Health Surveillance Checklist Template

Owned by the programme lead. Enter the date the checks start on the first task: every due date counts from it in working days. Choose the hazard group and whether this round sets up a new programme or is a periodic round, and the tasks for each answer appear.

• Set up the round: the workers, the hazard, the dates and the people — the site and group of workers, the hazard group, whether this round sets up a new programme or is a periodic round of one already running, the date the checks start, the occupational health provider if you have one, and the people; later tasks are assigned from these fields
• Read the risk assessment that calls for health surveillance — the assessment of this work, its date, the controls in place and the risk to health that remains after them; health surveillance follows from the assessment and does not replace the controls
• Confirm which regulation requires the surveillance — the regulation for this hazard and its test, and why the test is met for this group; the note below shows the regulation for the hazard on the first task
• Check for work that needs medical surveillance by an appointed doctor — asbestos, lead, ionising radiation, work in compressed air and the substances and processes in Schedule 6 of COSHH need medical surveillance under their own regulations, by a doctor appointed by HSE; this checklist does not cover them
• Read the last round’s review and its open actions — shown only for a periodic round: the last round’s signed-off review and any conditions, actions still open, workers due a check, and any change to the work, the controls or the risk assessment since
• Check the provider and the scheme still fit — shown only for a periodic round: the provider’s contract and staff, the checks and intervals the provider advised, and whether a change in the work means the scheme should change
• Arrange the medical surveillance outside this checklist — shown only when some of the work needs medical surveillance: book it with an appointed doctor under the regulation that requires it, and keep its records under that regulation; it runs alongside this programme

Applies only when this round sets up a new programme. HSE says a scheme should usually be set up with input from a competent occupational health professional: choose one, agree the scheme, and agree what you will see and what stays confidential.

• Decide what you need from an occupational health provider — in-house or an external provider, every health hazard the group is exposed to, the number of workers, their shifts and sites, and who will lead and manage the scheme
• Check the provider’s competence for this hazard — training and experience in health surveillance for this hazard, suitably qualified staff for the checks, and reports on each worker’s fitness to continue the work; if a GP offers the service, check they are competent in occupational medicine
• Agree the scheme with the provider — the checks for this hazard and how often, the baseline for new starters, who leads the scheme, roles and how you communicate, and how results reach you; the provider advises the checks, and this template prescribes none
• Agree what the provider reports to you and what stays confidential — each worker’s fitness for the task with the exposure and when their next check is due, for the health record; clinical notes and test results stay in the medical record the provider keeps, and you see them only with the worker’s written consent
• Agree how the health records are held — who in your organisation sees the health records, where they are kept, how they are kept secure and for how long; information about workers’ health is covered by data protection law

Everyone the assessment shows is exposed or liable to be exposed goes on the list, including new starters and people changing jobs. The hazard on the first task adds a task to agree its checks with the provider, and a trained employee doing some checks adds their training.

• List the workers who need health surveillance — everyone in the group the risk assessment shows is, or is liable to be, exposed, with their job, the work that exposes them, when they were last checked and whether they are due this round
• Include new starters and people changing jobs — a baseline check before, or as soon as possible after, exposure starts, so later checks have something to compare with; agree how HR tells the programme lead when someone joins or moves into the work
• Plan for shift, part-time, agency and remote workers — when and where each of them can be checked in working time, and for agency workers, who arranges their checks and who keeps their record, agreed with the agency
• Tell the provider about workers who may be at particular risk — anyone the provider should see first, such as someone who already has hearing loss before noise work or a circulatory condition before vibration work, as HSE describes; record only who was referred, never why
• Agree this round’s checks and who does them — the checks the provider advised for this round, who carries out each one, and whether a trained employee (a responsible person) does some of them, such as questionnaires or skin inspections, passing what they find to the provider
• Noise: agree the hearing checks — shown for noise: hearing checks in controlled conditions by someone with the appropriate training, the programme under the control of an occupational health professional, workers told their results, and a doctor’s examination where hearing damage is found, as HSE describes
• Hand-arm vibration: agree the questionnaires and referrals — shown for hand-arm vibration: the screening questionnaires HSE publishes, who gives them, how positive answers are referred to the provider, and the higher-level checks the provider’s qualified staff carry out
• Respiratory: agree the questionnaires and any examinations — shown for respiratory sensitisers or dusts: the questionnaires the provider uses, who gives them, how answers reach the provider, and any examination by a doctor or trained nurse the provider advises
• Skin: agree the skin checks and who does them — shown for substances that harm the skin: a baseline skin assessment, then regular skin inspections by a trained responsible person or an annual questionnaire, depending on the level of risk HSE describes, and how findings reach the provider
• Other substances: ask the provider about the checks and biological monitoring — shown for other substances hazardous to health: the checks the provider advises for the substance, and whether biological monitoring (measuring a substance or its breakdown products in a sample such as urine or blood) has a role
• Train or refresh the responsible person — shown when a trained employee does some checks: training and ongoing support from the provider, what they look for, how they record findings and pass them on, and that they do not interpret them

HSE says health surveillance only works with workers’ co-operation. Consult before the checks start, tell every worker what the scheme is for and what happens to the results, and record consent wherever clinical information is to be shared.

• Consult the safety representatives and the workers — the health hazards, the controls, the scheme and how the results will be used, with the trade union safety representative or employee representative and the workers concerned, before the checks start
• Tell each worker what the scheme is for and what happens to the results — why surveillance is needed, what the checks involve as the provider describes them, who sees which results, what will happen if ill health is found, and that they can see their own health record
• Explain the duty to attend, in working time and at the employer’s cost — each worker must attend when required, during working hours and at the employer’s cost; tell them what action you may take if someone refuses, as HSE advises
• Tell workers how to report symptoms between checks — the symptoms to watch for that the provider and HSE describe for this hazard, and whom to tell straight away, without waiting for the next check
• Record written consent where clinical information is to be shared — the health record holds fitness advice, not clinical information; where a worker agrees to share anything more with you, or you need to see their medical record, get their written consent first and keep it

The checks start on the date on the first task. Book everyone in working time, hold the checks, follow up anyone who misses one, and wait for the provider’s report: until it arrives, the round is not complete.

• Book every worker’s appointment — a time in working hours for each worker due this round, with cover for their work, and the provider’s visit or clinic confirmed
• Hold the checks — the provider’s staff carry out the checks agreed for this round; record who attended and who did not
• Hold the responsible person’s checks — shown when a trained employee does some checks: the questionnaires or inspections done as trained, with what they found recorded and passed to the provider without interpretation
• Follow up anyone who missed a check — a new appointment for each worker who was absent or refused, with the reason recorded and the action the scheme sets out if someone refuses
• Receive the provider’s report on the round — fitness for the task for each worker and when their next check is due; HSE says the surveillance is not complete until you have this feedback

The provider’s fitness advice goes into each worker’s health record; clinical results stay with the provider. Where a check finds a health effect linked to the work, the tasks the regulations require appear.

• Record each worker’s fitness advice — fit, fit with restrictions or not fit for the task with the exposure, as the provider advises, any restriction advised and when the next check is due; no clinical details
• Noise: make sure a worker with hearing damage is examined by a doctor — shown for noise: where a check finds identifiable hearing damage, the worker is examined by a doctor, who may refer them to a specialist; the steps that follow apply if the doctor or specialist considers the damage likely to be the result of noise
• Make sure the worker is told by a suitably qualified person — shown when a check found a health effect: a suitably qualified person tells the worker and, under COSHH and the vibration regulations, gives information and advice on further health surveillance; for noise, record the doctor’s examination first, in the task before this one
• Check whether a diagnosis must be reported under RIDDOR — shown when a check found a health effect: occupational asthma, occupational dermatitis, hand-arm vibration syndrome and carpal tunnel syndrome are among the diseases reportable when linked to the work RIDDOR lists, once the employer receives a doctor’s diagnosis
• Consider alternative work for the worker — shown when a check found a health effect: work with no risk of further exposure, taking into account the advice of the doctor or occupational health professional
• Keep a health record for each worker — the worker’s details, where they work, the hazards they are exposed to and their fitness to continue, kept for at least the period the regulation sets; no confidential medical information without the worker’s written consent
• Review the risk assessment — shown when a check found a health effect: the assessment reviewed in the light of the result, with the date and what changed
• Give workers access to their own health record — on reasonable notice, and copies to the enforcing authority when it asks; offer a worker a copy of their record when they leave, as HSE suggests
• Review the controls, taking the provider’s advice into account — shown when a check found a health effect: the measures that control the exposure reviewed, with any advice from the doctor, the occupational health professional or HSE, and the changes made
• Review the health of others similarly exposed — shown when a check found a health effect: a review of the health of the other employees who have been similarly exposed, including a medical examination where one is recommended

Look at the round as a whole: grouped results, what they say about the controls, the collective results shared with the workers and the next round booked. Then the responsible manager signs off the review. Nothing after the sign-off can be completed until it is done.

• Review grouped results with the provider — results for groups of workers doing similar work, in groups large enough to protect each worker’s anonymity, to see how well the controls work
• Record what the round shows about the controls — whether the results show the controls working, and any change to the risk assessment or the controls they point to; where a health effect was found, the reviews in Phase 6 come first
• Share the collective results with the workers — the results for the group in a form that cannot be linked to any one person, given to the workers and their representatives
• Book the next round — the date of each worker’s next check at the interval the provider advised, and the date the next round’s checklist starts
• Responsible manager signs off the round’s review — the checks held, the health records kept, any action on the results done, the collective results shared and the next round booked; nothing after this task can be completed until it is signed off

After the sign-off: complete what was missing or meet the conditions, send the summary to the provider and the safety representatives, and close the round.

• Not approved: complete what is missing and bring it back — shown when the review is not approved: finish the tasks or records the manager named, then change the decision on the sign-off, or un-complete it and complete it again
• Send the round’s summary to the provider and the safety representatives — the grouped results, the actions taken and the next round’s dates, with nothing that links a clinical result to a worker
• Meet the conditions of the sign-off — shown when the review is approved with conditions: each condition met and recorded, and the responsible manager told
• Close the round and file the records — the provider’s report, the health records updated, the reviews and the sign-off filed, and the next round’s checklist started from its date