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What is health monitoring?
Health monitoring is used to identify changes in a person's health status because of exposure to certain substances. Health monitoring can be useful following significant exposure to a substance and where there is an available valid health monitoring technique to detect adverse health effects from that exposure.
Asbestos-related diseases and health monitoring
Failure to adequately control exposure to airborne asbestos fibres can result in effects on the human body such as pleural plaques, and diseases such as asbestosis, asbestos-related lung cancer and mesothelioma.
The dose of asbestos fibres causing each of these effects is different, and risk of disease is related to the:
- duration and frequency of exposure
- type of asbestos fibre
- airborne concentration of asbestos fibres that are inhaled.
Repeated occupational exposures to airborne asbestos fibres can lead to a substantial cumulative exposure over time, which increases the risk of developing an asbestos-related disease in the future.
Health monitoring is only useful where a valid technique exists to detect a known health effect. As asbestos-related diseases develop over a long period of time, current health monitoring techniques have limitations in providing early warning of these diseases.
Health monitoring for asbestos includes:
- considering the worker's demographic, medical and occupational history
- considering records of the worker's personal exposure
- a physical examination of the worker with emphasis on the respiratory system.
Health monitoring would not ordinarily include a chest X-ray unless clinically recommended. There is no evidence to suggest that currently available radiology techniques are effective in pre-emptively identifying health effects from asbestos exposure.
When is health monitoring required?
Under the Work Health and Safety Regulation 2011 (WHS Regulation), a person conducting a business or undertaking (PCBU) must ensure health monitoring is provided if the worker is either:
- carrying out licensed asbestos removal work at a workplace and is at risk of exposure to asbestos when carrying out the work
- carrying out other ongoing asbestos removal work or asbestos-related work and is at risk of exposure to asbestos when carrying out the work.
Workers carrying out licensed asbestos removal work (Class A and Class B asbestos removal work)
Workers carrying out licensed asbestos removal work must have initial health monitoring carried out before starting the work.
Health monitoring requirements commenced on 1 January 2016. Licensed asbestos removalists must ensure their existing workers carrying out licensed asbestos removal work have health monitoring as soon as it can reasonably be arranged.
The medical practitioner providing or supervising the health monitoring will determine whether there is any need for future health monitoring for the worker, and if so, when this should be done.
If a PCBU is engaging a new worker to carry out licensed asbestos removal work and the worker has previously had asbestos health monitoring carried out, the PCBU can rely on the worker's previous asbestos health monitoring report if:
- the worker provides the PCBU with a copy of the asbestos health monitoring report
- the PCBU ensures the worker is provided with any future health monitoring recommended by the medical practitioner who provided or supervised the original health monitoring if the worker is carrying out licensed asbestos removal work for the PCBU at that time.
When auditing or inspecting a workplace where licensed asbestos removal work is being carried out, Workplace Health and Safety Queensland (WHSQ) inspectors will ask the licensed asbestos removalist for evidence of compliance (e.g. a health monitoring report from an appropriately experienced medical practitioner that shows the health monitoring for a worker has occurred and the recommended frequency of ongoing health monitoring including if no further health monitoring is required). Compliance with asbestos health monitoring requirements may also be considered as part of the process for obtaining or renewing an asbestos removal licence.
Workers carrying out ongoing asbestos-related work and non-licensed asbestos removal work
The PCBU will need to consider if their worker who will be carrying out ongoing non-licensed asbestos removal work or asbestos-related work is at risk. This means considering if the likelihood or potential for exposure to airborne asbestos fibres warrants health monitoring.
This would include taking into account factors such as:
- the potential for exposure or likely level of exposure during work activities
- the types of processes used during the work and if they are likely to make asbestos fibres airborne
- the control measures in place to prevent asbestos fibres becoming airborne and breathed in by the worker
- the frequency of potential exposure
- the duration of the work being carried out.
By complying with control measures outlined in the WHS Regulation, How to Manage and Control Asbestos in the Workplace Code of Practice 2011 and the How to Safely Remove Asbestos Code of Practice 2011, it is unlikely a worker carrying out non-licensed asbestos removal work or asbestos-related work from time to time would have a significant risk from exposure to airborne asbestos fibres and require health monitoring.
Some examples of workers that would fall into this category include:
- a plumber removing less than ten square metres of asbestos cement sheeting in a bathroom wall as part of a bathroom renovation
- an electrician cutting or drilling a small hole in an asbestos cement sheet ceiling to enable conduit or cable go through
- a carpenter removing less than ten square metres of asbestos cement sheeting to create a new doorway in a room
- a mechanic removing old brake pads suspected of containing asbestos
- a person sampling material suspected of containing asbestos.
An incidental exposure is where an individual may be exposed to a low level of asbestos dust for a short period of time (e.g. when a bystander is present when a worker disturbs asbestos containing material and asbestos fibres become airborne).
Health monitoring is not required for incidental exposures to airborne asbestos fibres. As asbestos-related diseases take many years to develop, there is no reason to subject individuals with a suspected incidental exposure to even small doses of ionising radiation from X-rays or CT scans.
Instead, WHSQ recommends the PCBU record the incident and take steps to ensure there are controls to prevent or minimise this kind of incident occurring in the future. The worker can register their suspected exposure through the National Asbestos Exposure Register. The incident does not need to be reported to WHSQ as a dangerous event.
If health monitoring is carried out
Where health monitoring is required, the licensed asbestos removalist must:
- ensure health monitoring is carried out by or done under the supervision of a registered medical practitioner with experience in health monitoring
- consult workers about choosing the registered medical practitioner for the health monitoring
- pay all expenses relating to asbestos health monitoring
- take all reasonable steps to obtain the health monitoring report from the medical practitioner as soon as practicable, and give the worker a copy of the report
- keep the worker's health monitoring report as a confidential record and not provide it to anyone without the worker's written consent.
Further guidance on content of a health monitoring report can be found at Safe Work Australia Reports and records
The licensed asbestos removalist is required to:
- keep a copy of their workers' health monitoring reports
- provide a copy of the health monitoring report to the worker.
It is recommended that workers also provide a copy of their health monitoring report to their own general practitioner.
Individuals who are registered for a My Health Record (the Australian Government's digital health record system) may be able to store their asbestos health monitoring report on this system. This requires the medical practitioner performing the health monitoring to be registered as a provider with My Health Record and the individual would need to give permission for the medical practitioner to upload the information to their My Health Record.
For more information about My Health Record, visit myhealthrecord.gov.au or ask the medical practitioner carrying out any asbestos health monitoring.