R112 Recommendation concerning Occupational Health Services in Places of Employment

Geneva, 24 giugno 1959

The General Conference of the International Labour Organisation,

Having been convened at Geneva by the Governing Body of the International Labour Office, and having met in its Forty-third Session on 3 June 1959, and
Having decided upon the adoption of certain proposals with regard to the organisation of occupational health services in places of employment, which is the fourth item on the agenda of the session, and
Having determined that these proposals shall take the form of a Recommendation,
adopts this twenty-fourth day of June of the year one thousand nine hundred fifty-nine, and the following Recommendation, which may be cited as the Occupational Health Services Recommendation, 1959:

I. Definition

1. For the purpose of this Recommendation the expression occupational health service means a service established in or near a place of employment for the purposes of:
(a) protecting the workers against any health hazard which may arise out of their work or the conditions in which it is carried on;
(b) contributing towards the workers' physical and mental adjustment, in particular by the adaptation of the work to the workers and their assignment to jobs for which they are suited; and
(c) contributing to the establishment and maintenance of the highest possible degree of physical and mental well-being of the workers.

II. Methods of Implementation

2. Having regard to the diversity of national circumstances and practices, occupational health services may be provided, as conditions require:
(a) by virtue of laws or regulations;
(b) by virtue of collective agreement or as otherwise agreed upon by the employers and workers concerned; or
(c) in any other manner approved by the competent authority after consultation with employers' and workers' organisations.

III. Organisation

3. Depending on the circumstances and the applicable standards, occupational health services:
(a) should either be organised by the undertakings themselves or be attached to an outside body;
(b) should be organised:
(i) as a separate service within a single undertaking; or
(ii) as a service common to a number of undertakings.
4. In order to extend occupational health facilities to all workers, occupational health services should be set up for industrial, non-industrial and agricultural undertakings and for public services: Provided that where occupational health services cannot immediately be set up for all undertakings, such services should be established in the first instance:
(a) for undertakings where the health risks appear greatest;
(b) for undertakings where the workers are exposed to special health hazards; (c) for undertakings which employ more than a prescribed minimum number of workers.
5. Where the organisation of an occupational health service, as defined in this Recommendation, is not for the time being practicable for geographical or other reasons defined by national laws or regulations, the undertaking should make arrangements with a physician or a local medical service for:
(a) administering emergency treatment;
(b) carrying out medical examinations prescribed by national laws or regulations; and
(c) exercising surveillance over hygiene conditions in the undertaking.

IV. Functions

6. The role of occupational health services should be essentially preventive.
7. Occupational health services should not be required to verify the justification of absence on grounds of sickness; they should not be precluded from ascertaining the conditions which may have led to a worker's absence on sick leave and obtaining information about the progress of the worker's illness, so that they will be better able to evaluate their preventive programme, discover occupational hazards, and recommend the suitable placement of workers for rehabilitation purposes.
8. The functions of occupational health services should be progressively developed, in accordance with the circumstances and having regard to the extent to which one or more of these functions are adequately discharged in accordance with national law or practice by other appropriate services, so that they will include in particular the following:
(a) surveillance within the undertaking of all factors which may affect the health of the workers and advice in this respect to management and to workers or their representatives in the undertaking;
(b) job analysis or participation therein in the light of hygienic, physiological and psychological considerations and advice to management and workers on the best possible adaptation of the job to the worker having regard to these considerations;
(c) participation, with the other appropriate departments and bodies in the undertaking, in the prevention of accidents and occupational diseases and in the supervision of personal protective equipment and of its use, and advice to management and workers in this respect;
(d) surveillance of the hygiene of sanitary installations and all other facilities for the welfare of the workers of the undertaking, such as kitchens, canteens, day nurseries and rest homes and, as necessary, surveillance of any dietetic arrangements made for the workers;
(e) pre-employment, periodic and special medical examinations:including, where necessary, biological and radiological examinations:prescribed by national laws or regulations, or by agreements between the parties or organisations concerned, or considered advisable for preventive purposes by the industrial physician; such examinations should ensure particular surveillance over certain classes of workers, such as women, young persons, workers exposed to special risks and handicapped persons;
(f) surveillance of the adaptation of jobs to workers, in particular handicapped workers, in accordance with their physical abilities, participation in the rehabilitation and retraining of such workers and advice in this respect;
(g) advice to management and workers on the occasion of the placing or reassignment of workers;
(h) advice to individual workers at their request regarding any disorders that may occur or be aggravated in the course of work;
(i) emergency treatment in case of accident or indisposition, and also, in certain circumstances and in agreement with those concerned (including the worker's own physician), ambulatory treatment of workers who have not been absent from work or who have returned after absence;
(j) initial and regular subsequent training of first-aid personnel, and supervision and maintenance of first-aid equipment in co-operation, where appropriate, with other departments and bodies concerned;
(k) education of the personnel of the undertaking in health and hygiene;
(l) compilation and periodic review of statistics concerning health conditions in the undertaking;
(m) research in occupational health or participation in such research in association with specialised services or institutions.
9. Where one or more of the functions enumerated in the preceding Paragraph are carried out, in accordance with national law or practice, by appropriate services other than occupational health services, these should provide the industrial physician with any relevant information he may wish to request.
10. Occupational health services should maintain close contact with the other departments and bodies in the undertaking concerned with questions of the workers' health, safety or welfare, and particularly the welfare department, the safety department, the personnel department, the trade union organs in the undertaking, safety and health committees and any other committee or any person in the undertaking dealing with health or welfare questions.
11. Occupational health services should also maintain relations with external services and bodies dealing with questions of the health, safety, retraining, rehabilitation, reassignment and welfare of the workers.
(1) Occupational health services should begin a confidential personal medical file at the time of a worker's pre-employment examination or first visit to the service and should keep the file up to date at each succeeding examination or visit.
(2) Occupational health services should maintain appropriate records, so that they can provide any necessary information concerning the work of the service and the general state of health of the workers, subject to the provisions of Paragraph 21.

V. Personnel and Equipment

13. Every occupational health service should be placed under the direction of a physician who will be directly responsible for the working of the service either to the management or to the body to which the service is subordinated.
14. The physicians in occupational health services should not have under their care a greater number of workers than they can adequately supervise, due account being taken of the particular problems that may be associated with the type and nature of the industry concerned.
15. The physicians in occupational health services should enjoy full professional and moral independence of both the employer and the workers. In order to safeguard this independence national laws or regulations, or agreements between the parties or organisations concerned, should lay down the terms and conditions of employment of industrial physicians and, in particular, the conditions concerning their appointment and the termination of their employment.
16. The physician in charge of an occupational health service should have received, as far as possible, special training in occupational health, or at least should be familiar with industrial hygiene, special emergency treatment and occupational pathology, as well as with the laws and regulations governing the various duties of the service. The physician should be given the opportunity to improve his knowledge in these fields.
17. The nursing staff attached to occupational health services should possess qualifications according to the standards prescribed by the competent body.
18. The first-aid personnel should:
(a) consist exclusively of suitably qualified persons; and
(b) be readily available during working hours.
19. The premises and equipment of occupational health services should conform to the standards prescribed by the competent body.

VI. Necessary Conditions for Performance of Functions

20. In order that they may efficiently perform their functions, occupational health services should:
(a) have free access to all workplaces and to the ancillary installations of the undertaking;
(b) inspect the workplaces at appropriate intervals in co-operation, where necessary, with other services of the undertaking;
(c) have access to information concerning the processes, performance standards and substances used or the use of which is contemplated;
(d) be authorised to undertake, or to request that approved technical bodies undertake:
(i) surveys and investigations on potential occupational health hazards, for example by the sampling and analysis of the atmosphere of workplaces, of the products and substances used, or of any other material suspected of being harmful;
(ii) the assessment of harmful physical agents;
(e) be authorised to request the competent authorities to ensure compliance with occupational health and safety standards.
21. All persons attached to occupational health services should be required to observe professional secrecy as regards both medical and technical information which may come to their knowledge in the exercise of the functions and activities enumerated above, subject to such exceptions as may be provided by national laws or regulations.

VII. General Provisions

22. All workers and their organisations should co-operate fully in attaining the objectives of occupational health services.
23. The services provided by occupational health services in pursuance of this Recommendation should not involve the workers in any expense.
24. Where national laws or regulations do not provide otherwise, and in the absence of agreement between the parties concerned, the expense of the organisation and operation of occupational health services should be borne by the employer.
25. National laws or regulations should specify the authority responsible for supervising the organisation and operation of occupational health services. They may, in appropriate cases, confer on recognised technical bodies the role of advisers in this field.

Fonte: ILO