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Medical Surveillance

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Health surveillance means planned regular health assessments based on best practices and legislation for all workers exposed to risk in the workplace, this includes vision screening5. Part of medical surveillance is the correct maintenance and storage of medical records, informing workers about the state of their health (which includes visions) and assessing the proper fit, cleaning, and maintenance of any personal protective equipment. Employees are required to co-operate with a health surveillance programme that includes vision screening by presenting at health surveillance appointments and cooperating with healthcare providers in full to achieve the best (most accurate) results possible.

Vision screening is only one component of a (VPP) and is done to prevent loss of vision and eye injuries and not to monitor them. Vision screening is done as required by legislation discussed in Chapter 3 and once the results are available action and exclusion criteria and interventions are required. Unlike audiometry where there is a great deal of legislation and consensus regarding fitness to work, action and exclusion criteria and minimum standards of vision required across the board, vision screening / eye conditions and sight are still being debated, a great deal of differing opinions exist.

All employers are required to advise the occupational medical practitioners of the hazards and risks in the workplace therefore assisting the medical team to decide on the required medical surveillance required, the intervals of assessment and management of the effects of exposure. Often this is contained in a code of practice for fitness to work or in action and exclusion criteria

Action criteria relating to fitness for work or exposure to ocular hazards and increased risk is defined as the minimum visual acuity required before certain interventions must take place.
Exclusion criteria for eyes and eyesight vary from one industry to another, from one job type to another and from country to country. Exclusion criteria disqualify workers from certain safety critical work, certain hazards, and visual risks.

Both action and exclusion criteria are legislated in mining operations, maritime and aviation industries, and transportation however it is not legislated in other industries where it remains the responsibility of the OMP in conjunction with the company to develop action and exclusion criteria to ensure a consistent approach to deal with abnormal results. These guidelines are often developed within certain types of industries in mind and international standards are used. For example:

Rail Safety Regulator – Human Factors management has a minimum fitness for duty guidelines.
South African Maritime Safety Authority – has sea farers minimum fitness guidelines.
South African Civil Aviation Authority – has minimum fitness guidelines for aviation.

In some instances, a “grandfather” clause may apply which allows existing workers to continue working with certain visual limitations but bars the employment of new workers with the same limitations from entering the workforce17,18,19.

In this chapter the most common action and exclusion criteria and minimum standards of fitness (relating to eyes and vision) will be outlined but technicians / OMP’s and OHNP’s need to ensure that the risks in the working environment where they are employed are defined and agreed to and meet best practice guidelines for that industry.

Table 10.1 Adapted from the Merchant Shipping Act19

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Table 10.2 Adapted from ANNEX 2 (Regulation 20) Colour and Form Vision Tests19

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Table 10.3 has been developed by the rail safety regulator as a guideline for vision criteria in the rail industry. This table recommends the standards for visual acuity for certain job types.

Table 10.3 Eyes and Vision Criteria in the Rail Industry20

Table 10.4 has been developed by South African Society of Occupational Medicine (SASOM) and is available in the SASOM Guideline 26, Vision Testing17,18. This table recommends the standards for visual acuity for certain job types. This table is ideal when starting out in an industry and can be added to and adjusted to meet the visual requirements by task where the technician / OHNP / OMP works.

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Table 10.3: Recommended vision standards by type of occupation17,18

Notes:

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In the mining environment according to Section 8.5.7.2.3 of the MHSA the minimum requirement for fitness on mines11 with regards to vision and eye disorders are as follows:

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Colour vision and normal visual fields are required for passengers, dangerous and non-dangerous goods conveyances, and certain other occupations, such as electricians.  A normal visual field refers to at least 50 degrees nasal and 70 degrees temporal vision.

Minimum Criteria of Fitness for Drivers in Terms of the National Road Traffic Act, No 93 of 1996

A person is disqualified from obtaining or holding a learner’s or driving licence in terms of the National Road Traffic Act, Act 93 of 1996 if15:

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A registered medical practitioner or occupational health practitioner must examine the applicant to determine whether or not he or she is disqualified from driving a motor vehicle as contemplated in section 15(1)(f) of the Act and must certify the applicant as medically fit on form MC not more than 2 months prior to the date of the application.

Table 10.5 has been developed by the South African Society of Occupational Medicine (SASOM) and is available in the SASOM Guideline 6 Guideline of the Medical Requirements for Fitness to Driver18. This table recommends the standards for visual acuity for certain job types. The NRTA requires that a licence holder or applicant be considered as suffering a prescribed impairment if unable to meet the eyesight requirements.


SASOM Driver Categories:

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Table 10.5 Adapted from the SASOM Fitness Criteria for Driving18

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Special considerations for visual disorders for all drivers.

The visual acuity must be at least, according to the Snellen rating, a minimum visual acuity, with or without refractive correction, of 6/12 (20/40) for each eye, or where the visual acuity of one eye is less than 6/12 (20/40) or where one eye of the person concerned is blind, a minimum visual acuity for the other eye of 6/9 (20/30).
If unable to meet this standard, the driver must not drive, and the licence must be refused or revoked. The law also requires all drivers to have a minimum field of vision, as set out in the NRTA.