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Content

Page
1 Introduction ................................................................................................................................... 2
2 Principles and Procedure .............................................................................................................. 2
3 Supporting Clauses..................................................................................................................... 66
4 Authorisation ........................................................................................................................... 1111
5 Revisions ................................................................................................................................ 1111
6 Development team .................................................................................................................. 1111
Annexes
Annex A Medical Surveillance Matrix ........................................................................................ 1212
Annex B Medical Surveillance and Control of Eskom Employees ............................................ 1515
Annex C Risk Exposure Medical Examination .......................................................................... 2222
Annex D Focused Medical Examinations .................................................................................. 2424
Annex E Shift Work Questionnaire ............................................................................................ 2525
Annex F Hazard Risk Exposure Questionnaire ......................................................................... 2626
Annex G Fitness to Drive/Critical Task Questionaire ................................................................ 2727

ll/EDC ISO formatted & checked (0.3) December 2007/published 13 Feb. 08


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1 Introduction
Medical Surveillance is based on the occupational risk exposure of employees. It is a statutory
requirement according to the Occupational Health and Safety Act no 85 of 1993 and forms an essential
component of an Occupational Health and Safety programme. The Medical Surveillance is a planned
programme of periodic medical examinations which may include clinical examination, biological
monitoring and/or medical tests of employees by an Occupational Health Nurse Practitioner or, in
prescribed cases, by an Occupational Medical Practitioner.

The purpose of medical surveillance is as follows:

a. To comply with statutory requirements


b. To determine fitness for duty by assessing:

i. Whether or not the prospective candidate or employee is physically/mentally fit, and able to
perform, the inherent requirements of the prospective or current job without any ill effects.

ii. Whether or not he/she is able to perform the work, but with reduced efficiency or
effectiveness.

iii. Whether he/she is able to perform the work, although this may adversely affect the medical
condition.

iv. Whether he/she is able to perform the work, but not without unacceptable risk to the health
and safety of himself/herself, other workers or the community.

v. Whether he/she is physically or mentally unable to perform the work in question.

vi. Whether he/she is disabled and voluntarily declares in terms of the Employment Equity Act as
they present themselves for examinations.

c. To provide a baseline health status against which future changes can be measured.

d. To ensure early identification of Occupational diseases at a reversible stage.

e. To ensure early identification of chronic medical conditions, which need continuous monitoring and
management.

2 Principles and Procedure

2.1 General Principle

2.1.1 The principle of conducting a General Occupational Medical Examination (GOME) is to detect a
disease at an early sub-clinical or pre-symptomatic stage, in order to take action to reverse these
effects, or to slow progression of the disease, e.g. Audiometric testing is applicable to employees
exposed to noise.

2.1.2 Personal monitoring means continuous screening of concentrations of exposure to hazardous


substances or stressors by applying monitors to individuals for a certain period. The monitors are
measured to establish the exact amount of exposure of the individuals to a specific substance or
stressor, e.g. dosimeter for ionizing radiation.

2.1.3 The frequency and the nature of the evaluation shall be based on the following:

a. The health hazards to which an individual is exposed and the length of time.

b. The health status of the individual (individual vulnerability).

c. The age of the individual.


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2.1.4 The Medical Surveillance Programme shall be co-ordinated by the relevant Occupational Health
Nurse Practitioner. For the programme to be effective and sustainable, the following elements are
essential:

The OHP, Occupational Hygienist, Risk Practitioner and line manager should:

a. Conduct a health risk assessment to determine the potential exposure to, hazards, hazardous
chemical substances and environmental stressors e.g. fly ash, asbestos and noise.

b. Identify the target organ that is exposed for appropriate medical screening e.g. hearing test for
noise.

c. Select the appropriate tests and specify testing schedule as well as action criteria e.g. 6/12 months
hearing test done on employees exposed to noise over 105 decibels.

d. Ensure biological monitoring is done on all employees exposed to hazardous chemical substances
such as toulene, mercury, benzene, PCP, and ionizing radiation.

e. Ensure that standardised testing methods and machines are used to ensure consistency.

2.1.5 When assessing fitness for duty, one of the following recommendations shall be made:

Cat Results Recommendations

1. Able to perform the work without any ill A No limitations/Restrictions


effects.

2. Able to perform the work, but with B Temporary Restriction


reduced efficiency or effectiveness.

3. Able to perform the work, although this C Adaptation of work environment.


may adversely affect the medical
condition.

4. Able to perform the work, but not without D Education or Training


unacceptable risks to the health and
safety of himself/herself, other workers
or the community

5. Physically or mentally unable to perform E Referral


the work in question.

6. Person with a disability as stipulated in F Declared/non declared


the EE Act. of 1998 (Add comments into
GA14)

2.1.6 The relevant line manager will be accountable for medical costs incurred as necessary, should
the employee need further tests to determine fitness for duty. The OHP should discuss proposed
referral with the line manager and Eskom Medical Practitioner before costs are incurred

2.1.7 A completed Man job/task specification form shall be completed by the line manager prior to a
medical evaluation with the most up to date risk profile.

2.1.8 A Hazard Risk Exposure Questionnaire (Annex G) shall be completed by line manager prior to
a medical evaluation.
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2.1.9 An individual OREP shall be compiled for each employee, as informed by the completed "man
job/task specification form" prior the medical evaluation by the OHP.

2.1.10 The OHP shall conduct relevant examination tests as indicated by the individual OREP. The
findings shall be recorded on the Medical Surveillance form (Annex B), communicated to the employee
and the line manager with employees informed consent.

2.2 Types of Medical Evaluation

There are four types of medical evaluations:

Pre-employment, Periodic, Transfer and Exit medical examinations.

2.2.1 General Occupational Medical Examination:

a. For a pre-employment medical examination complete Section A of Medical Surveillance Form


(Annex B)

b. When being transferred to a new risk area complete Section A of Medical Surveillance Form.

c. After a period of prolonged sick leave of > 30days. complete Section B of the Medical Surveillance
form.

d. When the employee leaves the organization by resignation, ill-health retirement and pension
complete Section C of the Medical Surveillance Form.

e. In the event that disabilities are picked up during the medical examination, as stipulated in the
EE Act. of 1998, employees are expected to voluntarily complete a declaration form which must be
endorsed by an Eskom Medical Practitioner. Some employees may choose not to declare.

Recommendations and results of the medical examination shall be discussed with the employee, and
with the line manager only with the full informed consent of the employee.

The OHP shall ensure that all data is captured on SAP EH&S.

2.2.1.1 The following documentation is required from HR Shared services and relevant line manager
prior to conducting a general occupational medical examination for a Pre-employment Health
Screening Medical, exit and, transfer medical evaluations.

a. Request shall be sent through the OHNP fourteen (14) days before the examination to allow for
proper planning

b. Man job/task specification form of the relevant medical examination shall be completed fully by
line manager.

c. GA14 (Annex D) for a Pre-employment or transfer medical evaluation.

2.2.2 Periodic Health Screening Medical:

a. Line Manager in collaboration with the OHP shall schedule employees according to the risk
profiles, e.g. noise, ionising radiation, dust, HCS, sewerage and drivers.

b. A completed man job/task specification form shall be given to the employee prior to the medical
examination

Note: Previous exposures to asbestos, silica and cadmium need continual monitoring even if persons are no longer
exposed in current occupations.
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2.2.3 Exit Health Screening Medical:

a. The exit health screening medical shall be conducted on employees transferring to other Eskom
business areas or going on retirement and separation. HR SSU shall request an exit medical
screening with the OHNP fourteen (14) working days after he/she has received the employees
resignation letter or GA2 if it is a transfer.

b. The OHP shall discuss the recommendations and results with the employee and the line manager
with the employees informed consent.

c. The OHP shall give the employee a copy of the medical results including the baseline hearing test
on request.

d. In the event that the exit medical screening results are abnormal, indicate a suspected
occupational exposure related disease; the employee shall be referred for confirmatory diagnosis
after consulting with the Eskom Occupational Medical Practitioner. Follow-up shall be ensured so
as to report the confirmed disease to COIDA.

The following people must be notified after obtaining confirmation to start Incident investigation:

i. Eskom Occupational Medical Practitioner;


ii. Line manager;
iii. Risk practitioner.

2.2.4 A General Occupational Medical Examination comprises of the following


examination(s)/test(s):

a. JJACCOL

b. Pulse and Blood Pressure

c. Urine testing

d. Height, weight and BMI

e. Abdominal Circumference

f. Vision test

g. Lung Function

h. Audiometric test

2.2.4.1 Hazard Risk Exposure Questionnaire Annex F

The purpose of this questionnaire is to obtain information regarding health risk exposure from the
prospective employee. It is intended to complement the information obtained from the completed man
job/task specification form and not to replace it. It shall be completed prior to all medical evaluations.

2.2.4.2 Fitness to Drive/Critical Task Questionnaire Annex G

The purpose of this questionnaire is to ask specific and detailed questions which pertain to driving and
critical tasks. This questionnaire shall be completed prior all medical examinations related to assessing
fitness to drive and performance of critical tasks.

2.2.4.3 Shift Work Questionnaire Annex E

The purpose of this questionnaire is to identify the early problems associated with shift work. It shall be
completed by all shift workers prior to periodic medical screening.
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2.2.4.4 Medical Surveillance Matrix (Annex A)

This matrix is a summary of the different types of medical evaluation, frequency, target organs and
medical tests such as biological monitoring to be done. The purpose of the matrix is to serve as a quick
reference. It should be used in conjunction with the medical surveillance protocols.

2.3 Record keeping

2.3.1 The OHP shall ensure that all data is captured on SAP EH&S.

2.3.2 The relevant OHP shall be responsible for the maintenance and administration of all applicable
medical records as determined by the OHS Act no 85 of 1993 and keep them for 50 (fifty) years in a
fire-proof cabinet or archive them where necessary.

2.3.3 If employee transfers to another BU, the relevant OHP shall ensure that the employees medical
files are forwarded to the next applicable OHP. An audit trail of the records shall be kept.

2.3.4 All medical records shall be kept in accordance with accepted medico-legal practice, as well as
Eskom requirements. They shall be kept in strict confidence. They shall only be discussed with other
members of the medical team on a need to know basis and, with the written informed consent of the
employee.

2.3.5 Medical records may be made available to other members of the medical team (any
professional registered with the Health Professions Council of South Africa, or the South African
Nursing Council), subject to the following requirements:

a. Information is required for legitimate purposes, and


b. Information is required in the ordinary course and scope of the team members duties, and
c. It is in the interest of the employee that such information be provided for case management in
cases of Incapacity Management and Accommodation Procedure.

2.3.6 Management shall only be provided with information on the following reasons:

a. Where the employees condition poses a threat to himself and/or others.

b. Where it is necessary for management to know about a reportable Occupational Disease or Injury
and an incident investigation is to be instituted.

c. Where it is necessary for management to institute additional control measures in terms of hazard
or environmental stressors control.

In all cases, written informed consent shall be obtained from the employee.

3 Supporting Clauses
Index of Supporting Clauses

3.1 Scope ....................................................................................................................................... 77


3.2 Normative/Informative References .......................................................................................... 77
3.3 Definitions ................................................................................................................................ 88
3.4 Abbreviations ........................................................................................................................... 88
3.5 Roles and responsibilities .................................................................................................... 1010
3.6 Implementation Date ............................................................................................................ 1010
3.7 Process for monitoring ......................................................................................................... 1010
3.8 Related/Supporting Documents ........................................................................................... 1010
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3.1 Scope

3.1.1 Purpose

The purpose of this document is to prescribe the procedure to be observed for the medical surveillance
and control of Eskom employees, bursars, learners, apprentices and contractors so as to establish and
maintain their physical and psychological capacity to efficiently discharge their duties and training.

3.1.2 Applicability

This procedure shall be applicable throughout Eskom Holdings Limited and its divisions.

3.2 Normative/Informative References

The following documents contain provisions that, through reference in the text, constitute requirements
of this procedure. At the time of publication, the editions indicated were valid. All controlled documents
are subject to revision, and parties to agreements based on this procedure are encouraged to
investigate the possibility of applying the most recent edition of the documents listed below.
Information on currently valid national and international standards and specifications can be obtained
from the Information Centre and Eskom Documentation Centre at Megawatt Park.

3.2.1 Informative

Employment Equity Act, No 55 of 1998

Labour Relations Act, No 66 of 1995

Basic Conditions of Employment Act, No 75 of 1997

Occupational Health and Safety Act, No 85 of 1993

Nursing Act No 50 of 1978

3.2.2 Normative

EPL 32-13: Health and Wellness Policy

EPC 32-72: Occupational Health and Safety Procedure

EPC 32-37: Substance Abuse Procedure

EPC 32-36: Smoking Procedure

Occupational Health and Safety Agreement

EPL 32-35: HIV and AIDS Policy

EPC 32-34: Employee Assistance Programme Procedure

EPC 32-95: Reporting, Recording and Investigation of Incidents

EPC 32-81: Management of Pregnancy in the Workplace

EPC 32-77: Management of Employee Incapacity due to Illness or Injury

EPC 32-343: Job Accommodation


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3.3 Definitions

3.3.1 Biological Monitoring: a planned programme of periodic collection and analysis of body fluids,
tissues, excreta, or exhaled air in order to detect and quantify the exposure to, or absorption of any
substance or organism by exposed persons.

3.3.2 Baseline Audiometry Screening: screening for hearing using equipment which meets
Eskoms prescribed standard, but conducted under conditions which comply with SANS 10 083
requirements in terms of mobile equipment requirements. The baseline report shall be used as
reference in the next hearing screenings that follow the baseline.

3.3.3 Medical Surveillance: is a planned programme of risk based periodic examinations (which
may include clinical examinations, biological monitoring or medical tests) of employees by an
occupational health nurse or in prescribed cases, by an occupational medicine practitioner. The results
from this programme act as an important indication of the adequacy of worksite health and safety
control measures.

3.3.4 Man-job/task specification form: A document in which critical performance areas (work
activities) of a particular job and the hazards to which the employee is exposed are identified. These
specifications will dictate the physical and mental inherent requirements necessary to perform the job.

3.3.5 Periodic Health Screening: a medical examination and/or tests performed on a regular basis
throughout an employees work life cycle in order to monitor their health status in relation to the
specific health and safety hazards to which they are exposed.

3.3.6 Occupational Health Practitioner: an Occupational Medicine Practitioner, or a person who


holds a qualification in Occupational Health recognised by the Medical and Dental Board of Health
Professions Council of South Africa, or the South African Nursing Council. This includes both
Occupational Medicine Practitioner(s) (OMP) and Occupational Health Nursing Practitioner(s) (OHNP).

3.3.7 Occupational Health: means the anticipation, recognition, evaluation and control of conditions
arising from the workplace, which may cause illness or adverse effects to persons.

3.3.8 Occupational Risk Exposure Profile: occupational risks that an employee is exposed to
and the relevant medical examinations and their frequency that must be conducted on the employee.

3.3.9 Risk: the probability that injury or damage will occur.

3.3.10 SAP EHS: the environment health and safety module of SAP .

3.3.11 GOME: A Comprehensive General Occupational Medical Evaluation.

3.4 Abbreviations

3.4.1 ABN: Abnormal


3.4.2 ALK: Alkaline Phosphatase
3.4.3 ALT: Alanine Transaminase
3.4.4 AST: Aspartate Transaminase
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3.4.5 BMI: Body Mass Index


3.4.6 BU: Business Unit
3.4.7 CO2: Carbon dioxide
3.4.8 CO: Carbon Monoxide
3.4.9 COIDA: Compensation for Occupational Injuries and Diseases Act of no. 30 of 1993
3.4.10 CXR: Chest X-ray
3.4.11 DB: Decibel
3.4.12 Dx: Distribution
3.4.13 EE Act: Employment Equity Act of 1998
3.4.14 ESR: Erythrocyte Sedimentation Rate
3.4.15 FBC: Full Blood Count
3.4.16 FEV: Forced Expiratory Volume
3.4.17 FVC: Forced Vital Capacity
3.4.18 (Gamma) GT: (Gamma) Glutamyl Transferase
3.4.19 GOME: General Occupational Medical Examination
3.4.20 HCS: Hazardous Chemical Substances
3.4.21 HR: Human Resources
3.4.22 ICAS: International Counselling Advisory Services
3.4.23 JJACCOL: Jaundice, Jugular, Anaemia, Clubbing, Cyanosis, Oedema, Lymphadenopathy
3.4.24 mths: Months
3.4.25 NAD: No Abnormality Detected
3.4.26 OHNP: Occupational Health Nursing Practitioner
3.4.27 OHS Act : Occupational Health and Safety Act no. 85 of 1993
3.4.28 OMP: Occupational Medicine Practitioner
3.4.29 OREP: Occupational Risk Exposure Profile
3.4.30 PBI: Percentage Binaural Impairment
3.4.31 PCB: Polychlorinated Biphenyl
3.4.32 PEV: Peak Expiratory Volume
3.4.33 PF: Peak Expiratory Flow
3.4.34 PHS: Periodic Health Screening
3.4.35 PLH: Percentage Loss Hearing
3.4.36 RBC: Red Blood Count
3.4.37 SAP EH&S: Systems Application Programme Environmental Health and Safety
3.4.38 SASOM: South African Society of Occupational Medicine
3.4.39 SF6: Sulphur Hexafluoride
3.4.40 SSU: Shared Services Unit
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3.5 Roles and responsibilities

Action step Responsibility Conditions


Divisions of Eskom Divisional Managing To ensure that officials within the Divisions comply
Holdings Limited Directors with this procedure.

a. The Health and Wellness Manager will be responsible for updating this procedure.

b. The Divisional HR Managers will be responsible for implementing the conditions in accordance
with this procedure.

3.5.1 Occupational Health Practitioner

The Occupational Health Practitioner shall:

a. Co -ordinate the medical surveillance programme.

b. Conduct medical surveillance in terms of the applicable statutory and ethical requirements.

c. Ensure that all medical records are captured into SAP EH&S and kept in a fireproof cabinet for
fifty years (50), under lock and key. Records shall be kept in confidence.

3.5.2 Line Manager

The relevant line manager shall, in consultation with the relevant OHP, safety risk practitioner,
occupational hygienist and occupational health and safety representatives with any other applicable
functionaries:

a. Conduct a Health Risk Assessment:

b. Complete the Hazard Risk Exposure Questionnaire;

c. Complete a man job/task specification form.

3.6 Implementation Date

The implementation date is December 2007.

3.7 Process for monitoring

System audits will be conducted and divisional HR Managers and Risk Managers will be informed of
the corrective actions to be taken.

3.8 Related/Supporting Documents

The document is superseded by Medical Surveillance Directive: ESKADABG4.


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4 Authorisation
This document has been seen and accepted by:

Name Designation
PJ Maroga Chief Executive
B Nqwababa Finance Director
ME Letlape Managing Director (Human Resources Division)
EN Matya Managing Director (Generation & Generation Primary Energy Divisions)
E Johnson Managing Director (Systems Operations and Planning Division)
MM Ntsokolo Managing Director (Transmission Division)
JA Dladla Managing Director (Office of the Chief Executive)
Dr SJ Lennon Managing Director (Corporate Services Division)
BA Dames Managing Director (Enterprises Division)
A Noah Managing Director (Distribution Division)

5 Revisions
Date Rev. Remarks

August 2007 0 Compile document

September 2007 0 EDC ISO formatted

December 2007 0 EDC ISO formatted and checked

6 Development team
The following functionaries have also provided input and have assisted with the development of this
procedure:

a. Dr Mike Simon
b. Sr Belina Ramogase
c. Dr Andre Botha
d. Dick Huyser
e. Sr Mary Marrie
f. Sr Thabitha Mashile
g. Sr Joey Mankge
h. Sr Christina Moleko
i. Sr Lallie Fourie
j. Sr Gele Mphasi
k. Sr Raelene Bloy
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Annex A
(informative)

Medical Surveillance Matrix


The following matrix is a summary for quick reference of the medical surveillance protocols described
in this procedure. The matrix should be used in conjunction with the specific medical protocols. The
Hazard Risk Questionnaire (Annex A) and Man-Job Specifications will determine the individual
Occupational Risk Exposure Profile and together with the purpose of the evaluation, will determine the
nature and frequency of the evaluation.

Frequency of
Situation Type of Medical Surveillance
surveillance
Pre-employment. GOME Pre-employment
At transfer GOME Prior to transfer
At exit from the organization. GOME Prior to leaving
After prolonged sick leave (> 30 days per GOME Post illness
annum, consecutive or intermittent).

On identifying new adverse information on GOME As required


a screening questionnaire

Heat-stress workers. GOME Annually


Periodic health screening Basic medical exam Determined by
Risk focused exam/tests specific protocol
Nuclear workers Done by OMP 12 monthly
Dept of Nuclear Safety
comprehensive
Noise exposed workers Audiometry and hearing
conservation program
85dB 105dB 12 mthly
>105dB 6 mthly
Organic solvent workers Hand and skin inspection 12 monthly
Ankle tendon jerks
Vibration sense (wrists and
malleoli)
Two point discrimination
Urine dipstix
FBC, ALT, AST, ALK.
Phosphate.
Gamma GT, Billirubin
Carbon monoxide exposed workers Headaches, fatigue, malaise, 12 monthly
Nausea at work. (Flu
symptoms.)
CO breathalyzer at end of shift
(This can be left to the
supervisor.)
Lead exposed workers Blood lead level Men: Baseline,
3 mths, 6 mths,
12 monthly.
Female: Baseline,
every 3 months
thereafter.
Mercury exposed workers Urine mercury levels. 12 monthly
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Annex A
(continued)

Frequency of
Situation Type of Medical Surveillance
surveillance
Cadmium exposed workers Urine beta-2-microglobu-lin 12 monthly
levels
Urine cadmium levels
Pulmonary function testing
Shift workers Shift Worker Questionnaire 12 monthly
Heavy Manual workers > 50 years Physical Ability 12 monthly
Assessment
Heavy Manual Workers < 50 Physical Ability Evaluation 24 monthly
Food handlers Hygiene education, Check 12 monthly
history of typhoid, colostomy,
respiratory disease.
Check skin.
Live Line workers Critical Task Questionnaire 12 monthly

Vibration exposed workers (whole-body) Ask re.: low back pain 24 monthly
Hand-arm Ask re.: hand or arm 24 monthly
pain/parasthesae
Vibration sense
Two point discrimination
Public Drivers permit Fitness to drive/critical task 12 monthly
(Code C1, C, EC, & EC1) (Medical questionnaire
Doctors only) * Requirements of Road Traffic
Special Drivers e.g. forklift/crane Act and SASOM Guidelines
Dx Critical Tasks * Risk exposure specific periodic
health screening
* These requirements apply to
drivers and critical task workers
Non-Vocational drivers Fitness to drive/critical task 36 monthly
questionnaire
Risk exposure specific periodic
health screening
Ergonomic exposure Specific questions related to 36 monthly
upper limb pain. If present try to
make a diagnosis
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Annex A
(concluded)

Frequency of
Situation Type of Medical Surveillance
surveillance
Asbestos exposed workers Respiratory system history and 24 monthly
examination
Pulmonary Function Tests
Chest X-Ray
Silica/dust exposed workers Ask re: cough, shortness of 24 monthly
breath.
Examine respiratory system
Pulmonary Function tests
36 monthly
Chest X-Ray
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Annex B
(informative)

Medical Surveillance and Control of Eskom Employees

MEDICAL SURVEILLANCE AND CONTROL OF


ESKOM EMPLOYEES
SCOPE:
This document comprises the prescribed form to be used in the medical evaluation and determination of the
NAME: .

UNIQUE NO: ..

occupational risk exposure profile (OREP) of all applicants and Eskom employees in accordance with:
Occupational Health and Safety Act and Regulations no. 85, of 1993
32-282 Procedure for Medical Surveillance
32-81 Procedure for Protection of employees during pregnancy and after birth of a child
32-73 Procedure for Primary health Care
SCSASACA2 - Medical Surveillance Standard (under review)
LD-1077: Requirements for the Medical and Psychological Surveillance and Control
ESKADAAS4: Medical Surveillance and Control of Nuclear Installation Personnel (under review)
KSA-055, Rev 1: Requirements for the Medical and Psychological Surveillance and Control
Programme
KAA-591: Medical and Psychological Surveillance and Control of Radiation Workers and Licensed
Operators
OBJECTIVES:
Medical Surveillance and Control of Radiation workers and Licensed operators

to evaluate and ensure the physical and psychological capacity of an applicant to work efficiently in his/her
intended occupation;
the promotion and securing of the health and safety of employees through the early detection of disease;
to ensure the safe performance of duties and execution of work processes through timeous detection of
risks to safety and health;
to comply with statutory requirements;
to establish a baseline of the employees health status and to monitor health throughout Eskom work-life.
MEDICAL EXAMINERS:
all pre-placement and periodic medical examinations are to be conducted by authorised Eskom
Occupational Health Practitioners (Occupational Health Nursing and Medicine Practitioners);
Where Eskom Occupational Health Practitioners are not available, pre-placement medical examinations
may be conducted by an external qualified Occupational Health Practitioner, if not available then by a
registered General Practitioner. Such medical examinations must be endorsed by an Eskom Occupational
SCSASACA2 - Medical Surveillance Standard

Health Practitioner prior to the appointment of the applicant;


pre-placement and periodic medical examinations of licensed operators (nuclear) and radiation workers
SCSPVACR2 - Periodic Health Screening

may only be conducted by a National Nuclear Regulator approved appointed medical practitioner;
32-282 Medical Surveillance Procedure

Pre-placement and periodic medical examinations of pilots to be conducted by a Civil Aviation Authority
registered Senior Medical Aviation Examiner.
INSTRUCTIONS:
the assessment of medical fitness is the responsibility of the Occupational Health Practitioner and is made
as a result of an appropriate medical evaluation, knowledge of the content and health risks of the
occupation, safety risk of the work process and with due regard to legislated requirements;
an OREP of each examinee is to be compiled at pre-placement, transfer and at periodic medical
evaluations;
the OREP of an employee shall determine the frequency and nature of the medical examination;
the periodic medical screening shall be dictated by the inherent requirements of the job and legislated
requirements and should include a clinical and occupational history and appropriate examination and tests;
business units are responsible for all costs of pre-placement and periodic medical examinations and related
special investigations;
the pre-placement and periodic medical examination form with attached special investigation reports and
the OREP of an employee are medico-legal documents which are to be retained by the employer for
50 (fifty) years from date of termination of employment.
copies of medical report shall be released to employees upon written request.

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Annex B
(continued)

DECLARATION

17. Declaration by applicant (initial your understanding and


acceptance of each paragraph) Initial
I hereby declare and warrant that to the best of my knowledge and
believe the above statements are true and complete in every respect
and I acknowledge that any misrepresentation or concealment of certain
information on my part renders me liable to immediate dismissal from
Eskoms service.
I acknowledge and understand that my duty to disclose all relevant
information includes not only responses to the questions contained in
this document, but the disclosure of all and any information pertaining to
my health and previous medical history, to enable Eskom to properly
assess my ability to perform the inherent requirements of the job I am
applying for.
I hereby authorize Eskom in rem suam and irrevocably to obtain any
information that Eskom in its sole discretion might consider necessary in
respect of my health from any person who has such information
available and I hereby indemnify anybody who, at the request of Eskom
supplies information, against any legal action whatsoever as a result of Signature of Applicant
them supplying the information. I undertake to sign the necessary
consents in this regard if required to do so. I further agree that should I
refuse to sign such consent, that my application with Eskom will no
longer be considered. I further indemnify Eskom against any legal
action, should it as a result of my refusal, no longer consider my
participation.
I agree that all special medical investigations, including blood tests,
deemed necessary by specific workplace circumstances may be
undertaken. I agree, that if employed, to undergo periodic medical
examinations and tests as prescribed in Eskom policies/directives and
standards on Occupational Health. I further acknowledge that should I
refuse a medical examination disciplinary action may be taken, which
may lead to my dismissal.
I hereby indemnify Eskom, the employees and any Health Practitioner
designated by Eskom for medical examination purposes, against any
claims flowing forth from any such medical examinations, reports and Signature of Medical Examiner
recommendations and the consequences thereof.
I hereby acknowledge that I will not be entitled to apply for early
retirement on the basis of ill health in the event that the condition which
has resulted in my inability to continue working for Eskom is one which:
I presently have and have not disclosed to Eskom;
I presently have but Eskom has employed me despite knowledge of
such condition on the express agreement that I will not be able to
apply for early retirement on the basis of ill health in respect of that
particular condition.
Note: NB: This medical examination is not intended to substitute for a
comprehensive examination by the applicants personal doctor and is not
intended to establish a doctor/patient relationship.

Date (DD-MM-CCYY)
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 17 of 17

Annex B
(continued)
A. PRE-PLACEMENT/TRANSFER MEDICAL EXAMINATION Date
1. Full Names, incl. Surname 2. Telephone Numbers 3. FREQUENCY CATEGORY BASED ON OREP (Page 5)
A B C D
4. Home Address ( ) (Work) 5. Occupation 6. Business Unit 7. Section
Postal Code
( ) (Home)
8. Date of birth 9. Age 10. Sex 11. Designation 12. ID Number 13. Unique No.
(DD-MM-CCYY)

14. Occupational History


Dates Occupational History and Hazard Exposure (in chronological order) Hazard Exposure
From To Organisation Location Occupation (Radiation, Noise, Asbestos, etc.)

15. Geographical History


From To Where grew up and lived Hazard Exposure

16. Medical History: If YES please provide complete details below (if space is insufficient, add supplementary notes on separate sheet)
(N = No, Y = Yes)
Have you ever had, or do you Have you ever had, or do you now Have you ever had, or do you now
N Y N Y N Y
now have: have: have:
1. Freq. or severe headache/ 12. Tuberculosis 23. Malignant tumours or cancer
migraine
2. Fainting attacks or dizziness 13. Stomach, liver/intestinal trouble 24. Skin disease (psoriasis/eczema)
3. Head injury/concussion/ 14. Heart trouble/high blood pressure 25. Sleep disorders
unconsciousness
4. Blackouts/epilepsy/fits 15. Shortness of breath, chest pain or 26. Varicose veins causing problems
palpitations
5. Depression/anxiety or any other 16. Sinus problems 27. Any symptoms which frequently
nervous or psychological prevent you from going to work for a
problems day or two or longer
6. Eye or vision trouble (except 17. Wrist, elbow, shoulder problems 28. Hernias
glasses)
7. Spectacles or contact lenses 18. Back/neck trouble, chronic 29. Any other illness or injury
backache, a pinched nerve in the
spine.
8. A discharge from either ear 19. Foot, ankle, knee or hip trouble Are you now or have you ever been: N Y
9. Hearing disorders or deafness 20. Arthritis or any joint problems. 30. Treated for alcohol/drug addiction
10. Allergies: Respiratory/Skin/ 21. Kidney stone or infections 31. A smoker (cigs. or pipe) if yes: How
Med. many per day: How long:
11. Asthma/lung disease/chronic 22. Diabetes, Thyroid, Blood disorders 32. Admitted to hospital (for any reason)
cough
33. Exercise: Time/frequency 34. Alcohol/drug consumption: Units per time
35. Hobbies: Type: 36. Medicine: Please indicate what medicines you are currently using or
have used at any time in the last 2 years (prescription and non-prescription)
37. (Females only) Date of last menstrual period / Last pregnancy:
43. Medical treatment within the last three (3) years, which required sick leave >7 days of hospitalisation
Date Name of Medical Practitioner, Specialist, etc. Diagnosis/treatment

REMARKS (To be completed by Medical Examiner, Comment in full on all items marked YES)
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 18 of 18

Annex B
(continued)
43. (cont.)
PRE-PLACEMENT/TRANSFER MEDICAL EXAMINATION

39. Mass 40. Height 41. Pulse 42. Blood 43. Urina-

Leucocyte

Not done
(kg) (cm) rate/min Pressure. lysis

Billirubin
Glucose

Ketones
Nitrates

Protein
Mm/hg

Urobil

Blood
pH
Lying Standing

BMI Abdominal circumference Normal /


Present
Abnormal /
not present
Mark each item in the appropriate column NAD ABN Not Mark each item in the appropriate column NAD ABN Not ABN
Done Done
44. JJACCOL 51. Neurological system (ankle jerks)
45. Head, face, scalp and neck 52. Upper and lower limbs (strength,
range and motion)
46. Ears, mouth, nose and throat 53. Spine and musculo-skeletal
47. Respiratory system 54. Genito-urinary
48. Cardiovascular and lymphatic 55. Skin and appendages
49. Lymphatic System 56. Psychological impression
50. Abdomen (viscera, hernia and liver) 57.
SPECIAL MEDICAL INVESTIGATIONS (To be conducted as prescribed by the OREP and on request of Eskom)
57. Vision examination 58. Screening Audiometric 59. Special examinations (Attach reports)
(Attach Audiogram)
Corrective lenses used? Yes No Frequency (H3) R L Lung function test Volume % NAD ABN
(Spirometric) (/)
Opthalmoscopy: (NAD / ABN) R L 250 FVC
Cornea/Lens/Fundi 500 FEV1
Visual acuity (corrected) R L 1 000 PF
Far (6 m) 6/ 6/ 2 000 FEV1/FVC%
3 000 Chest X-Ray (attach report)
Near (50 cm) 6/ 6/ 4 000
6 000 Vibration Sense
Night vision 6/ 6/ 8 000 Blood tests if indicated NAD ABN
Visual fields : (NAD / ABN) Categorization Full blood count/ESR
AST/ALT/Gamma GT/ALK.phosphate
Colour vision (state method) PLH Current Blood sugar
Blood lead
Orthorator PLH Base line Serum/RBC Choline-esterase
Ishihara PLH Shift Other blood investigations
Urinary mercury
Colour wires PBI Urinary Cadmium and Beta2
micro globulin
PAA results ( conducted in some sites)
Summary of findings: Describe every abnormality in detail
1 Significant medical history/findings
1 No abnormal medical findings
DECLARATION AND RECOMMENDATIONS BY MEDICAL EXAMINER
I hereby certify that I personally examined the applicant and this report and attachments embody my findings completely and correctly
The applicant (full name) ___________________________________________________________ Unique no.: _______________________________

Cat Recommendations Comments


1. Able to perform the work without any ill effects. A No limitations/Restrictions
2. Able to perform the work, but with reduced efficiency or effectiveness. B Temporary Restriction
3. Able to perform the work, although this may adversely affect the medical condition. C Adaptation of work environment
4. Able to perform the work, but without unacceptable risks to the health and safety of himself, other D Education/Training
workers or the community.
5. Physically or mentally incapable of performing the work in question. E Referred

6. Person with a disability as stipulated in EE Act. Then add to GA 14 comments. F Declared/Non-declared


Signature of OHP: ____________________________ Name and Qualifications: _____________________________ Date: _____________________
Medical Surveillance Unique Identifier 32-282
Revision 0
Page 19 OF 19

Annex B
(continued)
OCCUPATIONAL RISK EXPOSURE PROFILE

Name: A. Annual Food handlers B. 2-yearly Tech/other C. 3-yearly Admin D. More frequently
BU: Examiner: Nuclear Live-line workers Heavy manual <50 Driver IV (Compromised health)
Unique Nr.: Pilots Tech-chemical SHE & S
Department Date: Shiftworkers Heavy manual >50
Occupation: Heatworkers years,Drivers I,ll,lll Critical task

Wellness Quest

CoBreathalyser
Vibration sense
Resp.hist/exam

Ergonom. Eval.

Shiftwork Ques
Two pt. discrim

Crit Task/Driv Q
Skin hist/ exam

Beta 2 Microblob
Psycho-Eval
Lung Function
Audiometry

Cholinesterase
Frequency

Haz Quest
Full Exam

Compromised
Basic Exam
Exposure

Exposure

Exposure

Exposure

Exposure

GAMMA GT
ALK PHOS
Neuro

Vision

Cadmium
CXR

PCA

FBC

Mercury
Bilirubin

Normal

At Risk
S.ALT

Lead
AST
Physical
Env.
Noise 85 dB 12
105 dB
105 dB 6
Vibration 24
Thermal: Hot 12
Cold 24
Erg. Stress 36
Elect.Contact
Illumination 36
Phys. Work 24
Heavy >50 12
manual <50 24
Critical Task 24
Office 36
Plant/wshop
Field 24
Transport 24
Radiation
Env.
Ionising 5 mSc 24
>5 mSv 12
Non-ionising 24
EMF
U/V 24
Airborne
Env.
Asbestos 24
Silica 24
Coal Dust 12
Gases/ Vapours 12
(CO2, SF6)
Medical Surveillance Unique Identifier 32-282
Revision 0
Page 20 OF 20

Annex B
(continued)
Chemical
Env.
Metals: Lead 6/
12
Mercury 12
Cadmium 12
Weld & 12
solder fumes
Solvents, oils 12
& greases
PCB 12
Pesticides 12
Diesel/petrol 12
Psycho-
Social

Mental 12
Stress
Shift work 12
Other
Medical Surveillance Unique Identifier 32-282
Revision 0
Page 21 OF 21

Annex B (concluded)

OCCUPATIONAL RISK EXPOSURE CATEGORIES


Frequency of Exam
Occupational Risk

Blood

Urine
Exp. Profile

Months

BE - Basic Exam

Driver/
Quest.
Basic

CXR
LFT
AM
PE

VF

PCA
PE - Psychological Exam

TToxicol

LFTs
FBC
AM - Audiometry

CATEGORY LFT - Lung Function Test


Driver 1, 11, 12 CXR - Chest X-Ray
111
Driver 1V 36 VF - Vision Function
24 PCA - Physical Capacity
Critical task
Assess
Shift worker 12
Technical 24 FBC - Full Blood Count
Heavy 12
Manual
Admin 24 LFT - Liver Function
SHE & S 12 TOX - Toxicology
Nuclear 12
Medical Surveillance Unique Identifier 32-282
Revision 0
Page 22 OF 22

Annex C
(informative)
Risk Exposure Medical Examination
B. NOTE: Select appropriate examination/tests. RISK EXPOSURE MEDICAL EXAMINATION
C. Exit Examination
based on hazard profile of individual
1. Brief details of any illness, accident & treatment since last exam. T/F to BU OREP Category
2. Systematic history to be probed at each periodic medical exam.
Medical 3. Hobbies, smoking, alcohol, medication, diet and exercise habits.
4. Any new Allergies
Occ. Age OREP Occ. Age OREP Occ. Age OREP Occ. Age OREP
History Resigned Retirement
Exit Ill
Discharged Normal Early
health
Current Medical / Surgical / Psychosocial history
Histo
ry

Mass Kg; BMI=


Pulse Blood
Rate Pressure
Abdo. Circum
JJACCOL
Physical Examination

Head, face, scalp and neck


Ears, nose, mouth and throat
Respiratory System
Cardiovascular & lymphatic
Abdomen (viscera, hernia, liver)
Neurological system (ankle jerks)
Upper and lower limbs (strength, range of motion)
Spine and musculo -skeletal (cervical, thoracic, lumbar)
Vibration Sense
Skin and appendages
Psychological impression
Medical Surveillance Unique Identifier 32-282
Revision 0
Page 23 OF 23

Annex C
(concluded)

Visual acuity (corrected) Far (6 m) 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/


Vision

Near (50 cm) 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/ 6/


Visual fields NAD/ABN
Cornea/Lens/Fundi NAD/ABN
Hea- Categorization % HL % Disability % HL % Disability % HL % Disability % HL % Disability % HL Disability
ring
FVC %
Function

Spirometry FEV% PEF %


Lung

FEV %
Chest X-Ray NAD/ABN
CO CO NAD/ABN/ Not done
PCA PCA NAD/ABN/ Not done
FBC NAD/ABN/ Not done
S. ALT NAD/ABN/ Not done
Blood

Gamma GT NAD/ABN/ Not done


Billirubin NAD/ABN/ Not done
Lead NAD/ABN/ Not done
Choline -esterase NAD/ABN/ Not done
Mercury NAD/ABN/ Not done
Urine

Cadmium NAD/ABN/ Not done


Beta 2 Micro globulin. NAD/ABN/ Not done
Urinalysis: Protein/Sugar/Blood/Leucocytes NAD/ABN Pro Sug Blood Leuc Pro Sug Blood Leuc Pro Sug Blood Leu Pro Sug Blood Leuc Pro Sug Blood Leuc
Results Recommendation (Tick appropriate column)
1. A
2. B
3.
COMMENTS

C
4. D
5. E
See page 4 for explanation
O.H. Practitioner Name & Signature
Medical Centre
Date
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 24 of 24

Annex D
(informative)
Focused Medical Examinations
FOCUSED MEDICAL EXAMINATIONS ADDITIONAL NOTES

Date Clinical Examination and Special Investigation Interventions/Referral

Termination of Employment/Transfer Medical Examination


Comment on: 1. Health Suitability for transfer to a different OREP and/or B.U.
2. Occupational hazard exposure incidents and injuries at work.
3. Presence of any occupational disease/s.
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 25 of 25

Annex E
(informative)

Shift Work Questionnaire

SURNAME ___________________ INITIALS ____________ UNIQUE NO ________________

QUESTIONS YES NO

1. Do you have trouble sleeping?


2. Do you often feel tired when you wake up?
3. Do you frequently have stomach or bowel complaints such as constipation and/or
diarrhoea, indigestion or heartburn?
4. Are you finding that you are using more alcohol or prescription tranquillisers or similar
drugs that you think may be good for you?
5. Have you had any accidents or near misses since your last medical assessment?
6. Do you often feel tired, unhappy or depressed without an obvious reason?
7. Do you think you are having more difficulties than normal in interpersonal relationships
at work and at home?
8. Are there any other aspects where you think shift work may be affecting your health or
happiness?

If you answered yes to any of the questions above, please provide any details in the space below.

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

The above information will be treated in the strictest confidence by Eskom Health and Wellness Services
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 26 of 26

Annex F
(Informative)

Hazard Risk Exposure Questionnaire

SURNAME ___________________ INITIALS ____________ UNIQUE NO ________________

Tick below
EXPOSURES QUESTION YES NO
1. Organic Do you work with or near electrical cleaning substances
solvents degreasing agents, thinners, petrol, pesticide or herbicide sprays,
oil based paints, varnishes or glues ?
Please list the substances you are exposed
to.

2. Ergonomics Do you have a painful condition of your hands, wrists, arms or


shoulders that has persisted for 6 weeks or longer?

3. Vibration Do drive or operate any Eskom vehicles or machinery ? If yes


please specify type. ...
Do you work with chain saws, pneumatic drills, brush-cutters,
grinders, jackhammers or any other vibrating machinery?

4. Silica. Do you, or have you EVER, routinely worked in or been in


proximity to, the following activities:
Jackhammer or pneumatic drill use.
Blasting.
Sandblasting.
Routine wall drilling.
Any other man-made dusty occupation.

5. Carbon Do you work in an un-vented workshop, garage or store where a


Monoxide motor vehicles engine is running, a forklift is operating, or any
other petrol or diesel or propane driven machine is operating or
confined spaces for extended periods?

6. Noise Do you, at any time, work with tools or machinery, travel in a


vehicle, whose noise level is such that you cannot comfortably
communicate with a person next to you?

7. Shift Work Do you perform regular shift work or abnormal overtime work?

8. Lead Do you engage in any of the following activities at work:


Shooting firearms on a firing range.
Welding.
Torch cutting.
Plumbing.
Repair of buildings.
Stripping, sanding or burning old paint.
Cable stripping.
Cable joining.
Automobile or other vehicle repair.
Soldering.
Any other exposure to lead.
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 27 of 27

Annex G
(informative)

Fitness to Drive/Critical Task Questionnaire

SURNAME __________________________ INITIALS ______________________________


UNIQUE NO _________________________ DATE OF BIRTH ________________________
WORKSTATION ______________________ WORK TEL NO _________________________
This questionnaire should be completed comprehensively. Please try to answer all the questions. The information will be
treated confidentially.
WARNING. You are accountable for the accuracy of your statements. If information is withheld or deliberately misleading,
you may be in contravention of the requirements specified in terms of the Road Traffic Act (93 of 1996.) and disciplinary
action may be taken against you.
Have any of the following conditions occurred on the job or off the job in the last 24 months?
Please tick either the Yes or No column as appropriate.

YES NO
1. Epileptic seizure?
2. Loss of consciousness or blackout?
3. Falling asleep while driving or similar activity?
4. Any disease or condition of the brain or nervous system?
5. Attacks of dizziness or vertigo (a spinning sensation)?
6. Attack(s) of temporary, partial or complete blindness?
7. A heart attack, angina or disturbance of the pulse rate or rhythm?
8. Any other heart disease?
9. High blood pressure?
If on treatment, please list your medication plus any side effects you may be
experiencing.
Name of medication and side effects

_________________________________________________________

Name of medication and side effects

_________________________________________________________

10. Diabetes?
If yes, (Circle the correct answer)
Insulin?
Tablets?
Both?

11. Serious psychiatric or psychological illness?


12. Alcohol abuse or dependence?
Medical Surveillance Unique Identifier: 32-282
Revision: 0
Page: 28 of 28

Annex G
(concluded)

13. Are you taking an anti-depressant, tranquillisers, and tablets for stress or nerves or
any other medication that could impair your response or driving ability?
If so, please list the names
13.1 _________________________________________________________
13.2 _________________________________________________________
13.3 _________________________________________________________

14. Do you use any of the illicit recreational drugs?


(e.g. Dagga, Ecstasy, LSD, amphetamines or cocaine.)
15. Any eye injury, illness or eye operation?
16. Are you suffering from any vision impairment?
17. Do you have any endorsements on your license related to your driving ability?

If the answer was yes to any of the above, please provide full details in the space below.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

__________________________________________________

DECLARATION: I certify that the above information is, to the best of my knowledge, a true and accurate reflection.

SIGNATURE ______________________________ DATE _________________________

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