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BOSH Training 2009 OSHC
OCCUPATIONAL HEALTH HAZARDS
Dale M. Hizon, M.D.Occupational Health Officer
Occupational Safety and Health Center
BOSH Training 2009 OSHC
CHEMICAL HAZARD
PHYSICAL HAZARD
BIOLOGICAL HAZARD
ERGONOMIC HAZARD
BOSH Training 2009 OSHC
OBJECTIVES: Discuss and explain common hazards in the
workplace and their effects to workers’ health.
Recommend appropriate measures to prevent occupational and work-related illnesses.
BOSH Training 2009 OSHC
OCCUPATIONAL HEALTH ( ILO/WHO ) Promote and maintain the highest degree of physical,
mental & social well-being of workers of all occupations
Prevent workers from departures due to health caused by their working conditions
Protect workers in their working environment from hazards and risks usually causing adverse health effects
Place & maintain a worker in an occupational environment adapted to his/her physiological ability
BOSH Training 2009 OSHC
HAZARD AND RISK
HAZARD- any source of
potential damage, harm or adverse health effects on something or someone under certain conditions at work.
RISK- the chance or
probability that a person will be harmed or experience an adverse health effect if exposed to a hazard.
BOSH Training 2009 OSHC
WORKPLACE HAZARDSSafety Hazards
working conditions where harm to the workers is of an immediate and violent nature
result in broken bones, cuts, bruises, sprains, loss of limbs, etc.
the harm results in some kind of injury to the worker
associated with poorly guarded or dangerous equipment and machinery
Health Hazards
working conditions which result in an illness
exposure to dangerous substances or conditions, such as chemicals, gases, dusts, noise etc.
often, latency between exposure and disease
BOSH Training 2009 OSHC
AgeAge
GenderGender
RaceRace
Medical Medical historyhistory
Genetic Genetic factorsfactors
LifestyleLifestyle
Workers’ Susceptibility Physical Physical
propertiesproperties
Multiplicity of Multiplicity of exposureexposure
Magnitude of Magnitude of exposureexposure
Duration ofDuration ofexposureexposure
Timing of Timing of exposureexposure
Workplace Factors
WORK-RELATED DISEASE
BOSH Training 2009 OSHC
CHEMICAL HAZARDS
BOSH Training 2009 OSHC
Chemical HazardsRoutes of entry into the body
Inhalation
Ingestion
Skin Contact
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Chemical HazardsRoutes of excretion
Gastro-intestinal (feces)
Renal (urine) Respiratory (exhalation)
Skin (sweat, hair, nails)
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LD 50 - Dose lethal to 50% of test animals
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Threshold:
•point at which toxicity first appears
•occurs at the point where the body's ability to detoxify or repair toxic injury has been exceeded.
BOSH Training 2009 OSHC
Chemical HazardsMeasures of concentration of toxic substances
Threshold Limit Value (TLV)- average concentration of an airborne substance to which most workers could be safely exposed over an eight-hour working day or forty-hour working week throughout a working lifetime
Maximal Allowable Concentration (MAC)- peak or maximum concentration of an airborne to which most workers could be safely exposed.
BOSH Training 2009 OSHC
Chemical HazardsClassification of Toxic Effects
Local toxicity- occurs at the site of chemical contact
Systemic toxicity- occurs distant from point of contact, may involve many organ systems
Acute toxicity-Acute toxicity- occurs almost immediately (hours/days) after an exposure
Chronic toxicity-Chronic toxicity- represents cumulative damage to specific organ systems; occurs many months or years to have recognizable clinical disease
BOSH Training 2009 OSHC
Chemical Hazards
Health Effects Renal Diseases Respiratory Diseases Skin Diseases Hematologic Diseases Cardiovascular Diseases Neurologic Diseases Carcinogenic Teratogenic
BOSH Training 2009 OSHC
Chemical HazardsEffects Chemical Agent Industry/Process
Renal Diseases: acute/chronic renal failure
Mercury, cadmium, chloroform
Battery, chemical industries, pesticide
Respiratory Diseases: Irritation, inflammation Solvents, ammonia Chemical industries
Pneumoconiosis Inorganic dust Mining, construction, sandblasting, coal
Cancer Chromium Plating, metal refining
BOSH Training 2009 OSHC
Chemical HazardsBlood Diseases: Anemia Lead Battery mfg., lead
smelting
Aplastic anemia Benzene Solvent & soap mfg.
Skin Diseases: Allergic/contact dermatitis
Plastic epoxides Plastic, varnish
Acne Cutting oils, grease Machine-tool operators
Skin Cancer Arsenic, tar Petroleum refinery
BOSH Training 2009 OSHC
Chemical HazardsLiver Disease: Acute liver toxicity Carbon
tetrachlorideCleaning fluids, dry cleaners
Liver cancer Vinyl chloride Plastics & vinyl chloride mfg.
Cardiovascular Disease: Hypertension Lead, Cadmium Battery mfg. &
recycling Atherosclerosis Carbon disulfide Degreasing, dry
cleaning Arrythmias Fluorocarbon,
trichloroethyleneRefrigeration, solvent workers
BOSH Training 2009 OSHC
PHYSICAL HAZARDS
BOSH Training 2009 OSHC
Physical Hazards Noise
Vibration
Extreme Temperature
Illumination
Radiation
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Ear Anatomy
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Types of Noise-Induced Hearing Loss
Temporary Threshold Shift (auditory fatigue) temporary loss of hearing acuity after exposure to
loud noise recovery within 16-48 hrs
Permanent Threshold Shift irreversible loss of hearing
NOISE
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Early Signs of Hearing Loss• Difficulty in understanding spoken words in a
noisy environment• Need to be near or look at the person
speaking to help understand words• Familiar sounds are muffled• Complaints that people do not speak clearly• Ringing noises in the ears (tinnitus)
NOISE
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Other Harmful Effects of Noise
• Hypertension• Hyperacidity• Palpitations • Disturbs relaxation and sleep
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Physical factor which affects man by transmission of mechanical energy from oscillating sources
TypesSegmental vibrationWhole body vibration
VIBRATION
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• Health Effects:—Hand Arm Vibration Syndrome (HAVS)—tingling, numbness, blanching of fingers—pain
Segmental Vibration:
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Health effects:Fatigue IrritabilityHeadacheDisorders of the spine
Whole Body Vibration:
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BOSH Training 2009 OSHC
EXTREME TEMPERATURE
Sources of heat stress:
Natural ConditionsHot work processes related to furnaces, kilns,
boilers and smelting
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Health Effects of Heat Stress
Disorders Clinical features
Prickly Heat (Miliaria rubra) Pruritic rash
Heat cramps Cramps in the body, usually legs
Heat exhaustion Dizziness, fainting attack, blurring of vision, cold, clammy and sweaty skin
Heat stroke Cyanosis, muscle twitchings, disorientation, delirium, convulsions
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EXTREME TEMPERATURE
Sources of Cold Environment:
Ice plants and freezers in the food industry
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Frostbite: reddening of skin, localized burning pain and numbness. Fingers, toes, cheeks, nose, ears are most susceptible.
trench foot or immersion foot: numbness, pain, cramps, ulceration and gangrene.
Health Effects of Cold Temperature
BOSH Training 2009 OSHC
BOSH Training 2009 OSHC
Area of Operation Min Lighting Level (lux)
Cutting ClothFine machining
2000
Transcribing handwritingDrafting
1000
WeldingFirst Aid station
500
Lunch RoomRest Room
300
Recommended Illumination LevelsRecommended Illumination Levels
ILLUMINATION
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Health Effects Visual FatigueDouble VisionHeadachesPainful irritation LacrimationConjunctivitis
Inadequate Illumination
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BOSH Training 2009 OSHC
0102104106108101010121014101610181020
X-rays, about 1 billion billion Hz can penetrate the body and damage internal organs and tissues by damaging importantmolecules like DNA.This is called “ionization.”
Microwaves, several billion Hz,can have “thermal” or hearingeffects on body tissues
Power frequency EMFs 50 or 60 Hz carry very little energy, have no ionizing effects and usually no thermal effects. They can, however, cause very weak electric currents to flow in the body.
Gamma rays
X-rays
Ultraviolet radiation ION
IZIN
G R
A DIA
TIO
N
Visible lightInfrared radiation
Microwaves
Radio waves
1022
Very low frequency (VLF)3,000 - 30,000 Hz
Extremely low frequency (ELF) 3 - 3,000 HzDirect current
60 Hz
15 - 30 Hz &50 - 90 Hz
800 - 900 MHz
Source Frequency in hertz (Hz)
Electromagnetic Spectrum
BOSH Training 2009 OSHC
RADIATION
Types Sources Health EffectsIonizing X-rays
Gamma raysCancer, congenital defects, death
Non-ionizing Ultraviolet
Infrared
Laser
skin redness, premature skin ageing, and skin cancer corneal and conjunctival burns, retinal injury, cataractSkin and eye problem
BOSH Training 2009 OSHC
BIOLOGICAL HAZARDS
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VIRUSES FUNGI
BACTERIA PARASITES
BIOLOGICAL HAZARDS
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Selected Infectious Diseases and Occupations
Agent / Disease Occupation
Colds, influenza, scarlet fever, diphtheria, smallpox
May be contracted anywhere
Tuberculosis Silica workers, people exposed to heat and organic dusts, and medical personnel
Anthrax Animal handlers and handlers of carcasses, skins, hides, or hair of infected animals, including wool carpet processors and handlers.
BOSH Training 2009 OSHC
Selected Infectious Diseases and Occupations
Agent / Disease Occupation
Ringworm (in horses, cattle, deer, pigs, cats, dogs, birds)
Pet shop salesmen, stockmen, breeders of cats and dogs, and other animal handlers
Tetanus Farmers (spores in soil) or anyone in contact with manure.
BOSH Training 2009 OSHC
Selected Infectious Diseases and Occupations
Agent / Disease Occupation
Psittacosis (in parrots, parakeets, pigeons, ducks, turkeys, chickens, etc.)
Pet shop personnel, gardeners, housewives, veterinary surgeons, and researchers.
Hookworm Miners, agricultural laborers, planters of sugar, tobacco, tea, rice and cotton, and brick and tunnel workers.
BOSH Training 2009 OSHC
Selected Infectious Diseases and Occupations
Agent / Disease OccupationRabies (e.g. dogs, bats, rats, pigs, cats)
Veterinarians, letter carriers, laboratory research workers, agricultural workers.
Fungus Farmers, outdoor workers, animal handlers
BOSH Training 2009 OSHC
HIV and AIDSA- Acquired
I- Immune
D- Deficiency
S- Syndrome serious and usually fatal
condition in which the body’s immune system is severely weakened and cannot fight off infection.
H- Human
I- Immunodeficiency
V- Virus virus which causes
AIDS
BOSH Training 2009 OSHC
Epidemiology of HIV and AIDS
Demographic Data Feb 2009 Jan – Feb 2009 Cumulative Data 1984 – 2009
Total Reported Cases 47 112 3,701
Asymptomatic Cases 45 107 2,893
AIDS Cases 2 5 808
Males 38 95 2,595*
Females 9 17 1,095*
Youth 15-24 y/o 12 31 537
Children <15 y/o 1 2 52
Reported deaths due to AIDS
0 0 317
Source: HIV / AIDS Registry, Department of Health, Philippines * Note: No data available on sex for eleven (11) cases.
BOSH Training 2009 OSHC
Modes of HIV Transmission
Reported Mode ofTransmission
Feb2009n=47
Jan-Feb2009
n= 112
Cumulative Data:1984—2009
N=3,701Sexual Contact 43 107 3,297
Heterosexual contact 13 36 2,034 (62%)
Homosexual contact 14 37 872 (26%)
Bisexual contact 16 34 391 (12%)
Blood / Blood Products 0 0 19
Injecting Drug Use 0 1 8
Needle Prick Injury 0 0 3
Mother-to-Child 1 2 49
No data available 3 3 325
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Body Fluids with High Viral Load
Blood Semen Vaginal and cervical mucus Breastmilk Amniotic fluid Cerebrospinal fluid
BOSH Training 2009 OSHC
Modes of Transmission• Unprotected penetrative sex
— semen, blood, vaginal secretions
• Blood transfusion on infected blood and blood products
• Sharing needles among
I.V. drug users
• Vertical/perinatal
— mother to infant
• Breastfeeding
BOSH Training 2009 OSHC
HIV is NOT transmitted…• through casual contact in any setting– schools, homes,
hospitals
• through insect, food, water, clothes, toilets, swimming pools, and drinking and eating utensils
BOSH Training 2009 OSHC
Prevention of HIV InfectionREMEMBER ABCDE!Abstinence
Be FaithfulCondomDo not inject Drugs/no
sharing of needles
Education
BOSH Training 2009 OSHC
TETANUS A neurological disorder
characterized by increased muscle tone and spasms, that is caused by tetanospasmin, a protein toxin elaborated by the organism Clostridium tetani.
It arises from the contamination of wounds with Clostridium spores.
BOSH Training 2009 OSHC
TETANUS Clinical Manifestations
Increased tone in the masseter muscle (lockjaw)
Sustained contraction of the facial muscles (risus sardonicus) and back muscles (opisthotonus)
Prevention Active immunization with
tetanus toxoid Careful wound
management
BOSH Training 2009 OSHC
TUBERCULOSIS caused by the bacteria,
Mycobacterium tuberculosis caused by droplet nuclei
released when sneezing and coughing
Symptoms: weight loss, low grade afternoon fever, persistent cough and sometimes, blood-streaked expectoration or hemoptysis
BOSH Training 2009 OSHC
Ten Leading Causes of Death by Sex Ten Leading Causes of Death by Sex Number, Rate/100,000 Population & Number, Rate/100,000 Population & Percentage, Philippines, 2004Percentage, Philippines, 2004
Cause Male Female Both Sexes
No. Rate Percent*
1. Heart Diseases 40,361 30,500 70,861 84.8 17.6
2. Vascular System Diseases 28,930 22,750 51,680 61.8 12.8
3. Malignant Neoplasm 21,395 19,129 40,524 48.5 10.1
4. Accidents** 28,041 6,442 34,483 41.3 8.6
5. Pneumonia 15,822 16,276 32,098 38.4 8.0
6. Tuberculosis, all forms 17,841 8,029 25,870 31.0 6.4
7. Ill-defined and unknown causes of mortality 10,941 10,362 21,278 25.5 5.3
8. Chronic lower respiratory diseases 13,084 5,891 18,975 22.7 4.7
9. Diabetes Mellitus 7,970 8,582 16,552 19.8 4.1
10. Certain conditions from perinatal period 7,809 5,371 13,180 15.8 3.6
Source: 2004 Philippine Health Statistics, Last Update: February 11, 2008* percent share from total deaths, all causes, Philippines ** External Causes of Mortality
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With DOTS90% CURE RATE
DOTS Strategy…the Solution!Directly Observed Therapy Short Course
BOSH Training 2009 OSHC
ERGONOMIC HAZARDS
BOSH Training 2009 OSHC
ERGONOMICS
Human Biological Science+
Engineering Science____________________________________
“ fitting the job to the worker”
MAXIMUM SATISFACTION AND INCREASE PRODUCTIVITY
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thetool
theworkstation
the task(job content &
context)
theorganization
theenvironment
ERGONOMICS
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Goalto reduce work-related musculoskeletal
disorders (MSDs) developed by workers
MSDs are injuries and illnesses that affect muscles, nerves, tendons, ligaments, joints or spinal discs.
ERGONOMICS
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Painful joints Pain, tingling, numbness in hands, wrists,
forearms, shoulders, knees and feet Shooting or stubbing pains Swelling or inflammation
Common Symptoms of MSDs
ERGONOMICS
BOSH Training 2009 OSHC
Fingers or toes turning white Back or neck pain Stiffness
Common Symptoms of MSDs
ERGONOMICS
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Static posture
Risk Factor: ERGONOMICS
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Forceful exertion
Risk Factor: ERGONOMICS
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Risk Factor: ERGONOMICS
Repetitive movement
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Risk Factor: ERGONOMICS
Extreme range of motion
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Risk Factor: ERGONOMICS
Awkward posture
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ERGONOMICS
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STRESS
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STRESS
The harmful physical and emotional responses that occurs when the requirements of the job do not match the capabilities, resources or needs of the worker.
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STRESS: Effects
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Manifestations of Stress
PHYSIOLOGICAL Heart rate Blood pressure Indigestion
BEHAVIORAL Drug use Alcohol intake Heavy smoking Impulsive emotional
behavior
Poor work & family relationship Social isolation Family abandonment Sleep problems
PSYCHOLOGICAL Fatigue Anxiety Tension Irritability Depression Boredom Inability to
concentrate Low esteem
STRESS
BOSH Training 2009 OSHC
BOSH Training 2009 OSHC
MONITORING
• Systematic, continuous, repetitive health-related activities that should lead to corrective action
• Types of monitoring1. Ambient / Environmental
2. Biological3. Medical Surveillance
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BIOLOGICAL MONITORING
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Biological Monitoring
Measurement of a substance, its metabolites or its effects in body tissues, fluids or exhaled air of exposed person
Assess exposure and health risk of workers
Complements exposure assessment by air sampling
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Biological Monitoring
Chemical /Determinant
Sampling Time BEI
LEADLead in Blood Not critical 30ug/100mlMERCURYTotal inorganic in urineTotal inorganic in blood
Prior to shiftEnd of shift at end of workweek
35ug/g15ug/L
CARBON MONOXIDECarboxyhemoglobin in blood
End of shift 3.5% of Hgb
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MEDICAL SURVEILLANCE
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Medical Surveillance
Identify cases
Analyze Trends and Patterns in the Workforce to Guide Prevention Efforts
Meet Regulatory Requirements
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Know the hazard - How worker is exposed- How worker is affected
Characterize the hazard - Exposure levels- Exposure duration
Know the worker - Susceptibilities
Obtain information on - Directed towards specificmedical examinations organ system
Analyze Medical Data - Disease, recovery, rehab- Effectiveness or failure of
control measures
Medical Surveillance
BOSH Training 2009 OSHC
Environmental monitoring
Biological monitoring and surveillance
Treatment and surveillance- Morbidity- Mortality
Workplace-Related Events
Exposure at the workplace- Chemicals- Physical agents
Biologically significant exposure- Chemicals absorbed- Early (reversible) changes
None
Early
Late
Clinical diagnosis
- measurable health effects
End effects- diseases- unfavorable events (spontaneous
abortion)
Monitoring Activity Health Effects
PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS
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Standards, Policies and Guidelines
Occupational Safety and Health Standards Rule 1050
Notification and Keeping of Records of Accidents and/or Occupational illnesses
Rule 1070Occupational Health and Environmental Control
Rule 1960Occupational Health Services
BOSH Training 2009 OSHC
Rule 1960:Occupational Health Services
1. Every employer shall establish in his place of employment occupational health services in accordance with the regulation and guidelines provided for under this rule.
2. The employer, workers, and their representatives, where they exist, shall cooperate and participate in the implementation of the organizational and other measures relating to occupational health services.
1961: General Provisions
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Rule 1960:Occupational Health Services
1963.01: Medicines and Facilities
1963.02: Emergency Medical and Dental Services
1963: Emergency Health Services
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Rule 1960:Occupational Health ServicesHazardous Workplaces:
Number of workers
OH Physician OH Dentist OH Nurse First Aider
1 – 50 1 Full time51 - 99 1 Part time
4 hours/day 6x/week
1 Full time
100 – 199 1 Part time4hrs/day 3x/week *
1 Part time4hrs/day 3x/week *
1 Full time 1 Full time
200 - 600 1 Part time4hrs/day 6x/week **
1 Part time4hrs/day 6x/week **
1 Full time 1 Full time
601 - 2000 1 Full time or 2 Part Time 4hrs/day 6x/week
1 Full time 1 Full time every shift
1 Full time every shift
2000 and more 1 Full time1 Part time 4hrs/day 6x/week
1 Full time 1 Full time every shift
1 Full time every shift*Alternate each day
** Alternate workshift in a day
BOSH Training 2009 OSHC
Rule 1960:Occupational Health Services
Non - Hazardous Workplaces:
Number of workers OH Physician OH Dentist OH Nurse First Aider
1 - 99 1 Full time
100 – 199 1 Part time4hrs/day 6x/week
1 Full time
200 - 600 1 Part time4hrs/day 3x/week *
1 Part time4hrs/day 3x/week *
1 Full time 1 Full time
601 - 2000 1 Part time4hrs/day 6x/week **
1 Part time4hrs/day 6x/week **
1 Full time every shift 1 Full time every shift
2000 and more 1 Full time1 Part time 4hrs/day 6x/week
1 Full time 1 Full time every shift 1 Full time every shift
*Alternate each day
** Alternate workshift in a day
BOSH Training 2009 OSHC
Rule 1960:Occupational Health Services
An employer may not establish an emergency hospital or dental clinic in his workplace as required in these regulations where there is a hospital or dental clinic which is located not more than five (5) kilometers away from the workplace, if situated in any urban area, or which can be reached in twenty-five (25) minutes of travel, if situated in rural area, and the employer has facilities readily available for transporting workers to the hospital or dental clinic in case of emergency.
1963.03: Emergency Hospital
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Rule 1960:Occupational Health Services
Health Examinations:EntrancePeriodic Special examinationTransfer examinationSeparation examination
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OCCUPATIONAL HEALTH PROGRAMS
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Key Elements of the Occupational Health Program
Health Protection
Health Promotion
Health Rehabilitation
BOSH Training 2009 OSHC
Health and Safety Programs
Hazards/ Disease
Source Health Effect Health Program
ChemicalSolvents Paints,
ThinnersIrritant, Multisystem effects
Surveillance for chemical exposureExposure monitoring (Biologic Monitoring)
PhysicalNoise Woodwork
OperationsHearing Impairment
Hearing Conservation Program
BOSH Training 2009 OSHC
Health and Safety ProgramsHazards/ Disease
Source Health Effect Health Program
BiologicTetanus Dirty Nails, soil Lockjaw, rigidity,
deathImmunization
Ergonomic StressesCumulative Trauma Disorder
Awkward postures, Heavy loads
Musculoskeletal Disorders
Management or personnel methods; Workplace modificationWorker education and training;Back Care Program
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Health Promotion Physical activity, Nutrition, Weight reduction
Immunization OSHS, RULE 1960
Smoking cessation RA 9211 Tobacco Regulation Act of 2003
HIV/AIDS RA 8504 Philippine AIDS Prevention and Control Act of
1998 National Workplace Policy on STD/HIV/AIDS initiated by
DOLE - 1997
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Health Promotion Drug Abuse Prevention and Control
RA 9165 Comprehensive Drugs Act of 2002 Department Order No. 53-03: Guidelines for the
Implementation of a Drug-Free Workplace Policy and Program for the Private Sector
Tuberculosis Prevention and Control Executive Order No. 187, Instituting a Comprehensive
and Unified Policy for Tuberculosis Control in the Philippines (CUP) (March 2003)
Department Order No. 73-05: Guidelines for the Implementation of Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace
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DEPARTMENT ORDER NO. 56-03
SECTION 2. New Priorities of the Family Welfare Programa) Reproductive Health and Responsible Parenthoodb) Education/Gender Equalityc) Spirituality or Value Formationd) Income Generation/Livelihood/Cooperativee) Medical Health Caref) Nutritiong) Environmental Protection, Hygiene and Sanitationh) Sports and Leisurei) Housingj) Transportation
RATIONALIZING THE IMPLEMENTATION OF THE FAMILY WELFARE PROGRAM (FWP) IN DOLE
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Approach in EnsuringWell-Being of Workers
Looking at developmental strategies
Information Education Training Campaigns Good practices Successful cases Competitions Demonstrations Interventions
Looking at regulatory requirements
Relevant laws, standards, issuances and guidelines Enforcement Implementation Inspection Evaluation
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Participatory Approach
Participation and involvement from stakeholders Coordinated intervention Learning from
specifications/guidelines, scientific data best practice
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Benefits to the workers Enhanced worker motivation and job satisfaction Added problem-solving capacity Greater acceptance of change Greater knowledge of work and organization Reduces the extent and severity of work related
injuries and illnesses Improves employee morale and productivity Reduces workers’ compensation costs
BOSH Training 2009 OSHC
THANK YOU FOR YOUR ATTENTION!
“I still need more healthy rest in order to work at my best. My health is the main capital I have and I want
to administer it intelligently.”
---Ernest Hemmingway
Nobel Prize winner for literature
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