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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 HSE’s current printed version.
Youcanbuythebookatwww.hsebooks.co.ukandmostgoodbookshops.
ISBN 978 0 7176 1978 8Price £9.50
Whereveryouworkthereisachancethatupperlimbdisorderscouldaffectyou.Theycancausepainandevenpermanentinjurytotheneck,shoulders,arms,wristsorhands.Inmostcasestheyarepreventableandthisbookshowsyouhowtoassessandminimisetherisksthroughpositiveaction.Itshouldhelpyoutocomplywiththelawandmakeyourworkplacesafer.
HSE Books
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Health and Safety Executive
© Crown copyright 2002
Firstpublished1990
ISBN9780717619788
Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorbyanymeans(electronic,mechanical,photocopying,recordingorotherwise)withoutthepriorwrittenpermissionofthecopyrightowner.
Applicationsforreproductionshouldbemadeinwritingto:TheOfficeofPublicSectorInformation,InformationPolicyTeam,Kew,Richmond,SurreyTW94DUore-mail:[email protected]
ThisguidanceisissuedbytheHealthandSafetyExecutive.Followingtheguidanceisnotcompulsoryandyouarefreetotakeotheraction.Butifyoudofollowtheguidanceyouwillnormallybedoingenoughtocomplywiththelaw.Healthandsafetyinspectorsseektosecurecompliancewiththelawandmayrefertothisguidanceasillustratinggoodpractice.
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ContentsPreface 5
Introduction 6Upper limb disorders: Understand the issues and commit to action 8 Understandtheissues 8Committoaction 11
Create the right organisational environment 13Participationandinvolvement 13Communication 14 Competence 14Allocationofresponsibilities 14
Assess the risk of ULDs in your workplace 15Whatisanergonomicsapproach? 15Identifyingproblemtasks 15Riskassessment 16ULDriskfactors 17
Reduce the risk of ULDs 24Lookingfor‘higherorder’solutions 24Usinganergonomicsapproach 24Basicprinciplesinimplementingsolutions 25Individualdifferences 25Suggestionsforreducingtherisk 25Otherguidanceonsolutions 25Afterimplementation 26
Educate and inform your workforce 27Trainingasacontrolmeasure 27Whoshouldreceiveeducation? 27Whatshouldtrainingcover? 27Makingtrainingmoreeffective 28Evaluationandfollowup 28
Manage any episodes of ULDs 29Reportingandrecording 29Referral 29Diagnosisandreturntowork 30Surveillance 31
Carry out regular checks on programme effectiveness 32Whymonitororreview? 32Monitoring 32Approachestomonitoring 32Examplesofpassiveandactivemonitoring 33Monitoringoutcomes 33Reviewing 34
Appendices 35Appendix1: Casestudies 35Appendix2: RiskFilter,RiskAssessmentWorksheets,suggestionsforreducing therisk 46Appendix3: Medicalaspectsofupperlimbdisorders 68
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Appendix4: Legalrequirements 76
References 81
Further information 89
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PrefaceTheHealthandSafetyCommission(HSC)hasastrategyfortacklingmusculoskeletaldisorders(MSDs)*includingupperlimbdisorders.ThestrategyadoptstheprinciplesofSecuringHealthTogether: A long-term occupational health strategy for England, Scotland and Wales.1ThisformsanintegralpartofRevitalising Health and Safety.2
Governmentdepartmentsinco-operationwithemployers,employees,tradeunions,employer’sorganisations,healthprofessionalsandvoluntarygroupshavesetseveralchallengingtargetsaspartofSecuring Health Together.ThesehavebeenusedinestablishinganHSCpriorityprogrammeformusculoskeletaldisorderswiththefollowingtargets,tobeachievedby2010:
n 20%reductioninincidenceofwork-relatedillhealthcausedbyMSDs;n 30%reductioninthenumberofworkingdayslostduetoMSDs.
Thepriorityprogrammeaimstoimprovecompliancewiththelaw,topromotecontinuousimprovement,andtodevelopthenecessaryknowledge,skillsandsupportsystemstoachievetheMSDtargets.Thisguidanceformsonestrandofthesupporttobeprovidedforemployers,employeesandthosewhoadvisethem.Itaimstoensurethattheyhavetherightinformationandadvicetopreventandmanageupperlimbdisordersintheworkplace.
* Thetermmusculoskeletaldisorders(MSDs)referstoproblemsaffectingthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.UpperlimbdisordersareasubcategoryofMSDs.
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Introduction
Understandtheissuesandcommittoaction
Createtherightorganisationalenvironment
AssesstheriskofULDsinyourworkplace
ReducetheriskofULDs
Educateandinformyourworkforce
ManageanyepisodesofULDs
Carryoutregularchecksonprogrammeeffectiveness
n IstheriskofULDsrecognisedinyourworkplace?n Ismanagementcommittedtopreventingor
minimisingtheriskofULDs?n Arethereadequatemanagementsystemsand
policiestosupportthiscommitment?
n Isworkerparticipationactivelysoughtandvalued?n Aresafetyrepresentativesinvolved?n Arealldepartmentsawareofthecontributiontheycanmake?n Iscompetenceensured?n Haveyouallocatedresponsibilities?
n AreanyULDshazardsidentifiedthroughsimplechecks?n AreriskfactorsforULDspresent?
Repetition Workingenvironment Workingposture PsychosocialfactorsForce IndividualdifferencesDurationofexposure
n HaveyouprioritisedyouractionstocontroltherisksofULDs?
n Haveyoulookedfor‘higherorder’solutions?n Haveyouutilizedanergonomicsapproach?n Haveyouimplementedsolutions?
n Haveyoueducatedandinformedyourworkforcetohelpprevention?
n HaveyouinvolvedsafetyrepresentativesincommunicatinginformationaboutULDsriskfactorsandcontrolmeasures?
n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworkpracticesandcontrolmeasures?
n HaveyouimplementedandsupportedasystemforearlyreportingofsystemsforULDs?
n DoyouactivelylookforsymptomsofULDs?n Haveyouarrangedforoccupationalhealthprovision?n Doyouhavesystemsinplaceforemployeesreturningto
workafteranULD?
n DoyouhavesystemsinplacetomonitorandreviewyourcontrolsforULDs?
n DoyouhavesystemsinplacetomonitorandreviewyourULDsmanagementprogramme?
n Areyouawareofnewdevelopments/information?n Doyouaimforcontinuousimprovement?
Figure 1 FrameworkforthemanagementofULDrisks
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1 Thisdocumentdescribeshowmanagers,togetherwiththeiremployees,cancooperatetominimisetherisksofupperlimbdisorders(ULDs)throughapositivemanagementapproach.ItgivesgeneralguidanceontheprocessesinvolvedandincludesariskassessmentfilterandworksheetsaswellasinformationonthemedicalaspectsofULDsandthelegalrequirements.
2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,arms,wrists,handsandfingers.ULDscanoccurinalmostanyworkplaceandtheycanusuallybeprevented.Whenpreventionhasnotworked,systemsareneededtomakesuretheyarepromptlyreported,properlydiagnosedandtreated.Employers’legalresponsibilitytopreventwork-relatedaccidentsandillhealthalsoappliestoULDs.
3 ThisguidancereplacesWork-related upper limb disorders: A guide to preventionandreflectsthechangesinourunderstandingofriskfactorsandcontrolstrategieswhichhaveemergedfromresearchoverthelastdecade.Thishasshowntheimportanceofpsychosocialriskfactorsactinginconjunctionwithphysicalriskfactors.IthasdemonstratedtheneedforanintegratedapproachtothemanagementofULDriskswhichaddressesbothorganisationalandphysicalaspectsoftheindividual’staskandworkenvironment.
4 Thisguidancepresentsanapproachwhichisbasedonsevenstagesinamanagementcycle.Thestagesare:
n understandtheissuesandcommittoaction;n createtherightorganisationalenvironment;n assesstheriskofULDsinyourworkplace;n reducetherisksofULDs;n educateandinformyourworkforce;n manageanyepisodesofULDs;n carryoutregularchecksonprogrammeeffectiveness.
5 Eachstageisconsideredinaseparatesectionoftheguidance.AnoverviewoftheapproachisshowninFigure1.(seealsoparagraph30)
6 Appendices1-4includethefollowing:
n Appendix1:illustratesreallifeexampleswheretherisksofULDshavebeenmanaged.
n Appendix2:providespracticalhelpwithriskassessmentandcontainsaRiskAssessmentFilterandWorksheetsandsuggestionsforreducingtherisk.
n Appendix3:givesbackgroundinformationonmedicalaspectsofULDs.n Appendix4:setsouttherangeoflegaldutieswhichapplytothe
preventionofULDs.
7 VibrationisincludedinthisdocumentwhereitcontributestothedevelopmentofULDs,buttheguidancedoesnotcoverallaspectsofthepreventionofvibration-inducedillnesses,suchasvibrationwhitefinger.3,4Inaddition,therisksofupperlimbdisordersduetoDisplayScreenEquipment(DSE)usearecoveredbytheDSEregulations,andseparateHSEguidanceisspecificallyavailableonthistopic.5,6DutyholdersmustcomplywiththeDSEregulations;howeverthisULDguidancemaybeusedtoprovidesupplementaryinformation.
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Upper limb disorders: Understand the issues and commit to action
n IstheriskofULDsrecognisedinyourworkplace?n IsmanagementcommittedtopreventingorminimisingtheriskofULDs?n Arethereadequatemanagementsystemsandpoliciestosupportthe
commitment?
Understand the issues
Whatareupperlimbdisorders?8 Thephrase‘upperlimbdisorders’isagenerallabelwhichisusedtoreferto
arangeofmedicalconditionswhichcanbecausedormadeworsebywork.Thereareanumberofcommontermswhicharealsoinusetodescribethesameconditions,ofwhichthemostwellknownis‘repetitivestraininjury’.Otherlesserknowntermsare‘cumulativetraumadisorder’,or‘occupationaloverusesyndrome’.Thesecommontermscanbemisleadingwithregardtothemanyfactorswhichcancontributetotheonsetoftheconditions,andforthisreasonthemoregeneraldescriptionof‘upperlimbdisorders’isusedinthisguidance.
9 Thetermupperlimbrefersto:
n thepartofthebody:thearmandhand,coveringaregionextendingfromthetipsofthefingerstotheshoulderandextendingintotheneck;
n thetissues:thesoft-tissues,musclesandconnectivetissues(tendonsandligaments)andthebonystructures,aswellastheskin,alongwiththecirculatoryandnervesupplytothelimb.
10 Theterm‘disorder’referstotheclinicaleffectsproducedbyunderlyingchangesinthetissues.Thesecomprisesymptomssuchaspain,experiencedbytheperson,andsignswhichareabnormalities,egintheappearanceofthelimb,whichmaybeapparenttothepersonormayonlybefoundonexaminationbyadoctor.Theseclinicaleffectsareaccompaniedbyfunctionalchanges,egareductionintheabilitytousetheaffectedpartofthelimbandareoftenassociatedwitharestrictionintherangeorspeedofmovement.Strengthandsensationmayalsobeaffected.Althoughtheclinicalandfunctionaleffectsareconfinedtothelimbitself,theirpresencewilloftenleadtoareductioninanindividuals’assessmentoftheirgeneralhealthandtoareductionintheirqualityoflife.
Figure 2
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11 Upperlimbdisorderscanbedescribedbythepartofthebodyaffected,orbythepresumedpathologicalmechanism.Therearecommontermsformanyoftheindividualconditions,suchas‘tenniselbow’and‘frozenshoulder’.AsimpleguidetothemorecommonupperlimbdisordersiscontainedinAppendix3.
12 PainisacommonsymptomofULDsbuttheexperienceofpainintheupperlimbisalsocommonamongstthegeneralpopulation.Therefore,feelingpainintheupperlimbisnotinitselfanindicationofthepresenceofanULD,andsuchsymptomsmaybedifficulttoattributetoworkwithanycertainty.
13 Paincanalsobeexperiencedintheformofstiffnessorsorenessofthemusclesaccompaniedbytemporaryfatigue.Thesesymptomsarecomparabletothosefollowingunaccustomedexertionwherenopermanentpathologicalconditionresults.Fullrecoveryusuallyoccursafterappropriaterest.
14 Atanyonetimeitispossibletoexperiencesymptomsintheupperlimbwhichresultfromanumberofdifferentcauses.ThisguidanceisprimarilyconcernedwithULDsforwhichthereisevidencetobelievethattheconditionscanbecausedby,ormadeworsebyworkactivity.
Areallupperlimbdisorderswork-related?15 Thesimpleanswerisno,butexperiencehasshownthatULDsareoften
directlylinkedtoworkplaceactivitiesorifduetoanon-workcause,madeworsebywork.
16 Itisimportanttorecognisethatthemusculoskeletalsystemiswellsuitedtoproducingrepeatedmotionsatlowforcelevels.Undesirableforcesmay,however,beimposedonmuscles,tendonsandjointsbysomejobdemandsandworkingpractices.Suchstressesareusuallywithinthephysicalcapabilityorstrengthofthetissues,providedtheforcesareofshortdurationandrestperiodsareadequate.Prolongedtissueloadingcausedbystaticpostureorperformanceofveryfrequentexertionscan,however,beharmful.
17 ThereareestablishedassociationsbetweenmanytypesofULDsandworktasks,orspecificriskfactorswithinthesetasks.7Evidencecomesfrom:
n anecdotalreportswhichhavehistoricallylinkedspecificoccupationsandparticularconditions;8
n clinicalcasestudiesandreportingschemesforoccupationaldiseases;9,10n workplacesurveysofsymptoms;11
n epidemiologicalreviews7,12andpopulationsurveys;13,14
n laboratorystudiesofthephysiologicalimpactofexperimentallyimposed physicalstresses.15,16,17
18 Thereviewsoftheepidemiologicalliterature7,18providegoodevidenceoftheassociationsbetweenworkplaceriskfactorsandULDs,particularlywhereworkersarehighlyexposedtotheseriskfactors.
19 Non-workactivities,suchasdomesticactivityandhobbies,maycontainsimilartypesofriskasarefoundinworkactivities.Thesetasksaregenerallynotasrepetitive,forceful,orprolongedasareworktasks.Also,theindividualhasahighdegreeofcontrolastowhentheactivitycanbetemporarilystoppedorabandonedaltogether.
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Howbigistheproblem?20 Musculoskeletaldisordersarethemostcommonworkrelatedailment
afflictingthegeneralpopulationinGreatBritain.Theyaccountformorethanhalfofallself-reportedoccupationalillhealth(morethan1millioncases).13Theseproblemsarenotconfinedtoparticularjobsorsectorsandarefoundthroughoutmostmanufacturingandserviceindustries.
21 Basedonahouseholdsurveydonein1995,anestimated506000peopleweresufferingfromamusculoskeletaldisorderwhichaffectedtheupperlimbsorneck.
22 Anestimatedminimum4.2millionworkingdayswerelostinBritainduetomusculoskeletaldisordersaffectingtheupperlimbsorneckin1995,witheachaffectedemployeetaking,onaverage,13daysoffwork.14Coststoemployersofmusculoskeletaldisordersoftheupperlimbsorneckwereestimatedtobeatleast£200million.
Whattypesofjobcarryparticularrisks?23 EvidencegatheredoverrecentyearsshowsthatULDsarenotconfinedtoany
oneparticulargroupofworkersorindustrialactivity,butarewidespreadintheworkforce.Thefollowinglistofgroupswhichhavereportedhighlevelsofarmpainillustratesthispoint.Acommonfeatureofthejobsisthattheirtaskshaverecognisedriskfactors:
n assemblylineworkers; n cleaninganddomesticstaff; n constructionworkers; n garmentmachinists; n hairdressers;
24 Thislistisnotexhaustive,andtherearemanyotherjobsthatcarryariskof
ULDs.Similarly,thepresenceofjobsonthislistdoesnotimplythattheriskofinjurytotheseworkerscannotbeadequatelycontrolled.
WhyshouldIbeconcerned?25 IfworkwhichcarriestheriskofULDsisnotmanagedproperlythenthe
consequencesareseenin:
n thehumancostofpainandsufferingexperiencedbyemployeesandtheirfamiliesthroughillhealth;
n lossofearnings;n lossoftheabilitytowork;n problemsinqualitycontrolandproductivity;n decreaseinefficiency;n sicknessabsence;n costsofstaffreplacementandtraining;n theriskoflitigation;n theriskofbadpublicity;n ariseininsurancepremiumsandcostsofcompensationtoinjured
workers.
26 Anywarningsignsmaybethe‘tipoftheiceberg’.Onepersonwithsymptomsmaymeantherearenumerousotherworkersalsoexposedtoriskfactors,andwhoareintheprocessofdevelopingadisorder.
Whataremylegalresponsibilities?27 TherearegeneraldutiesonallemployersundertheHealthandSafetyat
WorketcAct197419andtheManagementofHealthandSafetyatWork
n meatandpoultryprocessors;n mushroompickers;n potteryworkers;n secretaries/temps;n textileworkers.
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Regulations199920whichrequiretherisksofULDstobeaddressed.These,andotherlegalresponsibilitiesareoutlinedinAppendix4.
28 ULDshavealsobeenthesubjectofmuchcivillitigationoverthepasttwentyyears.21Althoughthelegalprocesshassometimesappearedinconsistentthereisnodoubtthattheemployer’sdutyofcaretowardstheiremployeeswithrespecttoULDsisnowwellestablishedinthecivilcourts.Thiscivillawdutyrunsparalleltotheemployer’sstatutoryresponsibilityunderhealthandsafetylegislation.
Commit to action
29 RealisingthatULDsmaybeariskwithin,andto,yourbusinessisnotenough.Itisessentialtoturnthatawarenessandunderstandingintoacommitmenttotakeactiontomanagetherisks.TheframeworkinFigure1outlinessevenstageswhichformasoundbasisfordevelopinganeffectiveprogrammeforthemanagementofULDrisks.
30 Thestagesareasfollows:
n Understand the issues and commit to action:ManagementandworkersshouldhaveanunderstandingofULDsandbecommittedtoactiononprevention.Thiscommitmentmaybeexpressedthroughpositiveleadershiponthetopic,bygeneratinganeffectivehealthandsafetypolicyonULDsandbyhavingappropriatesystemsinplace.Theseactionswillhelptopromoteapositivehealthandsafetycultureintheworkplace.
n Create the right organisational environment:Theorganisationalenvironmentshouldfosteractiveworkerparticipationandinvolvement,haveclearandopenlinesofcommunicationandencouragepartnershipworkinginthenextfivesteps.Thiswillinvolvedevelopingthecompetenciesofworkers,supervisorsandmanagersfortheirdifferingroles.
n Assess the risks of ULDs in your workplace:AcorefeatureofthemanagementprogrammeistoassesstheriskofULDs.Itneedstobedoneinasystematicwaybymanagersandworkerssothatthemainrisksintheworkplacecanbeidentifiedandprioritisedforaction.Asrisksarepotentiallywidespread,simplechecks,includingafilterquestionnairecanbeusedtoidentifyjobswhichrequireamoredetailedassessment.
n Reduce the risks of ULDs:Onceriskshavebeenassessedandprioritisedacoherentprocessofriskreductionshouldbeundertakenusinganergonomicsapproach.Possiblerisksshouldbereducedoreliminatedatsource.Implementationshouldincludeworkforceparticipationasthisisknowntoleadtobettersolutionsandmoreeffective,sustainedchanges.
n Educate and inform your workforce:Toenableparticipationandinvolvementoftheworkforceandforindividualstoassumetheirproperresponsibilities,provisionofeducationandinformationisvital.Trainingwillsupportallaspectsofthemanagementprogramme,andshouldbeconsideredasanongoingactivityandnotasa‘one-off’task.
n Manage any episodes of ULDs:ItisimportanttohaveasystemtomanageanyepisodesofULDs.Employeesshouldbeencouragedto
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identifyanysymptomsandtoreportthembeforetheybecomepersistent.Managersneedtorespondquicklybyreviewingrisksandintroducingmoreeffectivecontrols,ifnecessary.Theyalsoneedtoreassureemployeesthatreportingofsymptomswillnotprejudicetheirjoborposition.Earlymedicalmanagementcanstopestablishedcasesfromdeterioratingandalsohelptheprocessofreturntowork.
n Carry out regular checks on programme effectiveness:Toensure
thatthisprogrammecontinuestoworkproperlyovertimeregularchecksofeffectivenessshouldbecarriedout.ThiswillhelptoensurethatcontrolsonULDrisksremaineffectiveandwillallowyoutoprogressivelyimprovetheireffectiveness.
Managementcommitment31 Ifthisprogrammeofcontrolistoworkeffectivelythenitisimportantto
demonstratemanagementcommitmenttothewholeprocess.Effectivemanagementofoccupationalhealthrisksischaracterisedby:
n visibleseniormanagementinvolvement;n openmanagementstyle;n goodcommunicationswhichengenderownershipofproblems(ie
personalresponsibilityandparticipation);n anappropriatebalancebetweenhealthandsafetyandproductiongoals.
Supportingpoliciesandsystems32 AclearpolicyforthemanagementofULDssetsthedirectionforthe
organisationandmeansthatpeoplethroughouttheorganisation,howeverlargeorsmallitis,willknowthatthepreventionofULDsisanissuewhichhastobeaddressedinallstagesofbusinessplanning,bothforday-to-dayoperationsandinthelongerterm.
33 TheframeworkinFigure1andtheguidanceinthefollowingsectionsareameanstoturnyourintentionsintorealityandtokeeptheseintentionsunderscrutiny.
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Create the right organisational environment
n Isworkerparticipationactivelysoughtandvalued?n Aresafetyrepresentativesinvolved?n Arealldepartmentsawareofthecontributiontheycanmake?n Iscompetenceensured?n Haveyouallocatedresponsibilities?
34 TheeffectivemanagementofULDsrequiresseniormanagementcommitment.Inaddition,itneedsthepresenceintheorganisationofsharedandinterlinkedbeliefs,attitudesandbehavioursthatallowthemanagementofriskstoproceedeffectively.Theseelementsmakeupwhathasbeenreferredtoasthehealthandsafetyclimateorculture.KeyfeaturescrucialtodevelopingapositiveenvironmentfordealingwithULDproblemsinclude:
n participationandinvolvement;n communication;n competence;n allocationofresponsibilities.
Participation and involvement
35 Involvingstaffintheplanningandorganisationalprocessescanbeanimportantwayofincreasingthelikelihoodofsuccessofyourriskcontrolstrategy.Workershavefirst-handknowledgeandanalmostuniqueunderstandingaboutparticularaspectsofthetaskstheyperform.ItmayhoweverbeimportanttoprovideeducationandtrainingonULDsbeforeexpectingemployeestocontributefullytotheprocessofassessmentandcontrol.KeyindividualsareSafetyRepresentativesastheyprovideaneffectivechannelforcommunicationwiththeworkforcetheyrepresentandtheycanusetheirfunctionstoprovidea‘realitycheck’toensurethattheproposedcontrolmeasuresmightactuallywork.TheHealthandSafety(ConsultationwithEmployees)Regulations1996,22SafetyRepresentativesandSafetyCommitteesRegulations1996,23andtheOffshoreInstallations(SafetyRepresentativesandSafetyCommittees)Regulations198924requireyoutoconsultwithyouremployeesontheirhealthandsafetyatwork.ThiswouldextendtoactionsyouintendtotaketotackleULDs.FurtherinformationaboutemployeeparticipationcanbefoundinDevelopment of a framework for participatory ergonomics25 andalso Handle with care - assessing musculoskeletal risks in the chemical industry.26
36 AsupportivecompanycultureandopennesswillbeimportantfactorsinensuringthattheadverseeffectsofULDsarenot‘hidden’frommanagement.Encouragingearlyreportingofworkrelatedachesandpainstosupervisorsorlinemanagers,andinturntotheoccupationalhealthservice(ifyouhaveoneavailable)canprovidesignificantbenefitsforboththeemployeeandthecompany.Oneofthemaindifficultieswithreportingisthefearoftheoutcome,egpossiblybeingdeclaredunfitforwork.Thisiswhereanopen,positiveculturebecomesimportant.Employeesoughttofeelsafetoreportachesandpainsearlyintheironset.
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Communication
37 GoodcommunicationwillensurethatstaffmembersineverydepartmentofyourbusinessareawareoftherisksofULDsandwhattheycandotohelpreducethem.Productdesignstaffwillinfluencethedetailsofthemanufacturingprocessandthedecisionsofmarketingstaffwilldeterminethenatureofthepackagingrequired.Purchasingdepartmentswillcontrolthesourcingoftheequipmentusedandgeneralmanagementwilldeterminetermsandconditionsincludingworkingschedules.Insomecases,factorswhichinfluencetheserisksmaybecontrolledatadistanceinaparentorganisation.Arangeofmethodsshouldbeusedtoensurethateveryoneiskeptinformedofhowtheirrolescanimpactonotherworkersandalsothecompany’sprogrammeonthepreventionofULDs.Thesearelikelytoincludeseminars,meetings,postersandarticlesinthehousejournalornewsletter.Theinternetalsoprovidessomeusefulwebsites,someofwhichareincludedintheFurtherInformationsection.
38 Anopensystemofcommunicationshouldprovideopportunitiestodistributeinformationtoemployeesandalsoopportunitiesforfeedback.Thiscanbeinformal(egtosupervisors)ormorestructured,forexamplethroughregularsurveys.Ifcomplaintsoccurtheyshouldbeinvestigated.
Competence
39 ItisimportantthatpeoplearecompetenttopreventULDswithintheirtechnicalareasofresponsibility.Healthandsafetytrainingisimportant,payingparticularattentiontotheriskfactorsforULDsandhowthesemaybeavoided.Somegroupsofstaffmayrequirespecialisedtraining,egintheapplicationofergonomicprinciples,evaluationofworkplacechangesortherecognitionofupperlimbhealthcomplaints.
40 Theneedforcompetencealsoextendstoareassuchastheoperationofrecruitmentandplacementproceduresandsystemstoidentifytrainingneedswhenworkpracticesandtechnologieschange.Staffdevelopmentsystemscanbeusedtoensurethatindividualshaveaccesstothetrainingtheyrequire,andtheiroperationcanformpartoftheregularchecksonprogrammeeffectiveness.
Allocation of responsibilities
41 AsmanypeoplewillhavearoleinyourprogrammetopreventULDs,itisimportanttobeclearaboutwhoisresponsibleforwhatfunctions.Forexample,supervisorswhounderstandtheriskscantakeanactiveroleinhelpingtocontrolthem,andinencouragingstafftoreportanyproblems.Youmayneedtosetupsystemstodealwithanyproblemswhichmayoccur,toensureanearlyresponsetothem.
42 Settingobjectivesforyourorganisation,withclearrolesandaccountabilitieswillhelpkeepyouontarget.Youmaybeabletousebenchmarkingasawayofcheckingprogress,egbetweendepartmentsorwithneighbouringbusinesses.
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Assess the risk of ULDs in your workplace
n AreanyULDhazardsidentifiedthroughsimplechecks?n AreriskfactorsforULDspresent?n Repetition,workingposture,force,durationofexposure,working
environment,psychosocialfactors,individualdifferences,
43 AssessingtheriskassociatedwithULDsinvolvestwomajorstepsnamely:
n identifyingproblemtasks;andn riskassessment.
44 Anexampleofamethodfortacklingtheabovetwostepscanbefoundin
Appendix2.
45 Inordertobeabletogetthemostbenefitfromtheprocess,youandyourworkforceneedtobeabletoworktogethertoidentify,assessandcontroltheriskofULDs.Thisprocessshouldinvolveanergonomicsapproachandshouldincludetheparticipationofworkers.
What is an ergonomics approach?
46 Ergonomics(orhumanfactors),isconcernedwithensuringworkisdesignedtotakeaccountofpeople,theircapabilitiesandlimitations.Itsobjectiveistooptimisehealth,safetyandproductivity.AnergonomicsapproachisthemosteffectivewayofdealingwithULDproblems.Thisisbecauseitencouragesyoutotakeaccountofalltherelevantpartsoftheworksystemandrequiresworkerparticipation.
Identifying problem tasks
47 Therearetwomainapproachesyoucanusetoidentifyifyouhaveaprobleminyourworkplace.Firstlymanagersandworkerscanlookforanysignsofproblemsorsymptomsamongsttheworkforce.Secondly,youcanobserveworktasksthemselvestoseeifriskfactorsforULDsarepresent.ThiscanbedoneusingasimpleinitialassessmentofriskssuchastheriskfilterapproachfoundinAppendix2.Sourcesofinformationthatmayhelpincludeexpertadvice,industrystandardsandlegislativestandards.
Warning signs48 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 Paragraphs120-128outlineotherwaysofmonitoringthenumberofworkerswhoareexperiencingupperlimbpainordiscomfort.
Risk Filter 50 Adetailedassessmentofeveryjobcouldbeamajorundertakingand
mightbeanunnecessaryeffort.Tohelpidentifysituationswhereadetailedassessmentisnecessary,aFilterforaninitialscreeningoftaskshasbeendevised.WheretheFilteridentifiesseveralriskfactorsincombination,theriskofULDsislikelytobegreater.AcopyoftheRiskFilterandinstructionsforusecanbefoundinAppendix2.
Risk assessment
51 OnceyouhaveidentifiedthatcertaintasksmaybecreatingariskofULDs(bylookingforsignsandsymptomsandusingtheriskfilter),amoredetailedriskassessmentshouldbeconducted,involvingmanagersandworkers,inordertoascertainthelikelihoodandseverityofrisk.ULDassessmentworksheetsthatcanassistinrecognisingandrecordingriskfactors,canbefoundinAppendix2.
The risk assessment process52 Ajoboftenconsistsofseriesoftasks.Performingyourriskassessmentcan
besimplifiedbythinkingintermsofthesetasksandtheirsubsidiaryelements.Toillustratethispoint,Figure4describesthejobofaprocessworkerthatconsistsofthreedifferenttasksonanassemblyline:
n station1:attachingahandle;n station2:grinding,and;n station3:packing.
53 Ascanbeseeninthisexample,thesetaskscanalsobefurtherbrokendownintoelements,whicharedistinctsequencesofmovementwithinthetask.
54 Lookingattaskelementscanhelpbothinidentifyingthecausesofrisksandindevisingpotentialsolutions.Forexample,inthecaseoftheprocessworkertheriskfiltermightidentifythetaskofattachingahandle(station1)asposingapossiblerisk.Themoredetailedassessmentusingtheworksheetwouldidentifyrepeateduseofapinchgripwhenpickingupandpositioningthescrews(elements1and2),andawkwardarmpostureouttothesideofthebodywhendrilling(element3).Whenconsideringthetaskinthiswayitiseasiertolinktheriskstoparticularactionsoroperations,whichthenhelpswhenconsideringriskreductionmeasures.
55 Inthiscasebetterpositioningoftheassemblylineinrelationtotheworker,andre-orientatingtheobjectswillreducetherisktotherightarmandshoulder.Reducingthedurationspentonthetaskandintroducingmorefrequentbreakswillreducetheriskassociatedwithusingthepinchgrip.
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Figure 4 Thetasksandelementsofaprocessworker’srole
56 Remembertoconsiderwhetherworkersperformanumberofpotentiallyriskytasks(iethathavebeenhighlightedbytheriskfilter),inagivenshift.Ifthisisthecase,itisessentialthatyourriskassessmentconsiderstheoverallimpactofperformingthecombinationoftasksinyourriskassessment.Inpractice,thiswouldusuallymeanthataseparatefilterandriskassessmentworksheetwouldbefilledoutforeachtask,andthatthecompletedworksheetswouldbeconsideredincombinationwhendecidingontheoveralllevelofriskforthoseworkers.DetailedinstructionsfortheriskfilterandriskassessmentworksheetscanbefoundinAppendix2.
57 Otherriskassessmenttoolsareavailable.27,28,29,30Theserangefromstandardisedorquantitativetoolsthatareusuallyrequiredtobeundertakenbyacompetentperson,tosimplechecklists.Engagingacompetentpersonmaybeappropriateformorecomplexriskassessments.
ULD risk factors
58 Riskfactorscanbethoughtofastask,environment,orworker-relatedwithinanergonomicapproach.TheprincipalULDriskfactorsare:
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59 Eachoftheseriskfactors,includingtheirdefinitionsandwhytheycreatetheriskofULDs,willbediscussedinmoredetailinthefollowingparagraphs.
60 RiskfactorscommonlyinteractwitheachotherincreatingtheoverallriskofULDs.Forexample,thetaskofgrippingaheavypowertoolwithalargehandleforsixhourswouldresultinanawkward,forcefulgrippingpostureandexposuretovibrationoveraprolongedperiod.Thereforeworkingpostures,duration,forceandworkingenvironmentareallriskfactorsforinjuryinthistask.
61 Incontrast,ifthistaskwasonlydoneforashortperiodineachshift,theriskofinjurymaynotbehigh.Thisisdespitethefactthattheriskfactorsofworkingpostures;forceandvibrationarestillpresent.
62 Generally,thereisanincreasedriskofinjurywhenthereareanumberofriskfactorsactingincombination.However,oneriskfactoractingalonecancreateanunacceptableriskofinjuryifitissufficientlygreatinmagnitude,frequencyorduration.
Repetition63 Workisrepetitivewhenitrequiresthesamemusclegroupstobeused
overandoveragainduringtheworkingdayorwhenitrequiresfrequentmovementstobeperformedforprolongedperiods.
64 Rapidorprolongedrepetitionmaynotallowsufficienttimeforrecoveryandcancausemusclefatigueduetodepletionofenergyandabuildupofmetabolicwastematerials.Repeatedloadingofsofttissuesisalsoassociatedwithinflammation,degenerationandmicroscopicchanges.Fastmovementsandaccelerationrequirehighmuscleforces.
Figure 5
Taskrelatedfactorsn repetition;
n workingpostures;
n force;
n durationofexposure.
Environment-relatedfactorsn workingenvironment;
n psychosocialfactors.
Worker-relatedfactorsn individualdifferences.
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Workingposture65 Workingposturescanincreasetheriskofinjurywhentheyareawkwardand/
orheldforprolongedperiodsinastaticorfixedposition.
Figure 6
Awkward postures66 Anawkwardpostureiswhereapartofthebody(egalimbjoint)isused
wellbeyonditsneutralposition.Aneutralpositioniswherethetrunkandheadareupright,thearmsarebythesideofthebody,forearmsarehangingstraightoratarightangletotheupperarm,andthehandisinthehandshakeposition.Forexample,whenaperson’sarmishangingstraightdownwiththeelbowbythesideofthebody,theshoulderisinaneutralposition.However,whenemployeesareperformingoverheadwork(egrepairingequipmentoraccessingobjectsfromahighshelf)theirshouldersarefarfromtheneutralposition.
67 Whenawkwardposturesareadopted,additionalmusculareffortisneededtomaintainbodypositions,asmusclesarelessefficientattheextremesofthejointrange.Resultingfrictionandcompressionofsofttissuestructurescanalsoleadtoinjury.
Static postures68 Staticposturesoccurwhenapartofthebodyisheldinaparticularposition
forextendedperiodsoftimewithoutthesofttissuesbeingallowedtorelax.Whenholdingabox,forexample,itislikelythatthehandsandarmsareinastaticposture.
69 Staticloadingsrestrictbloodflowtothemusclesandtendonsresultinginlessopportunityforrecoveryandmetabolicwasteremoval.Musclesheldinstaticposturesfatigueveryquickly.
70 Inboththeabovetypesofposture(awkwardandstatic),theriskofULDswillberelatedtothenumberoftimesthepostureisrepeated,theamountofforcerequired,and/orthelengthoftimeitisheld.AswithalltheriskfactorsforULDs,theimpactoftheworkingpostureneedstobeunderstoodinrelationtootherriskfactors.
Force71 Forcecanbeappliedtothemuscles,tendons,nervesandjointsoftheupper
limbby:
n handlingheavyobjectswhenperformingtasks,ieanexternalload;n fastmovementorexcessiveforcegeneratedbythemusclesofthebody–
oftentobetransmittedtoanexternalload,egtryingtoundoastiffbolt;n localforceandstressfromitemscomingintocontactwithpartsofthe
upperlimb,suchasthehandleofapairofpliersdiggingintothepalmofthehand.
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Figure 7
72 Thelevelofforcethatisgeneratedbythemusclesisaffectedbyanumberoffactorsincluding:
n workingposture:thelevelofmusculareffortrequiredincreaseswhenapartofthebodyisinanawkwardposture;
n thesizeandweightofobjectsbeinghandled;n thespeedofmovement:asextraforceisneededatthebeginningand
endoffastmovementssuchashammering;andn vibratingtoolsorequipment:asoperatorsneedtouseincreasedgrip
forceinworkingwithvibratingequipment.73 Useofexcessiveforcecanleadtofatigueandifsustained,toinjury,either
throughasingle-eventstraininjuryorthroughthecumulativeeffectoftherepeateduseofsuchforce.Localforceandstresscanalsocausedirectpressureonthenervesand/orbloodvesselsandincreasetheriskofdiscomfortandinjury.
Force in gripping74 Theneedtogriprawmaterials,productortoolsisapotentialriskfactor
ifexcessiveforceisused.Theamountofforcerequiredtogripcanbeinfluencedbythetypeofgripused,thepostureofthewrist,exposuretocoldandvibrationandtheeffectsofwearinggloves.
75 Theforcerequiredtogripobjectsisalsodependentuponthematerialoritembeinggripped.Forexample,ascrewdriverhandlewithaflexiblegriprequireslessforcewhenbeingusedthanonewithaharderhandle.Thesizeoftheobjectbeinggrippedcanalsoaffecttheforcerequired.Forexample,plierswithtoowideortoonarrowaspanwillbemoredifficulttogrip.
76 Muscleforceisgreatestwhenapowergrip(eggrippingahandleinthepalmwithfingersandthumb)isusedas,thisallowsalargesurfaceareaofthehandtobeutilised.Thestrongestgripstrengthoccurswhenthewristisclosetothe‘handshake’positionandisslightlybentupwards.
Durationofexposure77 Durationreferstothelengthoftimeforwhichataskisperformed.It
includesthelengthoftimethatthetaskisundertakenineachshift,plusthenumberofworkingdaysthetaskisperformed(egfourhoursperday,fivedaysperweek).Durationisanimportantconceptinassessingtheriskofmusculoskeletaldisorders.
78 Itisgenerallyacceptedthatmanytypesofupperlimbdisordersarecumulativeinnature.Therefore,whendurationtimeisincreasedtheriskofinjuryisincreased.Thisisbecausewhenpartsofthebodyundertakeworkforperiodswithoutrest,theremaybeinsufficienttimeforrecovery.Consequently,timefortheindividual’sbodytorecoverfromaspecifictaskortasksisimportant.
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79 Shortexposuresareunlikelytocreatesignificantriskofinjury,exceptwherethetaskisexceptionallydemandingand/ortheworkerhasnotbeenallowedtobuilduptoitsdemandsoveraperiodoftime.Thiscanoccurafterreturntoworkfromholidaysorwithanincreaseinworkpace.
Figure 8
Workingenvironment80 Workingenvironmentreferstoaspectsofthephysicalworkenvironmentthat
canincreasetheriskofULDs.Thisincludesfactorssuchasvibration,coldandlighting.
Vibration81 Exposuretohand-armvibrationresultsfromtheuseofhand-held/guided
powertoolsandequipmentorfixedmachinerysuchasbenchgrinderswheretheworkpieceisheldbytheworker.VibrationcanincreasetheriskofULDsandisknowntocausevibrationwhitefingerandcarpaltunnelsyndrome,lossofsenseoftouchortemperature,painfuljointsandlossofgripstrength.Informationaboutthedose(ievibrationmagnitudeandexposuretime)ofvibrationisneededinordertoaccuratelyassesstherisk.FurtherinformationonvibrationcanbefoundinHand-arm vibration3,ISO5349-24andAppendix3.
Figure 9
Cold82 Workingincoldtemperatures,handlingcoldproductsorhavingcoldair
blowingonpartsofthebodycanplaceadditionaldemandsonthebodyaswellaspossiblyrequiringtheuseofpersonalprotectiveequipment(whichcancompoundtheriskbyrequiringadditionalforcetogrip).Exposuretocoldcanresultindecreasedbloodflowtothehandsandupperlimbs,decreasedsensationanddexterity,decreasedmaximumgripstrengthandincreasedmuscleactivity(whichispartofthebody’snaturalresponsetobeingcold).
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Figure 10
Lighting83 Thevisualdemandsofthetaskareanimportantconsideration,sincea
worker’sposturecanbelargelydictatedbywhattheyneedtosee.Dimlight,shadow,glareorflickeringlightcanencourageworkerstoadoptabentneckandpoorshoulderposturesinordertoseetheirwork,therebyexacerbatingtheeffectsofotherriskfactors.FurtherinformationonlightingcanbefoundinLightingatwork.31
Figure 11
Psychosocialfactors84 Physicalriskfactorsexerttheirharmfulinfluencethroughphysiologicaland
biomechanicalloadingoftheupperlimb.Ofequalimportanceisthelargebodyofworkshowingthataworker’spsychologicalresponsetoworkandworkplaceconditionshasanimportantinfluenceonhealthingeneralandmusculoskeletalhealthinparticular;thatis,workasexperiencedbyworkers.Thesearereferredtoaspsychosocialriskfactors.Theyincludethedesign,organisationandmanagementofworkandtheoverallsocialenvironmentingeneral(thecontextofwork)andalsothespecificimpactofjobfactors(thecontentofwork).Itisverylikelythatphysicalandpsychosocialriskfactorscombineandthatthegreatestbenefitwillbeachievedwhenbothareidentifiedandcontrolled.Manyoftheeffectsofthesepsychosocialfactorsoccurviastress-relatedprocesseswhichincludedirectbiochemicalandphysiologicalchanges.Alsoincludedareinstanceswhereindividualstrytocopewithstressfuldemandswithbehavioursthat,inthelongterm,maybedetrimentaltohealth.Anexamplewouldbewhereanindividual,becauseofhighworkloadordeadlines,foregoestherestbreakstowhichtheyareentitled.
85 Psychosocialriskfactorsarecommoninsectorswhereupperlimbdisordersoccur13.Importantaspectsofworkdesignincludetheamountofcontrolpeoplehaveintheirjobs,thelevelofworkdemands,thevarietyoftasksthattheyhavetocarryoutandthesupporttheyreceivefromsupervisorsand
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co-workers.Manyjobsarenotwelldesignedandincludesomeorallofthefollowingundesirablefeatureswhere:
n workershavelittlecontrolovertheirworkandworkmethods(includingshiftpatterns);
n tasksrequirehighlevelsofattentionandconcentrationespeciallyinconditionswheretheworkerhaslittlecontrolovertheallocationofefforttothetask;
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,psychosocialissuesarebestaddressedwithfullconsultationandinvolvementoftheworkforce.
Individualdifferences86 Allindividualsaredifferentandforbiologicalreasonstheremaybesome
peoplewhoaremoreorlesslikelytodevelopanULD.IndividualdifferencesmayalsohaveimplicationsforemployeesreportingULDtypeconditions.Whereanergonomicapproachisfollowed,thisshouldensurethattasksarewithinthecapabilitiesoftheentireworkforce.Somefactorsmayincreasetheriskofdevelopingsymptomsandshouldbeconsideredinthemanagementprogramme.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 ULDsn HaveyouprioritisedyouractionstocontroltherisksofULDs?n Haveyoulookedfor‘higherorder’solutions?n Haveyouutilisedanergonomicsapproach?n Haveyouimplementedsolutions?
87 Havingassessedtheworktodeterminethelikelihoodandscaleoftherisksassociatedwitheachoftherelevanttasks(andthetasksincombinationwhereapplicable),youmustimplementcontrolsinordertoreducetheserisksasfarasisreasonablypracticable.
88 Prioritiseactionssothat,forexample,seriousrisksaffectinganumberofemployeesaretackledbeforeanisolatedcomplaintofminordiscomfort.
Look for ‘higher order’ solutions
89 Ahierarchicalapproachtoriskreductionandcontrolshouldbefollowedwherepriorityisgiventoeliminationofriskatsource.Firstly,considerifitisreasonablypracticabletoeliminatethehazard,egbyredesignoftheworktask,bysubstitutionorreplacementoftoolsorcomponents,orthroughautomationofthetask.Insomecasesitmaybepossibletoisolatetherisksatsourcebyengineeringcontrolsorprotectivemeasures,egbyshieldingtheworkerfromdraughtsorbypreventingexposuretovibration.Wherethesearenotviable,thelowestorderinthehierarchyofcontrolsistominimiseriskbydesigningsuitablesystemsofwork,usingPPEifappropriateandtoprovidetraining.
Using an ergonomics approach
90 Asinriskassessment,anergonomicsapproachisimportantindevelopingyourinterventionstoreducerisk.Aparticipativeapproachtosolutionfindingisconsideredtobethemosteffectivemethodforinterventiondevelopment.18Interventionsmayinvolvechangestothetask,theworkingenvironment,ortheindividual(orworkgroup)ortoallofthese.Researchhasshownthatinterventionsthattakeaccountofalltheseaspectsaremoreeffectiveinreducingrisk:
n Changestotheworktask(s)mayincluderedesignoftheworkstationandworkequipment.Itmayincludetheprovisionofappropriatefurniture,equipmentortoolsthathavebeenmatchedtotheneedsoftheworkersandthetask.JobrotationorautomationmaybebeneficialinreducingULDrisks.
n Changestotheenvironmentcouldincludemodificationstothethermalconditions,vibrationexposureorlightinglevels.Changestoinfluencepsychosocialfactorsmayberequired.Areviewoftheworkorganisationandstructuresuchasreductionofworkhoursorchangestoschedulingofbreaks,ormodifyingpacingorincentiveschemesmayalsobehelpful.
n Trainingandprovisionofinformationtoindividualsorworkgroupsmayalsobeneededtosupportotherchanges.
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Basic principles in implementing solutions
91 Riskscanberemovedorreducedthroughsystematicattentiontosomeorallofthefactorsmentionedpreviously.Somehelpfulprinciplesare:
n greatbenefitoftenresultsfromsimpleandlowcostinterventions(egchangesinworkingheight)whicharegenerallymorepracticalandeasiertoimplement;
n consideranumberofpossiblesolutions,preferablytryingthemoutonasmallscalebeforedecidingononetoimplement;
n employeescanbeespeciallygoodatdevisingeffectiveandpracticalimprovementmeasures;
n checkthatanychangesdonotcreatenewhealthandsafetyriskselsewhere;
n successfulimplementationoftenrequirestheinvolvementofallemployeesfromthetopleveldownwards.Evensoundergonomicsolutionsmaynotbesuccessfuliftheyareimposed.Involvingworkersinproblemsolvingandtheimplementationprocesses,givesanenhancedsenseofownershipofthesolutionsandmaycreateagreatercommitmenttotheireffectiveimplementation;
n inlarge,geographicallyspreadorganisations,incorporateshort-termlocalinitiativesintothecompany’soverallhealthandsafetystrategy;
n refertocasestudiesfromothersources,egfromtradeassociationsortheInternet,forideasconcerningbestpracticesolutions.
Individual differences
92 AlltasksshouldbedesignedsotheycanbeundertakenwithoutcreatingariskofULDs.ThereisnoscientificallyvalidscreeningtestwhichcanpredictthefuturedevelopmentofULDsinanindividual.Placementproceduresshouldtakeaccountoftheriskassessment,jobrequirementsandtheindividualdifferencesoutlinedintheprevioussection.
93 Newemployees,particularlyyoungworkers,andthosereturningtoworkfromaholiday,sicknessorinjury,mayneedtobeintroducedtoaslowerrateofproductionthantheexisting‘workforce’,followedbyagradualincreaseinpace.Thisworksbest,forexample,byonlyworkingforalimitedtimeperdayatproductionspeed,increasingasappropriate.Introducingnewcomersataslowerpaceenablesthemtodevelopgoodworkpracticesbeforehavingtoconcentrateonworkingfastandhelpsthemtoassimilatetrainingmoreeffectively:ideally,earlytrainingshouldbedone‘off-line’.Regulation12intheManagementofHealthandSafetyatWorkRegulations199920detailsrequirementsconcerningnewemployees.
Suggestions for reducing the risk
94 SomeexamplesofapproachesthatmaybeusefulforreducingtheriskofULDsarelistedinAppendix2.
Other guidance on solutions
95 HSEhasproducedanumberofpublicationsthatprovideguidanceonreducingworkplacemusculoskeletaldisorders.Thisincludesguidancebasedoncasestudies33,34aswellassomethatisindustry-specific.InformationcanalsobefoundontheHSE,andsomeotherwebsites.See‘furtherinformation’forsources.
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96 Ifyouareunsureofhowtoapproachimplementingchangeswithintheworkplace,youmaywishtoconsiderseekingspecialistadvicefromanergonomistorotherworkplacehealthandsafetyconsultant.
After implementation
97 Finally,itisimportanttomonitorthesituationtomakesuresolutionsarestilleffectiveatalaterdate(particularlywheretheirsuccessdependsonsomeformoflearningorbehaviourchange).Keepabreastofnewdevelopments(egwhennewmachineryorstaffareintroducedintotheworkplaceorwhenotheralternativeriskcontrolmeasuresaredeveloped).Monitoringandreviewingareexplainedinparagraphs120-132.
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Educate and inform your workforce
n Haveyoueducatedandinformedyourworkforcetohelpprevention?n Haveyouinvolvedsafetyrepresentativesincommunicatinginformation
aboutULDriskfactors?n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworking
practicesandcontrolmeasures?
98 EducationandtrainingarecomplementarytoallotheraspectsofyourprogrammeforthepreventionofULDsandindeedarecriticaltoitssuccess.InformingstaffaboutsignsandsymptomsofULDs,riskfactors,controlmeasuresandtheneedforearlyreportingandactionwillimprovetheoveralleffectivenessofyourprogrammeandwillencourageemployeestobecomeactivelyinvolvedinidentifyingandcontrollingULDrisks.
Training as a control measure
99 TrainingshouldnotbereliedonastheprimarymeansofcontrollingtheriskofULDs.Influencingthewayworkersperformtasksthroughtrainingisanessentialpartofriskcontrol,butrelyingonthisalonehasbeenshowntohavelimitedsuccessinprevention.Trainingshouldideallycomplementotherhigherordercontrolsthathavealreadybeenimplemented(ieredesignoftheworktask,substitutionorreplacementoftoolsorcomponents,isolatingtheriskatthesourceetc).Itcanbeverybeneficialtoinvolveemployeesinthedevelopmentandpresentationoftraining.
Who should receive education?
100 Allworkers,supervisorsandmanagersshouldreceiveeducationonULDstoenablethemtoidentifytheearlywarningsignsofpotentialULDriskfactors.Educationshouldalsoextendtopurchasingstaff,engineers,maintenanceandsupportstaff,particularlywheretheyareinvolvedinspecifying,designingormodifyingworkequipmentinordertoincreasetheirawarenessofergonomicissuesandULDriskfactors.
What should training cover?
101 TrainingcanbedesignedbothtoraisegeneralawarenessofULDissuesandtoaddressthespecificneedsofaparticularjobortask.Generaltrainingshouldaimto:
n increaseawarenessandknowledgeofULDissues/problemsintheworkplace;
n reducethelikelihoodofULDproblemsbyprovidingadequateinformation:– recognitionofsymptomsofULDs(seeAppendix3);– riskfactorspresentintheworkplace;– safeworkingmethods;– correctoperationofcontrolmeasures;– theimportanceofproceduresfortheearlyreportingofULDsymptoms.
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102 Task-specifictrainingshouldconsiderULDriskfactorsassociatedwiththejobingreaterdetail.Suchtrainingshouldincludeareviewofriskfactorsrelatedtotasksandsafeworkingmethodsforthatparticulartask.Anyspecificcontrolmeasuresassociatedwiththejob,includingpersonalprotectiveequipmentshouldalsobecovered.
Making training more effective
103 TrainingthatinvolvesnomorethansittingwithanexperiencedemployeewhodoesnothaveappropriateunderstandingofULDsisunlikelytobesatisfactorysincebadhabitsandpracticescaneasilybepassedontothenewemployee.Whenattemptingtoalterworkerbehaviour,programmeswillneedtoconsider:
n adversetraditionalmethodsandingrainedhabits;n productionpressures;n anyperceptionthatnewmethodsaredifficultortimeconsuming;n anylackofunderstandingofriskfactorsforULDs;n situationswhereimprovementsinjobmethodsmaybeconstrainedby
poorworkplacelayout,materials,equipmentand/orjobdesign;n employeeinvolvement.Thisisfundamentaltothesuccessofanytraining
programme.Employersshouldpromoteparticipationbyencouragingdiscussion,askingemployeesforsuggestionsandcommentsontrainingissuesand,whereappropriate,involvingemployeesinthepresentationoftrainingmaterial;
n theroleofsafetyrepresentativesinpromotingsafeworkingpracticesandreinforcingtrainingmessages;
n theneedtoprovideopportunitiesforimmediatepracticeandfeedbacksoastocorrectperformanceandtoensurethatskilllevelscanbemaintainedfollowingtraining.Principlescoveredintrainingsessionsshouldbereinforcedbysupervisors,safetyrepresentativesandpeersonaregularbasis;
n theneedforperiodicrefreshertrainingforallemployees.
Evaluation and follow up
104 PeriodicevaluationofyourtrainingprogrammesshouldbeundertakenaspartofageneralreviewofyourULDpreventionprogramme.Employeesshouldbeinvolvedinthisprocess,particularlysafetyrepresentativesandsupervisors,whocanassesstheimpactandeffectivenessofthetrainingoffered.Trainingshouldalsobereviewedwhentherearechangesin:
n workplacelayouts,taskdesignorworkorganisationortheintroductionof
newworkequipment;n workpracticesorcontrolmeasures;n reportedinjurylevelsinotherworkplacesintheindustry,orinworkplaces
withsimilarjobs.
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Manage any episodes of ULDsn Haveyouimplementedandsupportedasystemforearlyreportingof
ULDs?n DoyouactivelylookforsymptomsofULDs?n Haveyouarrangedforoccupationalhealthprovision?n Doyouhavesystemsinplaceforemployeesreturningtoworkafteran
ULD?
105 AdequatecontrolofriskfactorswillgoalongwaytopreventtheoccurrenceofULDs.Duetoindividualdifferencesinthebody’sresponsetostressesitisnotpossibletoensurethateverypossibleepisodeofULDswillalwaysbeprevented.Itisnecessary,therefore,tohaveasysteminplacetomanageanyreportsorcasesofULDsthatariseintheworkforce.Theapproachtomanagingthesecomplaintsisbroadlysimilarwhethertheyarethoughttohavebeencausedbyworkactivity,beenmadeworsebytheworkorarelargelyunrelatedtoparticularworktasks.
Reporting and recording
106 IndividualswillvaryintheirwillingnesstoreportearlysymptomsofULDs.Itisimportanttomaintainaclimateinwhichearlyreportingofsymptomsisregardedpositivelyandthiswillbeencouragedifmanagersandsafetyrepresentativesbothemphasisethebenefitsofsuchearlydetectionofpossibleharm.Educationonpossiblesymptomsandsigns,whotoseeinthecompanyandwhathelptoexpectshouldbeprovidedtoallemployeeswherethereisaresidualriskofULDs.Employeesshouldbeadvisedtohaveanyrelevantsymptomsrecordedinthecompany‘accidentbook’.Anyfirstaidprovidedshouldalsobedocumented.
107 Ifsymptomsaresuchthatcontinuingtoworkdoesnotmakethemworse,thenitmaybeenoughtoprovidetheworkerwithreassurance,adviceonriskfactors,andtoreviewtheindividual’sworktaskswiththem.
108 Ifcontinuingtoworkatthesamejobcausessymptomstogetworseorbecomeprolonged,orifthepersonwasconcernedaboutthenatureofthesymptomsthenitwouldbeappropriatetoobtainfurtheradvicebymeansofareferraltoahealthprofessional.AdiagnosticsupportaidforULDshasbeendevelopedandislikelytobeofbenefittoGeneralPractitioners(GPs)andotherhealthprofessionals.35Ifsymptomsareaggravatedbyaperson’scurrentjobitisadvisabletolookforalternativeworkthattheycando,evenifthisisquitedifferentfromtheirnormalduties.Thiscanpreventtheneedforsicknessabsenceandallowforrecoverytimebeforereturntotheirnormalduties.
Referral
109 Onewaytoobtainhealthadviceisbyreferraltoanoccupationalhealthservice,eitheronoroffsite.Appendix3containsmoreinformationonthescopeofoccupationalhealthprovisionandhowtoaccessthis.Accesstoanoccupationalhealthservicewillusuallyallowboththeworkerandtheirmanagertobegivenappropriateadvicewithminimaldelay.Theindividualwillbeadvisedonthenatureoftheircomplaintandanyappropriatetreatment
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andthemanagercanbeadvisedwhetherthecomplaintsarelikelytohavebeenrelatedtoworkandtheshorttermimplicationsforcontinuingemployment.
110 IfanemployeeisoffsickwithwhatisbelievedtobeaULDthenitisusefultomakeearlycontactwiththeperson,forexampleatelephonecall,toseewhatyoucandotohelptheirreturntowork.Appendix3listsanumberofspecificmedicaldiagnosestolookoutforifyouareconcernedaboutcomplaintsofULDs.
111 Ifyoudonothaveaccesstoanoccupationalhealthservicethen,withyouremployee’sagreementandwrittenconsent,youcanwritetotheirGPaskingforareportwhichmayhelpyouinmanagingtheabsence.However,anysuchcommunicationhastocomplywiththeprinciplesdetailedintheAccesstoMedicalReportsAct,1988.36,37Thefollowingpointscouldberaised:
n thenatureoftheillness;n whetherthedoctorthinksitisrelatedtowork;n iftreatmentwillbenecessaryandtimerequiredtoaccesstreatment;n whenareturntoworkmaybeexpected;n whetheractivitywillneedtobelimitedforaperiodafterreturningtowork;n ifanylongtermeffectsaretobeexpectedfromtheillness.
112 Appendix3providesfurtherinformationonarangeofpossibletreatmentsforULDs.
Diagnosis and return to work
113 ReceiptofawrittendiagnosisofanupperlimbdisordermaytriggerarequirementtomakeareporttotherelevantenforcingauthorityunderTheReportingofInjuries,DiseasesandDangerousOccurrencesRegulations(RIDDOR).38,39,40ThisrequirementappliesonlytoasmallnumberofULDswhichariseinthecourseofspecifiedworkactivities.Appendix4providesfurtherdetails.
114 AnumberofULDsarealsoprescribedundertheSocialSecurity(IndustrialInjuries)(PrescribedDiseases)Regulations1985.41Atthetimeofwriting,thelistofULDswhicharePrescribedDiseasesisthesameasthosewhicharereportableunderRIDDOR.IndividualsdiagnosedwithsuchdisordersshouldbeadvisedthattheymightbeentitledtobenefitundertheIndustrialInjuriesScheme.
115 ConfirmationofacaseofanULDshouldbetakenasaprompttoconsiderwhetherexistingriskassessmentsandcontrolsareadequate.Thisisespeciallyimportantifthereareotherpreviouslyreportedcases.
116 Theexacttimingofanindividual’sreturntoworkwilldependonthemedicaladvicewhichtheyreceivewhichinturnwilldependonthenatureoftheunderlyingdisorder.Itisoftenpossibletoreturntoworkbeforesymptomshaveresolved,and,insomecasesthismaybeadvantageous.
117 Youmayalsoneedtoreviewyourarrangementsforoccupationalhealthadvicetoassistwiththemanagementofanyfurthercaseswhichmayoccur.Thisisparticularlyimportantinworkwherethereisalreadyexistingevidenceofupperlimbcomplaints.
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Surveillance
118 Healthsurveillancecanbeundertakenoneitheravoluntaryorastatutorybasis.TheApprovedCodeofPracticefortheManagementofHealthandSafetyatWorkRegulations20recommendsthathealthsurveillanceisundertakenwherecertaincriteriaaremet.Oneoftheseisaccesstoavalidmeansofdetectingthediseaseorconditionofconcern.Atpresentitisnotconsideredthatvalidtechniquesexistforthedetectionofchangeswhichreliablyindicatetheearlyonsetofspecificupperlimbdisorders.
119 Valuableinformationcanhoweverbeobtainedfromlessprecisemeasuressuchasreportsofsymptoms.Itisgoodpracticetoputinplacesystemswhichallowindividualstomakeearlyreportsofupperlimbcomplaints.Whereappropriatethesecanbesupplementedbyregularsurveysofsymptoms.FurtherinformationcanbefoundinHealth surveillance at work.42
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Carry out regular checks on programme effectiveness
n DoyouhavesystemsinplacetomonitorandreviewyourcontrolsforULDs?
n DoyouhavesystemsinplacetomonitorandreviewyourULDmanagementprogramme?
n Areyouawareofnewdevelopments/information?n Doyouaimforcontinuousimprovement?
Why monitor or review?
120 Inanymanagementsystemitisimportanttochecktheeffectivenessofyouractions,andthisisnolesssointhepreventionofULDs.Thesecheckscanbeconsideredattwolevels:
n monitoring:whichistheongoingandregularappraisaloftheproceduresandsystemswhichyouhaveinplacetocontrolrisk;and
n reviewing:whichisalessfrequentbutmorestrategicactivitywhichconsidershowwelltheoverallcontrolsareworkingandwhetheranychangesmightbebeneficialandreasonablypracticable.
Monitoring
121 Monitoringisanintegralpartofmanagementandrequirescommitment,consultationandparticipationatalllevelsintheorganisationinordertobefullyeffective.MonitoringgenerallyinvolvesrecordingtrendsinULDsymptomsandriskfactorsovertimeinordertoassesstheperformanceofexistingcontrolmeasuresandtoplanandimplementnewinterventions.
122 Factorstoconsiderinplanningmonitoringandreviewingsystemsinclude:
n method;n frequency;n whentomonitor;n costsandbenefits.
123 Themethodandfrequencyofmonitoringshouldbeconsideredwheninitiallyplanningandimplementingcontrolmeasures.Thescaleandextentofmonitoringrequiredwilldependonthedegreeofriskandtherelativecostsandbenefitsofavailablemethods.Itisimportantthatthereisconsultationwithemployeessothattheyarefullyawareofthemonitoringprocedureswhichareinplace.
Approaches to monitoring
124 Therearetwobroadapproachestomonitoringsystems–passiveandactivemonitoring.Table1comparesthegeneralfeaturesofeachapproach.
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Table 1 Generalfeaturesofpassiveandactivemonitoring
125 Someinitialvaluecanbegainedfrompassivemonitoringbutactivemonitoringbuildsonthisinformationandenablesanin-depthlookatriskfactors,signsandsymptomsinaspecificworkplace.Consultationwithemployeesisparticularlyimportantsincethereareethicalconsiderationsrelatingtothehandlingofpersonalhealthinformation.
Examples of passive and active monitoring
SomeexamplesofpassiveandactivemonitoringmethodsaregiveninTable2.
Table 2 Passiveandactivemonitoringmethods
Monitoring outcomes
126 Ininterpretinginformationobtainedfrommonitoringitisusefultolookforconsistentpatternsin:
n commentsfromemployees;n symptomsreported;n existingriskfactors;n resultsofsurveys.
Passive Active
Usesexistinginformationsourcesandmethods
Activeseekingofinformationaboutsigns,symptoms,riskfactors
Usuallyinexpensive Generallyinvolvesadditionalcosts
Usuallyundertakenfirst Usuallyundertakenasafollow-uptopassivemonitoringbutmaybethefirstlineapproachwherethereisasignificantULDrisk.
Datacodingandanalysisisusuallysimple Indepthdatacodingandanalysisrequirespecialistassistance.
Non-clinical Non-clinicalandclinicalindicatorsincluded
Readilyestablishedasinformationsourcesusuallydesignedforotheradministrativepurposes.
Recommendedwhenfacedwithan‘outbreak’ofULDs
Passive Active
Accidentbook/FirstaidrecordCompensationdata
WorkplacewalkthroughsBodymapping
Statutoryreportingsystems(RIDDOR)38 Taskanalysis
Medicalretirementreports Confidentialquestionnaires
Symptomsreported Healthinterviews
Sicknessabsencerecords Healthexaminations
Productionproductivityandqualitymeasures Exposurechecklist27
Staffturnover
Healthandsafetymeetings
Moraleandemployeesatisfaction
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127 Comparisonsbetweengroupsofemployeesindifferentlocationswithintheorganisationmaybehelpfulparticularlywheresimilarworkisbeingundertaken.Wherepracticable,comparingyourexperienceswithothercompaniesinyoursectormayalsoassistinevaluatingtheperformanceofyourcontrolmeasures.42,43
128 Whereproblemsareidentified,actionshouldbetakentorevisethemeasuresinyourmanagementpolicytoimprovecontroloftherisk.Employeesshouldbeadvisedofthesituationandanyappropriatemedicalmanagementmadeavailable.Furthermonitoringwilldetermineiftheserevisedmeasureshavebeeneffective.
Reviewing
129 ReviewingprovidesanopportunitytolookattheoverallperformanceofyoursystemsformanagingULDrisksandshouldbeconsideredasanintegralpartofthemanagementprocess.Itshouldbeundertakenwhenmonitoringsuggeststhatthecurrentpolicy/programmeisnotadequatelycontrollingtherisksorwhentechnicaldevelopmentsororganisationalchangesareplannedwhichmayalterthelevelsofrisk.
130Reviewingrelieslargelyontheuseofexistingmanagementinformationandmayoftenbeincorporatedinaperiodicreviewofbusinesseffectiveness,eg,aspartofaqualityprogramme.
131 Reviewing:
n needstobesystematicinapproach;n makesfulluseofexistingmanagementresources;n isanopportunitytolearnfromexperiencesgainedinmanagingULDrisk
factors,signsandsymptoms;n determineswhetherinterventionscontinuetobeeffective;n establisheswhetherriskshavebeencontrolledwherereasonably
practicable;n providesanopportunitytoassesswhetherimprovedcontrolmeasures
shouldbeintroduced.
132 Asystemshouldbeinplacetoensurethattheoutcomesfromthereviewareactedupon,feedingbackintothemanagementsystemasshowninFigure1.
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Appendices Appendix 1: Case studies
ThesecasestudieshavebeendividedintothestagespresentedinthemanagementmodelshowninFigure1.Thishasbeendoneretrospectivelysoallstagesofthemodelarenotalwaysfullyrepresented.
Case study A: Easter egg and chocolate box packing Background1 AlargefactoryidentifiedanumberoftasksthatcreatedariskofULDs:
n Task 1: Easter egg packingForpackingEastereggs,eightseparatecomponentswereassembledbyhand.Mostofthesecomponentsarrivedasflat-packswhichthenhadtobefoldedandbentintothecorrectshape.Theoperatorsonthistaskwerepaidpieceworkratesdependentuponthenumberofeggstheyassembledinaworkday.
n Task 2: Chocolate box packingDuringtheproductionofboxesofchocolates,twolayersofchocolatesinaplasticmouldedtray,apadofcorrugatedcardboard,andthe‘unitkey’(ietoidentifythefillinginthechocolate)wereneededtobepackedintodifferent-sizeboxes.Theboxeswerepresentedtotheoperatoronamovingconveyor,and,astheywentpast,differentoperatorshadtoputdifferentcomponents(thechocolates,themouldingsinwhichtheysit,thecardboardpad,andinformationleaflets)intotheboxesinaflowassemblyoperation.
Understandtheissuesandcommittoaction2 Thecompanyphysiotherapistandothermedicaldepartmentstaffwereseeing
peoplefromtheeggandchocolatepackagingdepartmentwithULDs.Withthepermissionoftheemployeesconcerned,managementhadbecomeawareofULDreferralsandhaddirectedactionontheissue.
Createtherightorganisationalenvironment3 Thecompanydoctor,theoperationsmanagerandtheindustrialengineerfor
thesiteworkedwithemployeesthroughouttheprocessofassessment.Trialsofsolutionstoreducetheriskswerealsodoneinaparticipativemanner.
AssesstheriskofULDsinyourworkplace4 Ariskassessmentoftask,environmentandindividualfactorsforULDs
identifiedthefollowingriskfactors:
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5 Ifworkerswererotatingbetweenthetwotasks,theymayhavebeenatanincreasedriskofULDs.BothtaskspresentverysimilarriskfactorsforULDs(repetitionofsimilarupperlimbposturesforlongperiods)andincombination,furtherincreasetheriskofULDs.Thisexamplehighlightstheimportanceoflookingattheriskassessmentsoftasksincombinationwhereworkersareperformingmultipletasksduringtheshift.
ReducetheriskofULDs6 Aftertheassessmentwascompleteditwasdeterminedthatcertainelements
neededtoberedesigned:
n thepackingoperationwasredesignedtoremovetheriskelementofcardboardbendingandthesnappingshutoftheplasticmould.Thisreducedthenumberofuncomfortablewristandhandmovements;
n thepaystructurewaschangedfrompieceworktosalariedwork;n forchocolateboxassembly,engineersdevelopedamock-upworkstation
totrialwithoperatorsinwhichtherateofcompletionofthetaskwasdeterminedbytheoperator,notbytheconveyor;
Task 1: Easter egg packing
Task-relatedfactors
Repetition: Thistaskwashighlyrepetitivewithworkersperformingthesamefinger,wrist,armandshouldermovementsmanytimesperminute.
Working posture: Thetaskrequiredmanymovementsofthehandandwrist,egsidewaysbendingandbendingthewristsupanddownwhilefoldingthecardboardandsnappingaplasticcoverovertheeggs.Theelbowwasoftenheldandmovedinpositionsawayfromthebody.
Force: Snappingoftheplasticcoverovertheeggsrequiredforcewithpinchgrip.
Duration of exposure: Workersconductedthistaskforprolongedperiodseachday.
Environment-relatedfactors:
Psychological factors: Workerswerepaidonapieceworkbasiswhichmayhaveencouragedthemtopushthemselvesbeyondthepointatwhichtheyexperienceddiscomfort.Thismayalsohaveinfluencedtheworkers’willingnesstoreportupperlimbdiscomfortforfearofreducedworkinghours/speedetc
Task 2: Chocolate box packing
Task-relatedfactors
Repetition: Thistaskwashighlyrepetitivewithworkersperformingthesameupperlimbmovementsmanytimesperminute.Theoperator’sworkratewasdeterminedbytheconveyorspeed.
Working posture: Theboxdesignmadeitdifficulttoplacethecomponentsaccuratelyintheboxeswhentheconveyorwasmovingquickly.Thismeantthatworkersassumedawkwardposturesoftheshoulderandwrist.
Duration of exposure: Workersundertookthistaskforprolongedperiodseachday.
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n asingleoperatorundertookthewholeassemblytaskratherthanputtingonecomponentinthebox(iejobenlargement);
n engineersworkedoutthebestangleforviewingthecomponents,fortakingthemofftheconveyor,andforassemblingthemwithouttwistingandturning;
n aftertestingoutthisdesignwiththeparticipationoftheoperatorsthenewlinewasbuiltandinstalled.
ManageanyepisodesofULDs7 Thecompanyemploysaphysiotherapistandothermedicaldepartmentstaff
inordertomanageanyepisodesofULDsandfacilitaterehabilitationandreturntoworkwherepossible.
Carryoutregularchecksonprogrammeeffectiveness8 ForEastereggpacking:
n fewercasesofwristandhandproblemsarenowreportedtomedicalstaff;
n overallefficiencyoftheproductionlinehasimproved;n thenumberofunitsdamagedhasdecreased,andthevisualqualityofthe
finishedproducthasimproved;n theamountofmaterial(chocolate,plastic,cardboard)wastedhas
decreased;n staffmoralehasimproved;n theeggproductionworkflowiseasiertomanageandregulate;andn thereneedstobelessstaffrotationbecausethenatureofthejobhas
improved.
9 Forthechocolateboxpacking:
n operatorcomforthasincreased,astheadjustabilityineachworkstationcanbeusedtomeeteachoperator’sneeds;
n assemblyqualityhasimproved,astheoperatorsarenolongertryingtoputthecomponentsintoamovingbox.
10 Packingoperationsareperformedmanuallyinarangeofdifferentindustries.Asthiscasestudyillustrates,theoperatorisoftenrequiredtousepositionsofthehandandwrist,whichcanleadtoupperlimbdisorders,especiallywhencombinedwithhighforceand/orrepetition.Thecompanyhasbenefitedinbothproductionefficiencyandstaffwellbeingandhealthbyrecognisingriskswithinthetask,andinvestinginergonomicchangestothetasksandpackagingmaterials.
Case study B: Computer use in news media organisation
TheworkcoveredbythiscasestudywassubjecttotheDisplayScreenEquipmentRegulations.ThiscasestudyshowshowthestructuredapproachintheguidancecanhelpcomplywiththeRegulationsinanunusualsituationwithcomplexchallenges.
Background11 Formanyyearsalargenewsmediaorganisationhadusedacomputer-based
systemtostoreandtransfernewsstories.Thiswasgraduallybecomingoutdatedandrequiredupgradingduetodevelopmentsintheelectronictransferofstoriesandtheneedforafastermoreefficientsystem.
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12 Anew‘off-the-shelf’packagebasedonanexistingandwidelyusedsystemwaschosen.Someadaptationsweremadeforthecurrentorganisationanditwasinstalledinthenewsroomandelsewhere.Accompanyingtherolloutwasaprogrammeofchangemanagementthatincludedadviceonimplementation,installationandtrainingforusersincludingworkstationadjustmentandposture.
Understandtheissuesandcommittoaction13 Theuseofthenewsystemledtounanticipatedconsequencesbecauseit
wasbeingusedforataskforwhichitwasnotdesigned–thepreparationofsometimeslengthy,in-depthnewsstoriesratherthanshortbulletin-stylepieces.
14 Priortotheintroductionofthenewsystem,comparativelyfewcasesofULDshadariseneventhoughcomputerisedtechnologyhadbeeninuseformanyyears.Therethenfollowedarapidsurgeinnewcasesintheorderofathreetofourfoldincreaseoverthepreviousyears.
Createtherightorganisationalenvironment15 Rightfromthebeginninganopen-mindedpolicywasadoptedsothatallstaff
couldbekeptfullyinformedoftheextentoftheproblemanditsprogress. AssesstheriskofULDsinyourworkplace16 Assessmentoftask,environmentandindividualfactorsforULDsrevealedthat
thesoftwaredidnotcopewithpagebreaks,spellchecking,cut-and-pasteeditingfacilitiesandtheneedforthenewsorganisationtocopewithnon-Englishmaterial.Thetaskoftextinputandeditingagainstconstantdeadlineswasnowmuchmoreonerousthanwithastandardwordprocessingstylepackage.Unfortunatelytheimplementationofthisnewsystemcoincidedwiththeoutbreakofamajorinternationalnewseventnecessitatinganenormousincreaseinworkload.Inaddition,organisationalchangeswerebeingmadetothebusinessinfrastructureincommonwiththosebeingmadeelsewhereatthetime.Thisinevitablyledtouncertaintyaboutthefuture,insecurityonthepartoftheworkforce,andtohigherlevelsofstress.
17 IdentifiedriskfactorsforULDsincluded:Task-relatedfactors
Repetition: Staffwereperformingmultiplemouseclicksaswellashighlyrepetitivekeying.
Working posture: Positionofthekeyboard,mouseandmonitormeantthatstaticcontractionoftheshoulderandneckmuscleswasoccurringwhenworkerswereusingtheinputdevicesand/orlookingatthescreen.Wristpostureswerealsoproblematicforsomeworkers.
Duration of exposure: Textinputandeditingtaskswereperformedforprolongedperiodseachday.Theoutbreakofthemajorongoingnewseventmeantthatmanyworkerswereworkinglongerhours.
Environment-relatedfactors
Psychosocial factors: Organisationalchanges,strictdeadlinesandworkloadassociatedwiththemajornewseventwereallidentifiedaspsychosocialriskfactors.
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ReducetheriskofULDs18 ControlstoreducetheriskofULDswereimplementedasfollows:
n computerrelatedequipmentwhichincludedhardware,softwareandfurniturewasreviewedbythesafetymanager;
n changestoworkstationlayoutweremadetoimproveworkingpostures,particularlyinrelationtotheupperlimbandmouseandkeyboarduse.
n Thisfocusedontheriskfactorofworkingposture;n changesweremadetothesoftwaretoreducerepetition;n themanageralteredtheworkorganisationincludingworkpatternsand
shifts.Thisrectifiedanyadverseworkpracticesandincludedcontroloverworkqualityanddeadlines.Thesecontrolsfocusedontheriskfactorsofdurationandpsychosocialfactors.
ManageanyepisodesofULDs19 Earlyreportingofindividualcasestotheoccupationalhealthdepartmentwas
encouragedsothatstepscouldbetakenbymanagerstominimisetheimpactofsymptoms.Threemainroutesofmanagementweredrawnup:
n aself-helprouteincludingarangeofphysicaltherapiesandrelaxationexercises;
n atherapeuticroutetoinvestigatesymptomsandsigns,carryoutdiagnosticandotherinvestigationsandrefer,asappropriate,fortreatmentoptions–donebytheoccupationalhealthdepartment.Treatmentcouldincludemedication,onwardreferraltoGPorspecialist,physiotherapyorcounselling;
n frominitialonsetorreportingofsymptoms,acycleoffourweekswasallowedfortheabovetobeaccomplished,afterwhichacaseconference/reviewmeetingwouldtakeplacetodetermineiftheindividualwasnowfitandcouldreturntowork,wasimprovingandcouldreturntomodifiedworkorwheretheprogrammehadfailedandajobchangewasrequired.
Carryoutregularchecksonprogrammeeffectiveness20 Afterseveralyearsfromtheinitialoutbreakthenumberoforiginalcaseshad
halved,ofwhichmorethan60%weredeemedtobecuredordormant.
21 Thisstudyshowsthattheoutlookforthemajorityofcasesshouldbegoodsolongasaprogrammeisadoptedwhichencouragesearlyreportingandmanagementofcaseswithoutfearofprejudice,inanenvironmentofmutualco-operationbetweenemployees,managers,unions,safetyofficers,ITspecialistsandoccupationalhealthprofessionals.
Case Study C: Healthcare product packing
Background22 Alargemanufacturingcompanywithseveralfactorysitesproducesand
packsawiderangeofcosmeticandskincareproducts.Theseoftenhaveshortpackingruntimes,andsomeproductlinesaredifficulttoautomate.ThecompanyrecognisedthatthehighlymanualpackagingtaskspresentedariskofULDsandtookmeasurestotacklethese.
Understandingtheissuesandcommittoaction23 ThecompanyidentifiedtheneedtotakeactiontoreducetheriskofULDs
andforaproactivesystemtomanageULDreferrals/casesacrossthedifferentfactorysites.ThiswasmetthroughthedevelopmentofacompanyULDpolicy.Acompanyergonomistwasalsorecruitedtodevelopandfacilitateanergonomicsprogramme.
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Createtherightorganisationalenvironment24 ManagersandoperatorshadbeenawareofreportedsymptomsofULDsand
weresupportiveofmeasurestoreducethese.Fromthestarttheergonomistworkedcloselywithoccupationalhealthstaffandmanagement.
25 Packingteamleadersandseniorteammemberswithresponsibilityforthehealthandsafetyoftheirparticularareaweretrainedinsafetyriskassessmentandtheidentificationofpossibleriskreductionmeasures.
AssesstheriskofULDsintheworkplace26 Athree-stageriskassessmentprocesswassetup:
n detailedriskassessmentsofthepackagingtaskswereundertakenusingtherapidupperlimbassessment(RULA)method28andabodypartdiscomfortandpsychosocialsurvey.Theseformedthebasisforprioritisingriskreductionrecommendations;
n seniorteammembersregularlyassesstheriskofULDsduringroutineriskassessmentsoftheirpackinglines.Theyareencouragedtoidentifyandimplementriskreductionmeasuresandcanseekadvicefromthecompanyergonomist;
n whenanewproductistobeintroducedtoaline,a‘changecontrolassessment’isundertakentoidentifyanyspecificproblemswhichmayrelatetothepackingofthatproduct,andpossiblesolutions.
AnexampleofataskidentifiedduringapackingtrialriskassessmentasposingaULDriskwassealingatwo-pieceglassjarusingawiremetalclasp.Thetaskrequiredrepetitiveactivityandtheapplicationofforcetoclosetheclasp.Therewasalsotheriskofpressurepointsonthepalmfromthewire.TheriskofULDsassociatedwiththetaskwasreducedbyencouragingoperatorstostandratherthansittomakeiteasiertoapplyforce;providingaleatherpalmprotector;ensuringtwopeopleundertookthetasktoreducedurationofexposureandincreaserecoverytime;andprovidingguidanceontaskprocedure.Afterimplementation,noULDsymptomswerereportedfromthispackingoperation.
ReducetheriskofULDs27 Thefollowingmeasuresapplytoallpackinglines:
n allpackingemployeesrotatetoadifferenttaskevery30minutes.Wherepossible,rotatedtasksaresignificantlydifferentintermsofupperlimbmovementsrequired;
n increasedautomation,standardisationofpackaging,andwaysofreducingrepetitivemovementsaresoughtatthedesignstage(egreducingthenumberofturnsrequiredtofastenalid);
n developmentofproceduresthatencourageoperatorstoadoptgoodposturesandmovementsonpackingtasks;
n thedevelopmentandavailabilityofriskreducingaids(egtoolsandequipment);
n increasedawarenessofULDissuesamongtheworkforce,andencouragementofallemployeestoparticipateinidentifyingriskreductionmeasuresandsolutions.
Educateandinformyourworkforce28 AleafletonULDs,coveringcausesofULDs,howtoidentifysignsand
symptoms,andwhattodoiftheseareexperienced,wasissuedtoallstaffwithafollow-upissueafter18months.
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29 Whereappropriate,awarenesstrainingisprovidedbythecompanyergonomisttopromotesuitableworkingtechniquesthatcanbeusedtoreduceULDrisk.
ManageanyepisodesofULDs30 ThecompanypolicyrequiresemployeestoreportanyULDsymptomsto
theirteamleaderwhorefersthemtotheoccupationalhealthservice.Theirworkstationandtasksareassessedinlightoftheproblemsexperiencedandappropriaterecommendationsgiven.Theteamleaderreviewsthesituationweekly,andoccupationalhealthstaffregularlymonitortheemployee’ssymptoms.
Carryoutregularchecksonprogrammeeffectiveness31 Regularhealthandsafetygroupmeetings(involvingseniormanagement,
occupationalhealthstaff,thecompanyergonomist,factoryengineersandsafetyrepresentatives)reviewriskmanagementissuesandtheimpactofriskreductionmeasurestaken.Theyalsoprovideeffectiveroutesofcommunicationbetweenstaffinvolved.
32 Followingtheinitialawarenessraisingcampaign(whichincludedissueoftheULDleaflet)therewasanexpectedincreaseinreferralstotheoccupationalhealthservice.Thiswasfollowedbyasteadyreductioninreferralrateoverthefollowingtwoyears.Whentheleafletwasre-issuedtheanticipatedincreaseinreferralswasnotexperienced.
33 Thereareongoingreviewsofoccupationalhealthdata,andafollow-upbodypartdiscomfortsurveyisplannedtoevaluatetheimpactoftheriskreductionprogramme.
Case Study D: New counter design for cashiers
Background34 Aleadingbookmaker’sgroupwithover11000staffand2000shops
plannedtoroll-outaradicallynewdesignofelectronicpoint-of-sales(EPOS)systemandassociatedcounter.PreventionofULDriskswasamajorconsiderationintheselectionofequipment,designofthecounter,furnitureandsoftware.Thenewdesignandmanagementprogrammehadtoaccommodatearangeofshopenvironments,staffregularlymovingbetweenpremisesanddifferentcashierworkstations.
35 Thecashier’staskforwhichthenewdesignwasspecifiedmainlyinvolvessittingattheworkstationanddealingwithtransactions(handlingbettingslipsandmoney).TheEPOSsysteminvolvessomecomputerwork(keyboardandmouseuse)tohandleandprocessbets.
Understandtheissuesandcommittoaction36 ManagementrecognisedthatULDriskfactorswerepresentinthecashier’s
taskegrepetitivelyreachingtothecountertopandawkwardstretchestoreachequipment.Seniormanagementwassupportiveoftheplantointroducenewcounterdesignguidelinesandrecognisedthepotentialimpactonoccupationalhealth.
Createtherightorganisationalenvironment37 Itwasagreedthatthenewcounterdesignandlayoutshouldbebasedon
ergonomicscriteria.Managementalsorecognisedthatprovidinginformationtoemployeesandhavingameansofidentifyinganyhealthproblemswasessentialinmanagingoccupationalhealth.Aprojectteamwasassembled
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withrepresentativesfromfacilitiesmanagement,healthandsafety,ITandITdevelopment,linemanagement,andthegeneralworkforcetospecifyanddevelopthenewcounterlayoutandassociatedequipment.
AssesstheriskofULDsintheworkplace38 Ariskassessmentidentifiedthatcertainmovementsandtaskswouldbe
required(reachingtocountertop,cashdrawer,handlingmoneyetc)whichcontainedtheULDriskfactorsofrepetition,reachingandawkwardposture.Thisenabledergonomicscriteriatobespecifiedforthecounterdesign.
ReducetheriskofULDs39 ToreducetherisksofULDs:
n ergonomicsadvicewassoughtforbodydimensioncriteriaonwhichtobasethecounterdesign;
n mock-upsofcountersweretrialledbycashiers;n computerrelatedequipmentincludingscanner,printerandscreen,and
theirlayoutwerereviewedandtrialledtoreducetheriskofULDsandensuretheireaseofuse,(egscanningratherthankeyboardusewasselectedfordataentryandequipmentwasplacedwithinthezoneofcomfortablereach);
n thesoftwaredesignreducedthepressureoncashiersbyhelpingwithmanagementofdeadlines,forexample,takingbetsinrelationtowhenracesstarted;
n managementalsoensuredthatthereweresufficientstaffineachshoptoallowrestandrecoveryduringtheshift,andtocoverparticularlybusyperiods.
Educateandinformyourworkforce40 Informationonsettinguptheworkstationandchairadjustmentwasprovided
onthecompanyintranettowhichallcashiershaveaccess.Inaddition,onanongoingbasisemployeesarepromptedtocompleteanon-lineassessmentoftheirworkstationafteracertainnumberoflog-ons.Thisalsodirectsstafftorelevantguidancedocumentation.
ManageanyepisodesofULDs41 Mosthealthproblemsareidentifiedintheon-lineassessmentorthrough
theabsencemanagementsystem.Anyproblemsidentifiedarereportedtotheemployee’slinemanager,andtothesafetymanager,anditisthelinemanager’sresponsibilitytoactionchange(egreplacefaultyequipment).Whereaproblemhasbeenidentifiedtheemployeecompletesanon-lineassessment21daysaftertheinitialreport.Iftheproblemhasnotbeenresolveditisreportedtoahigherlevelofmanager,andare-assessmentiscompletedafterafurther21days.Continuingproblemsarereportedtoadirectorofthecompany.Thisprovidesanincentiveforreportedproblemstobedealtwithrapidlyandensuresthatawarenessisraisedamongallstaff.
42 Expertmedicalandergonomicssupportisavailableforanyemployeewithanongoinghealthproblem,sothatindividualworkstationscanbeassessedandappropriateadjustmentsmade.
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Carryoutregularchecksonprogrammeeffectiveness
43 AnexpertergonomicevaluationofthenewcountersidentifiedthattheydidnotposeasignificantriskofULDs.Ongoingmonitoringofoccupationalhealthdatacontinues.Furtherinvestigationistakingplaceintothedesignofbettingslipstoallowmoreelectronicrecognitionofoptions(ieusingtickboxes)sothattheamountofmouseusebycashiersdealingwithtransactionscanbereduced.
Case Study E: Addressing ULDs in poultry processing
Background44 Alargepoultryprocessingcompanywithanumberofdifferentsiteswantedto
systematicallytackletheirULDproblems. Understandtheissuesandcommittoaction45 Thecompanyhadreceivedguidancefromtheirindustryfederationandwas
awareoftheextentofULDproblemsinthesector.TherehadalsobeenasignificantnumberofreferralstotheiroccupationalhealthdepartmentandclaimsforULDs,whichactedasamotivatortotackletheseissues.Althoughmanagershadbeenawareoftheissues,attitudeschangedsignificantlywhenthecostofplacingpeoplewithULDsontolighterdutieswascalculated,andfoundtobeconsiderable.
Createtherightorganisationalenvironment46 Followingareviewoftheirhealthandsafetymanagementsystems,the
companyestablishedaprogrammeforthepreventionofULDs.Policieswerewritten,arrangementsandproceduresputinplace,androlesandresponsibilitiesclarified.
47 Multidisciplinaryergonomicsteamswerecreated,involvingalllevelsofthebusinessandledbylinemanagers.Teamsweregivenanergonomicstrainingprogrammetoraiseawarenessoftheissuesandidentifywaysofreducingtherisks.Inaddition,thecompany’soccupationalhealthnursesweregivenamoreproactiveroleinmanagingULDsandworkedcloselywithfirstlinemanagers.
AssesstheriskofULDsintheworkplace48 TheULDriskassessmentswereintegratedintothesafetymanagementof
thebusiness.Generalriskassessmentsaredonebytrainedriskassessorsundertheguidanceofthelinemanagerofthedepartment.TheassessmentconsidersarangeofrisksandusesspecificchecklistsforULDs,manualhandlingandergonomicsissues.IftheseidentifyapotentialULDrisk,apersontrainedinergonomicsoranoccupationalhealthnurseundertakesamoredetailedassessment.
ReducetheriskofULDs49 Becausestaffontheshopfloorhavehadergonomicstrainingtheyhavebeen
abletogeneratemanyworkplaceimprovementsthemselves.Itisprimarilythroughtheempowermentandcommitmentofthefirstlinemanagersthattheprocesshasbeensuccessful.
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‘Chicken hang on’
Oneofthepoultryprocessingactivitiesinvolveshangingchilledwholebirdsontomovingshacklelinessothattheycanbecutintochickenportionsbyamachine.Thetaskrequiresindividualbirdstobepickedfromahoppersituatedinfrontoftheoperatorandthelegsofthebirdplacedintheshackleonasuspendedconveyor.Theoperatorscarryingoutthistaskworkinteamsofthree,atarateof70birdsperminute.Adecisionwastakentoreplacethecutupmachinesand,asapartofthatproject,toredesignthe‘hang-on’workstationtoreducetheULDriskandthewastefulhandlinginvolvedintheexistingprocess.
A detailed assessment revealed the following:
Atwo-phasere-designwasimplementedtoreduce,andultimatelyeliminate,therisk.
Phase 1 Redesignedworkstation–reducedheightofshackleonconveyor;
repositionedbirddeliveryhoppersothereachdistancesrequiredwerereduced;redesignedshackletomakeattachmenteasier.Employeeswereconsultedandinvolvedinthedesignoftherevisedworkplace.
Phase 2 Directfeedofbirdsfromanothershackleline,totheshacklelineonthe
automaticcutupmachine,thuseliminatingtheneedtomanuallyhangbirds.
Outcomesinclude: Significantreductioninergonomicrisk;reductionofreportedULDsfrom
theactivity;reductioninnumberofemployeesonlighterdutiesfromthisoperation;amarkedimprovementinproductivity.
Educateandinformyourworkforce50 AllstaffreceiveinductiontrainingwhichcoverstheriskofULDs,control
measuresandreportingprocedures.Furtherinformationandtrainingaregivenonthejob.TheprofileofULDshasbeenraisedwithinthecompanyandthereisopencommunicationabouttheissue.
Taskrelatedriskfactors
Repetition: Thetaskwashighlyrepetitivewithupto25cyclesperminute.Thetaskwasalsomachinepaced.
Working postures: Workershadtoreachforwardanddowntopickupthebirds,thenuptoplacethemintheshackle.Positioningthebirdtoalignwiththeshacklealsorequiredawkwardpostures.
Force: Someforcewasrequiredtoplacebirdsintheshackle;Birdsweighupto2kgs.
Duration of exposure: Workersconductedthistaskforprolongedperiodseachday.
Environmentrelatedriskfactors
Working environment: Lowworkroomtemperature(12ºC)andlowtemperatureofproduct(3ºC)
Psychosocial factors: Theworkwasmachinepaced.
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ManageanyepisodesofULDs51 IfanemployeeexperiencesULDsymptomstheyarereferredthroughtheir
linemanagertotheoccupationalhealthdepartmentwhowillassesstheirconditionandwork,andmakerecommendationsconcerningappropriateaction(workplaceortaskmodifications,rest,lighterduties).Occupationalhealthstaffundertakeon-goingsurveillanceofthosewithproblems.AphysiotherapistisavailableonsitetotreatandadvisethosewithULDs.
Carryoutregularchecksonprogrammeeffectiveness52 ThecompanyundertakesasixmonthlyauditoftheULDprogrammeto
reviewthemanagementsystemandprocedures,theireffectivenessandtheimpacttheyhavehad,andtoidentifyanyfurtherimprovements.
53 Recentexaminationofthecostofplacingpeopleonlightduties(largelyduetoULDs)identifiedthatinasampleweekin1998of2300processingstaff,60(2.6%)wereonlightduties.Followingtheergonomicsprogramme,inthesamesampleweekin2001only16staff(0.7%)wereonlightduties.Indirectlabourcostsalonethecompanyestimatethatthisreductionequatestoasavingof£500000.Inonefactory,thenumberofpeopleplacedonlightdutieshasfallenbyalmost80%inthisperiod.
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Appendix 2: Risk Filter and Risk Assessment Worksheets
TheaimoftheRiskFilteristosetoutanapproximatethresholdbelowwhichtheriskofULDsislikelytobelow.TheguidelinesintheRiskFilterandWorksheetsareprovidedasanaidtoriskassessment.Theyhavebeendevelopedfromthescientificliteratureandfromexpertopinion.Assuch,theyarenotpreciseexposurelimits,butareintendedtohelpyoutoidentifythepotentialrisksandpossiblemeasurestoreducethem.
OthermethodsofassessmentareavailableandmaybeequallyappropriateinassessingthelevelofriskofULDs.27,28,29,30
Overview
1 TogethertheRiskFilterandRiskAssessmentWorksheetsprovideatwo-stageassessmentprocess,whichmaybephotocopiedforuse:
n Stageone:UsetheRiskFiltertohelpidentifysituationswhereamoredetailedassessmentisnecessary.(Pleasenotethatcertainriskfactorshavebeenpurposelyomittedinthefilterinordertoprovideauseable,firststage,screeningtool.)
n Stagetwo:UsetheRiskAssessmentWorksheetstoconductamoredetailedriskassessmentforthosetasksidentifiedbytheRiskFilter
2 Beforeundertakingyourassessment,youshouldread‘AssesstheriskofULDsinyourworkplace’(whichprovidesguidanceonriskassessmentandriskfactors)(seeparagraphs43-86).Inorderforyourassessmenttobeeffectiveyoushould:
n involveyourworkforceintheassessmentandcontrolprocesstotakeadvantageoftheirintimateknowledgeofthework;
n explaintotheworker(s)whatyouaredoingpriortoassessingatask.Youshouldalwaysemphasisethattheassessmentisofthetaskandnotthe worker’sperformance;
n walkthroughtheareaandidentifyanytasksthatrelatetodisplayscreenequipmentorinvolvemanualhandlingbecauseyoualsoneedtoreferto specificguidanceontherelevantregulationstoassessthese;
n makesurethatyouhavespentsometimeobservingthejobandwhatyouareseeingisrepresentativeofnormalworkingprocedures;
n observealltheworkersforashortperiodoftimewhereseveralpeopledothesamejob,toensurethatyouhavesomeinsightintothedemandsofthejobfromallworkers’perspectives;
n completetheassessmentintheworkplace(wherepossible,andifitissafetodoso);
n focusontheupperlimbateachstepensuringyouconsiderthefingers,hands,arms,elbows,shouldersandneck;
n wheretheRiskFilterindicatesfurtheractionmoveontostagetwooftheassessmentusingtheRiskAssessmentWorksheets.
3 Equipmentthatmaybeusefulincludes:
n stopwatchortimertomeasurecycletimes;n videocameratoallowformoredetailedanalysisofmovementcycles,and
fortheassessmenttobefinalisedawayfromtheworkplaceifnecessary;n scales/forceguage(springbalanceandstring)tomeasuretheweight/
forcesrelatedtoupperlimbactivities.
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Read the following guidance in conjunction with the risk filter.
Duration: Aconsiderationofduration,orexposuretime,asariskfactorforULDs
wouldincludeboththelengthoftimethatataskisperformedinatypicalworkingdayaswellashowoftenitisrepeated(egdaily,weeklyorlessoften).Buildingsuchacomplexfactorintoasimpleriskfilterandworksheetisdifficult.‘2consecutivehours’or‘morethan2hourstotalperworkday’havebeenusedasbasicbuildingblocksofexposuretimethroughouttheguidelinesintheriskfilterandriskassessmentworksheets.‘Consecutive’inthiscontextmeansthetaskorsimilargroupsoftasksarerepeatedsuccessivelythroughoutthe2hourperiod.Itmustbeemphasisedthatthe2hourperiodisnotalimitandshouldbeappliedpragmatically.
Forexample,ifataskwasperformedfor1hourand40minutes,followedbya10minutebreak,thenforanother1hourand40minutes,followedbyanotherbreak,andsoon,throughoutan8hourworkday,theworkerhasnotstrictlyworkedmorethan‘2consecutivehours’.Thedurationofexposureforthistask,however,iscertainlyhighandwouldbeofconcerniftheotherriskfactorsforULDwerealsopresent.Conversely,ifthetaskrequirementsareexceptionallydemanding,adurationoflessthan‘2consecutivehours’maypresentanunacceptablerisk.
STAGE 1: Risk Filter procedure
Ensure you have read ‘Assess the risk of ULDs in your workplace’ and the general guidance at
the beginning of this Appendix prior to undertaking your assessment.
4 CompletingtheFilterinvolves:
n recordingthebasicdetailsofthetasksuchasthedate,nameofthetask,theassessorandtaskdescription;
n probablyusingaseparateFiltersheetforeachtask;n goingthrougheachstepinturnandplacingatickineachboxwhereyou
observeexamplesoftheserisks;n planningamoredetailedriskassessmentifanyoftheriskfactorsare
ticked;n identifyingthosetaskswiththemostriskfactors(themorethereare
thegreatertherisk)tohelpinprioritisingtasksforthesecondstageriskassessment.
5 Step 1: Signs and symptoms:Lookfor:
n actualcasesofULDsinwork:– reviewsicknessabsencerecordsandmedicalcertificatesreceived;– askyouroccupationalhealthserviceforanonymousinformationabout
casesofULDs;n complaintsofachesorpains:
– checktheaccidentbookandortreatmentbookformentionof‘sprainsandstrains’andanyothertypesofachesandpains;
– talktomanagers,supervisorsandworkers;
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n improvisedchangestoworkequipment,furnitureortools:– walkthroughtheworkplacetoidentifyimprovisedchanges;– checkwithmanagers,supervisorsandworkersfor“difficult”jobsor
thosewhichhavebecomemore“difficult”recently.
6 Step 2: Repetition:Checkforfrequentmovementsforprolongedperiods.Examplesmayincluderepeatedhandpressoperations,repeatedtriggeringoperations,repeatedcuttingactions,repeatedhandlingetc.
A‘Cycle’referstoasequenceofactionsofrelativelyshortdurationthatisrepeatedoverandover,andisalmostalwaysthesame.Theyarenotnecessarilyassociatedwithonesinglejointmovement,(suchastheelbow),butwithmovementsofoneormorepartsofthelimb(suchasreaching,manipulatingandplacinganobject).Cyclesarenotalwaysclear-cut,andinsuchcasesobserversshouldlookforsimilaractionsthatarerepeated.
Asimpletaskmayconsistofasequenceofmovementswhichwouldberepeatedandthereforeformthecycle.Amorecomplextaskmayconsistofelements(asdescribedinparagraph53)someorallofwhichmaybedistinctcycles.
7 Step 3: Working postures:Checkforposturesthatareawkwardand/orheldforprolongedperiodsinastaticorfixedposition.Checkfingers,wrists,hands,arms,shouldersandnecks.Remember:Themorethejointsdeviatefromtheirneutralposition,thegreatertherisk.
8 Step 4: Force:Checkforsustainedorrepeatedapplicationofforce.
9 Step 5: Vibration: Makeanoteofthetypeofvibratingtoolsorequipmentsuchasgrinders,polishersetc.thatareusedforthestage2assessment.
Youshouldalsobeawarethatpsychosocialandworkingenvironmentfactors(suchashighjobdemandsandlackofcontrol,coldandlighting)couldfurtherincreasetheriskofULDs.Thesefactorsareexpandedinthefullriskassessment.
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RISK FILTERTask: ______________________________________________________________________________________________Assessor: __________________________________________________________________________________________Date: _______________________________________ Location/work area:____________________________________
IF YOU ANSWER YES TO ANY OF THE STEPS, YOU SHOULD THEN MAKE A FULL RISK ASSESSMENT OF THE TASK. REMEMBER TO CONSIDER ALL OF THE BODY PARTS OF THE UPPER LIMBS (FINGERS, HANDS, WRISTS, ARMS, SHOULDERS AND NECK). ANSWER ALL QUESTIONS
Step 1: Signs and symptoms
Are there any: Medically diagnosed cases of ULDs in this work? Complaints of aches and pains? Improvised changes to work equipment, furniture or tools?
Are any of these present?
YES
NO
Move on to Step 2
Step 2: Repetition
Are there repetitive elements such as: Repeating the same motions every few seconds? A sequence of movements repeated more than twice per minute? More than 50% of the cycle time involved in performing the same sequence of motions?
For more than 2 hours total per shift?
YES
NO
Move on to Step 3
Step 3: Working postures
Are there any working postures such as: Large range of joint movement such as side to side or up and down? Awkward or extreme joint positions? Joints held in fixed positions? Stretching to reach items or controls? Twisting or rotating items or controls? Working overhead?
For more than 2 hours total per shift?
YES
NO
Move on to Step 4
Step 4: Force
Are there any forces applied such as: Pushing, pulling, moving things (including with the fingers or thumb? Grasping/gripping? Pinch grips ie holding or grasping objects between thumb and finger? Steadying or supporting items or work pieces? Shock and/or impact being transmitted to the body from tools or equipment? Objects creating localised pressure on any part of the upper limb?
Sustained or repeated application of force for more than 2 hours total per shift?
YES
NO
Move on to Step 5
Step 5: Vibration
Do workers use any powered hand-held or hand-guided tools or equipment or do they hand-feed work pieces to vibrating equipment?
Regularly (ie at some point during most shifts)?
YES
NO
Ifyouansweryestoanyofthesteps,youshouldmakeafullriskassessmentofthetask.
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STAGE 2: Risk Assessment Worksheets procedure
ReadthefollowingguidanceinconjunctionwiththeRiskAssessmentSheetsoverleaf.Ensureyouhaveread‘AssesstherisksofULDsinyourworkplace’(seeparagraphs43-86)andthegeneralguidanceatthebeginningofthisAppendixpriortoundertakingyourassessment.
n.b. The risk factor of ‘duration’ is addressed within the guidance values for other risk factors and
therefore does not have a heading in its own right.
10 CompletingtheRiskAssessmentWorksheetsinvolves:
n usingasetofWorksheetsforeachtask;n recordingbasictaskdetailsontheWorksheets,suchashowlongthe
taskiscarriedout,ataskdescriptionetc.(Anexampletaskdescriptionis:aworkerreachesforscrews,placestheminpositionatheadheight,thenusescounterbalanceddrilltofixscrews.Thefinishedproductisthenpushedacrossthebodytothenextstation);
n goingthrougheachriskfactorinturn,observingthetask(s)inrelationtotheappropriateguidelinestoseeifariskofULDsispresent;
n recordingwhichaspectsofthetask(s)presenttherisk;n notingdownpossiblecontroloptions;n identifyingthosetaskswiththemostriskfactorstohelpinprioritising
tasksforaprogrammeofcontrol(themore‘yes’ticksthegreatertherisk).
Completing each risk factor
11 Thefollowingproceduresshouldbeobservedwhencompletingeachriskfactor:
n placeatickinthe‘Yes’boxwhereyouobserveexamplesoftheseriskfactorsandatickinthe‘No’boxwhenyoudonot;
n writedownwhatthepersonisdoinginrelationtothatriskfactorinthenextcolumn,including:– bodypartaffected;– howlongthetaskisbeingdone,forexamplenumberoftimesper
minute,numberofhoursperday.(egfivetimesperminute,fiveshiftsof7.5hours);
– whataspectsofthetaskarepresentingtherisk;– typeofworkequipment;– whetheranyreferencenumericalvaluesareexceeded(possibly
indicatinganelevatedlevelofriskforULDs)
n writedownanypossiblecontrolmeasuresthatcanbetakentominimisetheriskofinjuryinthesecondlastcolumn.Somecontroloptionsarelistedinthefinalcolumn,theseareexplainedinfurtherdetailinAppendix2:‘Suggestionsforreducingtherisk’.Thecontrolslistedrepresentsomeoptionsonlyandarenotanexhaustivelist.
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Completing the action plan
12 Thefollowingproceduresshouldbeobservedwhencompletingtheactionplan:
n summariseandprioritisethecontroloptions;– examinethecompletedriskassessmentandtheidentifiedcontrol
optionstoprioritiseaction.Identifytaskswiththehighestnumberof‘Yes’ticks.Taskswithahighernumberof‘Yes’ticksmayrequiremoreimmediateaction;
– whereyouhaveestablishedthattherearediagnosedcasesofULDsorcomplaintsofdiscomfortetc.aswellasriskfactors,viewthiscombinationasahighpriorityforimplementingcontrolmeasures
n developashort,mediumandlongtermstrategytoimplementcontrols,andplacedatesagainstthese;
n enteradateforre-evaluationintheactionplantabletoensurethatimplementationdatesaremonitored.
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RISK ASSESSMENT WORKSHEETS
Worksheet Reference Number
Task description:Date:____________________________________Name of assessor:________________________Task:____________________________________No. of employees that conduct this task_____How long is the task typically undertaken for:a) without a break________________________b) in a typical shift (excluding breaks)________________________________________________
How frequently is the task undertaken(eg. daily, weekly):___________________________Other tasks undertaken by worker that maypose risk of ULDs (include worksheet reference numbers):
___________________________________________What hand tools are used in the task:________________________________________________________________________________________________
1 Repetition
For 2 consecutive hours per work day:
Describe any problem(s) and probable cause(s):Describe what the person is doing eg. hand operation of drill 10 times per minute. Performed 3 hours per day, five days per week.
Describe any risk control options you have identified
Control options(not exhaustive list)
1.1 Does the task involve repeating the same movements every few seconds?
A ‘Cycle’ is asequence of actions of relatively short duration that is repeated over and over, and is almost always the same. A cycle is not necessarily associated with one single joint movement, but also with complex movements of one or more parts of the body.
Reduce repetition:
Mechanise or automate repetitive functions Use power ratchet tools Remove machine or other pacing Restructure task (Job design) Remove or monitor piecework schemes
Reduce duration:
Implement job enlargement Ensure adequate breaks Implement job rotation Limit/control overtime
1.2 Is there a cycle or sequence of movements that is repeated twice perminute or more
OR
More than 50% of the task involves performing a repetitive sequence of motions?
1.3 Are the wrists/hands/fingers used intensively?
1.4 Is there repetitive shoulder/arm movement (ie regular arm movement with some pauses or almost continuous arm movement?)
1.5 Are tools used that require repetitive finger or thumb action?
Yes
No
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2 Working posture
Fingers, hands and wrist
Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. Static gripping posture used for up to 2 hours at a time, wrists repetitively bent sideways when drilling objects.
Describe any risk control options you have identified
Control options(not exhaustive list)
2.1 Is the wrist bent repetitively up and/or down?
Remember: the greater the deviation from a neutral position, the greater the risk.
Optimise working posture:
Modify operation or production method Relocate equipment or items Present work items differently Reduce amount of manipulation required Ensure equipment accounts for differences in worker size, shape and strength Ensure working heights are appropriate Ensure items are within reach distances Provide suitable (and adjustable) seating Use fixtures/jigs After tools or controls Ensure tools are suitable for task Ensure tools do not require awkward postures
2.2 Is the wrist held in a position that is bent upwards or downwards?
2.3 Are the fingers gripping or used while the wrists are bent?
2.4 Is the wrist bent repetitively to either side?
2.5 Is the wrist held bent to either side?
2.6 Are the hands repetitively turned or twisted so that the palm is facing up or downwards?
2.7 Are the hands held with the palms facing up or down?
2.8 is a wide finger and/or hand span needed to grip, hold or manipulate items?
2.9 Do static postures of the fingers, hand or wrist occur, for more than two consecutive hours per working day?
2.10 Are there tools, equipment and/or work pieces that are poorly shaped and/or do not fit the hand comfortably?
2.11 Are there any tools, hand held equipment or work pieces that are too large or small to be gripped easily?
2.12 Are tools designed for right handed use only?
Yes
No
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3 Working posture
Arms and shoulders
Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. Shoulder held in fixed position with elbow out to the side for up to 2 hours at a time. This is due to the work height.
Describe any risk control options you have identified
Control options(not exhaustive list)
3.1 Is work performed above the head or with the elbows above the shoulders for more than 2 hours total in a working day?
Remember: the greater the deviation from a neutral position, the greater the risk.
Optimise working posture:
Automate or mechanise Modify operation or production method Relocate equipment or items Present work items differently Reduce amount of manipulation required Ensure workplaces and equipment account for differences in worker size, shape and strength Ensure working heights are appropriate Ensure items are within reach distances Provide suitable (and adjustable) seating Use fixtures/jigs Alter tools or controls Ensure tools are suitable for task Ensure tools do not require awkward postures Provide arm support for precision work
3.2 Does the task involve repetitively moving the upper arms out to the side of the body?
3.3 Does the task involve holding the upper arms out to the side of the body without support?
3.4 Do static postures of the shoulder or elbow occur, for more than two consecutive hours per work day?
3.5 Does the work involve any other postures such as:
Awkward forward or sideways reaching? Awkward reaching behind the body? Awkward reaching across the body?
Workstation layout and working height can be a major influence on working postures
Yes
No
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4 Working posture
Head and neck
Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. neck held in fixed bending position to see screw holes.
Describe any risk control options you have identified
Control options(not exhaustive list)
4.1 Does the task involve repetitively bending or twisting the neck?
Remember: the greater the deviation from a neutral position, the greater the risk.
Optimise working posture:
Ensure visual requirements are not too demanding Provide visual aids Ensure lighting is suitable Reposition items that workers are required to look at
4.2 Does the task involve holding the neck bent and/or twisted for more than 2 hours total per working day?
4.3 Do the visual demands of the task require the worker to view fine details and adopt awkward positions?
4.4 Do aspects of lighting such as dim light, shadow, flickering light, glare and/or reflections cause the worker to adopt awkward postures?
Yes
No
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5 Force Describe any problem(s) and probable cause(s):eg. Drill handle is too small resulting in increased gripping force for up to 4 hours per day. Also high force applied to screws
Describe any risk control options you have identified
Control options(not exhaustive list)
5.1 Does the task require repetitive or static application of force?
For the hand/wrist, high-force tasks are those with estimated average individual hand force requirements of 4 kg or above.
Optimise working posture:
Reduce forces necessary Use power tools Can the function be achieved differently? Use jigs to hold items Reduce weight of items Present items differently Increase mechanical advantage After task to use stronger muscles Use foot pedals If gloves used check that they are appropriate Maintain tools Ensure tools are suitable for task Improve handles Use light weight tools Use tool counterbalances Ensure tool handles fit workers comfortably
5.2 Is it a pinch grip being used repetitively or statically for more than two hours total per work day?
For example, pinching an unsupported object weighing 0.9 kg (2 lbs) or more per hand, or using a similar pinching force (eg holding a small binder clip open).
5.3 Does the worker use the grip of the finger, thumb or hand as a pressing tool?
5.4 Do tools require the application of pressure on a trigger or button?
5.5 Does the hand apply force by twisting objects/tools or squeezing items?
5.6 Is the hand or wrist used as a hammer?
5.7 Is force being applied when the wrists are bent and/or with the arms raised?
5.8 Does the task require the wearing of gloves which affect gripping?
5.9 Do any objects, work pieces, tools or parts of the workstation impinge or create localised pressure on any part of the body?
Yes
No
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6 Working environment Describe any problem(s) and probable cause(s):eg. Workers exposed to hand vibration from drill up to 4 hours per day. Workers have cold air blowing on hands from exhaust.
Describe any risk control options you have identified
Control options(not exhaustive list)
6.1 Are vibration exposures likely to regularly exceed HSE’s recommended action level of 2.8 m/s2 A(8)?
- impulsive tools (chipping hammmers,needle guns, hammer drills, etc)may exceed HSE’s recommendedaction level after only a few secondsuse per day and are highly likely toexceed the action level after30 minutes use per day
- Rotary tools (grinders, sanders, etc may exceed HSE’s recommendedaction level after only a few minutesuse per day and are highly likely toexceed the action level after 2 hoursuse per day
Improve the working environment:
Use alternative process(es) Select alternative lower vibration equipment Use balancers/ tensioners Maintain equipment Reduce exposure time to vibration Provide information and training Conduct health surveillance Avoid working in cold Avoid handling or insulate cold items or tools Redirect blowing air Use warm clothing
6.2 Do tools create or transmit jerky actions, shock or torque (twisting)?
6.3 Does the task involve working in cold or in draughts, particularly with cold air blowing over the hands?
6.4 Does the task involve holding cold tool handles, work items or other cold objects?
Yes
No
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7 Psychosocial factors (These factors are best dealt with through discussion with workers. Sensitivity may be required)
Describe any problem(s) and probable cause(s):eg. Workers are on piecework system. Support from supervision and co-workers is low.
Describe any risk control options you have identified
Control options(not exhaustive list)
7.1 Is the work placed?ie machine or team sets the pace, or the work rate is otherwise not under the worker’s control?
Reduce force:
Reduce monotony Ensure reasonable workload and deadlines Ensure good communication and reporting of problems Encourage teamwork Monitor and control overtime and shiftwork Reduce or monitor productivity relatedness of pay systems Provide appropriate training
7.2 Is there a system of work, or piecework, which encourages workers to skip breaks or to finish early?
7.3 Do workers find it difficult to keep up with their work?
7.4 Do workers feel that there is a lack of support from supervisors or co-workers?
7.5 Is there overtime/shiftwork that is unplanned, unmonitored and/or not organised to minimise risk of ULDs?
7.6 Do the tasks require high levels of attention and concentration?
7.7 Do the workers have little or no control over the way they do their work?
7.8 Are there frequent tight deadlines to meet?
7.9 Are there sudden changes in workload, or seasonal changes in volume without any mechanisms for dealing with the change
7.10 Do workers feel that they have been given sufficient training and information in order to carry out their job successfully?
Yes
No
8 Individual differences Describe any problem(s) and probable cause(s):eg. No system for gradual return to work
Describe any risk control options you have identified
Control options(not exhaustive list)
8.1 Are any workers potentially at increased risk of ULS due to:
being new employees or returning to work after a long break; differences in competence and skills; being part of vulnerable groups such as older, younger workers, new or expectant mothers; disability and health status.
Improve the working environment:
Allow for a gradual build up to full production speed Provide suitable training to develop the skills required Seek advice on special requirements
Yes
No
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REMEMBER TO CONSIDER HOW THE RISK FACTORS INTERACT WITH EACH OTHER(eg are forces repetitively in awkward posture etc)
ACTION PLAN
Worksheet reference
Controls to be implemented Priority Who is responsible for implementing controls?
Target implementation date
Date ofre-evaluation
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Suggestions for reducing the risk
*Thisisnotanexhaustivelist.Innovativeideasforcontrollingrisksareoftendevisedbyworkersor
thosefamiliarwiththetask.
Reducingrepetition Generally Reducethenumberofrepetitivemovementsand
therateatwhichtheyaremade,especiallywhere thesearecombinedwithapplyingforceand/orin awkwardpostures.
Limitthedurationofcontinuousworkor restructureworkmethodstoprovidegreater variety.
Automation and Canmachinerydothehighlyrepetitivefunctionsmechanisation morevariedjobsfortheworkers(Takecareto avoidcreatingrepetitive,boringandmonotonous taskstofeedthemachinerywithwork).
Avoidpacingofthework.Automatedmachinery andteamworkingcanallacttoincreasethework rate.Aimtoallowpeopletocontroltheirown paceofwork.
Tools Usepowertoolsinplaceofmanualtools. Usemanualtoolswithratchetdevicestoreduce
thenumberofmovementsrequired,eg screwdriversorspanners(seealso‘Tools’).
Job design Breakuplongperiodsoffrequentrepetitionsand staticinactivityorspreadrepetitionsacrossboth hands.
Sharerepetitiveworkthroughteamworkorjob rotation.
Distributetheworkloadoverdifferentmuscle groupsandjoints.
Job enlargement Consideraddingextraactivitiestothejobto providevarietyinpostureandspeedofwork.
Rest breaks Breaks,beforetheonsetoffatigue,areimportant. Consultationwithworkersmayhelptosetan
adequateworkrestratiooralternativelyallocate timeswhenworkersshouldrotatefroma specifictask.
Increasethefrequencyofbreaks.Frequentshort breaksarepreferabletoafewlongones.
Job rotation Rotatetheworkertoperformothertasks,which variesbodypartactionandspeed.Remember thatrotatingtoataskthatutilisesthesameparts ofthebodyandpresentsthesameriskfactorsfor injuryastheoriginaltaskwillnotproviderest periodsforthepartsofthebodythatareat
riskofULDs(seealso‘Jobrotation’in‘Reducing duration’).
Overtime Placealimitonormonitorovertimeandprovide sufficientrestbreakstoaccountforprolonged exposure.
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Optimisingworkpostures
PoorworkstationandequipmentdesignisusuallyresponsibleforposturalproblemsleadingtoULDs.Thereareanumberofmethodsforreducingposturalproblems.
Generally Enableworktobedonewiththejointsatabout
themidpointsoftheirrangeofmotion. Reducethetimespentholdingand/orrepeating
awkwardpostures. Avoidusingstaticposturesforprolongedperiods.
Workstation and Considerthelocation,anglesandheightoftool design equipment,controlsorworkpiecesinrelationto theoperator.Modifytoimproveposture.
Ensureworkplacesandworkequipmentare designedorselectedtoaccountfordifferencein size,shapeandstrengthofworkers.
Altertooldesigntoimprovewristposture.
Work organisation Canchangesbemade‘upstream’ofthejob?ie and job design doesthetaskreallyhavetobelikethis,orcan alterationsintheprocesselsewheremeanthat itemsdonothavetobeassembled/presentedin thisway?
Canthesequencebechangedtomakethetask lessawkward?
Presentation/ Considerpositionofthework,andtheuseof orientation of work fixturesandjigstoangleandholdworkinmore
items accessiblepositions. Considerhowthebodywillinterfacewiththe
equipment. Arethereobjectsorattachmentsthatactas
obstaclesandleadtopoorposture?
Seating Ensureseatsareadjustable. Ensurethatthereissufficientspacetoenable
workerstomakeeffectiveuseoftheadjustable featuresoftheirchairs.
Doworkersknowhowtoadjusttheirchairs? Ensurethatthereissufficientlegspaceforthe
workertostretchandmakechangesinlegand footposture.
Confinedlegspacecanconstrainoverallbody posture.
Reach distances Placeequipmentandmaterialswithinprimary reachzoneskeepingrepetitivereachingasclose aspossibletothebodyandalwayswithin 450mmofthefrontoftheoperator.
Figure12illustrateshowthemostfrequentlyused itemshavebeenpositionedwithineaseofreach areasoftheworker.
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Figure 12
Forfurtherinformationonreachdistances, workingzonesandseatingrefertoSeating at work.44
Working height Cantheheight,angleandpositionatwhichthe workisbeingconductedbechangedtoimprove visibilityofthetask?
Seated workstationtablesshould accommodatethelargestusers.Platforms, adjustablechairsandfootrestscanbeusedby smalleruserstoachieveoptimalworkingheight.
Standing workstationsshouldbeusedforjobs
thatrequirealotofbodymovementandgreater force.
Figure 13
Themostsuitableworkingheightdependsupon
thenatureofthetaskbeingperformed(See Figure13)
Manipulative tasks(involvingamoderatedegree
ofbothforceandprecision):tableheightshould be50-100mmbelowelbowheight.
Precision tasks(includingwriting):tableheight
shouldbefrom50-100mmaboveelbowheight. Heavier tasks(particularlyiftheyinvolve
downwardpressuretobeappliedonthework piece):tableheightshouldbefrom00-250mm belowelbowheight.
Thedimensionsabovearemerelygeneral guidelinesandcanbeappliedtobothseatedand standingworktasks.
Giventhatindividualsdiffersignificantlyintheir build,elbowheight,asareferencepointwillvary
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considerablyfrompersontoperson.Inaddition, differenttypesoftasksmayrequiresignificantly differentworkingheight.Itistherefore recommendedthatadjustableheightsurfacesbe providedwhereverpossible.(Itisnotalwaysthe worksurfaceheightthathastobealtered; platformscanbeusedtoaltertheeffective height).
Sit/stand workstationsenableworkerstovary theirworkingposture.Forsit/standworkstations provideappropriateandadjustablechairs, adjustabletablesorstandingplatforms.
(SeeFigure14).
Figure 14
Arm support Providesupporttothearmswhentheyareraised
ifpossible,andwhenprecisionworkisbeing performed.
Providepurposebuiltsupportswhereneededto improvecomfortandworkingposture.
Vision and lighting Considerprovidingvisionaids,ifapplicable,such asmagnifyingglasses.
Ensurethatlightingissuitableandadequatefor theworkundertaken.
Reducingforce General Reduceforcesrequired,especiallywhenapplied
incombinationwithpoorpostures,eguseweaker springsintriggers,anduseotherpowersources ratherthanmusclepower.
Reducefrequencywithwhichforceneedstobe applied(seealso‘Reducingrepetition’).
Reducetimespentapplyingforce.Thisespecially relatestostaticforcesbeingappliedand sustainedforsteadyingorsupportingitemsor grippingtools.
Exertingexcessiveforceoftenresultsfrom inappropriateworkingheightforthetask.For appropriateworkingheightsreferto‘Optimising workingpostures’.
Work organisation Considerwhyhighforcesarenecessary. and job design Isitbecauseofill-fittingcomponents,lackof
maintenanceorheavyitems?Canthisbe addressed‘upstream’ofthisjob?Throughbetter maintenance?Byreducingtheweightofitems,
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eventhosethatarenotlifted,butsimplymoved oracceleratedmanually.
Presentation/ Consideralteringthepositionorpiecesortools orientation of work sothatanyforcecanbeappliedmoreeasilyand
items efficientlyieimprovethepostureoftheworkers whenapplyingforces(See‘Awkwardposture’).
Distribute force and Canfootpedalsbeusedtoprovideforce? enable stronger muscle Distributeforcerequirementsoverseveralfingers
groups to be used ratherthanone.Allowoperatorstousealternate handstooperatecontrols.
Mechanical advantage Providesomemeansofincreasingmechanical advantage,suchaslongerlevers,orothermeans ofmechanicalassistance.
Gloves Selectappropriategloves.Poorglovedesignor inappropriatechoiceofglovesorglovesizingcan
leadtopoorsenseoftouchandincreasedeffort ingripping.
Tools Uselightweighttoolsorprovidesupports,jigsor counterbalancedevices.
Handtoolsshouldnotrequireexcessiveforceor havehandlesthataretoolargeorsmall.They shouldnotexertpressureordigintothehand. (Formoreinformationsee‘Tools’).
Keepcuttingedgessharpandmovingparts appropriatelylubricated.
Contact force or Iftherearesharporhardcontactpointsbetween localised pressure equipmentandworkersconsiderremoving,
flatteningorlevelling. Reducingduration Generally Allowforshortbreaksinwork. Developawork/restregimewhichprovides
sufficienttimeforrecovery. Monitorandmanageovertimeworking. Considerjobenlargement,jobrotation.
Job rotation Jobrotationhasthepotentialtoreduceduration ofexposure.Rememberthatrotatingtoatask thatutilisesthesamepartsofthebody,and presentsthesameriskfactorsforinjury,asthe originaltaskwillnotproviderestperiodsforparts ofthebodythatareatriskofULDs.
Whenjobrotationisintroducedbeawareofthe following:
n trainingmayberequiredtogivetheworkers
thenecessaryskills;n skillsusedononetaskmayinterferewith
thoseonsubsequenttasksandtherefore,timeforreadjustmentbetweentasksmaybenecessary;
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n timemaybeneededtoallowworkerstogetusedtoeachjobintherotationsequence;
n rotationmayhaveonlyasuperficialimpactuponriskexposure.Inpractice,thesamelevelofphysicaldemandmayremaineventhoughitappearstobequitedifferent.
Environment Vibration Uselowvibrationequipment. Ensurethattoolsarewellmaintainedsoasto
reduceexcessvibration. Purchasetoolswithvibrationdampingoradd
vibrationdampingtoexistingtools.45
Minimisetheamountoftimethatworkersare usingvibratingtools.
Anti-vibrationglovescanbeappropriateinsome situations,howevertheirimpactongripstrength andtypemustbeconsidered.
Ensureworkersaretrainedintherisksassociated withvibration.
Vision and lighting Ensuretaskilluminationisatalevelthatallows theworkertocomfortablyviewtheworkpiece withoutsquintingoralteringtheirposture.
Shadowsorreflections,flickeringlightsandglare shouldalsobecontrolledastheyoftencause peopletoadoptawkwardpostures.
Alllightsourcesshouldberegularlymaintained.
Temperature and Thermalconditionsintheworkplaceshouldbe ventilation suchthatallworkersarereasonablycomfortable regardlessofseasonalvariance.
Avoidpositioningworkstationsinthevicinityofair ventsasdraughtsmaycausemusculoskeletal discomfort.
Wherepossibleensurethattoolsandproducts handledbyworkersarenotundulycold.
Psychosocial Job content Reducemonotonousaspects,rotateworkers
betweentasks. Ensurereasonableworkloads–assessspeedof
production. Involveemployeesindeterminingworkload. Ensureagoodclimateofcommunication. Ensuretaskclarity–clearperformance
requirements,feedbackonperformanceandlines ofreporting.
Encourageteamwork. Monitorandmanageovertimeworking.
Overtimeincreasesdurationofexposureand decreasesthetimeforrecovery.Thereshouldbe abreakbeforestartingovertime.
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Work pressures Ensurepaydoesnotrelatedirectlytoproduction. Bonussystemsandjob-and-finishcanincrease therisksbecausetheyencouragepeopletowork beyondtheirnaturalcapacity.Ifthereisabonus system,trytoreducetheextentofproductivity relatedness,aimforabalancebetweenbonus systemsandworkload.
Ensureagoodclimateofcommunication. Developanappropriateworkrestschedule. Allowforshortbreaksormicropausesinwork
schedules. Allowagradualbuilduptofullproductionspeed,
forexample,whennewworkersstartandwhen peoplereturnfromabsence.
Allowtimeformaintenanceoftools,sharpening etc.
Tools Selection Inselectingtools,atrialperiodwithseveral
workersisrecommended.Thepurchasershould alsohavesomeknowledgeofthetaskforwhich thetoolwillbeusedpriortoselection.
Itshouldbepossibletousethetoolineitherhand –orprovideaspecifictoolforlefthanded workers.
Size Considerdifferencesinmaleandfemalehand sizes,andtheeffectofwearinggloves.
Toolslikepliersshouldnotrequireawidehand span,around60mmisgood.
Handle design Toolhandlesshouldenableastraightwrist
posture(handshake)andavoidawkwardhand andwristpostures.
Ensurehandlesarelongenoughtofitthewhole handinapowergrip.
Avoidrigidhardsurfacedhandles,sharpedgesor narrowhandlesthatplacelocalisedpressureon thehand.
Figure 15
Force Wherenotusedasasafetydevice(ie‘dead
man’shandle’)triggersandswitchesshould notrequirecontinuousapplicationofforce. Providetriggerlockswhereoperationissustained (formorethanabout30seconds).
Theoperatingforceshouldbeaslowaspossible. Triggersshouldenableoperationbymorethan
onefinger. Returnspringsincuttingtoolsandplierscanhelp,
butensurethespringresistanceisnottoogreat.
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Weight Shouldbeminimised,especiallyforprecision work.Aimforaround1.5kgandnomorethan 2.3kgforpowertools.
Suspendthetoolorusecounterbalances.
Figure 16
Vibration Purchaselowvibrationequipment. Ensurethattoolsarewellmaintained.Asktool suppliersforvibrationdatarelatedtohowyou willusethetoolandforadviceonsafeuse,eg dailymaximumuseagetime.Keeptoolswell maintainedtoretainlowestvibrationperformance andkeepsharp.Blunttoolsarelesseffectiveand meanlongerexposuretimefortheoperator.45
Figure 17 Illustrates vibration and optimal wrist posture
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Appendix 3: Medical aspects of upper limb disorders (ULDs)
1 Thissectionprovidesoutlinedetailsforarangeofdisordersthatmedicalpractitionerscommonlydiagnose.Itisnotintendedtobeadefinitivemedicalreferenceforsuchdisordersoramethodofself-diagnosis.ItalsogivesguidanceonthehealthmanagementofULDs,coveringissuessuchastreatmentandrehabilitationandoccupationalhealthsupport.HealthmanagementisanimportantaspectoftheoverallmanagementofULDsinyourworkplace.
Introduction
2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,arms,wrists,handsandfingers.Thelimbcanbethoughtofasamechanicalsystemmadeupofrigidlinks,(thebones),movingatjoints,whichareheldtogetherbyligamentsandsurroundingtissues(capsules).Musclesareattachedtothesebonesbytendons,whichtransmittheforceproducedduringmusclecontractionacrossajoint,resultinginmovementoftheboneandthelimbsegment,towhichthemuscleisattached.
3 Muscularactivitycanbeeitherstaticordynamic.Staticeffortisusedtosupportorpositionthelimbandholditinspace.Dynamiceffortresultsinmovement.Forexample,whencuttingapieceofwoodonearmismovedtocutthewoodandholdthesaw,whiletheotherworksstaticallyinholdingandsteadyingthewood.Movementsdependonacomplexpatternofmuscleactivation.Theenergyneededformuscleactioncomesthroughthebloodsupply,whichalsoremoveswastemetabolicproducts.Tendonsaresmoothandslipperyandinplacesarecoveredbysynovialtissue.Thisproducesafluidtolubricatemovementandisparticularlyfoundinmanyofthetendonsofthewristandhand.
4 Varioustheoriesexisttoexplainhowupperlimbdisordersarisewithinthetissuesandonerecognisedmodeldetailstheinteractionofexposure,dose,responseandcapacity.17
5 Thepathophysiologicalprocessesinvolvedmayincludedisruptionanddeformationoftissuestructuresasaresultofphysicalloadingorcompression,changesinthemetabolismofmuscleandothertissues,ortheeffectoffactorssuchasinfection,inflammation,degenerationandtheimmuneresponse.Personalfactorssuchasage,sex,pregnancy,genetics,bodyshape,medicalhistory,nutritionalstatus,personalityandbehaviouralsohaveaninfluenceonpresentation,progressandrecovery.
ULDcomplaints
6 SymptomsandsignsassociatedwithULDsincludethefollowing:
n pain;n acheordiscomfort;n tenderness;n swelling.
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7 Abnormalsensationsthatmayoccurare:
n numbness;n tingling;n pinsandneedles;n burningsensation;n feelingofwarmth;n cramp.
8 Otherobservationsmayinclude:
n stiffness;n impairmentofmovement;n weakness;n reducedgrip;n musclespasms.
9 SignsofULDscanbeminimalorabsentatexaminationbutthismaydependontheexperienceofthehealthprofessionalinexaminingthemusculoskeletalsystem.Guidanceisavailabletoassistdoctorsintheassessmentofsymptomsandsigns.35
10 Signsthatcanbedetectedmightinclude:
n anappearanceofswellingordeformity;n changesinskincolour;n tendernessontouchingtheaffectedpart;n asensationof‘crackling’(calledcrepitus)whentendonsaremoved;n touchingparticularareaofskinmayprecipitatesymptoms.Iftheseare
elicitedtheareasmaybereferredtoastriggerpoints;n jointmovementmayberestrictedandpainful;n lossofmusclepowermaybeseeninfunctionssuchasgraspingand
gripping;n theresponsetostimulatingtheskinmaybereducedorlost(lossof
sensationtotouch).
11 Upperlimbdisordersfallintooneoftwobroadcategories,thoseconditionsthatarerecognisedasdiscretediseaseswithcharacteristicfeatures,andnon-specificpainsyndromeswhereitisnotpossibletodefineaspecificunderlyingcauseforthepain,whichistheprincipalcharacteristicfeatureofthedisorder.
Recognised medical diseases
12 Thesecanbegroupedbythemainanatomicalstructuresinvolvedasthefollowingexamplesshow:
n tendon-relateddisorders:tenosynovitis,DeQuervain’sdiseaseofwrist,tendinitis,triggerfinger,epicondylitis;
n nerve-relateddisorders:Peripheralnerveentrapment(median,radial,ulnarnerves);
n muscle-relateddisorders:writer’scramp;n neurovasculardisorders:Thesensorineuralandvascularcomponentsof
thehand-armvibrationsyndrome;n jointrelateddisorders:osteoarthritis,shouldercapsulitis,ganglion;n softtissuedisorders:beathand,beatelbow,Dupuytren’scontracture.
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13 Theseconditionsareusuallydiagnosedbythenatureofonsetandprogressionovertime,ofcertainsymptomsandthepresenceofclinicalsignsonexamination.TheessentialdefiningfeaturesofarangeofcommonULDshavebeendetailedandthecriteriaforidentificationagreedataconsensusmedicalconference.46
14 Intheprocessofaclinicalassessment,somespecialtestsmayberequiredtocheckforgeneralmedicalconditionsortoconfirmthediagnosis,egbloodtestsforevidenceofrheumaticdiseaseorendocrinedisturbance,oraurinetestfordiabetes.Occasionallyspecialistconfirmatorytestsarerequired,egelectricaltestsofnerveconductionormusclefunction,orimagingtestssuchasX-rays,bonescan,orMagneticResonanceImaging(MRI).
Non-specific pain syndromes
15 Inmanyindividualsaspecificdiseasemightnotbeidentifiableandthentheappropriatedescriptortouseisthemainsymptomcomplaintiepainanditsanatomicallocation.Non-specificarmpaincanbecomparedwithnon-specificlowbackpain(LBP),whereitisalsonotpossibletopreciselydefineaspecificunderlyingcauseforthepain.Suchnon-specificpainsyndromesarenolessrealthanthediscreteconditionsandtheimpactonfunctionmaybeequallysevere.Medicalenquiryshouldconsidersuchfeaturesas:
n siteandtimeofonsetofpain;n character,intensity,frequency,durationandradiationofpain;n precipitatingfactors;n provoking,relievingfactors;n influenceofrestandactivity(work,home,leisure);n associatedsymptoms;n psychosocialfactors.
16 Mostofuswillexperiencearmpainatsometimeandforthemajorityitwillbeabriefself-limitingepisodeandnotindicativeofseriousharm.Howeverinsituationswherepaindoesnotimprovewithrest,ifitisdisturbingsleep,recurringorpersistinginnaturethenmedicaladviceshouldbesought.
17 Inaminorityitcanbesaidthatpainitselfbecomesthediseaseratherthanbeingsolelyasymptomofdisease.Thisisthoughttoarisebecausethestimulusofpainhasthepotentialtomakethenervoussystemmoreresponsivetofurtherstimulation,aprocessknownasneuralsensitisation.Thismechanismunderliesthedevelopmentofprolongedandprogressivesymptomsinsomepeople,wherearmpainbecomessevereandchronic,withimpaireduseofthelimbandthedevelopmentofapermanentdisability.Thismaybedifficulttotreatandislikelytorequireatrialofacombinationofinterventionsincludingbehaviouraltherapy.Therationaleofearlyassessment,advice,appropriatetreatmentwhereindicated,andadjustmentstowork,shouldassistinpreventing,oratleastreducingtheimpactofsuchcasesandreducetheburdenofillhealth.
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An A-Z of upper limb disorders
* TheseassociationsarederivedfromtheNIOSHreviewoftheepidemiologicalliteratureofrelevant
authors.7
Disorder Description Association with occupational activity*
BURSITIS/CELLULITIS(beatelbow,beathand)
Adistensionofthefluidsac(bursa)and/orinfectionofthesubcutaneoustissues.Thebursaandtheoverlyingskinmayalsobecomeinfected.Beathandisaninfectioninthepalmofthehand.Redness,heat,swellingandpainatrelevantanatomicalsite.
Associatedwithrepeated(beatelbow,beathand)localtraumafromprolongedleaning,orpressure,frictionoverelbow.Useofhandtoolseghammersandshovels,togetherwithabrasionfromdirt/dust.
CARPAL TUNNEL SYNDROME
Aperipheralnervedisorderresultingfromcompressionofthemediannerveasitentersthepalmofthehand.Tingling,numbness,tendernesscanoccurseveralhoursafteractivityandappearinthepartsofthehandinnervatedbythemediannerve,(mainlyinthethumb,index,middleandsideofringfinger).Characteristicintensificationatnightandreliefgainedbyhangingthearmoverthesideofbed.Weaknessofgrippingandclumsiness.
Associatedwith;-highlyrepetitivework;-forcefulwork;-handarmvibration.Strongassociationwithacombinationofriskfactorsegforce,repetitionandposture.
CRAMP OF THE HAND Afocaldystonia,whichaffectsthecontrolandco-ordinationofmuscleactivity.Spasmofthemusclesinthehandorforearmisobserved.Thisoftenoccurswheninitiatingspecificmovementsandtheeffectmayimpairtheuseoftheentirelimb.Itgenerallypreventstheintendedactionfrombeingperformed.Duringanepisodetheremaybestiffnessortightnessinthehand.
Associatedwithprolongedperiodsofrepetitivemovementsofthefingers,handorarm.
CUBITAL TUNNEL SYNDROME
Aperipheralnervedisorder resultingfromcompressionoftheulnarnerveattheelbow. Itcausesmedialelbowpainandtendernessandnumbnessandtinglingintheringandlittlefinger.Theremaybeweaknessofmovementofthesefingers,impairedgripandclumsiness.
Associatedwithdirectpressureortrauma.
DE QUERVAIN’S DISEASE Alocalisedswellinginvolvingtwotendonsthatmovethethumbandwhichpassthroughafibroustunnelinthewrist.Activityrelateddiscomfortisexperiencedovertheradialaspectofthewristandforearm.Useofthehandandthumbforgraspingbecomesincreasinglypainful.
Associatedwith;-repetition;-force;-posture.Strongassociationwithacombinationoftheseriskfactors.Canbeassociatedwithdirecttraumaoftheradialaspectsofthewrist.
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DUPUYTREN’S CONTRACTURE
Athickeningofthetissuebelowtheskininthepalmofthehandwhichresultsinaprogressivecontractureappearing,especiallyoftheringandlittlefingerofoneorbothhands.Itisapainlessthickening,possiblywithapalpablenoduleinthepalmarcrease.Oneormorefingerscancurlupandcannotbestraightened.
Nogenerallyacceptedassociations
EPICONDYLITIS (Tennis/Golfer’selbow)
Adegenerationorinflammationoftheshorttendonous.attachmentsfromtheforearmmusclestotheboneattheelbow.Ontheinsideofthearmtheseattachatthemedialepicondyleandontheoutsideatthelateralepicondyle.Localtendernessisfeltattheattachmentofthetendonandiscommonlyknownastenniselbow(lateralepicondylitis)orgolferselbow(medialepicondylitis).Paincanradiateintotheforearmandisactivitydependant.Theremaybeweaknessofgrip.
Associationswithforcefulworkactivities.Strongassociationwithcombinationsofriskfactors;force,repetition,posture.
GANGLION Acystfilledwithsynovialfluidarisingfromajointortendonsheathandusuallyfoundonthebackofthehandorwrist.Theswellingcanvaryinsizeandbetenseandfirmorsoftandsqueezableandisusuallypainless.
Nogenerallyacceptedassociations
OSTEOARTHRITIS Adisturbanceinthesmootharticularcartilagesurfaceswhichlinejoints,withassociatedchangesinthesurroundingbone,includingbonyovergrowth.Thiscanaffectanyarticulatingjoint,whichintheupperlimbincludesthoseintheneck,shoulder,elbow,wrist,thumbandfingers.Symptomsincludestiffnessandachingpainonmovementoftheaffectedjoint.Painmayradiatefromneckintothearm(knownasreferredpain).Theremaybelimitationinthefullrangeofjointmovementandbonyswellings.Sometimesthereisagratingnoiseonmovement(crepitus).
Occupationalexposuresmaymodifythisdiseaseprocess.
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ROTATOR CUFF TENDINITIS – BICIPITAL TENDINITIS
Aninflammationordegenerationofthetendonsintheregionoftheshoulderjoint.Symptomsareachingandpainintheshoulderwhichmaybeprovokedbylyingontheaffectedsideatnight.Thereislimitationofcertainshouldermovementsdependentonwhattendonisaffected.Inbicipitaltendonitispainisexperiencedinthefrontoftheshoulderandonraisingthearminfront.
Associatedwithhighlyrepetitiveworkandshoulderposturesgreaterthan60degreesflexion,abduction.
SHOULDER CAPSULITIS (Frozenshoulder)
Aninflammationordegenerationofshoulderjointtissue.Thereisagradualonsetofstiffnessandpainintheshoulderwhichismoresevereatnightandwithincreasingrestrictioninallshouldermovements.
Nogenerallyacceptedassociations
STENOSING TENOSYNOVITIS (Triggerfinger/thumb)
Atendonsheathswellinginoneofthetendonsthatcrossthepalmofthehandandrundownthepalmarsurfaceofthefinger/thumb.Thisrestrictstendonmovementthroughafibrousringtermedapulley.Triggering,clickingorcatchingfeltonstraighteningthefingersorthumbandisoftenworseinthemorning.Atendernoduleisfeltinthepalmjustbeyondthebaseofthefinger.
Possibleassociationwithoveruse.
TENOSYNOVITIS Aninflammationoftendonsheathsatthewrist.Achingandpainisfeltintheaffectedtendonwhichisworseonmovement.Usuallythereislocaltendernessandswelling.Theoverlyingskinmayappearredandwarmwithagratingfeelingfeltoverthetendon(crepitus)duringmovement.Graspingandpinchingmaybeweakdependinguponthetendonaffected.
Associatedwith;-repetition;-force;-posture.Strongassociationwithacombinationoftheseriskfactors
VIBRATION WHITE FINGER Thisisadisorderarisingfromimpairmentofbloodcirculationinthefingersandoccursinperiodicattacksusuallyprovokedbycold.Thefinger/sturnwhite(blanch)withassociatednumbnessandtingling.Restorationofbloodflowresultsinpainfulredthrobbingfingers.Inseverecasesthereisblanchingofmostfingers,co-ordinationanddexterityisimpaired.
Associatedwithexposuretovibrationtransmittedtothehandandarmfromworkprocesses
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Treatments and rehabilitation
18 AcuteULDsaregenerallycurableifrecognisedearlyandaccuratelydiagnosed.Evenwheresymptomshavebecomechronicandsevere,occupationalrehabilitationcanbesuccessful.TheapproachtomostpainfromacuteULDsistorestthelimbandreducesoft-tissueinflammation.Additionalactionsmaybeconcernedwithincreasingmusclestrength,rangeofjointmovementandfunctionalcapacity.
19 Oneofthemosteffectivemeansofrestingtheaffectedpartistoreduceoreliminateexposuretothetaskswhichmayhavecontributedtotheonsetofthecondition,whethertheseariseinoccupationalornon-occupationalactivity,orinbothsettings.Ashortperiodofcompleterestmaybehelpfulparticularlyifinflammationispresent.Protractedrestshouldbeavoidedunlessundermedicalsupervisionasthiscanleadtodeconditioningandweakeningofthemusclesandassociatedstructures.
20 Anti-inflammatorydrugsandanalgesicmedications,’painkillers,’canbetakenduringthistime.Intheshortterm,theuseofpainkillersmayallowcontinuationofwork.Thisrunstherisk,however,ofexacerbatingorprolongingtheepisodeofillhealthifworkactivityisacontributoryoraggravatingfactortoanindividual’ssymptoms.Localareasoftendoninflammationcanbetreatedwithsteroidandlocalanaestheticinjectionsduringtheperiodofrest.Theireffectivenessiscompromisedifriskfactorsinworkactivitiesarenotalsoreducedoreliminated.
21 Immobilisationbyappropriatesplintingorsupportofthesymptomaticareacanbeused,butthisneedstobecarefullysupervisedasthereisariskofweakeningthelimb.Theregularuseofsupportivebandaginginaworkplacetoassistindividualssufferingarmpainshouldhoweverbediscouraged.Thisisunlikelytobeeffectivetreatmentonitsown,anditindicatesthatthereisanunderlyingproblemwhichshouldbetackled.
22 Physiotherapyandoccupationaltherapypractitionerscanprovidearangeoftreatmentstoassistwiththerestorationoffunctionandrehabilitation.Thismightincludespecificexercisesand/orstretchingofmusclesandnerves,jointmobilisation,electrotherapy,ultrasound,coldandheatapplications.Someexpertsconsiderthatmorespecialised‘neurodynamic’techniquescanbeofbenefitwherepainisthemainproblem,althoughthisapproachremainscontroversial.Practitionersofmanipulativetherapiessuchasosteopathsandchiropractorscanalsoprovidetreatmentsandadviceonrehabilitationandprevention.
23 Specialistopinionshouldideallybeobtainedfrompractitionerswhohaveexperienceintherecognition,treatmentandmanagementofULDs.Thiscouldincludephysiciansspecialisinginrheumatology,musculoskeletalmedicine,neurology,psychology,andpaincontrol.Specialistsinoccupationalmedicinecanadviseonworkplaceissues.Specialistopinionmightinvolvereferraltospecialistsinhand,orthopaedicorplasticsurgeryor,neurosurgery.
24 Surgicaloptionsareusuallyconsideredafterlessinvasivetreatmentapproacheshavebeentried.Howquicklyaftersurgeryanemployeeisabletoreturntoworkwilldependonthesuccessofthesurgeryandthepost-operativerecovery.Theextenttowhichergonomichazardsintheworkplacehavebeenmodified,andtheresultsofanoccupationalhealthassessmentarealsorelevanttorecovery.
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25 Treatmentforchronicnon-specificarmpainusuallyrequiresadetailedapproachtobetakentotheindividualsufferer.Anumberofinterventionsarelikelytobeneededtostoptheprogressionofsymptoms,givetheindividualasenseofcontrolovertheirpainandavoiddeteriorationinmentalhealth.Therapeuticmeasuresarebasedonareductionofstress,byattentiontophysicalorpsychologicalstresses,counsellingandrelaxationtherapiesandpainrelief(tricyclicmedication,triggerpointtherapy,electricalstimulation,injectionsaroundnervesandacupuncturearepossibleapproaches).
26 Complementarytreatmentsareofferedbyavarietyoftherapistsandincludeacupuncture,homeopathy,andyoga,asexamples.Thereislittleresearchonwhichtobasetheselection,orassesstheeffectiveness,ofsuchtherapiesformanagingULDs.
Occupational health provision
27 Occupationalhealthbroadlyembracestheissuesconcerningpreventionofillnessfromwork,managingtheeffectsofillnessatworkandpromotinghealth.InthecontextofULDs,occupationalhealthservicescouldassistwith:
n identificationofhealthhazards,assessmentofrisk,andadviceoncontrolmethods;
n adviceonworkplacementofemployeesandmedicalfitnessforparticularworkduties;
n provisionofappropriateon-sitefirstaidandtreatmentfacilities;n identifyingcausesofillhealthwithintheworkforceandliaisonwithother
healthcareprofessionals,takingaccountofmedicalconfidentiality,andtheneedtoobtainanindividual’sconsent;
n advisingonsuitablehealthsurveys,theanalysisandinterpretationofhealthdataandundertakinghealthrelatedinterviewsorexaminations;
n developingprotocolsforthemanagementofULDsintheworkplaceincludingrehabilitation,exerciseprogrammesandreturntoworkarrangements;
n adviceonadjustmentstowork,orworkingarrangements,tosupportandmaintainemployment.
Where to get help
28 Therearevariouswaysinwhichoccupationalhealthsupportmightbearranged,includingprovisionofanin-houseserviceoruseofexternalproviders.Thelargeroccupationalhealthserviceswillbeledbyadoctorornurseandmaybepartofamultidisciplinaryhealthandsafetyteam.Thesemaybeprivateproviders,publicproviderssuchasanNHStrust,co-operativegroups,or‘groupoccupationalhealthservices’.Otherservicescomefromindependentoccupationalhealthphysiciansandnursesorfromgeneralpractitionersandpracticenursesworkinginoccupationalhealth.Professionalbodiescanprovidelistsofpractitioners(seeFurtherinformation).
29 HSE’sEmploymentMedicalAdvisoryService(EMAS)canadviseonoccupationalhealthservicesavailableinyourlocalareaandcangivegeneraladviceonthemanagementofthehealtheffectsofULDsintheworkplace.
30 Whereanindividualhasanongoingdisability,assistancewithworkplaceassessmentandadjustmentcanbeaccessedthroughthelocalDisabilityServiceTeamattheDepartmentforWorkandPensions(DWP).
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Appendix 4: Legal requirements
General
1 Employershavelegalresponsibilitiestoensurethehealthandsafetyatworkoftheiremployees,andthisincludesthepreventionofaccidentsandworkrelatedillhealthsuchasULDs.TheHealthandSafetyatWorketcAct197419placesgeneraldutiesonemployersandothers.TherearealsoanumberofRegulationswhichimposespecificrequirements,andthosemostrelevanttothepreventionofULDsinclude:
n ManagementofHealthandSafetyatWorkRegulations;20
n Workplace(Health,SafetyandWelfare)Regulations;47
n HealthandSafety(DisplayScreenEquipment)Regulations;5
n ProvisionandUseofWorkEquipmentRegulations;48
n PersonalProtectiveEquipmentatWorkRegulation;49
n ManualHandlingOperationsRegulations;50
n ReportingofInjuries,DiseasesandDangerousOccurancesRegulations1995(RIDDOR).38,39,40
2 ThefollowingparagraphssummarisethosepartsofthelawthatareparticularlyrelevanttopreventionofULDs.Theyprovidepertinentinformationontheregulationsandassociatedguidanceandapprovedcodeofpractice(whererelevant),butdoesnotattempttogiveacomprehensivegeneralsummaryofeachpieceoflegislation.
Health and Safety at Work etc Act 197419
3 TheActimposesdutiesoneveryoneconcernedwithworkactivities,includingemployers,self-employed,employees,manufacturersanddesigners.Thedutiesareimposedbothonindividualpeopleandoncorporations,companies,partnerships,localauthoritiesetc.Thedutiesareexpressedingeneraltermssothattheyapplytoalltypesofworkactivityandsituations.
4 Section2oftheActputsadutyonallemployerstoensure,sofarasisreasonablypracticable,thehealth,safetyandwelfareatworkofalltheiremployees.Themostimportantareasrelateto:
n theprovisionandmaintenanceofplant(egmachineryandequipment),andsystemsofworksuchthattheyaresafeandwithoutriskstohealth;
n theuse,handling,storageandtransportofarticlesandsubstancesatwork;
n theprovisionofinformation,instruction,trainingandsupervision,asnecessary;
n theprovisionandmaintenanceofaworkingenvironmentthatissafeandfreeofriskstohealth.
5 Inaddition,adutyisplacedonemployers,unlessexemptedbytheAct,toprepareandrevise,asappropriate,awrittenstatementoftheirgeneralpolicywithrespecttothehealthandsafetyatworkofemployees,thearrangementsforcarryingoutthepolicy,andtobringittotheattentionofemployees.Thisappliestoundertakingswithfiveormoreemployees.Suchpolicystatementsshould,whereappropriateincludereferencetoarrangementsinplaceforthepreventionofULDs.
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6 Section3oftheActplacesdutiesonemployerstopreventotherpeople,whoarenottheiremployees,beingexposedtoriskstotheirhealthandsafety.
7 Section7oftheActplacesdutiesonemployeestotakereasonablecareforthehealthandsafetyofthemselvesandofotherpersonswhomaybeaffectedbywhattheydo,orfailtodo,atwork.
Management of Health and Safety at Work Regulations 199920
8 TheseRegulationssetoutbroadgeneraldutieswhichapplytoalmostallkindsofwork.Theyplaceanumberofrequirementsonemployersto:
n assesstherisktothehealthandsafetyoftheiremployeesandtoanyoneelsewhomaybeaffectedbytheiractivity,sothatthenecessarypreventiveandprotectivemeasurescanbeidentified;
n theassessmentshouldtakeintoaccountrisksrelatingtoneworexpectantmothers(thisisrelevantbecausepregnancycanaffectULDrisksduetohormonalchangeswhichaffectligaments,posture,bloodpressureandcausefatigue);
n makearrangementsforputtingintopracticethehealthandsafetymeasuresthatfollowfromtheriskassessment.Thiscoversplanning,organisation,control,monitoringandreview,iethemanagementofhealthandsafety;
n providesuchhealthsurveillanceasisappropriatehavingregardtothehealthandsafetyriskswhichareidentifiedbytheassessment;
n appointcompetentpeopletohelpdeviseandapplythemeasuresneededtocomplywithemployers’dutiesunderhealthandsafetylaw(seeparagraphs39-40);
n giveemployeesinformationabouthealthandsafetymatters;n co-operatewithanyotheremployerswhoshareaworksite;n provideinformationtopeopleworkingintheirundertakingwhoarenot
theiremployees;n makesurethatemployeeshaveadequatehealthandsafetytrainingand
arecapableenoughattheirjobstoavoidrisk;andgivesomeparticularhealthandsafetyinformationtotemporaryworkers,tomeettheirspecialneeds.
9 TheRegulationsalso:
n placedutiesonemployeestofollowhealthandsafetyinstructionsandreportdanger;
n requireemployerstoconsultemployees’safetyrepresentativesandprovidefacilitiesforthem.Consultationmusttakeplaceonsuchmattersastheintroductionofmeasuresthatmaysubstantiallyaffecthealthandsafety;thearrangementsforappointingcompetentpersons;healthandsafetyinformationandtrainingrequiredbylaw;andhealthandsafetyaspectsofnewtechnologybeingintroducedtotheworkplace.
Workplace (Health, Safety and Welfare) Regulations 199247
10 Theaimoftheregulationsistoensurethatworkplacesmeetthehealth,safetyandwelfareneedsofeachmemberoftheworkforce.Aswellasfactories,shopsandofficestheregulationscoverschools,hospitals,hotels,placesofentertainment,roadsandpathsonindustrialestates,andtemporaryworksites(butnotconstructionsitesastheyarecoveredbyseparatelegislation-Construction(Health,SafetyandWelfare)Regulations199651andTheConstruction(DesignandManagement)Regulations1994.52
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11 TheRegulationsexpandonemployer’sdutiesinsection2oftheHealthandSafetyatWorketc.Act1974,andareintendedtoprotectthehealthandsafetyofeveryoneintheworkplace,andtoensurethatadequatewelfarefacilitiesareprovidedforthoseatwork.
12 Variousaspectsoftheworkplacearecoveredincluding:
n workstationsandseating:workstationsshouldbearrangedsothateachtaskcanbecarriedoutsafelyandcomfortablyintermsofheightoftheworksurfaceandaccessibilitytonecessaryitems,withfreedomofmovement
n maintenanceoftheworkplace,andofequipment,devicesandsystems. Equipmentshouldbemaintainedinefficientworkingorder
n temperatureinindoorworkplaces:duringworkinghoursthetemperatureinworkplacesinsidebuildingsshouldprovidereasonablecomfortwithoutneedforspecialclothing(specialcircumstancesapply,egforfoodhandling)
n lighting:thisshouldbesufficienttoenablepeopletoworkandusefacilities.Wherenecessary,locallightingshouldbeprovidedatindividualworkstations.
Health and Safety (Display Screen Equipment Regulations) 19925
13 TheRegulationsapplywhereworkershabituallyusedisplayscreenequipment,suchascomputers,asasignificantpartoftheirnormalwork.IntermsofpreventingULDstheyrequireemployersto:
n assessandreducerisks:themainhealthproblemsincludeupperlimbpainsanddiscomfort;temporaryvisualfatigue(possiblyleadingtotheadoptionofawkwardpostureswhichcancausefurtherdiscomfortintheupperlimbs);fatigueduetopoorworkstation,tasksorenvironmentdesign,andstress;
n ensureworkstationsmeetminimumrequirements.Inmostcasesthedisplayscreenshouldswivelandtilt,befreeofreflectionsandglareandhaveaclear,stableimage.Thekeyboardshouldtiltandbeseparatefromthescreen,withlegiblekeys.Theworkstationshouldbesufficientlylargetoallowflexibilityandcomfort.Theworkchairshouldbestable,comfortable,adjustableinheightandthebackshouldadjustinheightandtilt.Afootrestshouldbemadeavailable,ifneeded.Theenvironmentsuchasspace,lighting,heatandhumidityshouldbeadequate,andsoftwareshouldbesuitableandeasytouse;
n planbreaksorchangesofactivity.TiminganddurationofthesearenotstipulatedintheRegulationsasitdependsonthenatureofthework.Howeverbreaksshouldbeincludedintheworkingtime,preferablyshortfrequentbreaksawayfromthescreenandtakenbeforetheonsetoffatigue;
n providehealthandsafetyinformationandtraining;n provideeyetestsonrequest,andspecialspectaclesifrequiredforDSE
work.
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Provision and Use of Work Equipment Regulations 199848
14 TheRegulationsplacegeneraldutiesonemployersandlistminimumrequirementsforworkequipmenttodealwithhazardsinalltypesofindustry.TheRegulationsrequireemployersinallindustriestoensurethatworkequipmentissuitableforthepurposeandsafetouse.‘Workequipment’coverseverythingfromahandtool,throughmachinesofallkinds,toaconnectedseriesofmachinessuchasaproductionline.Theterm‘use’includesstarting,stopping,programming,setting,transporting,repairing,modifying,maintaining,servicingandcleaning.TheRegulationsrequirethatworkequipmentissuitableandsafefortheworkcarriedoutanddoesnotposeanyhealthorsafetyrisk.
15 Thegeneraldutiesrequireemployersto:
n takeintoaccounttheworkingconditionsandrisksintheworkplacewhenselectingequipment;
n makesurethatequipmentissuitablefortheintendeduseandthatitisusedwithsuitablesafetymeasures;
n ensurethatitisproperlymaintainedandinspectedasnecessary;n takeaccountofergonomicriskswhenselectingworkequipment,(ie
ensurethatequipmentandoperatingpositions,workingheights,reachdistancesetc.arecompatiblewiththeintendedoperator);
n giveadequateinformation,instructionandtrainingonuseoftheequipmentbeforeuse.
Personal Protective Equipment at Work Regulations 199249
16 TheRegulationsplaceadutyonemployerstoensurethatsuitablepersonalprotectiveequipment(PPE)isprovidedtoemployeeswhomaybeexposedtoarisktotheirhealthandsafetywhileatwork,incircumstanceswheresuchriskscannotbeadequatelycontrolledbyothermeans.PPEshouldtakeintoaccountergonomicrequirementsofthepersonwhowearsitandbecapableoffittingthewearercorrectly.
17 AnexampleofPPEishandandarmprotectionwhichisusedtoprovideprotectionagainstarangeofindustrialhazards,butwhichmayalsoreducetheabilitytogripandcontributetoULDs.
Manual Handling Operations Regulations 199250
18 Theseregulationsapplytoallmanualhandlingtasks,ietaskswhichinvolvetransporting,suchaslifting,pushing,pullingorsupportingaload.Inworkplaces,thereareawiderangeofhandlingandtransportingprocessestakingplace,rangingfromassemblylinework,liftingboxes,bagsandcomponents,tohelpingpeoplewithlimitedmobilitywiththeirdaytodayactivities.TheRegulationsapplytooperationswhichcancauseinjurynotonlytothebackbutmayalsoaffectallpartsofthebodyincludingtheupperlimbs.
19 Theregulationsplacedutiesontheemployerto:
n avoidtheneedforundertakinganymanualhandlingoperationsatworkwhichinvolveariskofbeinginjured,sofarasisreasonablypracticable;
n whereitisnotreasonablypracticabletoavoidriskofinjury,carryoutanassessmentoftheriskstotakeintoaccountthetask,load,workingenvironmentandtheworker’sindividualcapabilitytocarryoutthetask.
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HSEguidanceontheregulationsprovidesguidelinesforliftingloads;themaximumweightdependsonfactorssuchasheightofthelift,thedistancethattheobjectisextendedfromthebody,whethertheemployeeismaleorfemale,andwhethersittingorstanding;
n whereitisnotreasonablypracticabletoavoidriskofinjury,totakeappropriatestepstoreducetheriskofinjuryfromhazardousmanualhandlingtothelowestlevelreasonablypracticable.
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR)38
20 RIDDORplacesadutyonemployers,ontheself-employedandonthoseincontrolofworkpremisestoreportcertainwork-relatedaccidents,diseases,anddangerousoccurrencestotheenforcingauthorities(HSEorlocalauthorities).Ifadoctordiagnosesandreportstoanemployerthatanemployeeissufferingfromareportablework-relateddisease,andthepersonconcernediscurrentlyemployedinanassociatedworkactivity,thentheemployermustsend,eitherbypostorelectronicallyviatheHSEwebsite,acompleteddiseasereportformtotherelevantenforcingauthority.
21 IntermsofULDs,thediseaseswhichinspecifiedcircumstancesarereportablearecrampofthehandorforearm,subcutaneouscellulitisofthehand,bursitisorsubcutaneouscellulitisarisingatorabouttheelbow,traumaticinflammationofthetendonsofthehandorforearm,carpaltunnelsyndromeandhand-armvibrationsyndrome(althoughthelatterisoutsidethescopeofthisguidance).
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ReferencesReferences Cited in Text
1 Securing health together: A long term occupational health strategy for England, Scotland and WalesMisc225HSEBooks2000
2 Revitalising Health and Safety: Strategy Statement June 2000TheStationeryOffice2000.FurthercopiesareavailablefromDepartmentoftheEnvironment,TransportandtheRegions,FreeLiteratureService,POBox236,Wetherby,WestYorkshireLS237NB.
Tel:08701226236Fax:08701226237Website:http://www.detr.gov.uk/pubs/index.htm
3 Hand-arm vibrationHSG88HSEBooks1994ISBN0717607437
4 Mechanical Vibration: Guidelines for the measurement and assessment of human exposure to hand-transmitted vibration. Part 2: Practical guidance for measurement at the workplaceFirstEditionISO5349-22001
5 Display screen equipment work. Health and Safety (Display Screen Equipment) Regulations 1992. Guidance on RegulationsL26HSEBooks1992ISBN0717604101
6 Working with VDU’sLeafletINDG36(rev1)HSEBooks1998(singlecopyfreeorpricedpacksof10ISBN0717615049)
7 BernardBPandPutz-AndersonV(editors)Musculoskeletal disorders and workplace factors. A critical review of epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity and lower backNationalInstituteforOccupationalSafetyandHealthDHHS(NIOSH)PublicationNo.97-1411997
8 HunterDThe Diseases of Occupations(Ninthedition)ArnoldLondon2000 ISBN0340677503
9 CherryNetal‘Surveillanceofwork-relateddiseasesbyoccupationalphysiciansintheUK:OPRA1996-1999’Occupational Medicine200050(7)496-503.
10 CherryNetal‘Thereportedincidenceofwork-relatedmusculoskeletaldiseaseintheUK:MOSS1997-2000’Occupational Medicine200151(7)450-455
11 MackayCetalMusculoskeletal disorders in supermarket cashiersHSEBooks1998ISBN071760831X
12 Work-Related Upper Limb Disorders: A Review of the EvidenceNationalResearchCouncilWashingtonDCNationalAcademyPress1998ISBN0309063272
13 JonesJRandHodgsonJTSelf reported work related Illness in 1995: Results from a household surveyHSEBooks1998ISBN071761509XandJonesJR,HodgsonJTandOsmanJSelf reported working conditions in 1995HSEBooks1997ISBN0717614492
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14 Information sheet 2/99/EMSU Economic Impact: Revised data from Self-reported Work-related Illness survey in 1995 (SWI95)AvailablefromHSE’sEpidemiologyandMedicalStatisticsUnitandHSE’swebsitewww.hse.gov.uk
15 ChaffinDandAnderssonG(editors)Occupational biomechanics(Thirdedition)Wiley1999ISBN0471246972
16 WhitingWandZernickeR(editors)Biomechanics of musculoskeletal injuryLeedsHumanKinetics1998ISBN0873227794
17 ArmstongT,BuckleP,FineLetal.‘Aconceptualmodelforwork-relatedneckandupper-limbmusculoskeletaldisorders.Scandinavian Journal of Work Environment & Health19931973-84
18 BucklePandDevereuxJWork related neck and upper limb musculoskeletaldisordersEuropeanAgencyforSafetyandHealthatWorkLuxembourg1999ISBN9282881741
19 Health & Safety at Work etc Act 1974Ch3TheStationeryOffice1974ISBN0105437743
20 Management of health and safety at work. Management of Health and Safety at Work Regulations 1999. Approved Code of Practice and guidanceL21(Secondedition)HSEBooks2000ISBN0717624889
21 Work related upper limb disorders; the development of an interactive databaseHSEContractresearchreport.(Tobepublished).Forfurtherinformationsee‘otherwebsites’.
22 A guide to the Health and Safety (Consultation with Employees) Regulations 1996. Guidance on RegulationsL95HSEBooks1996ISBN0717612341
23 Safety representatives and safety committeesL87(Thirdedition)HSEBooks1996ISBN0717612201
24 A guide to the Offshore Installations (Safety Representatives and Safety Committees) Regulations 1989. Guidance on RegulationsL110(Secondedition)HSEBooks1998ISBN0717615499
25 HainesHMandWilsonJRDevelopment of a framework for participatory ergonomicsCCR174HSEBooks1998ISBN0717615731
26 Handle with care. Assessing musculoskeletal risks in the chemical industryHSEBooks2000ISBN071761770X
27 LiGandBucklePEvaluating change in exposure to risk for musculoskeletal disorders: A practical toolCRR251HSEBooks1999ISBN071761722X
28 McAtamneyLetalReducing the risks of work related upper limb disordersInstituteofOccupationalErgonomicsNottinghamUniversity1992.
29 BucklePTUC Guide to assessing WRULD risksTradeUnionCongress,CollegeHillPressLondon1994ISBN1850062773
30 LiGandBuckleP(editors)‘Currenttechniquesforassessingphysicalexposuretowork-relatedmusculoskeletalrisks,withemphasisonposturebasedmethods’Ergonomics199942(5)674-695
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31 Lighting at workHSG38(Secondedition)HSEBooks1997ISBN0717612325
32 New and expectant mothers at work: A guide for employersHSG122HSEBooks1994ISBN0717608263
33 A pain in your workplace? Ergonomic problems and solutionsHSG121HSEBooks1994ISBN0717606686
34 WoodsVandBucklePResearch into practice – the value of case studies in reducing musculoskeletal problems in the cleaning industry. Proceedings Premus 2001,FourthInternationalScientificConferenceonPreventionofWork-RelatedMusculoskeletalDisorders
35 GravesRJ,SinclairDTetalDevelopment and evaluation of diagnostic support aids for upper limb disordersCRR280HSEBooks2000ISBN0717618242
36 Access to Medical Reports Act 1988 (c.28)TheStationaryOfficeISBN0105428884.
37 CoxRAetalFitness for Work: The Medical Aspects(Thirdedition)OxfordUniversityPress2000ISBN0192630431
38 A guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995L73(Secondedition)HSEBooks1999ISBN0717624315
39 RIDDOR Reporting: Information about the new incident centreMISC310HSEBooks2001
40 RIDDOR ExplainedHSE31(rev1)HSEBooks2001
41 Social Security (Industrial Injuries)(Prescribed Diseases) Regulations 1985TheStationeryOfficeISBN0110564679
42 Health surveillance at workHSG61(Secondedition)HSEBooks1999ISBN071761705X
43 Health and safety benchmarking – Improving together: Guidance for thoseinterested in applying benchmarking to health and safetyLeafletINDG301HSEBooks1999(singlecopyfreeorpricedpacksof10ISBN0717624943)
44 Seating at workHSG57(Secondedition)HSEBooks1997ISBN0717612317
45 Vibration solutions: Practical ways to reduce the risk of hand-arm vibration injuryHSG170HSEBooks1997ISBN0717609545
46 HarringtonJMetal‘Surveillancecasedefinitionsforworkrelatedupperlimbpainsyndromes’Occupational and Environmental Medicine199855(4)264–271
47 Workplace health, safety and welfare. Workplace (Health, Safety and Welfare) Regulations 1992. Approved Code of PracticeL24HSEBooks1992ISBN0717604136
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48 Safe use of work equipment. Provision and use of work equipment regulations 1998. Approved code of practice and guidance(Secondedition)HSEBooks2001ISBN0717616266
49 Personal protective equipment at work. Personal Protective Equipment at Work Regulations 1992. Guidance on RegulationsL25HSEBooks1992ISBN0717604152
50 Manual handling. Manual Handling Operations Regulations 1992. Guidance on RegulationsL23(Secondedition)HSEBooks1998ISBN0717624153
51 A guide to the Construction (Health, Safety and Welfare) Regulations1996LeafletINDG220HSEBooks1996(singlecopyfreeorpricedpacksof10ISBN0717611612)
52 Managing construction for health and safety. Construction (design and management) regulations 1994. Approved code of practiceHSEBooks1995ISBN0717607925
Whileeveryefforthasbeenmadetoensuretheaccuracyofthereferenceslistedinthis
publication,theirfutureavailabilitycannotbeguarenteed.
Upperlimbdisordersintheworkplace Page85of89
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HSE publications
JacksonPRandParkerSK(editors)Change in manufacturing: How to manage stress-related risksHSEBooks2001ISBN0717620867
Enforcement policy statementMISC030HSEBooks2001
SinclairDT,GravesRJetalFeasibility of developing a prototype decision aid for initial medical assessment of work-related upper limb disordersCRR279HSEBooks2000ISBN0717618234
General ventilation in the workplace: Guidance for employersHSG202HSEBooks2000ISBN0717617939
Health risks from hand-arm vibration: Advice for employersLeafletINDG175(rev1)HSEBooks1998(singlecopyfreeorpricedpacksof10ISBN0717615537)
CoxT,GriffithsA,BarlowCetalOrganisational interventions for work stress: A risk management approachHSEBooks2000ISBN0717678382
Power tools: How to reduce vibration health risks - Guide for employersLeafletINDG338HSEBooks2001(singlecopyfreeorpricedpacksof15ISBN0717620085)
Stating your business: Guidance on preparing a health and safety policy document for small firmsLeafletINDG324HSEBooks2000(singlecopyfreeorpricedpacksof5ISBN0717617998)
Successful health and safety managementHSG65(Secondedition)HSEBooks1997ISBN0717612767
McCaigRandHarringtonM(editors)The changing nature of occupational healthHSEBooks1998ISBN0717616657
Thermal comfort in the workplace: Guidance for employersHSG194HSEBooks1999ISBN0717624684
Upper limb disorders: Assessing the risksLeafletINDG171HSEBooks1994(singlecopyfreeorpricedpacksof10ISBN0717607518)
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General Texts
HelanderMA Guide to the Ergonomics of ManufacturingTaylor&Francis1997ISBN0748401229
MoonSDandSauterSL(editors)Beyond Biomechanics: Psychosocial aspects of musculoskeletal disorders at workTaylorandFrancis1996ISBN0748403213
PheasantSBodyspace: Anthropometry, Ergonomics and the Design of Work(Secondedition)Taylor&Francis1996ISBN0748400672
SluiterJK,RestKM,Frings-DresenMHWCriteria document for the evaluation of the work-relatedness of upper extremity musculoskeletal disordersCoronelInstituteforOccupationalandEnvironmentalHealth,UniversityofAmsterdam,Netherlands2000
Putz-AndersonVCumulative trauma disorders: A manual for musculoskeletal diseases of the upper limbsTaylor&Francis1998ISBN0850664055
DulJandWeerdmeesterB(editors)Ergonomics for beginners – A quick reference guide(Thirdedition)Taylor&Francis2000ISBN0748400796
PheasantSErgonomics, Work and HealthMcMillanPress1991ISBN0309072840
O’NeilREurope Under Strain: A report on Trade Union initiative to combat workplace musculoskeletal disordersTUTBBrussels1999ISBN2930003294
WilsonJRandCorlettEN(editors)Evaluation of Human Work: A practical ergonomics methodologyTaylor&Francis1995ISBN0748400842
KroemerKHEandGrandjeanE(editors)Fitting the Task to the Human(Fifthedition)Taylor&Francis1997ISBN0748406654
ParkerSKandWallTDJob and work design: organising work to promote well-being and effectivenessSageLondon1998ISBN0761904204
Musculoskeletal disorders and the workplace: Low back and upper extremities NationalResearchCouncilNationalAcademyPress2001ISBN0309072840
KasdanML‘Occupational hand injuries’ Occupational Medicine: State of the Art Reviews19894(3)395-574
HadlerNMOccupational Musculoskeletal Disorders(Secondedition)LippincottWilliamsandWilkins1999ISBN0781714958
ClarkTSandCorlettEN(editors)The ergonomics of workspaces and machines: A design manual(Secondedition)Taylor&Francis1995ISBN0748403205
DiMartinoVandCorlettN(editors)Work organisation and ergonomicsInternationalLabourOfficeGeneva1998ISBN9221095185
KuorinkaIandForcierL(editors)Work related musculoskeletal disorders (WMSDs): A reference book for preventionTaylor&Francis1995ISBN0748401318
HutsonMAWork-related upper limb disorders: Recognition and management Butterworth-Heinmann1999ISBN0750645482
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Government bodies
HealthandSafetyExecutive:www.hse.gov.uk
HSEEmploymentMedicalAdvisoryService–lookfordetailsofyourlocalHSEofficeinthetelephonedirectoryorHSEwebsite.
DepartmentofHealth:www.doh.gov.uk
DepartmentforWork&Pensions/Disabilityserviceteam:www.disability.gov.uk
LocalAuthorityEnvironmentalHealthOfficers’:contacttheEnvironmentalHealthOfficeofyourLocalAuthority
Professional and Other Associations
BritishChiropracticAssociationBlagraveHouse,17BlagraveStreetReading,Berkshire.RG11QBTel:01189505950Web:www.chiropractic-uk.co.uk
BritishInstituteofMusculoskeletalMedicine34TheAvenueWatford,Herts.WD13NSTel:01923220999 Web:www.bimm.org.uk
CharteredSocietyofPhysiotherapy14BedfordRowLondonWC1R4EDTel:02073066666ScottishOfficeTel:01312261441,WelshOfficeTel:02920382428Web:www.csphysio.org.uk
CollegeofOccupationalTherapists106-114BoroughHighStSouthwarkLondonSE11LBTel:02073576480www.cot.co.uk
FacultyofOccupationalMedicineoftheRoyalCollegeofPhysicians6StAndrew’sPlaceRegent’sPark,LondonNW14LBTel:02073175890Web:www.facoccmed.ac.uk
GeneralOsteopathicCouncil176TowerBridgeRoadLondonSE13LUTel:02075376655Web:www.osteopathy.org.uk
InstituteofOccupationalSafetyandHealthTheGrange,HighfieldDriveWigston,LeicestershireLE181NNTel:01162573100Web:www.iosh.co.uk
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OccupationalTherapyinWorkPracticeandProductivityc/oSpecialistSectionsOfficerCollegeofOccupationalTherapists106-17BoroughHighStreetSouthwarkLondonSE11LBhttp://www.cot.co.uk/special/otwpp.htm.
RoyalCollegeofNursing20CavendishSquareLondonW1M0AB.Tel:02074093333Web:www.rcn.org.uk
SocietyofOccupationalMedicine6StAndrew’sPlaceRegent’sPark,London,NW14LBTel:02074862641Web:www.som.org.uk
TheAssociationofCharteredPhysiotherapistsinOccupationalHealthandErgonomics(ACPOHE)POBox121LondonE17Tel:01964534376http://www.acpoh.co.uk
TheErgonomicsSocietyDevonshireHouse,DevonshireSquareLoughborough,LeicestershireLE113DWTel:01509234904Web:www.ergonomics.org.uk
TheRSIAssociation380-384HarrowRoadLondonW92HUTel:02072662000Web:www.rsi-uk.org.uk
Other Websites
EuropeanAgencyforSafetyandHealthatWorkGranVia33E-48009BilbaoSpainTel:+34944794360Email:[email protected]:http://agency.osha.eu.int/andhttp://europe.osha.eu.int/good_practice/risks/msd/
NationalHealthServicehttp://www.nhsplus.nhs.uk
NationalInstituteforOccupationalHealthandSafety(NIOSH)(USA):http://www.cdc.gov/niosh/homepage.html
Workrelatedupperlimbdisorders:adatabaseofcourtjudgementshttp://www.lboro.ac.uk/wruld-db
Further informationForinformationabouthealthandsafetyringHSE’sInfolineTel:08453450055Fax:08454089566Textphone:08454089577e-mail:[email protected],CaerphillyBusinessPark,CaerphillyCF833GG.
HSEpricedandfreepublicationscanbeviewedonlineororderedfromwww.hse.gov.ukorcontactHSEBooks,POBox1999,Sudbury,SuffolkCO102WATel:01787881165Fax:01787313995.HSEpricedpublicationsarealsoavailablefrombookshops.
BritishStandardscanbeobtainedinPDForhardcopyformatsfromtheBSIonlineshop:www.bsigroup.com/ShoporbycontactingBSICustomerServicesforhardcopiesonlyTel:02089969001e-mail:[email protected].
TheStationeryOfficepublicationsareavailablefromTheStationeryOffice,POBox29,NorwichNR31GNTel:08706005522Fax:08706005533e-mail:[email protected]:www.tso.co.uk(Theyarealsoavailablefrombookshops.)StatutoryInstrumentscanbeviewedfreeofchargeatwww.opsi.gov.uk.
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