Chapter 2

Occupational Health and Hygiene

a.Overview of Occupational Health

b.Intro and Fundamentals of Toxicology
c. Occupational Health Standards
d.Overview and basic Principles of Industrial
Hygiene
e.Physical and Chemical Hazards
f. Classification of Chemicals, Packaging and
Labelling
g.Material Safety Data Sheet (MSDS)
h.Chemical Health Risk Assessment
i. Chemical Hazards Management
j. Chemical and Biological Monitoring and
Medical Surveillance
k.Ventilation and Indoor Air Quality
l. Biological Hazard
m. Workplace Ergonomics and Ergonomics
Risk Factors
n.Occupational and Psychological Stress
o.Mental Workload and Shift Work
p.Occupational first aid
2.a Occupational Health and Hygiene
2.a.1 Overview of Occupational Health

1. Workers represent half the world’s

population and are the major contributors to
economic and social development. Their health
is determined not only by workplace hazards
but also by social and individual factors and
access to health services.

2. Despite the availability of effective

interventions to prevent occupational hazards
and to protect and promote health at the
workplace, large gaps exist between and within
countries with regard to the health status of
workers and their exposure to occupational
risks. Still only a small minority of the global
workforce has access to occupational health
services.

3. Increasing international movement of jobs,

products and technologies can help to spread
innovative solutions for prevention of
occupational hazards, but can also lead to a
shift of that risk to less advantaged groups. The
growing informal economy is often associated
with hazardous working conditions and involves
such vulnerable groups as children, pregnant
women, older persons and migrant workers.

4. The present plan of action deals with all

aspects of workers’ health, including primary
prevention of occupational hazards, protection
and promotion of health at work, employment
conditions, and a better response from health
systems to workers’ health. It is underpinned
by certain common principles. All workers
should be able to enjoy the highest attainable
standard of physical and mental health and
favourable working conditions. The workplace
should not be detrimental to health and well-
being. Primary prevention of occupational
health hazards should be given priority. All
components of health systems should be
involved in an integrated response to the
specific health needs of working populations.
The workplace can also serve as a setting for
delivery of other essential public-health
interventions, and for health promotion.
Activities related to workers’ health should be
planned, implemented and evaluated with a
view to reducing inequalities in workers’ health
within and between countries. Workers and
employers and their representatives should also
participate in such activities.
2.b Intro and Fundamentals of Toxicology
Toxicology (from the Greek words toxicos and
logos) is the study of the adverse effects of
chemicals on living organisms. It is the study of
symptoms, mechanisms, treatments and detection of
poisoning, especially the poisoning of people.

2.b.1 Chemical Toxicology

Chemical toxicology is a scientific discipline involving
the study of structure and mechanism related to the
toxic effects of chemical agents, and encompasses
technology advances in research related to chemical
aspects of toxicology. Research in this area is
strongly multidisciplinary, spanning computational
chemistry and synthetic chemistry, proteomics and
metabolomics, drug discovery, drug metabolism and
mechanisms of action, bioinformatics, bioanalytical
chemistry, chemical biology, and molecular
epidemiology.
2.c Occupational Health Standards

The shipyard employer have to set its own Health

standard where to provide:

• Integrate safety and health issues in all aspects

of the work place.
• Take effective action to provide and maintain a
safe and healthy work environment.
• Disseminate information and promote
communication on safety and health.
• Plan, develop, implement, and monitor the
safety and health program.

The Employee is expected to:

• Work in a safe and healthy manner.

• Encourage others to work in a safe and healthy
manner.
• Discourage others from working in an unsafe
manner.
• Co-operate to support and promote safety and
health in the work place.
• Report any unsafe conditions that come to
attention at work.
Refer to File “Mental health and work: Impact,
issues and good practices”
2.d Overview and basic Principles of
Industrial Hygiene

Definition

–Science and art devoted to the anticipation,

recognition, evaluation, and control of those
workplace environmental factors which may cause
sickness, impaired health and well-being, or
significant discomfort and inefficiency among
workers or among citizens of the community

Refer to File “Industrial Hygiene”.

2.e Physical and Chemical Hazards

2.e.1 Hazards (What Is a Hazard?)

A hazard is anything that could cause injury or

illness. A hazard could be caused by:
• The materials and equipment we work with
• The layout of the work area
• The system or procedure used to perform work
tasks
2.e.2 Hazard Classification
Most hazards fall into one of five categories: physical, chemical, biological,
psychological and ergonomic. Examples of these are shown in the following
table:

Physical Chemical Biological Psychological Ergonomic

Unguarded Fumes Infections Overwork Manual
machinery handling
Noise Liquids Bacteria Shift work Workstation
design
Overcrowding Gases Viruses Harassment Tool and
equipment
design
Incorrect Powders Parasites Discrimination Job and
lighting task design
Heat and cold Dust Diseases Stress Furniture
and layout

2.e.3 Hazard examples

2.e.3.1 Incorrect lighting

The amount of light must be correct for the area;

problems may be caused by both lack of light,
flickering light or light that is too bright. Incorrect
lighting can cause eyestrain, tiredness, headaches
and blurred vision.

Make sure that:

lighting enables clear vision of moving machine parts
and safety signs must be clearly visible to avoid
accidents
corridors, stairs and rooms with no direct sunlight
are well lit to avoid trips and falls
it is easy to see the colour of objects.
Such as:
− electrical wires to ensure correct connection
− lights on control panels to ensure correct
operation of equipment.

2.e.3.2 Excessive Heat

Heat stress may be caused by work processes or

climatic or environmental conditions including task
requirements, work rate, air flow, air temperature,
humidity or required protective clothing.

The effects of heat stress may include feeling weak

and dizzy or fainting. Heat exhaustion due to
dehydration can also cause fainting, tiredness,
headache, nausea and flushed skin. Heat stroke is a
serious condition and requires medical attention.

Avoid heat stress, heat exhaustion and dehydration

by drinking water at frequent intervals, taking
regular rest breaks during excessive heat and
wearing appropriate clothing.
2.e.3.3 Hazardous locations and confined working
areas

Hazardous locations include areas where flammable

or explosive substances are or have been present,
and confined working spaces with limited or no
natural ventilation. Work processes which generate
heat and can be dangerous in these locations include
flame heating, oxy cutting, gouging, arc welding,
grinding. If you are in any doubt about the safety of
a location, see your supervisor before starting work.

Before work can begin in one of these areas, the

safety officer responsible must be informed. The
officer must inspect the site thoroughly and make
any special safety recommendations. The safety
officer must issue a work permit before any work can
begin. A typical work permit lists all the specific
requirements and must be signed by the responsible
officer.
2.e.4 Hazard Control

There are four main steps in hazard management:

hazard identification
risk assessment
risk control or reduction
 monitoring and evaluation.

These steps may be required in any of the following

events:

when management and employees become aware of

a hazard during regular hazard inspection when
planning a new task or project when developing a
new facility when purchasing new machinery,
equipment, furniture or substances when planning
changes to the workplace or work processes after an
incident where an accident was prevented as part of
an accident investigation.

Step 1: Identifying a hazard

Hazards may be identified through:

workplace inspections or audits
incidents / injury / illness reports
talking to employees
safety and health committee meetings
liasing with industry bodies, unions or
employee associations
contact with government authorities
Learnin
g
activity Identifying a hazard
Using the methods outlined in Step
1: Identifying a hazard, trainees to
identify and record 10-20 hazards
that could be encountered in the
ship building industry

Some examples of hazards that may be identified

include:

materials or equipment too heavy for one

person to lift without help
a container used for a chemical is cracked
power tool leads left lying across a walkway
ear plugs are out of stock
safety guard removed from machinery for
repairs, not replaced
tools or tool handles chipped or damaged
fire extinguisher misplaced
person working in a confined space without
appropriate training in safety requirements
safety notices obscured by machinery or other
notices
heavy equipment or supplies stored above
waist height..

Refer to File “Unsafe Work Environment”

Step 2: Risk assessment

As soon as a hazard is identified, the risks must be

assessed. To determine the level of risk, you need to
consider;

Outcome – what would happen if a person came

into contact with the hazard? For example: fatality,
major injury, and minor injury.

Probability – how often is contact with the hazard

likely to occur? For example regularly, frequently,
occasionally, seldom, never.

Exposure – how many people are exposed to the

hazard?

existing controls– Are there any control methods

already in place?

Risk assessment evaluates the probability of an

incident occurring as a result of the hazard; and the
possible consequences of any such incident. When
the risk is assessed, control of the hazard can be
prioritised. The priority for any hazard that could
cause injury would be ‘immediate urgent action’;
hazards with less associated risk could be marked
as: ‘resolve today’ or ‘resolve within seven days’.
 Some of the key points about assessing the risk in
the workplace are as follows:
Assessments must cover all potential risks to the
safety and health of people in the workplace.
Assessments must cover all potential risks to the
safety and health of people affected by the operation
of the workplace or by the services or products of
the workplace.
The employer must review the original assessment
whenever new or changed work practices,
substances or plant are introduced to the workplace.
Where groups of workers are especially at risk, the
groups must be identified as a part of the
assessment, with specific strategies identified. For
example young, inexperienced workers or workers
with a disability.

All potential workplace hazards must be assessed in

terms of their danger to life and their long range and
short-range effects on health. This can be
accomplished through knowledge of the hazards,
experience and quantitative data.

Learning
activity Risk assessment

Trainees, as a group, to discuss and record

the risks associated with 5 of the hazards
identified in the previous activity.
Step 3: Risk Control

Once problems have been identified and assessed,

the next step is to carefully consider how to best
control the hazard. A hierarchy of controls is used
both for hazard control, and as a starting point when
implementing safety and health procedures.

The hierarchy ranks control measures for overall

effectiveness in risk reduction. This means that
solutions at the top of the hierarchy are to be
considered first, as the most efficient and effective
immediate control of hazards.

1st - Elimination
This means removal of the risk and could involve
actions such as:
taking away obsolete equipment
reducing the volume of chemicals stored on site.

2nd – Substitution
Where elimination is not possible, the next option is
to use different methods or materials that reduce or
eliminate the hazard, such as:
using a work procedure that is less hazardous
substituting a chemical that is less hazardous
replacing one piece of equipment with another that is
less dangerous.

3rd - Engineering controls

 Hazards that can neither be eliminated nor
substituted may be made safer by introducing
methods or equipment to reduce danger, for
example:
creating a barrier between persons and the hazard
by enclosure or isolation
fitting machine guarding
improve ventilation
applying wetting down techniques
using mechanical aids.

Elimination, substitution and engineering controls

create a physically safer workplace.

4th - Administrative controls

Administrative controls may be used in addition to
the previous measures to:
reduce the exposure of any one person to a specific
hazard
ensure that operators are fully trained in the use of
machinery and equipment
ensure that workers are fully aware of safety and
health issues and regulations associated with their
tasks.

Administrative controls include: job rotation, time

limits, permit-to-work systems, restricted access,
documented work instructions, general safety rules
and procedures, training and supervision.
 5th - Personal protective equipment (PPE)
All workers have the responsibility of ensuring their
own safety by using PPE at all relevant times. PPE
includes: hearing protection devices, goggles, safety
footwear, gloves, overalls and protective suits.

Learning
activity Risk Control

Trainees, as a group, to discuss and record

the best means of
control for the 5 hazards identified in the
previous activity.

Step 4: Monitoring and Evaluation

After the first three hazard control steps have been

taken, there should be a planned period of
monitoring to ensure that the risk is eliminated,
reduced or controlled. Monitoring involves checking
the situation periodically to make sure that the steps
are still in use or still effective. An evaluation may be
conducted by the safety officer or employer to assess
the effectiveness of the control steps

Learning
activity
Hazard Audit

Trainees to conduct a hazard audit in the

workshop and prepare a written report
2.f Classification of Chemicals,
Packaging and Labeling

The production and use of chemicals are

fundamental factors in the economic development of
all countries, whether they are industrialized or
developing. In one way or another, chemicals affect
directly or indirectly the lives of all humans and are
essential to our feeding (fertilizers, pesticides, food
additives, packing), our health (pharmaceuticals,
cleaning materials), or our well being (appliances,
fuels, etc).
The first and most essential step leading to safe use
of chemicals is to know their identity, to their
hazards to health and the environment and the
means to control them. This knowledge should be
available with reasonable effort and cost.
Furthermore, this inherently complex knowledge
must be organized in such a way that essential
information on the hazards and corresponding
protective measures can be identified and conveyed
to the user in a form that is easy to understand.
The International Labour Organization (ILO) has
adopted the Convention No. 170 and
Recommendation No. 177 on `Safety in the use of
chemicals at work' in 1990.
International, regional, and national classification
and labelling systems are already established and
tested in practice.
 • The United Nations Recommendations on the
Transport of Dangerous Goods is widely
recognized and used among the UN member
states.
• An example of a system that has been designed
for use in several countries is the classification
and labelling system of the European
Communities (EC).
• Several functioning national systems, such as
those of Canada and USA, may also be used as
models for national systems.

2.f.1 Identification and Classification

The objective is to identify the hazardous properties
of chemicals which may constitute a risk during
normal handling or use, risks to health, property or
the environment.
The user of the chemicals is also to be introduced to
the hazards they present and given the basic
information, in a suitable manner, such as using a
properly made label.
2.f.2 What is a hazardous chemical ?
The following properties contribute to risk to health
resulting from acute, repeated or prolonged
exposure:
• very toxic or toxic
• harmful
• corrosive
• irritant
• cancer causing
• hazards to reproduction
• can cause non-heritable birth defects
• sensitizing
Fire and explosion hazards may be classified as
follows
• explosive
• oxidizing
• extremely flammable
• highly flammable
• flammable
The following properties present a hazard to the
environment and are:
• toxic to living organisms
• persistent in the environment
• bioaccumulative
Also substances and preparations that cannot be
classified by using the above system may be
regarded as dangerous if they have properties which
are hazardous to health, to living organisms or if
they can damage property.

2.f.3 How to pass on the information to

users?
All chemicals, both substances and preparations,
should have a clear marking to indicate their
identity.
The packages and containers of dangerous
substances and preparations should, in addition to
marking only, to have a label with required
information.
The label should draw attention to the inherent
danger to persons handling or using the chemical.

2.f.4 Where to find information about

hazardous chemicals?
The chemical supplier, manufacturer or importer,
should be able to provide detailed information and a
Safety Data Sheet.
In certain countries, such as those of the EU, the
manufacturer or importer has the obligation to find
and give adequate information about a chemical for
assessment of the health and environmental hazards
of his chemical for handling and for its labeling.
Safety data sheets have been prepared on many
dangerous substances and preparations by
manufacturers. These should go together with the
product to the occupational user. The information in
these is not always validated or checked.

2.f.5 How to classify for a label?

The label is the basic tool to keep the user informed
on the classification and the most important safety
precautions.
This information must be given if the preparation
contains at least one substance classified as
dangerous to man or the environment or if the
preparation is otherwise regarded as dangerous, e.g.
flammable, explosive.
In EU countries the label must clearly show
• the trade name
• the name and the address, including telephone
number, of the manufacturer, the importer or
the distributor
• the chemical name of the substance (in the case
of a preparation, the chemical names of the
hazardous components)
• danger symbols
• risk phrases (R-phrases)
• safety phrases (S-phrases)
• the quantity of the contents of the package or
container
The labels should be in the national, official
language(s).
The label should show the chemical names of
substances that are primarily responsible for the
hazards. As a general rule a maximum of four
chemical names on the label should be sufficient.
In some cases, more than four names may be
necessary; for example all cancer causing
substances in the preparation must be identified and
the corresponding R- and S-phrases presented on
the label.
If the preparation contains one or more of the
substances requiring the following R-phrases, both
the name of the substance and the R-phrase should
be mentioned in the label:
R39, R40, R42, R43, R42/43, R45, R46, R47,
R48, R49, R60, R61, R62, R63, R64
As a general rule a maximum of four R-phrases and
four S- phrases should suffice to describe the risks
and to formulate the most appropriate safety advice.
Symbols showing the most serious hazards should be
chosen where more than one danger symbol has to
be assigned. As a general rule a maximum of two
danger symbols are used.
The explanation of the letter symbols appearing in
the attached lists are given below. Each letter
symbol refers to a danger symbol or pictogram.
 Physico-Chemical Properties1
Code
Letter(s) Danger
Description
& Symbol
Meaning
Solid, liquid, pasty or gelatinous substances and
preparations which may react exothermically
E without atmospheric oxygen thereby quickly
Explosive evolving gases, and which under defined test
conditions detonate, quickly deflagrate or upon
heating explode when partially confined.
Liquid substances and preparations having an
F+ extremely low flash point and a low boiling point
Extremely and gaseous substances and preparations which
Flammable are flammable in contact with air at ambient
temperature and pressure.
a. Substances and preparations
which may become hot and finally catch fire
in contact with air at ambient temperature
without any application of energy,
b. Solid substances and
preparations which may readily catch fire
after brief contact with a source of ignition
F and which continue to burn or to be
Highly consumed after removal of the source of
Flammable ignition,
c. Liquid substances and
preparations having a very low flash point, or

d. Substances and preparations

which, in contact with water or damp air,
evolve extremely flammable gases in
dangerous quantities.
(none) (no Liquid substances and preparations having a low
Flammable symbol) flash point.

Substances and preparations which give rise to a

O
highly exothermic reaction in contact with other
Oxidizing
substances, particularly flammable substances.
 Health Effects1
Note: Some symbols appear more than once in the following table.
Please study the first column carefully.
Code
Danger
Letter(s) & Description
Symbol
Meaning

C Substances and preparations which may, on

Corrosive contact with living tissues, destroy them.

Substances and preparations which, were they

to enter into the environment, would present
or might present an immediate or delayed
N danger for one or more components of the
Dangerous For environment.
The
Environment Does not apply to preparations. In certain
cases, some substances do not need to be
labelled with the danger symbol for this
category.
Substances and preparations which in very low
T+ quantities cause death or acute or chronic
Very toxic damage to health when inhaled, swallowed or
absorbed via the skin.
Substances and preparations which in low
T quantities cause death or acute or chronic
Toxic damage to health when inhaled, swallowed or
absorbed via the skin.
Non-corrosive substances and preparations
Xi which, through immediate, prolonged or
Irritant repeated contact with the skin or mucous
membrane, may cause inflammation.
Substances and preparations which may cause
Xn death or acute or chronic damage to health
Harmful when inhaled, swallowed or absorbed via the
skin.
Sensitizing Substances and preparations which, if they are
inhaled or if they penetrate the skin, are
Xn capable of eliciting a reaction by
Sensitizing by hypersensitization such that on further
inhalation (i.e. Xn exposure to the substance or preparation,
or Xi) characteristic adverse effects are produced.
Xi
 Sensitizing by
skin contact
Carcinogenic
Substances and preparations which, if they are
T - Category 1 (depends
1 inhaled or ingested or if they penetrate the
on
skin, may induce cancer or increase its
T - Category 2 category)
incidence
Xn - Category
3
Mutagenic
Substances and preparations which, if they are
T - Category 1 (depends
1 inhaled or ingested or if they penetrate the
on
skin, may induce inheritable genetic defects or
T - Category 2 category)
increase their incidence.
Xn - Category
3
Toxic for
reproduction Substances and preparations which, if they are
inhaled or ingested or if they penetrate the
(depends
T - Category 1 skin, may produce or increase the incidence of
1 on
non-inheritable adverse effects in the progeny
category)
T - Category 2 and/or of male or female reproductive
Xn - Category functions or capacity.
3

Definitions of data components in labels

COMPONENTS ILO UN RTDG EC USA CANADA
FORMAT none defined size of labels Minimum label none defined 1. Supplier
varies with dimensions are label:must
transport defined for appear on all
mode. different controlled
package products
capacities; received at
contrasted work-places;
danger symbols required
and background information
(black on yellow must be set
background); aside from sales
language must information;
be that of the surrounded by
country where WHMIS ; must
the product is be printed in
put on market. contrasting
colours; must
have all texts in
English and
French.
 2. Workplace
label:must
appear on all
products
produced in a
workplace or
transferred to
other containers
by the
employer; may
appear in
placard form on
products
received in bulk.
DATA 1. Trade name not 1. Chemical 1. Chemical 1. Supplier
ELEMENTS 2. Chemical mandated. identity identity label:
identity The UN RTDG 2. Hazard 2. Supplier -product
3. Supplier label defines symbol and identification identifier
identification. hazards by indication of 3. Appropriate -supplier
4. Hazard the use of danger hazard identification
symbols symbols, 3. Risk phrases warnings -reference to
5. Risk phrases colours and 4. Safety existing CSDS
6. Safety danger phrases Employer must -hazard
phrases warning 5. Supplier ensure that symbols;
7. Batch words for identification labels and and for
identification specific (full address other forms of containers
8. Reference to hazards and tel. No.) warning are in over 100 ml:
existing CSDS (explosive, 6. EEC number English and -risk and safety
9. Hazard radioactive, if allocated may add other phrases
classification corrosive, 7. the wording languages if -first aid
etc.). "EEC label" appropriate. measures
where 2. Workplace
appropriate
label:
-product
identifier
-information for
the safe
handling of the
products
-reference to an
existing CSDS.
-may contain
WHMIS hazard
symbols or
other
pictograms.
OTHER Legibility, Placarding of ANSI Standard Chemical name
REQUIREMENTS durability and transport Z-129.1.1988 may be replaced
size, uniformity units is defines by generic
of labels and defined, acceptable name or
symbols, including precautionary number in the
including form, phrases and case of products
colours.In minimum size hazard covered by
general, all and colour of symbols. provisions on
containers of placards. exemption for
hazardous confidential
 chemicals business
should at least information.
indicate the
hazards of the
contents
through
appropriate
wording or
symbols.

2.g Material Safety Data Sheet (MSDS)

A Material Safety Data Sheet (MSDS) for a chemical

substance may be referred to as a Chemical Safety
Data Sheet (CSDS). The terms Material Safety Data
Sheet and MSDS are used in this section for all types
of materials, as this is the more globally accepted
practice.

All hazardous chemicals used in the workplace must

have a Material Safety Data Sheet (MSDS). The
MSDS is a document that describes the properties
and uses of the substance, including the name; the
chemical and physical properties; health hazard
information; precautions for use and safe handling
information.

The MSDS should be supplied by the manufacturer or

importer of the substance and should be clear, easy
to read and written in plain language.

The MSDS should include following information:

 • Trade or common name of the chemical, the
company identification and the name and
address of the supplier;
• The composition of ingredients;
• Hazard identification;
• First aid measures;
• Fire fighting measures;
• Accidental release measures;
• Handling and storage procedures;
• Exposure control and personal protection;
• Physical and chemical properties;
• Stability and reactivity data;
• Toxicological information;
• Ecological information;
• Disposal information; and
• Transport information.

Details on how to prepare a MSDS can be found in

the publication:
Guidelines for the Formulation of a Chemical Safety
Data Sheet (DOSH, 1997).

2.g.1 Interpreting a Material Safety Data

Sheets
Before you use any chemical in the workplace, you
should carefully read the label on the container. If
chemicals are poured into smaller containers for
easier use, the container should be clearly labelled to
show:
the location of the MSDS, and instructions to read
this before using the chemical
 the exact contents
the dilution required for specific tasks
the protective clothing required
safety precautions
what to do in the event of accidents such as splashes
onto the skin or into the eye or accidental
ingestion
how to dispose of the chemical safely so as not to
cause harm to any person or to the environment.
If this information is not included, you should contact
the manufacturer and ask for the MSDS.

Learnin Trainees to research the MSDS of 3 chemicals used in

g
activity the ship building industry.
The Physical and Theoretical Chemistry Laboratory at
Oxford University, UK gives comprehensive information
about chemicals and their Material Safety Data Sheets,
including how to interpret the sheets.

The following web site is a good source of information

for this activity:
http://ptcl.chem.ox.ac.uk/MSDS/#MSDS

The link for Interpreting MSD Sheets is:

http://ptcl.chem.ox.ac.uk/MSDS/interpretingmsds.html

2.h Chemical Health Risk Assessment

Refer to File “CHRA”

2.i Chemical Hazards Management

Refer to File “Hazmat Management”
Refer to File “Hazmat Enforcement”
2.j.Chemical and Biological Monitoring and
Medical Surveillance

The purpose for performing medical monitoring of

employees is to detect physiological changes in an
employee, which may be due to exposures to
hazardous levels of physical, chemical or radioactive
stresses the employee may experience on the job.
Medical monitoring of employees is also used to
measure the effectiveness of engineering and
administrative controls, and can involve biological
monitoring.

2.j.1 Definitions

Biological Monitoring
– Biological monitoring can provide a reasonable
indication of exposures to hazardous environmental
stresses the employee might encounter on the job.
Biological monitoring is also an attempt to quantify
an employee's exposure for a period of time either
prior to, or as a result of employment at CSUF. It
involves the collection of biological samples such as
urine, their examination for the presence of
hazardous materials or their metabolites, and a
comparison to biological exposure indices for healthy
workers.

Exposure
 – contact with a biological, chemical, or physical
hazard.

Hazardous Material
– is any substance or compound that has the
capability of producing adverse effects on the health
and safety of humans.

Medical Monitoring
– is the systematic collection and analysis of
health information on groups of workers potentially
exposed to harmful agents, for the purpose of
identifying health effects at an early and hopefully
reversible stage. Government codes require that
employees with potential exposures to certain
harmful agents shall receive medical monitoring
examinations. These exams serve the purpose of
detecting adverse health effects, which could
possibly be related to workplace exposures.

Early detection of disease will result in earlier

treatment and will also allow for cessation of
additional exposures that could aggravate a
potentially serious medical condition.

Occupational Disease
– is a disease caused by exposures to hazards in the
workplace.
The health risk (or hazard) from a particular
chemical is a function of both its toxicity and the
exposure dose actually absorbed by the user.
• Toxicity is the capacity of a material to produce
injury or harm when the chemical has reached a
sufficient concentration (dose) at a certain site in
the body.
• Exposure dose is the amount of chemical that
has been absorbed by the body and could
therefore reach that site to do harm.
• The risk, or hazard, of working with that
chemical is the probability that this dose
concentration will occur.
In other words, a carcinogen used inside a properly
functioning lab hood could pose far less of a health
risk than a low-toxicity alcohol used in closed
quarters, with poor ventilation and no skin
protection.

2.j.2 Routes of Exposure

Exposure to toxic substances in the workplace can
result from chemicals being inhaled, ingested or
being absorbed through the skin (including mucus
membranes). Figure 1 presents the pathway by
which a chemical substance in the workplace
environment can produce toxic effect. By being
aware of these routes of exposure, the conservator
can both better judge the potential for exposure and
also better control that exposure. For example, a
large number of chemicals including some solids as
well as many liquids, can be absorbed through intact
skin and into the bloodstream. By being aware of
this potential route of exposure, conservators can
modify their work habits or even use protective
clothing (e.g., impermeable gloves) to prevent this
dermal absorption. Also, ingestion of a compound
can be direct (e.g., hand to mouth) but is more likely
to be indirect (e.g., substance getting onto food or
drink in the workplace). The value of frequent
washing and restrictions on consumption of food and
beverage in the studio or lab should be obvious.

Fig. 1 Exposure pathway for workplace chemicals

2.j.2.1 Environmental Monitoring

If inhalation is the only significant route of entry to
the body, then the results of ambient air samples
taken within the person’s “breathing zone” reflect the
dose of that chemical to the body. The collection
device is placed close to the person’s breathing zone,
typically on the worker’s lapel. The device may be
connected to a battery-operated, calibrated sampling
pump, which is worn through the work/exposure
period, often an 8-hour shift or 15-minute short term
exposure period. Validated sampling and analytical
methods are followed, such as those published by
the National Institute for Occupational Safety and
Health (NIOSH). The sample is analyzed by a
qualified laboratory for the concentration of the
chemical studied, and the results are compared with
established regulatory standards, such as the
Permissible Exposure Limits (PELs) promulgated by
the OSHA or consensus guidelines, such as the
annually-revised Threshold Limit Values (TLVs) of
the American Conference of Governmental Industrial
Hygienists (ACGIH), or the NIOSH Recommended
Exposure Limits (RELs). None of these
concentrations should be construed as absolute lines
between safe and unsafe exposures, but should be
evaluated in the overall exposure assessment.
Contacts for these organizations are listed in the
reference section of this Guide.
Other techniques for estimating the potential for
environmental exposures are occasionally used such
as wipe samples to estimate the concentration of a
toxic chemical on work surfaces or even on the
workers skin. There are, however, only a few
validated techniques for collecting and analyzing
these types of samples, or standards against which
to judge results (such as lead), so these procedures
are generally of qualitative , not quantitative, value
to the investigator.

2.j.2.2 Biological Monitoring

If significant exposure can occur through routes of
entry other than inhalation, biological monitoring
may be warranted. The most widely accepted forms
of biological monitoring include exhaled breath,
urine, and blood testing. Alterations in these
concentrations reflect absorption by all routes of
entry, reflect physiological responses unique to the
individual, and offer information beyond that
provided by air sampling alone.
The reference values most commonly used in this
case are guidelines such as the annually revised
Biological Exposure Indices (BEIs), published by the
ACGIH. BEIs, like the TLVs, RELs and PELs, do not
represent a sharp distinction between hazardous and
non-hazardous exposures. The ACGIH
Documentation of the BEIs states: “Alterations in
function or unusual laboratory findings can be
viewed as evidence of harm, or they can be viewed
as only a marker that exposure has occurred.
Interpretation of biological monitoring is complicated
by the fact that the concentration of the material
measured is not exactly equivalent of the exposure
dose. When a chemical is absorbed into the body,
excretion of earlier ingestion of that substance may
be occurring at the same time.” Action on
unexpected values should not be based on a single
isolated measurement but on measurements of
multiple sampling.
There are 36 compounds for which BEIs have been
established. These 36 compounds are listed in Table
1, along with the biological matrix used for their
evaluation. BEIs listed in that table are established
by the ACGIH. Additional information on these
guidelines can be obtained from that organization
(see Resource List at end of this Guide). The BEI
values should be used only by a medically-trained
individual familiar with their interpretation, and then
only with the aid of the documentation for BEIs
which is also available from the ACGIH.
Table 1. Chemicals with Established BEIs
Biological Biological
Chemical Chemical
Specimen specimen
Acetone Urine Methanol Urine
Analine Urine or blood Methemoglobin inducers Blood
Arsenic Urine Methoxyethanol Urine
Benzene Urine Methoxyethyl acetate Urine
Exhaled air, urine or
Cadmium Urine or blood Methyl chloroform
blood
Methylene bis(2-
Carbon disulfide Urine Urine
chloroaniline)
Carbon monoxide Blood or exhaled air Methyl ethyl ketone Urine
Chlorobenzene Urine Methyl isobutyl ketone Urine
Chromium Urine Nitrobenzene Urine or blood
Cobalt Urine or blood Organophosphorus
Dimethylacetamide Urine cholinesterase inhibitors Blood
Dimethylformamide Urine Parathion Urine or blood
Ethoxyethanol Urine Pentachlorophenol Urine or blood
Ethoxyethyl Exhaled air, urine or
Urine Perchloroethylene
acetate blood
Ethyl benzene Urine or exhaled air Phenol Urine
Fluorides Urine Styrene Urine or blood
Furfural Urine Toluene Urine or blood
Urine, blood or
Hexane Urine or exhaled air Tricholorethylene
exhaled air
Lead Blood Vanadium Pentoxide Urine
Mercury Urine or blood Xylenes Urine
2.j.2.3 Critical Factors for Biological Monitoring:
1. The timing of the sample collection is critical, and
the protocol guidelines must be followed. This is
because different chemicals and their markers take
different times to make themselves available for
sampling in the same body medium, as characterized
by their half-life. The BEI measurements may be
intended to represent peak exposures, or to reflect
equilibrium levels attained only after steady state
has been reached.
2. When interpreting biological monitoring data, the
physician must take into consideration factors that
contribute to individual variation in response to the
exposure. You and your colleagues will likely have
differences in pulmonary function, hemodynamics,
body composition, efficacy of excretory organs, and
activity of enzyme systems that mediate metabolism
of the chemical. Other factors to consider include
personal factors (age, sex, pregnancy, medications,
state of health), lifestyle choices (smoking, drug use,
eating habits, and personal hygiene), and
environmental exposures outside the workplace. It is
possible to exceed the BEIs and not experience
adverse health effects. Your personal or company
physician must carefully evaluate your personal
profile and integrate all necessary information into
the interpretation of biological monitoring results.
3. To assist in the interpretation of biological
monitoring, particularly the BEIs, the physician is
referred to the ACGIH Documentation of the BEIs
which detail specific information on the above
variables as they relate to a specific chemical agent,
and lists quality control measures to be taken in the
sampling, handling, and analysis of specimens.

2.j.2.4 When is biological monitoring necessary or

appropriate?
1. Specific monitoring may be mandated by an OSHA
standard (Table 2), or may be recommended by the
documentation of a specific BEI.
2. The effectiveness of personal protective
equipment (or even personal hygiene, work
practices, and engineering controls) in creating a
barrier against the hazardous agent can be
evaluated through monitoring for the marker of the
exposure. For example, airborne concentrations of
inorganic arsenic may be undetectable in the
breathing zone during handling of treated objects.
However, high concentrations in the urine may
indicate inadvertent ingestion though lack of gloves
and poor hand or face washing practices.
3. Biological monitoring should be used to
substantiate air monitoring, or to determine the
potential for absorption via the skin and GI tract. It
should be conducted when it offers an advantage
over the use of air monitoring alone.
2.j.2.5 When should biological monitoring not be
used?
Biological monitoring should not be used as your
personal exposure control method, because it
measures dose only after it has occurred and may
affect bodily functions in some way. Biological
monitoring and medical surveillance are not
substitutes for environmental or personal sampling
but should be used to complement them.

Table 2. OSHA Standards with Medical Examination or Surveillance

Requirements, Title 29 Code of Federal Regulations (CFR) Part 1910
1910.95 Occupational noise exposure
1910.134 Respiratory protection
1910.139 Respiratory protection for M. tuberculosis
Asbestos (and 1926.1101 – Asbestos in Construction
1910.1001
Industry)
1910. Select Carcinogens
1003
4-Nitrobiphenyl
alpha-Naphthylamine
Methyl chloromethyl ether
3,’-Dichlorobenzidine (and its salts)
bis-Chloromethyl ether
beta-Naphthylamine
Benzidine
4-Aminodiphenyl
Ethyleneimine
beta-Propiolactone
2-Acetylaminofluorene
4-Dimethylaminoazo-benzene
N-Nitrosodimethylamine
1910.1017 Vinyl chloride
1910.1018 Inorganic arsenic
1910.1025 Lead
1910.1027 Cadmium
1910.1028 Benzene
1910.1029 Coke oven emissions
1910.1030 Bloodborne pathogens
1910.1043 Cotton dust
1910.1044 1,2-dibromo-3-chlorpropane
1910.1045 Acrylonitrile
1910.1047 Ethylene oxide
1910.1048 Formaldehyde
1910.1050 Methylenedianiline
1910.1051 1,3-Butadiene
1910.1052 Methylene chloride
Occupational exposure to hazardous chemicals in
1910.1450
laboratories

2.j.3 Medical Monitoring

Medical monitoring is conducted on exposed individual to evaluate any adverse
health effects of those exposures. The major purpose is the early detection of
disease or conditions for which treatment can prevent further illness. Health
surveillance of a population of workers for disease is used to predict effect and
can also be a valuable tool in hazard control, by detecting when an initially
effective control or work practice has lost effectiveness.

Recommendations for medical monitoring tests are in the purview of the

physician, based on reported symptoms and knowledge (provided by the
conservator) of chemicals to which the patient is exposed. Be respectful of the
fact that physicians receive a standardized medical school education, and that
occupational and environmental medicine is considered a specialty requiring
further training in epidemiology, toxicology, industrial hygiene, and case
management of occupational injuries and illnesses. Physicians specializing in
occupational medicine are certified by the American Board of Preventive
Medicine. Additional medical resources can be found on the attached listing of
Occupational Health Clinics, as published by the Association of Occupational
and Environmental Clinics

2.k Ventilation and Indoor Air Quality

2.k.1 IAQ
Indoor air quality (IAQ) is a term referring to the air
quality within and around buildings and structures,
especially as it relates to the health and comfort of
building occupants.
Proper ventilation helps improve indoor air quality.
Ventilation can control indoor humidity and airborne
contaminants, both of which either contribute to or
act as health hazards. The American Society of
Heating, Refrigerating, and Air Conditioning
Engineers (ASHRAE) and several states (Minnesota,
Washington, and Vermont) have ventilation
standards designed to ensure acceptable indoor air
quality.

High indoor humidity can spur mold growth. High

humidity may result from poor
construction/rehabilitation, site design that does not
properly manage water, and/or inadequate air
exchange. A reasonable target for relative humidity
is 30-60 percent. A low cost hygrometer, available at
hardware stores, can be used to measure relative
humidity. In cool climates, inadequate ventilation in
the winter can contribute to excessive moisture and
humidity because normal activities create moisture
(cooking, bathing, breathing), and there is
insufficient natural ventilation (opening windows) or
mechanical ventilation (fans, exhaust systems) to
remove the moisture. In warmer climates, the
heating, ventilation, and air conditioning (HVAC)
system can pull warmer, humid air inside. In this
case, the ventilation system may help create indoor
humidity problems unless the system also
dehumidifies the air.
2.k.2 Common sources of airborne contaminants
include:

Indoor contaminants. These include
chemicals used in the construction or renovation
of buildings (e.g., glues, off-gassing from
carpets, emissions from particle board, cleaning
compounds). In addition, appliances that burn
gas can produce particulates and carbon
monoxide. Incomplete combustion and poor
ventilation of these appliances (cook stoves, gas
furnaces, gas boilers, and gas water heaters) can
contribute to indoor contaminants. Gas cook tops
should be used with fans that send exhaust
outside. Gas-fired heating appliances should be
sealed and power-vented systems installed to
remove products of incomplete combustion.
Wood-burning stoves can also create particulates
and must be vented outside.


Outdoor contaminants. Outdoor particulates
can be drawn inside when the heating or cooling
system draws air into a home. Particulates and
allergens found in outdoor air can be asthma
triggers. Filtering incoming air for HVAC systems
effectively filters particulates. Experts
recommend using filters with a MERV 6-8, but
higher MERV levels trap smaller particles and
generally are more appropriate for those with
 allergies or where the indoor environment has a
high concentration of mold spores, dust particles,
or other allergens.

2.k.3 Ventilation
Two types of ventilation can help control harmful air
contaminants and humidity: spot ventilation and
dilution ventilation. Spot ventilation draws air from a
particular location (e.g., bathroom, kitchen) and
exhausts it to the outside. Dilution ventilation
address low-level contamination throughout the
home.
Spot Ventilation. Exterior exhaust fans should be
installed in all bathrooms and kitchens. These fans
remove humidity and carbon monoxide. The most
effective fans are quiet and durable. Use fans that
operate at one sone or less and exhaust to the
outdoors. Fans equipped with timers or de-
humidistat controls are useful to ensure the fans run
for a sufficient period of time. A good rule of thumb
is to run a bathroom fan for about 45 minutes after a
shower.
Dilution Ventilation. Dilution ventilation addresses
the entire living space. Air changes (exchanging
indoor air with outdoor air) and air cleaning help
determine the effectiveness of dilution. Air changes
result from a combination of natural ventilation
(infiltration; leakage; windows) and mechanical
(controlled) ventilation. Air cleaning occurs when
particulates are filtered and when air is dehumidified
to remove moisture. The goal is to provide sufficient
changes to ensure a healthy environment. There are
several types of heating and cooling systems with
filtration that can be installed to accomplish this. A
common element necessary in all systems is duct
sealing, particularly on the return side (side drawing
in the air). The Air Conditioning Contractors
Association (ACCA) provides guidance on duct
sealing in its Manual D: Duct Design.

Techniques for analyzing IAQ include collection of air

samples, collection of samples on building surfaces
and computer modelling of air flow inside buildings.
The resulting samples can be analyzed for mold,
bacteria, chemicals or other stressors. These
investigations can lead to an understanding of the
sources of the contaminants and ultimately to
strategies for removing the unwanted elements from
the air.
2.k.4 Common pollutants
Radon
Radon is an invisible, radioactive atomic gas that
results from the radioactive decay of radium, which
may be found in rock formations beneath buildings
or in certain building materials themselves. Radon is
probably the most pervasive serious hazard for
indoor air in the United States and Europe, probably
responsible for tens of thousands of deaths from
lung cancer each year.
Molds and other allergens
These biological chemicals can arise from a host of
means, but there are two common classes: (a)
moisture induced growth of mold colonies and (b)
natural substances released into the air such as
animal dander and plant pollen. Moisture buildup
inside buildings may arise from water penetrating
compromised areas of the building envelope or skin,
from plumbing leaks, from condensation due to
improper ventilation, or from ground moisture
penetrating a building part. In areas where cellulosic
materials (paper and wood, including drywall)
become moist and fail to dry within 48 hours, mold
mildew can propagate and release allergenic spores
into the air.
Carbon monoxide
One of the most acutely toxic indoor air
contaminants is carbon monoxide (CO), a colorless,
odorless gas that is a byproduct of incomplete
combustion of fossil fuels. Common sources of
carbon monoxide are tobacco smoke, space heaters
using fossil fuels, defective central heating furnaces
and automobile exhaust. Improvements in indoor
levels of CO are systematically improving from
increasing numbers of smoke-free restaurants and
other legislated non-smoking buildings. By depriving
the brain of oxygen, high levels of carbon monoxide
can lead to nausea, unconsciousness and death.
According to ACGIH (American Conference of
Governmental Industrial Hygienist), the TWA (Time
Waited Average) limit for carbon monoxide (630-08-
0) is 25 ppm.
Volatile Organic Compounds
Volatile organic compounds (VOCs) are emitted as
gases from certain solids or liquids. VOCs include a
variety of chemicals, some of which may have short-
and long-term adverse health effects. Concentrations
of many VOCs are consistently higher indoors (up to
ten times higher) than outdoors. VOCs are emitted
by a wide array of products numbering in the
thousands. Examples include: paints and lacquers,
paint strippers, cleaning supplies, pesticides, building
materials and furnishings, office equipment such as
copiers and printers, correction fluids and carbonless
copy paper, graphics and craft materials including
glues and adhesives, permanent markers, and
photographic solutions.
Legionella
Legionellosis or Legionnaire's Disease is caused by a
waterborne bacterium that grows best in slow
moving or still warm water. The primary route of
exposure is aerosolization, most commonly from
evaporative cooling towers or showerheads. A
common source of Legionella in commercial buildings
is from poorly placed or maintained evaporative
cooling towers, which often release aerosolized water
that may enter nearby ventilation intakes. Outbreaks
in medical facilities and nursing homes, where
patients are immuno-suppressed and immuno-weak,
are the most commonly reported cases of
Legionellosis. More than one case has involved
outdoor fountains in public attractions. The presence
of Legionella in commercial building water supplies is
highly under-reported, as healthy people require
heavy exposure to acquire infection.
Asbestos fibers
The U.S. Federal Government (www.osha.gov) and
some States have set standards for acceptable levels
of asbestos fibers in indoor air. Many common
building materials used before 1975 contain
asbestos, such as some floor tiles, ceiling tiles,
taping muds, pipe wrap, mastics and other insulation
materials. Normally significant releases of asbestos
fiber do not occur unless the building materials are
disturbed, such as by cutting, sanding, drilling or
building remodelling. There are particularly stringent
regulations applicable to schools. Inhalation of
asbestos fibers over long exposure times is
associated with increased incidence of lung cancer.
While smokers have a greater risk of lung cancer
than asbestos workers that do not smoke smokers
that are exposed to high levels of asbestos over
many years have a much greater risk of developing
lung cancer than either smokers that have not been
exposed to asbestos, or persons that have been
exposed to high levels of asbestos that do not
smoke.
Carbon dioxide
Carbon dioxide (CO2)is a surrogate for indoor
pollutants emitted by humans and correlates with
human metabolic activity. Carbon dioxide at levels
that are unusually high indoors may cause occupants
to grow drowsy, get headaches, or function at lower
activity levels. Humans are the main indoor source of
carbon dioxide. Indoor levels are an indicator of the
adequacy of outdoor air ventilation relative to indoor
occupant density and metabolic activity. To eliminate
most Indoor Air Quality complaints, total indoor
carbon dioxide should be reduced a difference of less
than 600 ppm above outdoor levels. NIOSH
considers that indoor air concentrations of carbon
dioxide that exceed 1,000 ppm are a marker
suggesting inadequate ventilation. ASHRAE
recommends that carbon dioxide levels not exceed
700 ppm above outdoor ambient levels.[6] The UK
standards for schools say that carbon dioxide in all
teaching and learning spaces, when measured at
seated head height and averaged over the whole day
should not exceed 1,500 ppm. The whole day refers
to normal school hours (i.e. 9.00am to 3.30pm) and
includes unoccupied periods such as lunch breaks.
Canadian standards limit carbon dioxide to 3500
ppm. OSHA limits carbon dioxide concentration in
the workplace to 5,000 ppm for prolonged periods,
and 35,000 ppm for 15 minutes.
Ozone
Ozone is produced by ultraviolet light from the Sun
hitting the Earth's atmosphere (especially in the
ozone layer), lightning, certain electric devices (such
as air ionisers), and as a byproduct of other types of
pollution.
Ozone exists in greater concentrations at altitudes
commonly flown by passenger jets. Reactions
between ozone and onboard substances, including
skin oils and cosmetics, can produce toxic chemicals
as byproducts. Ozone itself is also irritating to lung
tissue and harmful to human health. Larger jets have
ozone filters to reduce the cabin concentration to
safer and more comfortable levels.
Outdoor air used for ventilation may have sufficient
ozone to react with common indoor pollutants as well
as skin oils and other common indoor air chemicals
or surfaces. Particular concern is warranted when
using "green" cleaning products based on citrus or
terpene extracts as these chemicals react very
quickly with ozone to form toxic and irritating
chemicals as well as fine and ultrafine particles.
Ventilation with outdoor air containing elevated
ozone concentrations may complicate remediation
attempts.[8]
Developing countries
A major source of indoor air pollution in developing
countries is the burning of biomass (e.g. wood,
charcoal, dung, or crop residue) for heating and
cooking. The resulting exposure to high levels of
particulate matter resulted in between 1.5 and 2
million deaths in 2000.[9]

2.k.5 HVAC design

HVAC is an initialism or acronym that stands for

"heating, ventilating, and air conditioning".
HVAC is sometimes referred to as climate control
and is particularly important in the design of medium
to large industrial and office buildings such as
skyscrapers and in marine environments such as
aquariums, where humidity and temperature must
all be closely regulated whilst maintaining safe and
healthy conditions within.)
The "green design" movement in the commercial and
residential HVAC industry emphasizes paying
attention to the issue of indoor air quality throughout
the design and construction stages of a building's
life.
One technique to reduce energy consumption while
maintaining adequate air quality, is demand
controlled ventilation. Instead of setting throughput
at a fixed air replacement rate, carbon dioxide
sensors are used to control the rate dynamically,
based on the emissions of actual building occupants.
For the past several years, there have been many
debates among indoor air quality specialists about
the proper definition of indoor air quality and
specifically what constitutes "acceptable" indoor air
quality.
One way of quantitatively ensuring the health of
indoor air is by the frequency of effective turnover of
interior air by replacement with outside air. In the
UK, for example, classrooms are required to have
2.5 outdoor air changes per hour. In halls, gym,
dining, and physiotherapy spaces, the ventilation
should be sufficient to limit carbon dioxide to 1,500
ppm.
2.l Biological Hazard

A biological hazard or biohazard is an organism, or substance derived from

an organism, that poses a threat to (primarily) human health. This can include
medical waste or samples of a microorganism, virus or toxin (from a biological
source) that can impact human health. It can also include substances harmful
to animals. The term and its associated symbol is generally used as a warning,
so that those potentially exposed to the substances will know to take
precautions. There is also a biohazard HCS/Workplace Hazardous Materials
Information System (WHMIS) logo which utilizes the same symbol.

In Unicode, the biohazard sign is U+2623 (☣).

Biohazardous agents are classified for transportation by UN number:

• UN 2814 (Infectious Substance, Affecting Humans)

• UN 2900 (Infectious Substance, Affecting Animals)
• UN 3373 (Diagnostic Specimen or Clinical Specimen or Biological
Substance, Category B)

UN 3291 (Medical Waste)

The international biological hazard symbol

Immediate disposal of used needles into a sharps
container is standard procedure.

Biohazard Placard - Pipeline and Hazardous Materials

Safety Admin.

The United States' Centers for Disease Control and

Prevention (CDC) categorizes various diseases in
levels of biohazard, Level 1 being minimum risk and
Level 4 being extreme risk.
• Biohazard Level 1:
Bacteria and viruses including Bacillus subtilis,
canine hepatitis, Escherichia coli, varicella (chicken
pox), as well as some cell cultures and non-
infectious bacteria. At this level precautions
against the biohazardous materials in question are
minimal, most likely involving gloves and some
sort of facial protection. Usually, contaminated
materials are left in open (but separately
indicated) trash receptacles. Decontamination
procedures for this level are similar in most
respects to modern precautions against everyday
viruses (i.e.: washing one's hands with anti-
bacterial soap, washing all exposed surfaces of the
lab with disinfectants, etc). In a lab environment,
all materials used for cell and/or bacteria cultures
are decontaminated via autoclave.
• Biohazard Level 2:
Bacteria and viruses that cause only mild disease
to humans, or are difficult to contract via aerosol in
a lab setting, such as hepatitis A, B, and C,
influenza A, Lyme disease, salmonella, mumps,
measles, scrapie, and HIV. "Routine diagnostic
work with clinical specimens can be done safely at
Biosafety Level 2, using Biosafety Level 2 practices
and procedures. Research work (including co-
cultivation, virus replication studies, or
manipulations involving concentrated virus) can be
done in a BSL-2 facility, using BSL-3 practices and
procedures. Virus production activities, including
virus concentrations, require a BSL-3 facility and
use of BSL-3 practices and procedures", see
Recommended Biosafety Levels for Infectious
Agents.
• Biohazard Level 3:
Bacteria and viruses that can cause severe to fatal
disease in humans, but for which vaccines or other
treatments exist, such as anthrax, West Nile virus,
Venezuelan equine encephalitis, SARS virus,
variola virus (smallpox), tuberculosis, typhus, Rift
Valley fever, Rocky Mountain spotted fever, yellow
fever, and malaria. Among parasites Plasmodium
falciparum, which causes Malaria, and
Trypanosoma cruzi, which causes trypanosomiasis,
also come under this level.

• Biohazard Level 4:
Exclusively viruses that cause severe to fatal
disease in humans, and for which vaccines or other
treatments are not available, such as Bolivian and
Argentine hemorrhagic fevers, H5N1(bird flu)
dengue fever, Marburg virus, Ebola virus,
hantaviruses, Lassa fever, Crimean-Congo
hemorrhagic fever,Y. Pestis and other hemorrhagic
diseases. When dealing with biological hazards at
this level the use of a Hazmat suit and a self-
contained oxygen supply is mandatory. The
entrance and exit of a Level Four biolab will contain
multiple showers, a vacuum room, an ultraviolet
light room, and other safety precautions designed
to destroy all traces of the biohazard. Multiple
airlocks are employed and are electronically
secured to prevent both doors opening at the same
 time. All air and water service going to and coming
from a Biosafety Level 4 lab will undergo similar
decontamination procedures to eliminate the
possibility of an accidental release.

2.mWorkplace Ergonomics and Ergonomics Risk

Factors

2.m.1 FACTORS CONTIBUTING TO

RISK OF INJURIES
Many risk factors contribute to ergonomic injuries. Some of
these factors are intrinsic to the individual while others arise
from the work environment. Ergonomic injuries are
preventable. Familiarize yourself with the different types of
risk factors and determine how you can minimize their impact
on your health and your ability to work safely and
comfortably.
Individual Contributing Factors for Ergonomic Injuries
Multiple factors influence the body and its tolerance to
activities. Those individual risk factors affect our susceptibility
to injuries. Some individual contributing factors can be
changed or minimized while others are outside of our control.
Age
Gender
Previous Injury
Health Factors
 Stress
Physical Conditioning
Computer Use
Extracurricular Activities

Extracurricular activities requiring heavy gripping and

pinching, whether it is sustained or repetitive, can increase
your risk of injuries.

2.m.2 Ergonomics: Risk Factor Checklist (Example)

Ergonomics for the Prevention of Musculoskeletal

Disorders: Guidelines for Retail Grocery Stores

Checklist for Identifying Potential Ergonomics

Risk Factors by Workplace Activity
If the answer to any of the following questions is
yes, the activity should be further reviewed.
Force in Lifting
• Does the lift involve pinching to hold the object?
• Is heavy lifting done with one hand?
• Are very heavy items lifted without the assistance
of a mechanical device?
• Are heavy items lifted while bending over, reaching
above shoulder height, or twisting?
• Are most items lifted rather than slid over the
scanner?
Force in Pushing, Pulling, Carrying
• Are dollies, pallet jacks, or other carts difficult to
get started?
• Is there debris (e.g., broken pallets) or uneven
surfaces (e.g., cracks in the floor) or dock plates that
could catch the wheels while pushing?
• Is pulling rather than pushing routinely used to
move an object?
• Are heavy objects carried manually for a long
distance?
Force to Use Tools
• Do tools require the use of a pinch grip or single
finger to operate?
• Are tools too large or too small for the employee's
hands?
• Repetitive Tasks Are multiple scans needed?
• Is a quick wrist motion used while scanning?
• Do repetitive motions last for several hours without
a break (e.g., slicing deli meats, scanning
groceries)?
• Does the job require repeated finger force (e.g.,
kneading bread, squeezing frosting, using pricing
gun)?
Awkward and Static Postures
• Is the back bent or twisted while lifting or holding
heavy items?
• Are objects lifted out of or put into cramped
spaces?
• Do routine tasks involve leaning, bending forward,
kneeling or squatting?
• Do routine tasks involve working with the wrists in
a bent or twisted position?
• Are routine tasks done with the hands below the
waist or above the shoulders?
• Are routine tasks done behind (e.g., pushing items
to bagging) or to the sides of the body?
• Does the job require standing for most of the shift
without anti-fatigue mats?
• Do employees work with their arms or hands in the
same position for long periods of time without
changing positions or resting?
Contact Stress
• Are there sharp or hard edges with which the
worker may come into contact?
• Do employees use their hands as a hammer (e.g.,
closing containers)?
• Does the end of the tool/utensil (knife) handle
press into the worker's palm?

Refer to File “Ergonomic in Nursing Homes”

2.n Occupational and Psychological Stress

About one-third of workers report high levels of stress. One-
fourth of employees view their jobs as the number one
stressor in their lives. Three-fourths of employees believe
the worker has more on-the-job stress than a generation
ago. Evidence also suggests that stress is the major cause
of turnover in organizations.
2.n.1 Occupational stress
Is the harmful physical and emotional response that
occurs when there is a poor match between job
demands and the capabilities, resources, or needs of
the worker. [1] Stress-related disorders encompass a
broad array of conditions, including psychological
disorders (e.g., depression, anxiety, post-traumatic
stress disorder) and other types of emotional strain
(e.g., dissatisfaction, fatigue, tension, etc.),
maladaptive behaviors (e.g., aggression, substance
abuse), and cognitive impairment (e.g.,
concentration and memory problems). In turn, these
conditions may lead to poor work performance or
even injury. Job stress is also associated with various
biological reactions that may lead ultimately to
compromised health, such as cardiovascular disease.
[2]

Refer to File “Occupational Stress”

2.n.2 Health and Healthcare Utilization

Problems at work are more strongly associated with

health complaints than are any other life stressor-
more so than even financial problems or family
problems. Many studies suggest that psychologically
demanding jobs that allow employees little control
over the work process increase the risk of
cardiovascular disease. On the basis of research by
the National Institute for Occupational Safety and
Health and many other organizations, it is widely
believed that job stress increases the risk for
development of back and upper- extremity
musculoskeletal disorders. High levels of stress are
associated with substantial increases in health
service utilization. Workers who report experiencing
stress at work also show excessive health care
utilization. In a 1998 study of 46,000 workers,
health care costs were nearly 50% greater for
workers reporting high levels of stress in comparison
to “low risk” workers. The increment rose to nearly
150%, an increase of more than $1,700 per person
annually, for workers reporting high levels of both
stress and depression. Additionally, periods of
disability due to job stress tend to be much longer
than disability periods for other occupational injuries
and illnesses.

2.n.3 Causes of Workplace Stress

Job stress results from the interaction of the worker and the
conditions of work. Views differ on the importance of worker
characteristics versus working conditions as the primary
cause of job stress. The differing viewpoints suggest
different ways to prevent stress at work. According to one
school of thought, differences in individual characteristics
such as personality and coping style are most important in
predicting whether certain job conditions will result in stress-
in other words, what is stressful for one person may not be a
problem for someone else. This viewpoint leads to
prevention strategies that focus on workers and ways to help
them cope with demanding job conditions. [1] Although the
importance of individual differences cannot be ignored,
scientific evidence suggests that certain working conditions
are stressful to most people. Such evidence argues for a
greater emphasis on working conditions as the key source of
job stress, and for job redesign as a primary prevention
strategy. Personal interview surveys of working conditions,
including conditions recognized as risk factors for job stress,
were conducted in Member States of the European Union in
1990, 1995, and 2000. Results showed a trend across these
periods suggestive of increasing work intensity. In 1990, the
percentage of workers reporting that they worked at high
speeds at least one-fourth of their working time was 48%,
increasing to 54% in 1995 and to 56% in 2000. Similarly,
50% of workers reported they work against tight deadlines at
least one-fourth of their working time in 1990, increasing to
56% in 1995 and 60 % in 2000. However, no change was
noted in the period 1995–2000 (data not collected in 1990) in
the percentage of workers reporting sufficient time to
complete tasks. [9] A substantial percentage of Americans
work very long hours. By one estimate, more than 26% of
men and more than 11% of women worked 50 hours per
week or more in 2000. These figures represent a
considerable increase over the previous three decades,
especially for women. According to the Department of Labor,
there has been an upward trend in hours worked among
employed women, an increase in extended work weeks (>40
hours) by men, and a considerable increase in combined
working hours among working couples, particularly couples
with young children. [10] [11]
2.n.4 Signs of Workplace Stress
Mood and sleep disturbances, upset stomach and
headache, and disturbed relationships with family and
friends are examples of stress-related problems. The effects
of job stress on chronic diseases are more difficult to see
because chronic diseases take a long time to develop and
can be influenced by many factors other than stress.
Nonetheless, evidence is rapidly accumulating to suggest
that stress plays an important role in several types of chronic
health problems-especially cardiovascular disease,
musculoskeletal disorders, and psychological disorders.

2.n.5 Prevention
A combination of organizational change and stress management is often the most
useful approach for preventing stress at work. [1]

How to Change the Organization to Prevent Job Stress[12]

 Ensure that the workload is in line with workers' capabilities and resources.
 Design jobs to provide meaning, stimulation, and opportunities for workers to use
their skills.
 Clearly define workers' roles and responsibilities.
 Give workers opportunities to participate in decisions and actions affecting their
jobs.
 Improve communications-reduce uncertainty about career development and
future employment prospects.
 Provide opportunities for social interaction among workers.
 Establish work schedules that are compatible with demands and responsibilities
outside the job.

St. Paul Fire and Marine Insurance Company conducted several studies on the effects
of stress prevention programs in hospital settings. Program activities included (1)
employee and management education on job stress, (2) changes in hospital policies
and procedures to reduce organizational sources of stress, and (3) establishment of
employee assistance programs. In one study, the frequency of medication errors
declined by 50% after prevention activities were implemented in a 700-bed hospital. In
a second study, there was a 70% reduction in malpractice claims in 22 hospitals that
implemented stress prevention activities. In contrast, there was no reduction in claims in
a matched group of 22 hospitals that did not implement stress prevention activities. [13]
2.o Mental Workload and Shift Work

2.o.1 An amount of labor

While a precise definition of a workload is elusive, a

commonly accepted definition is the hypothetical
relationship between a group or individual human
operator and task demands.
The assessment of operator workload has a vital
impact on the design of new human-machine
systems. By evaluating operator workload during the
design of a new system, or iteration of an existing
system, problems such as workload bottlenecks and
overload can be identified. As the human operator is
a central part of a human-machine system, the
correction of these problems is necessary for the
operation of safe and efficient systems.
An operating budget may include estimates of the
expected workload for a specific activity.

Refer to File “Shift Work”

2.o.2 Quantified effort

Workload can also refer to the total energy output of
a system, particularly of a person or animal
performing a strenuous task over time. One
particular application of this is weight lifting/weights
training, where both anecotal evidence and scientific
research has shown that it is the total "workload"
that is important to muscle growth, as opposed to
just the load, just the volume, or "time under
tension". In these and related uses of the word,
"workload" can be broken up into "work+load",
referring to the work done with a given load. In
terms of weights training, the "load" refers to the
heaviness of the weight being lifted (20kgs is a
greater load than 10kgs), and "work" refers to the
volume, or total number of reps and sets done with
that weight (20reps is more work than 10 reps, but 2
sets of 10 reps is the same work as 1 set of 20 reps,
its just that the human body cannot do 20reps of a
heavy weight without a rest, so its best to think of
2x10 as being 20 reps, with a rest in the middle).
This theory was also used to determine horse power,
which was defined as the amount of work a horse
could do with a given load over time. The wheel that
the horse turned in Watt's original experiment put a
certain load on the horse's muscles, and the horse
could do a certain amount of work with this load in a
minute. Provided the horse was a perfect machine, it
would be capable of a constant maximum workload,
so increasing the load by a given percentage would
result in the possible work done decreasing by the
same percentage, so that it would still equal "1 hp".
However, horses are not perfect machines and over
short time periods are capable of as much as 14hp,
and over long periods of exertion output an average
of less than 1hp.
The theory can also be applied to automobiles or
other machines, which are slightly more "perfect"
than animals, making a car heavier for instance,
increases the load that the engine must pull, likewise
making it more aerodynamic decreases drag, which
acts as a load on the car as well. Torque can be
thought of as the ability to move load, and the revs
are how much work it can do with that load in a
given amount of time. Therefore torque and revs
together create kilowatts, or total power output,
which can be related to the "workload" of the
engine/car, or how much work it can do with a given
amount of load. As engines are more mechanically
perfect than animals' muscles, and do not fatigue in
the same way, they will confirm much more closely
to the formula that if you apply more load, they will
do less work, and visa versa.

q.Occupational first aid

Sectio 6
n
Emergency First Aid

Refer to Training Manual 1011: Metal Trades Fitting: Workshop Safety

 First aid kits
First aid is the provision of emergency treatment and life support for people
suffering injury or illness. Basic workplace first aid kits should not include
medications of any type, including painkillers. A major concern with
dispensing medication is that a recipient may suffer an allergic reaction.
Many people are allergic to, or suffer an adverse reaction from taking
substances such as paracetamol or aspirin.

The contents of first aid kits vary according to the size of workplace and the
work performed. In most workplaces the following items are likely to be
included in a basic first aid kit:
emergency services telephone numbers and addresses
name and telephone number of workplace first aiders
basic first aid notes
individually wrapped sterile adhesive dressing
sterile eye pads
sterile covering for serious wounds
triangular bandages
safety pins
small sterile un-medicated wound dressing
medium sterile un-medicated wound dressing
large sterile un-medicated wound dressing
adhesive tape
rubber thread or crepe bandage
disposable gloves
scissors.

Additional supplies may include burns treatments and treatments for eye
injuries.

Trainees to inspect first aid kit, familiarise themselves

Learnin
g with contents and practice application of dressings
activity and bandages.

Refer to File “Fundamental to First Aid”