforce,and
encouragementofallemployeestoparticipateinidentifyingriskreduction
measuresandsolutions.
Educateandinformyourworkforce28 AleafletonULDs,coveringcausesofULDs,howtoidentifysignsand
symptoms,andwhattodoiftheseareexperienced,wasissuedtoallstaff
withafollow-upissueafter18months.
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29 Whereappropriate,awarenesstrainingisprovidedbythecompany
ergonomisttopromotesuitableworkingtechniquesthatcanbeusedto
reduceULDrisk.
ManageanyepisodesofULDs
30 ThecompanypolicyrequiresemployeestoreportanyULDsymptomsto
theirteamleaderwhorefersthemtotheoccupationalhealthservice.Their
workstationandtasksareassessedinlightoftheproblemsexperiencedand
appropriaterecommendationsgiven.Theteamleaderreviewsthesituation
weekly,andoccupationalhealthstaffregularlymonitortheemployees
symptoms.
Carryoutregularchecksonprogrammeeffectiveness
31 Regularhealthandsafetygroupmeetings(involvingseniormanagement,
occupationalhealthstaff,thecompanyergonomist,factoryengineersand
safetyrepresentatives)reviewriskmanagementissuesandtheimpact
ofriskreductionmeasurestaken.Theyalsoprovideeffectiveroutesofcommunicationbetweenstaffinvolved.
32 Followingtheinitialawarenessraisingcampaign(whichincludedissueofthe
ULDleaflet)therewasanexpectedincreaseinreferralstotheoccupational
healthservice.Thiswasfollowedbyasteadyreductioninreferralrateoverthe
followingtwoyears.Whentheleafletwasre-issuedtheanticipatedincreasein
referralswasnotexperienced.
33 Thereareongoingreviewsofoccupationalhealthdata,andafollow-upbody
partdiscomfortsurveyisplannedtoevaluatetheimpactoftheriskreduction
programme.
Case Study D: New counter design for cashiers
Background
34 Aleadingbookmakersgroupwithover11000staffand2000shops
plannedtoroll-outaradicallynewdesignofelectronicpoint-of-sales
(EPOS)systemandassociatedcounter.PreventionofULDriskswasa
majorconsiderationintheselectionofequipment,designofthecounter,
furnitureandsoftware.Thenewdesignandmanagementprogrammehadto
accommodatearangeofshopenvironments,staffregularlymovingbetween
premisesanddifferentcashierworkstations.
35 Thecashierstaskforwhichthenewdesignwasspecifiedmainlyinvolvessittingattheworkstationanddealingwithtransactions(handlingbettingslips
andmoney).TheEPOSsysteminvolvessomecomputerwork(keyboardand
mouseuse)tohandleandprocessbets.
Understandtheissuesandcommittoaction
36 ManagementrecognisedthatULDriskfactorswerepresentinthecashiers
taskegrepetitivelyreachingtothecountertopandawkwardstretchesto
reachequipment.Seniormanagementwassupportiveoftheplantointroduce
newcounterdesignguidelinesandrecognisedthepotentialimpacton
occupationalhealth.
Createtherightorganisationalenvironment37 Itwasagreedthatthenewcounterdesignandlayoutshouldbebasedon
ergonomicscriteria.Managementalsorecognisedthatprovidinginformation
toemployeesandhavingameansofidentifyinganyhealthproblemswas
essentialinmanagingoccupationalhealth.Aprojectteamwasassembled
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withrepresentativesfromfacilitiesmanagement,healthandsafety,ITandIT
development,linemanagement,andthegeneralworkforcetospecifyand
developthenewcounterlayoutandassociatedequipment.
AssesstheriskofULDsintheworkplace
38 Ariskassessmentidentifiedthatcertainmovementsandtaskswouldbe
required(reachingtocountertop,cashdrawer,handlingmoneyetc)which
containedtheULDriskfactorsofrepetition,reachingandawkwardposture.
Thisenabledergonomicscriteriatobespecifiedforthecounterdesign.
ReducetheriskofULDs
39 ToreducetherisksofULDs:
n ergonomicsadvicewassoughtforbodydimensioncriteriaonwhichto
basethecounterdesign;
n mock-upsofcountersweretrialledbycashiers;
n computerrelatedequipmentincludingscanner,printerandscreen,andtheirlayoutwerereviewedandtrialledtoreducetheriskofULDsand
ensuretheireaseofuse,(egscanningratherthankeyboardusewas
selectedfordataentryandequipmentwasplacedwithinthezoneof
comfort