1. Occupational Health & Industrial Hygiene Management FFBL – HSE Seminar
Dr. Tahir Baig Barlas
OHSE - Consultant
Barlas HSE Solutions, Systems Certification & CSR Consultancy Services

2. Ex – Corporate HSE Manager Azgard9 Group
WHO AM I ?
Ex – Corporate HSE Manager Azgard9 Group
(Pak American Fertilizers & Textile Business)
Ex – GM HSE PIA
EX- Country Corporate HSE Manager Shell Companies in Pakistan
Ex- Occupational Health Physician ICI Pakistan
Visiting HSE Consultant PSTD
OHS Training Resource – ILO Turin Italy

3. What HSE is all ABOUT!
Harry, age 16, Pulled into machinery in a factory. His arm was ripped off at the shoulder and his leg broken.

4. DRIVERS OF OCCUPATIONAL HEALTH PROGRAM
LOCAL LAGISLATION
HSE POLICY
OHSAS 18001/ ISO14001
MHMS
HEALTH
HEMP / MHMS
HSE-MS
Goal of no harm to People
Manage all HSE Risks
HRA of HSE Critical Activities
Implementation of Standards
To manage health risks in a way other business risks are being managed, the Group has mandated direction (HSE Policy), structured system (HSE MS) and the process (HEMP - HRA). A Shell owned company is required to implement the following in order to manage health risks as part of the HSE risks management.
HSE Policy Goal of no harm to people.
We live in a performance oriented world in which effects of past and present activities on the health is also of significant concern to all stakeholders (employees, general public, Regulators, NGO etc.)
HSEMS Manage all health risks
Company’s requirement (HEMP) to provide assurance that all health risks are managed at ALARP level.
HEMP HRA is a tool to apply HEMP to health risks associated with the company’s business.
MHMS It is a Group requirement to implement Minimum Health Management Standards (MHMS) of which HRA is an essential element.
HSE Policy
HSE-MS
Health, Safety and Environment Management System
HSE Management System (1999)
Minimum Health Management Standards

5. Aims of Occupational Health
Promote and maintain highest degree of physical, mental and social well-being of workers in all occupations;
Prevent among workers all departures from Health caused by their working condition;
Protect workers in their employment from risks resulting from factors adverse to health; and,
Place and maintain the worker in an occupational environment adapted to his physiological and psychological capacity.
Prediction of health outcomes!

6. Occupational Health Perspectives
There are generally two adopted views on Occupational Health:
Restricted or workplace focused
Wider view to include the workplace and the communities in and around the work site.
The limited view takes the perspective that the company’s responsibility towards employees health covers only those illness acquired through direct workplace exposures excluding illnesses which are acquired through outside exposures and personal behavior. As such the health programs covers only the identification, prevention and control of hazards inside the workplace. Conditions in the community affecting workers health is not the responsibility of the company but of public and external private health providers and practitioners.
The wider view on the other hand states that the health of the workers is determined by factors both inside and outside the workplace, and since both factors have an impact on workers efficiency and productivity should be given attention. Therefore, the health programs designed covers not only the identification, evaluation and control of health hazards at work but also include programs dealing with community and environmental health.
Health Risk Assessment is designed to focus on the workplace and this is what is addressed in this training package. However, it should be recognised that for the comprehensive management of occupational health these wider issues should be addressed.

7. Focus of Occupational Health
The maintenance and promotion of worker’s health and working capacity
The improvement of the working environment and work to become conducive to safety and health
Development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity
Other than the home environment, the workplace is the setting in which many people spend the largest proportion of their time. Workplace health hazards generally differ from those found in the general environment. Furthermore, because workers are often exposed in confined spaces, exposure levels to workplace hazards are often much higher than exposures to hazards in the general environment. In developing countries, workers may be exposed simultaneously to workplace hazards, to an unsafe housing environment, and a polluted general environment.
Each year, work-related injuries and diseases kill an estimated 1.1 million people worldwide, which roughly equals the global annual number of deaths from malaria.

8. HRA HSE Management System Hazard and Effects Management Process HEMP
Leadership and Commitment
Policy and Strategic Obj.
Management Review
Corrective Action &
Improvement
Audit
Org., Resp., Resources
Standards. & Doc.
Monitoring
Planning & Procedures
Hazard and Effects Management
Implementation
Corrective
Action
IDENTIFY
ASSESS
HEMP
CONTROL
RECOVER
HEMP
HSE Management System
Hazard and Effects
Management Process

9. Structure of HEMP Hazards and Effects Management (HEMP) Identify
Are people, environment or assets exposed to potential harm ?
What are the causes and consequences ?
How likely is loss of control ?
What is the risk and is it ALARP ?
Assess
Control
Can the causes be eliminated ?
What controls/barriers are needed ?
How effective are the controls/barriers ?
Can the potential consequences or effects be mitigated ?
What recovery measures are needed ?
Are recovery capabilities suitable and sufficient ?
Recover

10. What is Health? Health is defined as:
“Health is more than the absence of sickness! It is a state of spiritual, mental and physical well-being, which enables a person to face any crisis in life”
Pericles, 430 B.C.
Health is a state of spiritual, mental and physical well being

11. What Determines Your Health?
Who you are (PREDICT)
your genes
Your Lifestyle (PROMOTE)
diet - stress - smoking - exercise - alcohol - drugs
Your Environment (PROTECT)
domestic - workplace - leisure

13. “ Health is too important to leave it to the Doctors ”
It is a common feature that Health is seen as the responsibility of the Doctors.
Of course, by the time it is possible to diagnose a chronic illhealth effect it is too late...
We need to manage our health risks in the workplace in the same way as we manage safety and the environment, to minimise the chance that occupational illnesses occur. 6

14. A Few General Thoughts
Occupational health involves predicting vulnerabilities, promoting good health and protecting the workforce.
Exposure levels in the workplace can be much higher than those in general environment.
Occupational health deserves more focus because ill-health effects may not manifest for a long period of time.
The Health Risk Assessment identifies, evaluates and seek ways to control the impact of occupational hazards to the worker; hence preventing illnesses acquired through such direct workplace exposures
A responsible company goes beyond occupational health to promote general health and well-being

15. Health Risk Assessment
A structured approach to identifying evaluating and controlling health hazards in the workplace

16. HEALTH HEMP HRA IDENTIFY ASSESS CONTROL RECOVER
The 4 steps of HEMP when applied through the HRA tool identify and assess health risks, and specify appropriate exposure control and recovery measures.
It addresses full range of health effects and takes account of both probability and level of exposure to health hazards.
HEMP has four main steps:-
Identification - the gathering of information on health hazards within the workplace and their harmful effects
Assessment - the evaluation of the potential consequences of loss of containment of the hazard in respect of the potential risk to the business, thereby helping to identify priorities for HRA
Control - Putting 'barriers' or 'controls' between the potential for harm and the possibility of its happening, such that risks are controlled to 'as low as reasonably practicable' (ALARP).
Recovery - deciding on, and implementing, remedial measures to mitigate the effects should 'controls' fail thereby releasing the hazard, including measures to prevent escalation.

17. Hazards and Risks Hazard Exposure (Contact with hazard) Risk
Potential to cause harm
Exposure (Contact with hazard)
How much?
How long?
How frequent?
Risk
Likelihood that a hazard will cause harm
Hazard x Exposure
No Hazard = No Risk
Hazard, but No Exposure
= No Risk
Health Risk =
Hazard x Exposure

18. Types of Health Hazards
Psychological Stress, human interactions workplace relationships.
Psychological
Noise, heat, radiation, vibration, extreme temperatures,
Ergonomic
Physical
Workplace layout, manual handling, body posture and movement, micro environment, RSI, operations, tasks and jobs
Chemical
Biological
Gases, dust, metals, solvents, which may be present in the working environment as gases, vapours, mists/aerosols, fumes, dusts, liquids or solids.
Bacteria, fungi, viruses, insects and mites, moulds, yeast, related to the working environment

19. Occupational Chemical Exposure

20. Physical & Chemical Hazards
Welding fumes; noise
Heat
Dermatitis
Dust; noise

21. Ergonomics Risks Manual Handling Lifting Carrying Pushing Pulling
Moving
Twisting
Stretching

22. RSI – Repetitive Strain Injuries
Pain and discomfort
Heaviness
Pins - needles sensation
Numbness
It even disturbs sleep
Muscle weakness

23. Cause and Effect SAFETY HEALTH CAUSE CAUSE Time Heredity Dose
Previous Exposures
Lifestyle
EFFECT
EFFECT

24. Cause and Effect of work related injuries and diseases
Lung cancer
Cause is hard to see
Fume fevers
Stress
Leukaemia
Dermatitis
Musculo-skeletal disorders
Solvent Effects
Noise Induced
Hearing Loss
Welder’s Flash
Cause is
easy to see
Mesothelioma
Accidents
Minutes Days Months Years Decades

25. Key Elements of Occupational Health Program
Health Risk Assessment (HRA)
Monitoring of Health Performance and Incident Reporting & Investigation
Fitness to Work (FTW)
Product Stewardship
Local Health Facilities and Medical Emergency Response
Wellness Program – Healthy Lifestyle Workshops, Stress Management Program, Well Women’s Clinic, Travel Health Clinic

26. Comprehensive Occupational Health Program Health Risk Assessment

27. Identify Health Hazards & Their Harmful Effects
Agent
Source
Route
Harmful Effect
Silica dust (crystalline)
Used mineral oils
Noise
Heat
Legionella bacteria
Repetitive movements
Refractory bricks
Engine oil
Process noise above 85dB(A)
Plant heat
Spray cooling towers
Workplace design
Inhalation
Skin
Hearing
Whole body
Whole or part of body
Lung disease (silicosis)
Dermatitis, cancer
Hearing Loss
Heat stress, heat stroke
Legionnaire’s Disease
Musculo-skeletal disorders

28. Routes of intake Routes of intake of agents into the body Inhalation
Skin
Ingestion
Injection
Whole body

29. Basic Physiology Eye Ear Nose Mouth Lung Heart Liver Stomach Skin
Kidneys

30. Legionnaire’s disease
Biological Hazards
Insect-borne diseases
malaria, leptospirosis, dengue
Water-borne diseases
legionella
Food borne diseases
typhoid, dysentery, food poisoning
Infectious diseases
HIV, Hepatitis
Legionnaire’s disease
Malaria

31. Ergonomics & Psychological Hazards

32. “You spend half your life sacrificing your health to earn money
WORKLIFE BALANCE
“You spend half your life sacrificing your health to earn money
And the other half of your life spending the money you have earned to regain your health”
It is a common feature that Health is seen as the responsibility of the Doctors.
Of course, by the time it is possible to diagnose a chronic illhealth effect it is too late...
We need to manage our health risks in the workplace in the same way as we manage safety and the environment, to minimise the chance that occupational illnesses occur. 6

33. Assigning an Agent Hazard Rating1 2 3
Major health effects: Agents capable of irreversible health damage without loss of life, e.g. noise, poor manual handling taks, hand/arm vibration, chemicals causing systemic effects, sensitisers 4
Fatality or Permanent Total Disability: Agents capable of irreversible damage with serious disability or death, e.g. corrosives, known human carcinogens (small exposed population), heat, cold 5
Multiple Fatalities: Agents with the potential to cause multiple fatalities, e.g. chemicals with acute toxic effects (H2S, CO), known human carcinogens (large exposed population)
DEFINITION in terms of potential to cause harm
No injury or damage to health
Slight health effects: Not affecting work performance or causing disability - non toxic dusts (as an acute hazard)
Minor health effects: Agents capable of limited health effects which are reversible, e.g. irritant agents, defatting agents, many food poisoning bacteria

34. Assigning an Exposure Rating
DEFINITION
VERY LOW (A)
Exposures are negligible
LOW (B)
Exposures are controlled and likely to remain so in accordance with screening and performance criteria
MEDIUM (C)
Exposures are currently controlled to meet screening and performance criteria but control cannot be assured
HIGH (D)
Exposures are not adequately controlled to meet screening and performance criteria and continuously/regularly exceed Occupational Exposure Limits
VERY HIGH (E)
Exposures are excessive and will almost certainly result in health damage to persons exposed

35. Risk Assessment Matrix
Increasing Probability
Consequence
A B C D E
Never
heard
of in our Industry
Heard of
incident
in our
industry
Incident
has
occurred
in our
company
Happens
several
times
per year
in Co.
Happens
several
times
per year
at locn.
Rating
People
Assets
Environment
Reputation
No injury
No damage
No effect
No impact
Slight injury
Slight damage
Slight effect
Slight impact 1
Low
Minor
injury
Minor
damage
Minor effect
Limited impact 2
Major
injury
Localisd
damage
Localised
effect
Considerable
impact 3
Medium
Single
fatality
Major
damage
Major effect
Major
national 4
Multiple
fatalities
Extensive
damage
Massive
effect
Major
international
High 5

36. The Hierarchy of Controls

37. ALARP ? Risk to Cost of Health Control • Tolerability level ALARP
Legal Liability
Wasteful

38. As Low As Reasonably Practicable
What is ALARP ?
As Low As Reasonably Practicable
Five factors to consider
COST - The amount of money required to combat a slight possibility of risk is limited
OBVIOUSNESS - The more obvious the risk the greater the potential liability
INHERENT RISK - All work carries risk to some extent which is irreducible or irremovable and for which the employer cannot be held liable
LIKELIHOOD OF INJURY - The greater the risk, the greater the liability
SERIOUSNESS OF INJURY - The more serious the consequence the more precautions should be taken

39. Control Chart Third Priority No Immediate Action Required Second
First Priority
For
Action
Second
Priority
Third
Priority

40. Comprehensive Occupational Health Program Monitoring of Health Performance and Incident Reporting & Investigation

41. Exposure Measurement Baseline Survey Detailed Survey
May include worst case
Detailed Survey
To define the degree and pattern of exposure
Routine Exposure Monitoring
Monitoring as a control/barrier in its own right
Competence

42. When to Measure Exposure ?
An agent has irreversible effects (e.g. carcinogens)
Justification for additional control measures
Choice of control measures (e.g. for noise control)
Verification of the efficiency of control measures
Employee concerns are expressed
Legal / Customer requirements
Epidemiological studies

43. Health Surveillance Audiometry Program Spirometry Program
Biological Monitoring Program
Drugs & Alcohol Abuse Program
keep records on individual exposures
Develop Work History of Employee Exposure
use medical or biological procedures to identify significant abnormalities as early as possible
consider appropriateness of test procedures

44. Comprehensive Occupational Health Program Fitness to Work (FTW)

45. Initial screening evaluation
Fitness to Work (FTW)
Employee selected for position for which fitness to work medical evaluation is required
Periodic review
Initial screening evaluation
With cause evaluation
Further evaluation required
No medical concerns
Detailed medical and task assessment
Unfit for task
Accommodation process
Fit for task

46. Comprehensive Occupational Health Program Health Facilities and Medical Emergency Response

47. 3 Pillars and 7 Principles of SD
Delivering Value to Customers
Meeting Profit Targets
Respecting and Safeguarding People
Purpose
Earning our right to grow
Contributing to Communities
Building Stakeholder Relations
Reducing Impact on the Environment
Using Resources Efficiently

48. Philosophy of HSE Management Systems – Continuous Improvement!

49. Thank you for your attention Any Questions!