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Health and Safety Executive

Upper limb disorders in the workplace

This is a free-to-download, web-friendly version of HSG60 (Second edition, published 2002). This version has been adapted for online use from HSE’s current printed version.

Youcanbuythebookatwww.hsebooks.co.ukandmostgoodbookshops.

ISBN 978 0 7176 1978 8Price £9.50

Whereveryouworkthereisachancethatupperlimbdisorderscouldaffectyou.Theycancausepainandevenpermanentinjurytotheneck,shoulders,arms,wristsorhands.Inmostcasestheyarepreventableandthisbookshowsyouhowtoassessandminimisetherisksthroughpositiveaction.Itshouldhelpyoutocomplywiththelawandmakeyourworkplacesafer.

HSE Books

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© Crown copyright 2002

Firstpublished1990

ISBN9780717619788

Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,ortransmittedinanyformorbyanymeans(electronic,mechanical,photocopying,recordingorotherwise)withoutthepriorwrittenpermissionofthecopyrightowner.

Applicationsforreproductionshouldbemadeinwritingto:TheOfficeofPublicSectorInformation,InformationPolicyTeam,Kew,Richmond,SurreyTW94DUore-mail:[email protected]

ThisguidanceisissuedbytheHealthandSafetyExecutive.Followingtheguidanceisnotcompulsoryandyouarefreetotakeotheraction.Butifyoudofollowtheguidanceyouwillnormallybedoingenoughtocomplywiththelaw.Healthandsafetyinspectorsseektosecurecompliancewiththelawandmayrefertothisguidanceasillustratinggoodpractice.

Upperlimbdisordersintheworkplace Page3of89


ContentsPreface 5

Introduction 6Upper limb disorders: Understand the issues and commit to action 8 Understandtheissues 8Committoaction 11

Create the right organisational environment 13Participationandinvolvement 13Communication 14 Competence 14Allocationofresponsibilities 14

Assess the risk of ULDs in your workplace 15Whatisanergonomicsapproach? 15Identifyingproblemtasks 15Riskassessment 16ULDriskfactors 17

Reduce the risk of ULDs 24Lookingfor‘higherorder’solutions 24Usinganergonomicsapproach 24Basicprinciplesinimplementingsolutions 25Individualdifferences 25Suggestionsforreducingtherisk 25Otherguidanceonsolutions 25Afterimplementation 26

Educate and inform your workforce 27Trainingasacontrolmeasure 27Whoshouldreceiveeducation? 27Whatshouldtrainingcover? 27Makingtrainingmoreeffective 28Evaluationandfollowup 28

Manage any episodes of ULDs 29Reportingandrecording 29Referral 29Diagnosisandreturntowork 30Surveillance 31

Carry out regular checks on programme effectiveness 32Whymonitororreview? 32Monitoring 32Approachestomonitoring 32Examplesofpassiveandactivemonitoring 33Monitoringoutcomes 33Reviewing 34

Appendices 35Appendix1: Casestudies 35Appendix2: RiskFilter,RiskAssessmentWorksheets,suggestionsforreducing therisk 46Appendix3: Medicalaspectsofupperlimbdisorders 68



Appendix4: Legalrequirements 76

References 81

Further information 89



PrefaceTheHealthandSafetyCommission(HSC)hasastrategyfortacklingmusculoskeletaldisorders(MSDs)*includingupperlimbdisorders.ThestrategyadoptstheprinciplesofSecuringHealthTogether: A long-term occupational health strategy for England, Scotland and Wales.1ThisformsanintegralpartofRevitalising Health and Safety.2

Governmentdepartmentsinco-operationwithemployers,employees,tradeunions,employer’sorganisations,healthprofessionalsandvoluntarygroupshavesetseveralchallengingtargetsaspartofSecuring Health Together.ThesehavebeenusedinestablishinganHSCpriorityprogrammeformusculoskeletaldisorderswiththefollowingtargets,tobeachievedby2010:

n 20%reductioninincidenceofwork-relatedillhealthcausedbyMSDs;n 30%reductioninthenumberofworkingdayslostduetoMSDs.

Thepriorityprogrammeaimstoimprovecompliancewiththelaw,topromotecontinuousimprovement,andtodevelopthenecessaryknowledge,skillsandsupportsystemstoachievetheMSDtargets.Thisguidanceformsonestrandofthesupporttobeprovidedforemployers,employeesandthosewhoadvisethem.Itaimstoensurethattheyhavetherightinformationandadvicetopreventandmanageupperlimbdisordersintheworkplace.

* Thetermmusculoskeletaldisorders(MSDs)referstoproblemsaffectingthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.UpperlimbdisordersareasubcategoryofMSDs.



Introduction

Understandtheissuesandcommittoaction

Createtherightorganisationalenvironment

AssesstheriskofULDsinyourworkplace

ReducetheriskofULDs

Educateandinformyourworkforce

ManageanyepisodesofULDs

Carryoutregularchecksonprogrammeeffectiveness

n IstheriskofULDsrecognisedinyourworkplace?n Ismanagementcommittedtopreventingor

minimisingtheriskofULDs?n Arethereadequatemanagementsystemsand

policiestosupportthiscommitment?

n Isworkerparticipationactivelysoughtandvalued?n Aresafetyrepresentativesinvolved?n Arealldepartmentsawareofthecontributiontheycanmake?n Iscompetenceensured?n Haveyouallocatedresponsibilities?

n AreanyULDshazardsidentifiedthroughsimplechecks?n AreriskfactorsforULDspresent?

Repetition Workingenvironment Workingposture PsychosocialfactorsForce IndividualdifferencesDurationofexposure

n HaveyouprioritisedyouractionstocontroltherisksofULDs?

n Haveyoulookedfor‘higherorder’solutions?n Haveyouutilizedanergonomicsapproach?n Haveyouimplementedsolutions?

n Haveyoueducatedandinformedyourworkforcetohelpprevention?

n HaveyouinvolvedsafetyrepresentativesincommunicatinginformationaboutULDsriskfactorsandcontrolmeasures?

n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworkpracticesandcontrolmeasures?

n HaveyouimplementedandsupportedasystemforearlyreportingofsystemsforULDs?

n DoyouactivelylookforsymptomsofULDs?n Haveyouarrangedforoccupationalhealthprovision?n Doyouhavesystemsinplaceforemployeesreturningto

workafteranULD?

n DoyouhavesystemsinplacetomonitorandreviewyourcontrolsforULDs?

n DoyouhavesystemsinplacetomonitorandreviewyourULDsmanagementprogramme?

n Areyouawareofnewdevelopments/information?n Doyouaimforcontinuousimprovement?

Figure 1 FrameworkforthemanagementofULDrisks



1 Thisdocumentdescribeshowmanagers,togetherwiththeiremployees,cancooperatetominimisetherisksofupperlimbdisorders(ULDs)throughapositivemanagementapproach.ItgivesgeneralguidanceontheprocessesinvolvedandincludesariskassessmentfilterandworksheetsaswellasinformationonthemedicalaspectsofULDsandthelegalrequirements.

2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,arms,wrists,handsandfingers.ULDscanoccurinalmostanyworkplaceandtheycanusuallybeprevented.Whenpreventionhasnotworked,systemsareneededtomakesuretheyarepromptlyreported,properlydiagnosedandtreated.Employers’legalresponsibilitytopreventwork-relatedaccidentsandillhealthalsoappliestoULDs.

3 ThisguidancereplacesWork-related upper limb disorders: A guide to preventionandreflectsthechangesinourunderstandingofriskfactorsandcontrolstrategieswhichhaveemergedfromresearchoverthelastdecade.Thishasshowntheimportanceofpsychosocialriskfactorsactinginconjunctionwithphysicalriskfactors.IthasdemonstratedtheneedforanintegratedapproachtothemanagementofULDriskswhichaddressesbothorganisationalandphysicalaspectsoftheindividual’staskandworkenvironment.

4 Thisguidancepresentsanapproachwhichisbasedonsevenstagesinamanagementcycle.Thestagesare:

n understandtheissuesandcommittoaction;n createtherightorganisationalenvironment;n assesstheriskofULDsinyourworkplace;n reducetherisksofULDs;n educateandinformyourworkforce;n manageanyepisodesofULDs;n carryoutregularchecksonprogrammeeffectiveness.

5 Eachstageisconsideredinaseparatesectionoftheguidance.AnoverviewoftheapproachisshowninFigure1.(seealsoparagraph30)

6 Appendices1-4includethefollowing:

n Appendix1:illustratesreallifeexampleswheretherisksofULDshavebeenmanaged.

n Appendix2:providespracticalhelpwithriskassessmentandcontainsaRiskAssessmentFilterandWorksheetsandsuggestionsforreducingtherisk.

n Appendix3:givesbackgroundinformationonmedicalaspectsofULDs.n Appendix4:setsouttherangeoflegaldutieswhichapplytothe

preventionofULDs.

7 VibrationisincludedinthisdocumentwhereitcontributestothedevelopmentofULDs,buttheguidancedoesnotcoverallaspectsofthepreventionofvibration-inducedillnesses,suchasvibrationwhitefinger.3,4Inaddition,therisksofupperlimbdisordersduetoDisplayScreenEquipment(DSE)usearecoveredbytheDSEregulations,andseparateHSEguidanceisspecificallyavailableonthistopic.5,6DutyholdersmustcomplywiththeDSEregulations;howeverthisULDguidancemaybeusedtoprovidesupplementaryinformation.



Upper limb disorders: Understand the issues and commit to action

n IstheriskofULDsrecognisedinyourworkplace?n IsmanagementcommittedtopreventingorminimisingtheriskofULDs?n Arethereadequatemanagementsystemsandpoliciestosupportthe

commitment?

Understand the issues

Whatareupperlimbdisorders?8 Thephrase‘upperlimbdisorders’isagenerallabelwhichisusedtoreferto

arangeofmedicalconditionswhichcanbecausedormadeworsebywork.Thereareanumberofcommontermswhicharealsoinusetodescribethesameconditions,ofwhichthemostwellknownis‘repetitivestraininjury’.Otherlesserknowntermsare‘cumulativetraumadisorder’,or‘occupationaloverusesyndrome’.Thesecommontermscanbemisleadingwithregardtothemanyfactorswhichcancontributetotheonsetoftheconditions,andforthisreasonthemoregeneraldescriptionof‘upperlimbdisorders’isusedinthisguidance.

9 Thetermupperlimbrefersto:

n thepartofthebody:thearmandhand,coveringaregionextendingfromthetipsofthefingerstotheshoulderandextendingintotheneck;

n thetissues:thesoft-tissues,musclesandconnectivetissues(tendonsandligaments)andthebonystructures,aswellastheskin,alongwiththecirculatoryandnervesupplytothelimb.

10 Theterm‘disorder’referstotheclinicaleffectsproducedbyunderlyingchangesinthetissues.Thesecomprisesymptomssuchaspain,experiencedbytheperson,andsignswhichareabnormalities,egintheappearanceofthelimb,whichmaybeapparenttothepersonormayonlybefoundonexaminationbyadoctor.Theseclinicaleffectsareaccompaniedbyfunctionalchanges,egareductionintheabilitytousetheaffectedpartofthelimbandareoftenassociatedwitharestrictionintherangeorspeedofmovement.Strengthandsensationmayalsobeaffected.Althoughtheclinicalandfunctionaleffectsareconfinedtothelimbitself,theirpresencewilloftenleadtoareductioninanindividuals’assessmentoftheirgeneralhealthandtoareductionintheirqualityoflife.

Figure 2



11 Upperlimbdisorderscanbedescribedbythepartofthebodyaffected,orbythepresumedpathologicalmechanism.Therearecommontermsformanyoftheindividualconditions,suchas‘tenniselbow’and‘frozenshoulder’.AsimpleguidetothemorecommonupperlimbdisordersiscontainedinAppendix3.

12 PainisacommonsymptomofULDsbuttheexperienceofpainintheupperlimbisalsocommonamongstthegeneralpopulation.Therefore,feelingpainintheupperlimbisnotinitselfanindicationofthepresenceofanULD,andsuchsymptomsmaybedifficulttoattributetoworkwithanycertainty.

13 Paincanalsobeexperiencedintheformofstiffnessorsorenessofthemusclesaccompaniedbytemporaryfatigue.Thesesymptomsarecomparabletothosefollowingunaccustomedexertionwherenopermanentpathologicalconditionresults.Fullrecoveryusuallyoccursafterappropriaterest.

14 Atanyonetimeitispossibletoexperiencesymptomsintheupperlimbwhichresultfromanumberofdifferentcauses.ThisguidanceisprimarilyconcernedwithULDsforwhichthereisevidencetobelievethattheconditionscanbecausedby,ormadeworsebyworkactivity.

Areallupperlimbdisorderswork-related?15 Thesimpleanswerisno,butexperiencehasshownthatULDsareoften

directlylinkedtoworkplaceactivitiesorifduetoanon-workcause,madeworsebywork.

16 Itisimportanttorecognisethatthemusculoskeletalsystemiswellsuitedtoproducingrepeatedmotionsatlowforcelevels.Undesirableforcesmay,however,beimposedonmuscles,tendonsandjointsbysomejobdemandsandworkingpractices.Suchstressesareusuallywithinthephysicalcapabilityorstrengthofthetissues,providedtheforcesareofshortdurationandrestperiodsareadequate.Prolongedtissueloadingcausedbystaticpostureorperformanceofveryfrequentexertionscan,however,beharmful.

17 ThereareestablishedassociationsbetweenmanytypesofULDsandworktasks,orspecificriskfactorswithinthesetasks.7Evidencecomesfrom:

n anecdotalreportswhichhavehistoricallylinkedspecificoccupationsandparticularconditions;8

n clinicalcasestudiesandreportingschemesforoccupationaldiseases;9,10n workplacesurveysofsymptoms;11

n epidemiologicalreviews7,12andpopulationsurveys;13,14

n laboratorystudiesofthephysiologicalimpactofexperimentallyimposed physicalstresses.15,16,17

18 Thereviewsoftheepidemiologicalliterature7,18providegoodevidenceoftheassociationsbetweenworkplaceriskfactorsandULDs,particularlywhereworkersarehighlyexposedtotheseriskfactors.

19 Non-workactivities,suchasdomesticactivityandhobbies,maycontainsimilartypesofriskasarefoundinworkactivities.Thesetasksaregenerallynotasrepetitive,forceful,orprolongedasareworktasks.Also,theindividualhasahighdegreeofcontrolastowhentheactivitycanbetemporarilystoppedorabandonedaltogether.



Howbigistheproblem?20 Musculoskeletaldisordersarethemostcommonworkrelatedailment

afflictingthegeneralpopulationinGreatBritain.Theyaccountformorethanhalfofallself-reportedoccupationalillhealth(morethan1millioncases).13Theseproblemsarenotconfinedtoparticularjobsorsectorsandarefoundthroughoutmostmanufacturingandserviceindustries.

21 Basedonahouseholdsurveydonein1995,anestimated506000peopleweresufferingfromamusculoskeletaldisorderwhichaffectedtheupperlimbsorneck.

22 Anestimatedminimum4.2millionworkingdayswerelostinBritainduetomusculoskeletaldisordersaffectingtheupperlimbsorneckin1995,witheachaffectedemployeetaking,onaverage,13daysoffwork.14Coststoemployersofmusculoskeletaldisordersoftheupperlimbsorneckwereestimatedtobeatleast£200million.

Whattypesofjobcarryparticularrisks?23 EvidencegatheredoverrecentyearsshowsthatULDsarenotconfinedtoany

oneparticulargroupofworkersorindustrialactivity,butarewidespreadintheworkforce.Thefollowinglistofgroupswhichhavereportedhighlevelsofarmpainillustratesthispoint.Acommonfeatureofthejobsisthattheirtaskshaverecognisedriskfactors:

n assemblylineworkers; n cleaninganddomesticstaff; n constructionworkers; n garmentmachinists; n hairdressers;

24 Thislistisnotexhaustive,andtherearemanyotherjobsthatcarryariskof

ULDs.Similarly,thepresenceofjobsonthislistdoesnotimplythattheriskofinjurytotheseworkerscannotbeadequatelycontrolled.

WhyshouldIbeconcerned?25 IfworkwhichcarriestheriskofULDsisnotmanagedproperlythenthe

consequencesareseenin:

n thehumancostofpainandsufferingexperiencedbyemployeesandtheirfamiliesthroughillhealth;

n lossofearnings;n lossoftheabilitytowork;n problemsinqualitycontrolandproductivity;n decreaseinefficiency;n sicknessabsence;n costsofstaffreplacementandtraining;n theriskoflitigation;n theriskofbadpublicity;n ariseininsurancepremiumsandcostsofcompensationtoinjured

workers.

26 Anywarningsignsmaybethe‘tipoftheiceberg’.Onepersonwithsymptomsmaymeantherearenumerousotherworkersalsoexposedtoriskfactors,andwhoareintheprocessofdevelopingadisorder.

Whataremylegalresponsibilities?27 TherearegeneraldutiesonallemployersundertheHealthandSafetyat

WorketcAct197419andtheManagementofHealthandSafetyatWork

n meatandpoultryprocessors;n mushroompickers;n potteryworkers;n secretaries/temps;n textileworkers.



Regulations199920whichrequiretherisksofULDstobeaddressed.These,andotherlegalresponsibilitiesareoutlinedinAppendix4.

28 ULDshavealsobeenthesubjectofmuchcivillitigationoverthepasttwentyyears.21Althoughthelegalprocesshassometimesappearedinconsistentthereisnodoubtthattheemployer’sdutyofcaretowardstheiremployeeswithrespecttoULDsisnowwellestablishedinthecivilcourts.Thiscivillawdutyrunsparalleltotheemployer’sstatutoryresponsibilityunderhealthandsafetylegislation.

Commit to action

29 RealisingthatULDsmaybeariskwithin,andto,yourbusinessisnotenough.Itisessentialtoturnthatawarenessandunderstandingintoacommitmenttotakeactiontomanagetherisks.TheframeworkinFigure1outlinessevenstageswhichformasoundbasisfordevelopinganeffectiveprogrammeforthemanagementofULDrisks.

30 Thestagesareasfollows:

n Understand the issues and commit to action:ManagementandworkersshouldhaveanunderstandingofULDsandbecommittedtoactiononprevention.Thiscommitmentmaybeexpressedthroughpositiveleadershiponthetopic,bygeneratinganeffectivehealthandsafetypolicyonULDsandbyhavingappropriatesystemsinplace.Theseactionswillhelptopromoteapositivehealthandsafetycultureintheworkplace.

n Create the right organisational environment:Theorganisationalenvironmentshouldfosteractiveworkerparticipationandinvolvement,haveclearandopenlinesofcommunicationandencouragepartnershipworkinginthenextfivesteps.Thiswillinvolvedevelopingthecompetenciesofworkers,supervisorsandmanagersfortheirdifferingroles.

n Assess the risks of ULDs in your workplace:AcorefeatureofthemanagementprogrammeistoassesstheriskofULDs.Itneedstobedoneinasystematicwaybymanagersandworkerssothatthemainrisksintheworkplacecanbeidentifiedandprioritisedforaction.Asrisksarepotentiallywidespread,simplechecks,includingafilterquestionnairecanbeusedtoidentifyjobswhichrequireamoredetailedassessment.

n Reduce the risks of ULDs:Onceriskshavebeenassessedandprioritisedacoherentprocessofriskreductionshouldbeundertakenusinganergonomicsapproach.Possiblerisksshouldbereducedoreliminatedatsource.Implementationshouldincludeworkforceparticipationasthisisknowntoleadtobettersolutionsandmoreeffective,sustainedchanges.

n Educate and inform your workforce:Toenableparticipationandinvolvementoftheworkforceandforindividualstoassumetheirproperresponsibilities,provisionofeducationandinformationisvital.Trainingwillsupportallaspectsofthemanagementprogramme,andshouldbeconsideredasanongoingactivityandnotasa‘one-off’task.

n Manage any episodes of ULDs:ItisimportanttohaveasystemtomanageanyepisodesofULDs.Employeesshouldbeencouragedto



identifyanysymptomsandtoreportthembeforetheybecomepersistent.Managersneedtorespondquicklybyreviewingrisksandintroducingmoreeffectivecontrols,ifnecessary.Theyalsoneedtoreassureemployeesthatreportingofsymptomswillnotprejudicetheirjoborposition.Earlymedicalmanagementcanstopestablishedcasesfromdeterioratingandalsohelptheprocessofreturntowork.

n Carry out regular checks on programme effectiveness:Toensure

thatthisprogrammecontinuestoworkproperlyovertimeregularchecksofeffectivenessshouldbecarriedout.ThiswillhelptoensurethatcontrolsonULDrisksremaineffectiveandwillallowyoutoprogressivelyimprovetheireffectiveness.

Managementcommitment31 Ifthisprogrammeofcontrolistoworkeffectivelythenitisimportantto

demonstratemanagementcommitmenttothewholeprocess.Effectivemanagementofoccupationalhealthrisksischaracterisedby:

n visibleseniormanagementinvolvement;n openmanagementstyle;n goodcommunicationswhichengenderownershipofproblems(ie

personalresponsibilityandparticipation);n anappropriatebalancebetweenhealthandsafetyandproductiongoals.

Supportingpoliciesandsystems32 AclearpolicyforthemanagementofULDssetsthedirectionforthe

organisationandmeansthatpeoplethroughouttheorganisation,howeverlargeorsmallitis,willknowthatthepreventionofULDsisanissuewhichhastobeaddressedinallstagesofbusinessplanning,bothforday-to-dayoperationsandinthelongerterm.

33 TheframeworkinFigure1andtheguidanceinthefollowingsectionsareameanstoturnyourintentionsintorealityandtokeeptheseintentionsunderscrutiny.



Create the right organisational environment

n Isworkerparticipationactivelysoughtandvalued?n Aresafetyrepresentativesinvolved?n Arealldepartmentsawareofthecontributiontheycanmake?n Iscompetenceensured?n Haveyouallocatedresponsibilities?

34 TheeffectivemanagementofULDsrequiresseniormanagementcommitment.Inaddition,itneedsthepresenceintheorganisationofsharedandinterlinkedbeliefs,attitudesandbehavioursthatallowthemanagementofriskstoproceedeffectively.Theseelementsmakeupwhathasbeenreferredtoasthehealthandsafetyclimateorculture.KeyfeaturescrucialtodevelopingapositiveenvironmentfordealingwithULDproblemsinclude:

n participationandinvolvement;n communication;n competence;n allocationofresponsibilities.

Participation and involvement

35 Involvingstaffintheplanningandorganisationalprocessescanbeanimportantwayofincreasingthelikelihoodofsuccessofyourriskcontrolstrategy.Workershavefirst-handknowledgeandanalmostuniqueunderstandingaboutparticularaspectsofthetaskstheyperform.ItmayhoweverbeimportanttoprovideeducationandtrainingonULDsbeforeexpectingemployeestocontributefullytotheprocessofassessmentandcontrol.KeyindividualsareSafetyRepresentativesastheyprovideaneffectivechannelforcommunicationwiththeworkforcetheyrepresentandtheycanusetheirfunctionstoprovidea‘realitycheck’toensurethattheproposedcontrolmeasuresmightactuallywork.TheHealthandSafety(ConsultationwithEmployees)Regulations1996,22SafetyRepresentativesandSafetyCommitteesRegulations1996,23andtheOffshoreInstallations(SafetyRepresentativesandSafetyCommittees)Regulations198924requireyoutoconsultwithyouremployeesontheirhealthandsafetyatwork.ThiswouldextendtoactionsyouintendtotaketotackleULDs.FurtherinformationaboutemployeeparticipationcanbefoundinDevelopment of a framework for participatory ergonomics25 andalso Handle with care - assessing musculoskeletal risks in the chemical industry.26

36 AsupportivecompanycultureandopennesswillbeimportantfactorsinensuringthattheadverseeffectsofULDsarenot‘hidden’frommanagement.Encouragingearlyreportingofworkrelatedachesandpainstosupervisorsorlinemanagers,andinturntotheoccupationalhealthservice(ifyouhaveoneavailable)canprovidesignificantbenefitsforboththeemployeeandthecompany.Oneofthemaindifficultieswithreportingisthefearoftheoutcome,egpossiblybeingdeclaredunfitforwork.Thisiswhereanopen,positiveculturebecomesimportant.Employeesoughttofeelsafetoreportachesandpainsearlyintheironset.



Communication

37 GoodcommunicationwillensurethatstaffmembersineverydepartmentofyourbusinessareawareoftherisksofULDsandwhattheycandotohelpreducethem.Productdesignstaffwillinfluencethedetailsofthemanufacturingprocessandthedecisionsofmarketingstaffwilldeterminethenatureofthepackagingrequired.Purchasingdepartmentswillcontrolthesourcingoftheequipmentusedandgeneralmanagementwilldeterminetermsandconditionsincludingworkingschedules.Insomecases,factorswhichinfluencetheserisksmaybecontrolledatadistanceinaparentorganisation.Arangeofmethodsshouldbeusedtoensurethateveryoneiskeptinformedofhowtheirrolescanimpactonotherworkersandalsothecompany’sprogrammeonthepreventionofULDs.Thesearelikelytoincludeseminars,meetings,postersandarticlesinthehousejournalornewsletter.Theinternetalsoprovidessomeusefulwebsites,someofwhichareincludedintheFurtherInformationsection.

38 Anopensystemofcommunicationshouldprovideopportunitiestodistributeinformationtoemployeesandalsoopportunitiesforfeedback.Thiscanbeinformal(egtosupervisors)ormorestructured,forexamplethroughregularsurveys.Ifcomplaintsoccurtheyshouldbeinvestigated.

Competence

39 ItisimportantthatpeoplearecompetenttopreventULDswithintheirtechnicalareasofresponsibility.Healthandsafetytrainingisimportant,payingparticularattentiontotheriskfactorsforULDsandhowthesemaybeavoided.Somegroupsofstaffmayrequirespecialisedtraining,egintheapplicationofergonomicprinciples,evaluationofworkplacechangesortherecognitionofupperlimbhealthcomplaints.

40 Theneedforcompetencealsoextendstoareassuchastheoperationofrecruitmentandplacementproceduresandsystemstoidentifytrainingneedswhenworkpracticesandtechnologieschange.Staffdevelopmentsystemscanbeusedtoensurethatindividualshaveaccesstothetrainingtheyrequire,andtheiroperationcanformpartoftheregularchecksonprogrammeeffectiveness.

Allocation of responsibilities

41 AsmanypeoplewillhavearoleinyourprogrammetopreventULDs,itisimportanttobeclearaboutwhoisresponsibleforwhatfunctions.Forexample,supervisorswhounderstandtheriskscantakeanactiveroleinhelpingtocontrolthem,andinencouragingstafftoreportanyproblems.Youmayneedtosetupsystemstodealwithanyproblemswhichmayoccur,toensureanearlyresponsetothem.

42 Settingobjectivesforyourorganisation,withclearrolesandaccountabilitieswillhelpkeepyouontarget.Youmaybeabletousebenchmarkingasawayofcheckingprogress,egbetweendepartmentsorwithneighbouringbusinesses.



Assess the risk of ULDs in your workplace

n AreanyULDhazardsidentifiedthroughsimplechecks?n AreriskfactorsforULDspresent?n Repetition,workingposture,force,durationofexposure,working

environment,psychosocialfactors,individualdifferences,

43 AssessingtheriskassociatedwithULDsinvolvestwomajorstepsnamely:

n identifyingproblemtasks;andn riskassessment.

44 Anexampleofamethodfortacklingtheabovetwostepscanbefoundin

Appendix2.

45 Inordertobeabletogetthemostbenefitfromtheprocess,youandyourworkforceneedtobeabletoworktogethertoidentify,assessandcontroltheriskofULDs.Thisprocessshouldinvolveanergonomicsapproachandshouldincludetheparticipationofworkers.

What is an ergonomics approach?

46 Ergonomics(orhumanfactors),isconcernedwithensuringworkisdesignedtotakeaccountofpeople,theircapabilitiesandlimitations.Itsobjectiveistooptimisehealth,safetyandproductivity.AnergonomicsapproachisthemosteffectivewayofdealingwithULDproblems.Thisisbecauseitencouragesyoutotakeaccountofalltherelevantpartsoftheworksystemandrequiresworkerparticipation.

Identifying problem tasks

47 Therearetwomainapproachesyoucanusetoidentifyifyouhaveaprobleminyourworkplace.Firstlymanagersandworkerscanlookforanysignsofproblemsorsymptomsamongsttheworkforce.Secondly,youcanobserveworktasksthemselvestoseeifriskfactorsforULDsarepresent.ThiscanbedoneusingasimpleinitialassessmentofriskssuchastheriskfilterapproachfoundinAppendix2.Sourcesofinformationthatmayhelpincludeexpertadvice,industrystandardsandlegislativestandards.

Warning signs48 WarningsignscanindicatethepresenceofhazardsrelatingtoULDs.Signsof

existingULDproblemscaninclude:

n injuryandillnessrecords;n jobswhichworkersarereluctanttodo;n jobswhereworkerscomplainofdiscomfort;n workershavingmadeadaptationstoworkstations,toolsorchairs;n workersrequestingtobere-deployedortakenoffajob;n splintsorbandagesbeingworn,and/or;n useofpainkillers.



Figure 3

49 Paragraphs120-128outlineotherwaysofmonitoringthenumberofworkerswhoareexperiencingupperlimbpainordiscomfort.

Risk Filter 50 Adetailedassessmentofeveryjobcouldbeamajorundertakingand

mightbeanunnecessaryeffort.Tohelpidentifysituationswhereadetailedassessmentisnecessary,aFilterforaninitialscreeningoftaskshasbeendevised.WheretheFilteridentifiesseveralriskfactorsincombination,theriskofULDsislikelytobegreater.AcopyoftheRiskFilterandinstructionsforusecanbefoundinAppendix2.

Risk assessment

51 OnceyouhaveidentifiedthatcertaintasksmaybecreatingariskofULDs(bylookingforsignsandsymptomsandusingtheriskfilter),amoredetailedriskassessmentshouldbeconducted,involvingmanagersandworkers,inordertoascertainthelikelihoodandseverityofrisk.ULDassessmentworksheetsthatcanassistinrecognisingandrecordingriskfactors,canbefoundinAppendix2.

The risk assessment process52 Ajoboftenconsistsofseriesoftasks.Performingyourriskassessmentcan

besimplifiedbythinkingintermsofthesetasksandtheirsubsidiaryelements.Toillustratethispoint,Figure4describesthejobofaprocessworkerthatconsistsofthreedifferenttasksonanassemblyline:

n station1:attachingahandle;n station2:grinding,and;n station3:packing.

53 Ascanbeseeninthisexample,thesetaskscanalsobefurtherbrokendownintoelements,whicharedistinctsequencesofmovementwithinthetask.

54 Lookingattaskelementscanhelpbothinidentifyingthecausesofrisksandindevisingpotentialsolutions.Forexample,inthecaseoftheprocessworkertheriskfiltermightidentifythetaskofattachingahandle(station1)asposingapossiblerisk.Themoredetailedassessmentusingtheworksheetwouldidentifyrepeateduseofapinchgripwhenpickingupandpositioningthescrews(elements1and2),andawkwardarmpostureouttothesideofthebodywhendrilling(element3).Whenconsideringthetaskinthiswayitiseasiertolinktheriskstoparticularactionsoroperations,whichthenhelpswhenconsideringriskreductionmeasures.

55 Inthiscasebetterpositioningoftheassemblylineinrelationtotheworker,andre-orientatingtheobjectswillreducetherisktotherightarmandshoulder.Reducingthedurationspentonthetaskandintroducingmorefrequentbreakswillreducetheriskassociatedwithusingthepinchgrip.



Figure 4 Thetasksandelementsofaprocessworker’srole

56 Remembertoconsiderwhetherworkersperformanumberofpotentiallyriskytasks(iethathavebeenhighlightedbytheriskfilter),inagivenshift.Ifthisisthecase,itisessentialthatyourriskassessmentconsiderstheoverallimpactofperformingthecombinationoftasksinyourriskassessment.Inpractice,thiswouldusuallymeanthataseparatefilterandriskassessmentworksheetwouldbefilledoutforeachtask,andthatthecompletedworksheetswouldbeconsideredincombinationwhendecidingontheoveralllevelofriskforthoseworkers.DetailedinstructionsfortheriskfilterandriskassessmentworksheetscanbefoundinAppendix2.

57 Otherriskassessmenttoolsareavailable.27,28,29,30Theserangefromstandardisedorquantitativetoolsthatareusuallyrequiredtobeundertakenbyacompetentperson,tosimplechecklists.Engagingacompetentpersonmaybeappropriateformorecomplexriskassessments.

ULD risk factors

58 Riskfactorscanbethoughtofastask,environment,orworker-relatedwithinanergonomicapproach.TheprincipalULDriskfactorsare:



59 Eachoftheseriskfactors,includingtheirdefinitionsandwhytheycreatetheriskofULDs,willbediscussedinmoredetailinthefollowingparagraphs.

60 RiskfactorscommonlyinteractwitheachotherincreatingtheoverallriskofULDs.Forexample,thetaskofgrippingaheavypowertoolwithalargehandleforsixhourswouldresultinanawkward,forcefulgrippingpostureandexposuretovibrationoveraprolongedperiod.Thereforeworkingpostures,duration,forceandworkingenvironmentareallriskfactorsforinjuryinthistask.

61 Incontrast,ifthistaskwasonlydoneforashortperiodineachshift,theriskofinjurymaynotbehigh.Thisisdespitethefactthattheriskfactorsofworkingpostures;forceandvibrationarestillpresent.

62 Generally,thereisanincreasedriskofinjurywhenthereareanumberofriskfactorsactingincombination.However,oneriskfactoractingalonecancreateanunacceptableriskofinjuryifitissufficientlygreatinmagnitude,frequencyorduration.

Repetition63 Workisrepetitivewhenitrequiresthesamemusclegroupstobeused

overandoveragainduringtheworkingdayorwhenitrequiresfrequentmovementstobeperformedforprolongedperiods.

64 Rapidorprolongedrepetitionmaynotallowsufficienttimeforrecoveryandcancausemusclefatigueduetodepletionofenergyandabuildupofmetabolicwastematerials.Repeatedloadingofsofttissuesisalsoassociatedwithinflammation,degenerationandmicroscopicchanges.Fastmovementsandaccelerationrequirehighmuscleforces.

Figure 5

Taskrelatedfactorsn repetition;

n workingpostures;

n force;

n durationofexposure.

Environment-relatedfactorsn workingenvironment;

n psychosocialfactors.

Worker-relatedfactorsn individualdifferences.



Workingposture65 Workingposturescanincreasetheriskofinjurywhentheyareawkwardand/

orheldforprolongedperiodsinastaticorfixedposition.

Figure 6

Awkward postures66 Anawkwardpostureiswhereapartofthebody(egalimbjoint)isused

wellbeyonditsneutralposition.Aneutralpositioniswherethetrunkandheadareupright,thearmsarebythesideofthebody,forearmsarehangingstraightoratarightangletotheupperarm,andthehandisinthehandshakeposition.Forexample,whenaperson’sarmishangingstraightdownwiththeelbowbythesideofthebody,theshoulderisinaneutralposition.However,whenemployeesareperformingoverheadwork(egrepairingequipmentoraccessingobjectsfromahighshelf)theirshouldersarefarfromtheneutralposition.

67 Whenawkwardposturesareadopted,additionalmusculareffortisneededtomaintainbodypositions,asmusclesarelessefficientattheextremesofthejointrange.Resultingfrictionandcompressionofsofttissuestructurescanalsoleadtoinjury.

Static postures68 Staticposturesoccurwhenapartofthebodyisheldinaparticularposition

forextendedperiodsoftimewithoutthesofttissuesbeingallowedtorelax.Whenholdingabox,forexample,itislikelythatthehandsandarmsareinastaticposture.

69 Staticloadingsrestrictbloodflowtothemusclesandtendonsresultinginlessopportunityforrecoveryandmetabolicwasteremoval.Musclesheldinstaticposturesfatigueveryquickly.

70 Inboththeabovetypesofposture(awkwardandstatic),theriskofULDswillberelatedtothenumberoftimesthepostureisrepeated,theamountofforcerequired,and/orthelengthoftimeitisheld.AswithalltheriskfactorsforULDs,theimpactoftheworkingpostureneedstobeunderstoodinrelationtootherriskfactors.

Force71 Forcecanbeappliedtothemuscles,tendons,nervesandjointsoftheupper

limbby:

n handlingheavyobjectswhenperformingtasks,ieanexternalload;n fastmovementorexcessiveforcegeneratedbythemusclesofthebody–

oftentobetransmittedtoanexternalload,egtryingtoundoastiffbolt;n localforceandstressfromitemscomingintocontactwithpartsofthe

upperlimb,suchasthehandleofapairofpliersdiggingintothepalmofthehand.



Figure 7

72 Thelevelofforcethatisgeneratedbythemusclesisaffectedbyanumberoffactorsincluding:

n workingposture:thelevelofmusculareffortrequiredincreaseswhenapartofthebodyisinanawkwardposture;

n thesizeandweightofobjectsbeinghandled;n thespeedofmovement:asextraforceisneededatthebeginningand

endoffastmovementssuchashammering;andn vibratingtoolsorequipment:asoperatorsneedtouseincreasedgrip

forceinworkingwithvibratingequipment.73 Useofexcessiveforcecanleadtofatigueandifsustained,toinjury,either

throughasingle-eventstraininjuryorthroughthecumulativeeffectoftherepeateduseofsuchforce.Localforceandstresscanalsocausedirectpressureonthenervesand/orbloodvesselsandincreasetheriskofdiscomfortandinjury.

Force in gripping74 Theneedtogriprawmaterials,productortoolsisapotentialriskfactor

ifexcessiveforceisused.Theamountofforcerequiredtogripcanbeinfluencedbythetypeofgripused,thepostureofthewrist,exposuretocoldandvibrationandtheeffectsofwearinggloves.

75 Theforcerequiredtogripobjectsisalsodependentuponthematerialoritembeinggripped.Forexample,ascrewdriverhandlewithaflexiblegriprequireslessforcewhenbeingusedthanonewithaharderhandle.Thesizeoftheobjectbeinggrippedcanalsoaffecttheforcerequired.Forexample,plierswithtoowideortoonarrowaspanwillbemoredifficulttogrip.

76 Muscleforceisgreatestwhenapowergrip(eggrippingahandleinthepalmwithfingersandthumb)isusedas,thisallowsalargesurfaceareaofthehandtobeutilised.Thestrongestgripstrengthoccurswhenthewristisclosetothe‘handshake’positionandisslightlybentupwards.

Durationofexposure77 Durationreferstothelengthoftimeforwhichataskisperformed.It

includesthelengthoftimethatthetaskisundertakenineachshift,plusthenumberofworkingdaysthetaskisperformed(egfourhoursperday,fivedaysperweek).Durationisanimportantconceptinassessingtheriskofmusculoskeletaldisorders.

78 Itisgenerallyacceptedthatmanytypesofupperlimbdisordersarecumulativeinnature.Therefore,whendurationtimeisincreasedtheriskofinjuryisincreased.Thisisbecausewhenpartsofthebodyundertakeworkforperiodswithoutrest,theremaybeinsufficienttimeforrecovery.Consequently,timefortheindividual’sbodytorecoverfromaspecifictaskortasksisimportant.



79 Shortexposuresareunlikelytocreatesignificantriskofinjury,exceptwherethetaskisexceptionallydemandingand/ortheworkerhasnotbeenallowedtobuilduptoitsdemandsoveraperiodoftime.Thiscanoccurafterreturntoworkfromholidaysorwithanincreaseinworkpace.

Figure 8

Workingenvironment80 Workingenvironmentreferstoaspectsofthephysicalworkenvironmentthat

canincreasetheriskofULDs.Thisincludesfactorssuchasvibration,coldandlighting.

Vibration81 Exposuretohand-armvibrationresultsfromtheuseofhand-held/guided

powertoolsandequipmentorfixedmachinerysuchasbenchgrinderswheretheworkpieceisheldbytheworker.VibrationcanincreasetheriskofULDsandisknowntocausevibrationwhitefingerandcarpaltunnelsyndrome,lossofsenseoftouchortemperature,painfuljointsandlossofgripstrength.Informationaboutthedose(ievibrationmagnitudeandexposuretime)ofvibrationisneededinordertoaccuratelyassesstherisk.FurtherinformationonvibrationcanbefoundinHand-arm vibration3,ISO5349-24andAppendix3.

Figure 9

Cold82 Workingincoldtemperatures,handlingcoldproductsorhavingcoldair

blowingonpartsofthebodycanplaceadditionaldemandsonthebodyaswellaspossiblyrequiringtheuseofpersonalprotectiveequipment(whichcancompoundtheriskbyrequiringadditionalforcetogrip).Exposuretocoldcanresultindecreasedbloodflowtothehandsandupperlimbs,decreasedsensationanddexterity,decreasedmaximumgripstrengthandincreasedmuscleactivity(whichispartofthebody’snaturalresponsetobeingcold).



Figure 10

Lighting83 Thevisualdemandsofthetaskareanimportantconsideration,sincea

worker’sposturecanbelargelydictatedbywhattheyneedtosee.Dimlight,shadow,glareorflickeringlightcanencourageworkerstoadoptabentneckandpoorshoulderposturesinordertoseetheirwork,therebyexacerbatingtheeffectsofotherriskfactors.FurtherinformationonlightingcanbefoundinLightingatwork.31

Figure 11

Psychosocialfactors84 Physicalriskfactorsexerttheirharmfulinfluencethroughphysiologicaland

biomechanicalloadingoftheupperlimb.Ofequalimportanceisthelargebodyofworkshowingthataworker’spsychologicalresponsetoworkandworkplaceconditionshasanimportantinfluenceonhealthingeneralandmusculoskeletalhealthinparticular;thatis,workasexperiencedbyworkers.Thesearereferredtoaspsychosocialriskfactors.Theyincludethedesign,organisationandmanagementofworkandtheoverallsocialenvironmentingeneral(thecontextofwork)andalsothespecificimpactofjobfactors(thecontentofwork).Itisverylikelythatphysicalandpsychosocialriskfactorscombineandthatthegreatestbenefitwillbeachievedwhenbothareidentifiedandcontrolled.Manyoftheeffectsofthesepsychosocialfactorsoccurviastress-relatedprocesseswhichincludedirectbiochemicalandphysiologicalchanges.Alsoincludedareinstanceswhereindividualstrytocopewithstressfuldemandswithbehavioursthat,inthelongterm,maybedetrimentaltohealth.Anexamplewouldbewhereanindividual,becauseofhighworkloadordeadlines,foregoestherestbreakstowhichtheyareentitled.

85 Psychosocialriskfactorsarecommoninsectorswhereupperlimbdisordersoccur13.Importantaspectsofworkdesignincludetheamountofcontrolpeoplehaveintheirjobs,thelevelofworkdemands,thevarietyoftasksthattheyhavetocarryoutandthesupporttheyreceivefromsupervisorsand



co-workers.Manyjobsarenotwelldesignedandincludesomeorallofthefollowingundesirablefeatureswhere:

n workershavelittlecontrolovertheirworkandworkmethods(includingshiftpatterns);

n tasksrequirehighlevelsofattentionandconcentrationespeciallyinconditionswheretheworkerhaslittlecontrolovertheallocationofefforttothetask;

n workersareunabletomakefulluseoftheirskills;n theyarenot,asarule,involvedinmakingdecisionsthataffectthem;n theyareexpectedtocarryoutrepetitive,monotonoustasksexclusively;n workismachineorsystempaced(andmaybemonitoredinappropriately);n workdemandsareperceivedasexcessive;n paymentsystemsencourageworkingtooquicklyorwithoutbreaks;n worksystemslimitopportunitiesforsocialinteraction;n highlevelsofeffortarenotbalancedbysufficientreward(resources,

remuneration,self-esteem,status);

Aswithphysicalriskfactors,psychosocialissuesarebestaddressedwithfullconsultationandinvolvementoftheworkforce.

Individualdifferences86 Allindividualsaredifferentandforbiologicalreasonstheremaybesome

peoplewhoaremoreorlesslikelytodevelopanULD.IndividualdifferencesmayalsohaveimplicationsforemployeesreportingULDtypeconditions.Whereanergonomicapproachisfollowed,thisshouldensurethattasksarewithinthecapabilitiesoftheentireworkforce.Somefactorsmayincreasetheriskofdevelopingsymptomsandshouldbeconsideredinthemanagementprogramme.Theseinclude:

n newemployeesmayneedtimetoacquirethenecessaryworkskillsand/orrateofwork;

n differenceincompetenceandskills;n workersofvaryingbodysizes,ieheight,reachetc.Thiscanleadto

adoptingpoorpostureswhenworkingatsharedworkstations;n vulnerablegroups,egolder,youngerworkersandneworexpectant

mothers;32

n healthstatusanddisability;n individualattitudesorcharacteristicsthatmayaffectcompliancewithsafe

workingpracticesorreportingofsymptoms.



Reduce the risk of ULDsn HaveyouprioritisedyouractionstocontroltherisksofULDs?n Haveyoulookedfor‘higherorder’solutions?n Haveyouutilisedanergonomicsapproach?n Haveyouimplementedsolutions?

87 Havingassessedtheworktodeterminethelikelihoodandscaleoftherisksassociatedwitheachoftherelevanttasks(andthetasksincombinationwhereapplicable),youmustimplementcontrolsinordertoreducetheserisksasfarasisreasonablypracticable.

88 Prioritiseactionssothat,forexample,seriousrisksaffectinganumberofemployeesaretackledbeforeanisolatedcomplaintofminordiscomfort.

Look for ‘higher order’ solutions

89 Ahierarchicalapproachtoriskreductionandcontrolshouldbefollowedwherepriorityisgiventoeliminationofriskatsource.Firstly,considerifitisreasonablypracticabletoeliminatethehazard,egbyredesignoftheworktask,bysubstitutionorreplacementoftoolsorcomponents,orthroughautomationofthetask.Insomecasesitmaybepossibletoisolatetherisksatsourcebyengineeringcontrolsorprotectivemeasures,egbyshieldingtheworkerfromdraughtsorbypreventingexposuretovibration.Wherethesearenotviable,thelowestorderinthehierarchyofcontrolsistominimiseriskbydesigningsuitablesystemsofwork,usingPPEifappropriateandtoprovidetraining.

Using an ergonomics approach

90 Asinriskassessment,anergonomicsapproachisimportantindevelopingyourinterventionstoreducerisk.Aparticipativeapproachtosolutionfindingisconsideredtobethemosteffectivemethodforinterventiondevelopment.18Interventionsmayinvolvechangestothetask,theworkingenvironment,ortheindividual(orworkgroup)ortoallofthese.Researchhasshownthatinterventionsthattakeaccountofalltheseaspectsaremoreeffectiveinreducingrisk:

n Changestotheworktask(s)mayincluderedesignoftheworkstationandworkequipment.Itmayincludetheprovisionofappropriatefurniture,equipmentortoolsthathavebeenmatchedtotheneedsoftheworkersandthetask.JobrotationorautomationmaybebeneficialinreducingULDrisks.

n Changestotheenvironmentcouldincludemodificationstothethermalconditions,vibrationexposureorlightinglevels.Changestoinfluencepsychosocialfactorsmayberequired.Areviewoftheworkorganisationandstructuresuchasreductionofworkhoursorchangestoschedulingofbreaks,ormodifyingpacingorincentiveschemesmayalsobehelpful.

n Trainingandprovisionofinformationtoindividualsorworkgroupsmayalsobeneededtosupportotherchanges.



Basic principles in implementing solutions

91 Riskscanberemovedorreducedthroughsystematicattentiontosomeorallofthefactorsmentionedpreviously.Somehelpfulprinciplesare:

n greatbenefitoftenresultsfromsimpleandlowcostinterventions(egchangesinworkingheight)whicharegenerallymorepracticalandeasiertoimplement;

n consideranumberofpossiblesolutions,preferablytryingthemoutonasmallscalebeforedecidingononetoimplement;

n employeescanbeespeciallygoodatdevisingeffectiveandpracticalimprovementmeasures;

n checkthatanychangesdonotcreatenewhealthandsafetyriskselsewhere;

n successfulimplementationoftenrequirestheinvolvementofallemployeesfromthetopleveldownwards.Evensoundergonomicsolutionsmaynotbesuccessfuliftheyareimposed.Involvingworkersinproblemsolvingandtheimplementationprocesses,givesanenhancedsenseofownershipofthesolutionsandmaycreateagreatercommitmenttotheireffectiveimplementation;

n inlarge,geographicallyspreadorganisations,incorporateshort-termlocalinitiativesintothecompany’soverallhealthandsafetystrategy;

n refertocasestudiesfromothersources,egfromtradeassociationsortheInternet,forideasconcerningbestpracticesolutions.

Individual differences

92 AlltasksshouldbedesignedsotheycanbeundertakenwithoutcreatingariskofULDs.ThereisnoscientificallyvalidscreeningtestwhichcanpredictthefuturedevelopmentofULDsinanindividual.Placementproceduresshouldtakeaccountoftheriskassessment,jobrequirementsandtheindividualdifferencesoutlinedintheprevioussection.

93 Newemployees,particularlyyoungworkers,andthosereturningtoworkfromaholiday,sicknessorinjury,mayneedtobeintroducedtoaslowerrateofproductionthantheexisting‘workforce’,followedbyagradualincreaseinpace.Thisworksbest,forexample,byonlyworkingforalimitedtimeperdayatproductionspeed,increasingasappropriate.Introducingnewcomersataslowerpaceenablesthemtodevelopgoodworkpracticesbeforehavingtoconcentrateonworkingfastandhelpsthemtoassimilatetrainingmoreeffectively:ideally,earlytrainingshouldbedone‘off-line’.Regulation12intheManagementofHealthandSafetyatWorkRegulations199920detailsrequirementsconcerningnewemployees.

Suggestions for reducing the risk

94 SomeexamplesofapproachesthatmaybeusefulforreducingtheriskofULDsarelistedinAppendix2.

Other guidance on solutions

95 HSEhasproducedanumberofpublicationsthatprovideguidanceonreducingworkplacemusculoskeletaldisorders.Thisincludesguidancebasedoncasestudies33,34aswellassomethatisindustry-specific.InformationcanalsobefoundontheHSE,andsomeotherwebsites.See‘furtherinformation’forsources.



96 Ifyouareunsureofhowtoapproachimplementingchangeswithintheworkplace,youmaywishtoconsiderseekingspecialistadvicefromanergonomistorotherworkplacehealthandsafetyconsultant.

After implementation

97 Finally,itisimportanttomonitorthesituationtomakesuresolutionsarestilleffectiveatalaterdate(particularlywheretheirsuccessdependsonsomeformoflearningorbehaviourchange).Keepabreastofnewdevelopments(egwhennewmachineryorstaffareintroducedintotheworkplaceorwhenotheralternativeriskcontrolmeasuresaredeveloped).Monitoringandreviewingareexplainedinparagraphs120-132.



Educate and inform your workforce

n Haveyoueducatedandinformedyourworkforcetohelpprevention?n Haveyouinvolvedsafetyrepresentativesincommunicatinginformation

aboutULDriskfactors?n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworking

practicesandcontrolmeasures?

98 EducationandtrainingarecomplementarytoallotheraspectsofyourprogrammeforthepreventionofULDsandindeedarecriticaltoitssuccess.InformingstaffaboutsignsandsymptomsofULDs,riskfactors,controlmeasuresandtheneedforearlyreportingandactionwillimprovetheoveralleffectivenessofyourprogrammeandwillencourageemployeestobecomeactivelyinvolvedinidentifyingandcontrollingULDrisks.

Training as a control measure

99 TrainingshouldnotbereliedonastheprimarymeansofcontrollingtheriskofULDs.Influencingthewayworkersperformtasksthroughtrainingisanessentialpartofriskcontrol,butrelyingonthisalonehasbeenshowntohavelimitedsuccessinprevention.Trainingshouldideallycomplementotherhigherordercontrolsthathavealreadybeenimplemented(ieredesignoftheworktask,substitutionorreplacementoftoolsorcomponents,isolatingtheriskatthesourceetc).Itcanbeverybeneficialtoinvolveemployeesinthedevelopmentandpresentationoftraining.

Who should receive education?

100 Allworkers,supervisorsandmanagersshouldreceiveeducationonULDstoenablethemtoidentifytheearlywarningsignsofpotentialULDriskfactors.Educationshouldalsoextendtopurchasingstaff,engineers,maintenanceandsupportstaff,particularlywheretheyareinvolvedinspecifying,designingormodifyingworkequipmentinordertoincreasetheirawarenessofergonomicissuesandULDriskfactors.

What should training cover?

101 TrainingcanbedesignedbothtoraisegeneralawarenessofULDissuesandtoaddressthespecificneedsofaparticularjobortask.Generaltrainingshouldaimto:

n increaseawarenessandknowledgeofULDissues/problemsintheworkplace;

n reducethelikelihoodofULDproblemsbyprovidingadequateinformation:– recognitionofsymptomsofULDs(seeAppendix3);– riskfactorspresentintheworkplace;– safeworkingmethods;– correctoperationofcontrolmeasures;– theimportanceofproceduresfortheearlyreportingofULDsymptoms.



102 Task-specifictrainingshouldconsiderULDriskfactorsassociatedwiththejobingreaterdetail.Suchtrainingshouldincludeareviewofriskfactorsrelatedtotasksandsafeworkingmethodsforthatparticulartask.Anyspecificcontrolmeasuresassociatedwiththejob,includingpersonalprotectiveequipmentshouldalsobecovered.

Making training more effective

103 TrainingthatinvolvesnomorethansittingwithanexperiencedemployeewhodoesnothaveappropriateunderstandingofULDsisunlikelytobesatisfactorysincebadhabitsandpracticescaneasilybepassedontothenewemployee.Whenattemptingtoalterworkerbehaviour,programmeswillneedtoconsider:

n adversetraditionalmethodsandingrainedhabits;n productionpressures;n anyperceptionthatnewmethodsaredifficultortimeconsuming;n anylackofunderstandingofriskfactorsforULDs;n situationswhereimprovementsinjobmethodsmaybeconstrainedby

poorworkplacelayout,materials,equipmentand/orjobdesign;n employeeinvolvement.Thisisfundamentaltothesuccessofanytraining

programme.Employersshouldpromoteparticipationbyencouragingdiscussion,askingemployeesforsuggestionsandcommentsontrainingissuesand,whereappropriate,involvingemployeesinthepresentationoftrainingmaterial;

n theroleofsafetyrepresentativesinpromotingsafeworkingpracticesandreinforcingtrainingmessages;

n theneedtoprovideopportunitiesforimmediatepracticeandfeedbacksoastocorrectperformanceandtoensurethatskilllevelscanbemaintainedfollowingtraining.Principlescoveredintrainingsessionsshouldbereinforcedbysupervisors,safetyrepresentativesandpeersonaregularbasis;

n theneedforperiodicrefreshertrainingforallemployees.

Evaluation and follow up

104 PeriodicevaluationofyourtrainingprogrammesshouldbeundertakenaspartofageneralreviewofyourULDpreventionprogramme.Employeesshouldbeinvolvedinthisprocess,particularlysafetyrepresentativesandsupervisors,whocanassesstheimpactandeffectivenessofthetrainingoffered.Trainingshouldalsobereviewedwhentherearechangesin:

n workplacelayouts,taskdesignorworkorganisationortheintroductionof

newworkequipment;n workpracticesorcontrolmeasures;n reportedinjurylevelsinotherworkplacesintheindustry,orinworkplaces

withsimilarjobs.



Manage any episodes of ULDsn Haveyouimplementedandsupportedasystemforearlyreportingof

ULDs?n DoyouactivelylookforsymptomsofULDs?n Haveyouarrangedforoccupationalhealthprovision?n Doyouhavesystemsinplaceforemployeesreturningtoworkafteran

ULD?

105 AdequatecontrolofriskfactorswillgoalongwaytopreventtheoccurrenceofULDs.Duetoindividualdifferencesinthebody’sresponsetostressesitisnotpossibletoensurethateverypossibleepisodeofULDswillalwaysbeprevented.Itisnecessary,therefore,tohaveasysteminplacetomanageanyreportsorcasesofULDsthatariseintheworkforce.Theapproachtomanagingthesecomplaintsisbroadlysimilarwhethertheyarethoughttohavebeencausedbyworkactivity,beenmadeworsebytheworkorarelargelyunrelatedtoparticularworktasks.

Reporting and recording

106 IndividualswillvaryintheirwillingnesstoreportearlysymptomsofULDs.Itisimportanttomaintainaclimateinwhichearlyreportingofsymptomsisregardedpositivelyandthiswillbeencouragedifmanagersandsafetyrepresentativesbothemphasisethebenefitsofsuchearlydetectionofpossibleharm.Educationonpossiblesymptomsandsigns,whotoseeinthecompanyandwhathelptoexpectshouldbeprovidedtoallemployeeswherethereisaresidualriskofULDs.Employeesshouldbeadvisedtohaveanyrelevantsymptomsrecordedinthecompany‘accidentbook’.Anyfirstaidprovidedshouldalsobedocumented.

107 Ifsymptomsaresuchthatcontinuingtoworkdoesnotmakethemworse,thenitmaybeenoughtoprovidetheworkerwithreassurance,adviceonriskfactors,andtoreviewtheindividual’sworktaskswiththem.

108 Ifcontinuingtoworkatthesamejobcausessymptomstogetworseorbecomeprolonged,orifthepersonwasconcernedaboutthenatureofthesymptomsthenitwouldbeappropriatetoobtainfurtheradvicebymeansofareferraltoahealthprofessional.AdiagnosticsupportaidforULDshasbeendevelopedandislikelytobeofbenefittoGeneralPractitioners(GPs)andotherhealthprofessionals.35Ifsymptomsareaggravatedbyaperson’scurrentjobitisadvisabletolookforalternativeworkthattheycando,evenifthisisquitedifferentfromtheirnormalduties.Thiscanpreventtheneedforsicknessabsenceandallowforrecoverytimebeforereturntotheirnormalduties.

Referral

109 Onewaytoobtainhealthadviceisbyreferraltoanoccupationalhealthservice,eitheronoroffsite.Appendix3containsmoreinformationonthescopeofoccupationalhealthprovisionandhowtoaccessthis.Accesstoanoccupationalhealthservicewillusuallyallowboththeworkerandtheirmanagertobegivenappropriateadvicewithminimaldelay.Theindividualwillbeadvisedonthenatureoftheircomplaintandanyappropriatetreatment



andthemanagercanbeadvisedwhetherthecomplaintsarelikelytohavebeenrelatedtoworkandtheshorttermimplicationsforcontinuingemployment.

110 IfanemployeeisoffsickwithwhatisbelievedtobeaULDthenitisusefultomakeearlycontactwiththeperson,forexampleatelephonecall,toseewhatyoucandotohelptheirreturntowork.Appendix3listsanumberofspecificmedicaldiagnosestolookoutforifyouareconcernedaboutcomplaintsofULDs.

111 Ifyoudonothaveaccesstoanoccupationalhealthservicethen,withyouremployee’sagreementandwrittenconsent,youcanwritetotheirGPaskingforareportwhichmayhelpyouinmanagingtheabsence.However,anysuchcommunicationhastocomplywiththeprinciplesdetailedintheAccesstoMedicalReportsAct,1988.36,37Thefollowingpointscouldberaised:

n thenatureoftheillness;n whetherthedoctorthinksitisrelatedtowork;n iftreatmentwillbenecessaryandtimerequiredtoaccesstreatment;n whenareturntoworkmaybeexpected;n whetheractivitywillneedtobelimitedforaperiodafterreturningtowork;n ifanylongtermeffectsaretobeexpectedfromtheillness.

112 Appendix3providesfurtherinformationonarangeofpossibletreatmentsforULDs.

Diagnosis and return to work

113 ReceiptofawrittendiagnosisofanupperlimbdisordermaytriggerarequirementtomakeareporttotherelevantenforcingauthorityunderTheReportingofInjuries,DiseasesandDangerousOccurrencesRegulations(RIDDOR).38,39,40ThisrequirementappliesonlytoasmallnumberofULDswhichariseinthecourseofspecifiedworkactivities.Appendix4providesfurtherdetails.

114 AnumberofULDsarealsoprescribedundertheSocialSecurity(IndustrialInjuries)(PrescribedDiseases)Regulations1985.41Atthetimeofwriting,thelistofULDswhicharePrescribedDiseasesisthesameasthosewhicharereportableunderRIDDOR.IndividualsdiagnosedwithsuchdisordersshouldbeadvisedthattheymightbeentitledtobenefitundertheIndustrialInjuriesScheme.

115 ConfirmationofacaseofanULDshouldbetakenasaprompttoconsiderwhetherexistingriskassessmentsandcontrolsareadequate.Thisisespeciallyimportantifthereareotherpreviouslyreportedcases.

116 Theexacttimingofanindividual’sreturntoworkwilldependonthemedicaladvicewhichtheyreceivewhichinturnwilldependonthenatureoftheunderlyingdisorder.Itisoftenpossibletoreturntoworkbeforesymptomshaveresolved,and,insomecasesthismaybeadvantageous.

117 Youmayalsoneedtoreviewyourarrangementsforoccupationalhealthadvicetoassistwiththemanagementofanyfurthercaseswhichmayoccur.Thisisparticularlyimportantinworkwherethereisalreadyexistingevidenceofupperlimbcomplaints.



Surveillance

118 Healthsurveillancecanbeundertakenoneitheravoluntaryorastatutorybasis.TheApprovedCodeofPracticefortheManagementofHealthandSafetyatWorkRegulations20recommendsthathealthsurveillanceisundertakenwherecertaincriteriaaremet.Oneoftheseisaccesstoavalidmeansofdetectingthediseaseorconditionofconcern.Atpresentitisnotconsideredthatvalidtechniquesexistforthedetectionofchangeswhichreliablyindicatetheearlyonsetofspecificupperlimbdisorders.

119 Valuableinformationcanhoweverbeobtainedfromlessprecisemeasuressuchasreportsofsymptoms.Itisgoodpracticetoputinplacesystemswhichallowindividualstomakeearlyreportsofupperlimbcomplaints.Whereappropriatethesecanbesupplementedbyregularsurveysofsymptoms.FurtherinformationcanbefoundinHealth surveillance at work.42



Carry out regular checks on programme effectiveness

n DoyouhavesystemsinplacetomonitorandreviewyourcontrolsforULDs?

n DoyouhavesystemsinplacetomonitorandreviewyourULDmanagementprogramme?

n Areyouawareofnewdevelopments/information?n Doyouaimforcontinuousimprovement?

Why monitor or review?

120 Inanymanagementsystemitisimportanttochecktheeffectivenessofyouractions,andthisisnolesssointhepreventionofULDs.Thesecheckscanbeconsideredattwolevels:

n monitoring:whichistheongoingandregularappraisaloftheproceduresandsystemswhichyouhaveinplacetocontrolrisk;and

n reviewing:whichisalessfrequentbutmorestrategicactivitywhichconsidershowwelltheoverallcontrolsareworkingandwhetheranychangesmightbebeneficialandreasonablypracticable.

Monitoring

121 Monitoringisanintegralpartofmanagementandrequirescommitment,consultationandparticipationatalllevelsintheorganisationinordertobefullyeffective.MonitoringgenerallyinvolvesrecordingtrendsinULDsymptomsandriskfactorsovertimeinordertoassesstheperformanceofexistingcontrolmeasuresandtoplanandimplementnewinterventions.

122 Factorstoconsiderinplanningmonitoringandreviewingsystemsinclude:

n method;n frequency;n whentomonitor;n costsandbenefits.

123 Themethodandfrequencyofmonitoringshouldbeconsideredwheninitiallyplanningandimplementingcontrolmeasures.Thescaleandextentofmonitoringrequiredwilldependonthedegreeofriskandtherelativecostsandbenefitsofavailablemethods.Itisimportantthatthereisconsultationwithemployeessothattheyarefullyawareofthemonitoringprocedureswhichareinplace.

Approaches to monitoring

124 Therearetwobroadapproachestomonitoringsystems–passiveandactivemonitoring.Table1comparesthegeneralfeaturesofeachapproach.



Table 1 Generalfeaturesofpassiveandactivemonitoring

125 Someinitialvaluecanbegainedfrompassivemonitoringbutactivemonitoringbuildsonthisinformationandenablesanin-depthlookatriskfactors,signsandsymptomsinaspecificworkplace.Consultationwithemployeesisparticularlyimportantsincethereareethicalconsiderationsrelatingtothehandlingofpersonalhealthinformation.

Examples of passive and active monitoring

SomeexamplesofpassiveandactivemonitoringmethodsaregiveninTable2.

Table 2 Passiveandactivemonitoringmethods

Monitoring outcomes

126 Ininterpretinginformationobtainedfrommonitoringitisusefultolookforconsistentpatternsin:

n commentsfromemployees;n symptomsreported;n existingriskfactors;n resultsofsurveys.

Passive Active

Usesexistinginformationsourcesandmethods

Activeseekingofinformationaboutsigns,symptoms,riskfactors

Usuallyinexpensive Generallyinvolvesadditionalcosts

Usuallyundertakenfirst Usuallyundertakenasafollow-uptopassivemonitoringbutmaybethefirstlineapproachwherethereisasignificantULDrisk.

Datacodingandanalysisisusuallysimple Indepthdatacodingandanalysisrequirespecialistassistance.

Non-clinical Non-clinicalandclinicalindicatorsincluded

Readilyestablishedasinformationsourcesusuallydesignedforotheradministrativepurposes.

Recommendedwhenfacedwithan‘outbreak’ofULDs

Passive Active

Accidentbook/FirstaidrecordCompensationdata

WorkplacewalkthroughsBodymapping

Statutoryreportingsystems(RIDDOR)38 Taskanalysis

Medicalretirementreports Confidentialquestionnaires

Symptomsreported Healthinterviews

Sicknessabsencerecords Healthexaminations

Productionproductivityandqualitymeasures Exposurechecklist27

Staffturnover

Healthandsafetymeetings

Moraleandemployeesatisfaction



127 Comparisonsbetweengroupsofemployeesindifferentlocationswithintheorganisationmaybehelpfulparticularlywheresimilarworkisbeingundertaken.Wherepracticable,comparingyourexperienceswithothercompaniesinyoursectormayalsoassistinevaluatingtheperformanceofyourcontrolmeasures.42,43

128 Whereproblemsareidentified,actionshouldbetakentorevisethemeasuresinyourmanagementpolicytoimprovecontroloftherisk.Employeesshouldbeadvisedofthesituationandanyappropriatemedicalmanagementmadeavailable.Furthermonitoringwilldetermineiftheserevisedmeasureshavebeeneffective.

Reviewing

129 ReviewingprovidesanopportunitytolookattheoverallperformanceofyoursystemsformanagingULDrisksandshouldbeconsideredasanintegralpartofthemanagementprocess.Itshouldbeundertakenwhenmonitoringsuggeststhatthecurrentpolicy/programmeisnotadequatelycontrollingtherisksorwhentechnicaldevelopmentsororganisationalchangesareplannedwhichmayalterthelevelsofrisk.

130Reviewingrelieslargelyontheuseofexistingmanagementinformationandmayoftenbeincorporatedinaperiodicreviewofbusinesseffectiveness,eg,aspartofaqualityprogramme.

131 Reviewing:

n needstobesystematicinapproach;n makesfulluseofexistingmanagementresources;n isanopportunitytolearnfromexperiencesgainedinmanagingULDrisk

factors,signsandsymptoms;n determineswhetherinterventionscontinuetobeeffective;n establisheswhetherriskshavebeencontrolledwherereasonably

practicable;n providesanopportunitytoassesswhetherimprovedcontrolmeasures

shouldbeintroduced.

132 Asystemshouldbeinplacetoensurethattheoutcomesfromthereviewareactedupon,feedingbackintothemanagementsystemasshowninFigure1.



Appendices Appendix 1: Case studies

ThesecasestudieshavebeendividedintothestagespresentedinthemanagementmodelshowninFigure1.Thishasbeendoneretrospectivelysoallstagesofthemodelarenotalwaysfullyrepresented.

Case study A: Easter egg and chocolate box packing Background1 AlargefactoryidentifiedanumberoftasksthatcreatedariskofULDs:

n Task 1: Easter egg packingForpackingEastereggs,eightseparatecomponentswereassembledbyhand.Mostofthesecomponentsarrivedasflat-packswhichthenhadtobefoldedandbentintothecorrectshape.Theoperatorsonthistaskwerepaidpieceworkratesdependentuponthenumberofeggstheyassembledinaworkday.

n Task 2: Chocolate box packingDuringtheproductionofboxesofchocolates,twolayersofchocolatesinaplasticmouldedtray,apadofcorrugatedcardboard,andthe‘unitkey’(ietoidentifythefillinginthechocolate)wereneededtobepackedintodifferent-sizeboxes.Theboxeswerepresentedtotheoperatoronamovingconveyor,and,astheywentpast,differentoperatorshadtoputdifferentcomponents(thechocolates,themouldingsinwhichtheysit,thecardboardpad,andinformationleaflets)intotheboxesinaflowassemblyoperation.

Understandtheissuesandcommittoaction2 Thecompanyphysiotherapistandothermedicaldepartmentstaffwereseeing

peoplefromtheeggandchocolatepackagingdepartmentwithULDs.Withthepermissionoftheemployeesconcerned,managementhadbecomeawareofULDreferralsandhaddirectedactionontheissue.

Createtherightorganisationalenvironment3 Thecompanydoctor,theoperationsmanagerandtheindustrialengineerfor

thesiteworkedwithemployeesthroughouttheprocessofassessment.Trialsofsolutionstoreducetheriskswerealsodoneinaparticipativemanner.

AssesstheriskofULDsinyourworkplace4 Ariskassessmentoftask,environmentandindividualfactorsforULDs

identifiedthefollowingriskfactors:



5 Ifworkerswererotatingbetweenthetwotasks,theymayhavebeenatanincreasedriskofULDs.BothtaskspresentverysimilarriskfactorsforULDs(repetitionofsimilarupperlimbposturesforlongperiods)andincombination,furtherincreasetheriskofULDs.Thisexamplehighlightstheimportanceoflookingattheriskassessmentsoftasksincombinationwhereworkersareperformingmultipletasksduringtheshift.

ReducetheriskofULDs6 Aftertheassessmentwascompleteditwasdeterminedthatcertainelements

neededtoberedesigned:

n thepackingoperationwasredesignedtoremovetheriskelementofcardboardbendingandthesnappingshutoftheplasticmould.Thisreducedthenumberofuncomfortablewristandhandmovements;

n thepaystructurewaschangedfrompieceworktosalariedwork;n forchocolateboxassembly,engineersdevelopedamock-upworkstation

totrialwithoperatorsinwhichtherateofcompletionofthetaskwasdeterminedbytheoperator,notbytheconveyor;

Task 1: Easter egg packing

Task-relatedfactors

Repetition: Thistaskwashighlyrepetitivewithworkersperformingthesamefinger,wrist,armandshouldermovementsmanytimesperminute.

Working posture: Thetaskrequiredmanymovementsofthehandandwrist,egsidewaysbendingandbendingthewristsupanddownwhilefoldingthecardboardandsnappingaplasticcoverovertheeggs.Theelbowwasoftenheldandmovedinpositionsawayfromthebody.

Force: Snappingoftheplasticcoverovertheeggsrequiredforcewithpinchgrip.

Duration of exposure: Workersconductedthistaskforprolongedperiodseachday.

Environment-relatedfactors:

Psychological factors: Workerswerepaidonapieceworkbasiswhichmayhaveencouragedthemtopushthemselvesbeyondthepointatwhichtheyexperienceddiscomfort.Thismayalsohaveinfluencedtheworkers’willingnesstoreportupperlimbdiscomfortforfearofreducedworkinghours/speedetc

Task 2: Chocolate box packing

Task-relatedfactors

Repetition: Thistaskwashighlyrepetitivewithworkersperformingthesameupperlimbmovementsmanytimesperminute.Theoperator’sworkratewasdeterminedbytheconveyorspeed.

Working posture: Theboxdesignmadeitdifficulttoplacethecomponentsaccuratelyintheboxeswhentheconveyorwasmovingquickly.Thismeantthatworkersassumedawkwardposturesoftheshoulderandwrist.

Duration of exposure: Workersundertookthistaskforprolongedperiodseachday.



n asingleoperatorundertookthewholeassemblytaskratherthanputtingonecomponentinthebox(iejobenlargement);

n engineersworkedoutthebestangleforviewingthecomponents,fortakingthemofftheconveyor,andforassemblingthemwithouttwistingandturning;

n aftertestingoutthisdesignwiththeparticipationoftheoperatorsthenewlinewasbuiltandinstalled.

ManageanyepisodesofULDs7 Thecompanyemploysaphysiotherapistandothermedicaldepartmentstaff

inordertomanageanyepisodesofULDsandfacilitaterehabilitationandreturntoworkwherepossible.

Carryoutregularchecksonprogrammeeffectiveness8 ForEastereggpacking:

n fewercasesofwristandhandproblemsarenowreportedtomedicalstaff;

n overallefficiencyoftheproductionlinehasimproved;n thenumberofunitsdamagedhasdecreased,andthevisualqualityofthe

finishedproducthasimproved;n theamountofmaterial(chocolate,plastic,cardboard)wastedhas

decreased;n staffmoralehasimproved;n theeggproductionworkflowiseasiertomanageandregulate;andn thereneedstobelessstaffrotationbecausethenatureofthejobhas

improved.

9 Forthechocolateboxpacking:

n operatorcomforthasincreased,astheadjustabilityineachworkstationcanbeusedtomeeteachoperator’sneeds;

n assemblyqualityhasimproved,astheoperatorsarenolongertryingtoputthecomponentsintoamovingbox.

10 Packingoperationsareperformedmanuallyinarangeofdifferentindustries.Asthiscasestudyillustrates,theoperatorisoftenrequiredtousepositionsofthehandandwrist,whichcanleadtoupperlimbdisorders,especiallywhencombinedwithhighforceand/orrepetition.Thecompanyhasbenefitedinbothproductionefficiencyandstaffwellbeingandhealthbyrecognisingriskswithinthetask,andinvestinginergonomicchangestothetasksandpackagingmaterials.

Case study B: Computer use in news media organisation

TheworkcoveredbythiscasestudywassubjecttotheDisplayScreenEquipmentRegulations.ThiscasestudyshowshowthestructuredapproachintheguidancecanhelpcomplywiththeRegulationsinanunusualsituationwithcomplexchallenges.

Background11 Formanyyearsalargenewsmediaorganisationhadusedacomputer-based

systemtostoreandtransfernewsstories.Thiswasgraduallybecomingoutdatedandrequiredupgradingduetodevelopmentsintheelectronictransferofstoriesandtheneedforafastermoreefficientsystem.



12 Anew‘off-the-shelf’packagebasedonanexistingandwidelyusedsystemwaschosen.Someadaptationsweremadeforthecurrentorganisationanditwasinstalledinthenewsroomandelsewhere.Accompanyingtherolloutwasaprogrammeofchangemanagementthatincludedadviceonimplementation,installationandtrainingforusersincludingworkstationadjustmentandposture.

Understandtheissuesandcommittoaction13 Theuseofthenewsystemledtounanticipatedconsequencesbecauseit

wasbeingusedforataskforwhichitwasnotdesigned–thepreparationofsometimeslengthy,in-depthnewsstoriesratherthanshortbulletin-stylepieces.

14 Priortotheintroductionofthenewsystem,comparativelyfewcasesofULDshadariseneventhoughcomputerisedtechnologyhadbeeninuseformanyyears.Therethenfollowedarapidsurgeinnewcasesintheorderofathreetofourfoldincreaseoverthepreviousyears.

Createtherightorganisationalenvironment15 Rightfromthebeginninganopen-mindedpolicywasadoptedsothatallstaff

couldbekeptfullyinformedoftheextentoftheproblemanditsprogress. AssesstheriskofULDsinyourworkplace16 Assessmentoftask,environmentandindividualfactorsforULDsrevealedthat

thesoftwaredidnotcopewithpagebreaks,spellchecking,cut-and-pasteeditingfacilitiesandtheneedforthenewsorganisationtocopewithnon-Englishmaterial.Thetaskoftextinputandeditingagainstconstantdeadlineswasnowmuchmoreonerousthanwithastandardwordprocessingstylepackage.Unfortunatelytheimplementationofthisnewsystemcoincidedwiththeoutbreakofamajorinternationalnewseventnecessitatinganenormousincreaseinworkload.Inaddition,organisationalchangeswerebeingmadetothebusinessinfrastructureincommonwiththosebeingmadeelsewhereatthetime.Thisinevitablyledtouncertaintyaboutthefuture,insecurityonthepartoftheworkforce,andtohigherlevelsofstress.

17 IdentifiedriskfactorsforULDsincluded:Task-relatedfactors

Repetition: Staffwereperformingmultiplemouseclicksaswellashighlyrepetitivekeying.

Working posture: Positionofthekeyboard,mouseandmonitormeantthatstaticcontractionoftheshoulderandneckmuscleswasoccurringwhenworkerswereusingtheinputdevicesand/orlookingatthescreen.Wristpostureswerealsoproblematicforsomeworkers.

Duration of exposure: Textinputandeditingtaskswereperformedforprolongedperiodseachday.Theoutbreakofthemajorongoingnewseventmeantthatmanyworkerswereworkinglongerhours.

Environment-relatedfactors

Psychosocial factors: Organisationalchanges,strictdeadlinesandworkloadassociatedwiththemajornewseventwereallidentifiedaspsychosocialriskfactors.



ReducetheriskofULDs18 ControlstoreducetheriskofULDswereimplementedasfollows:

n computerrelatedequipmentwhichincludedhardware,softwareandfurniturewasreviewedbythesafetymanager;

n changestoworkstationlayoutweremadetoimproveworkingpostures,particularlyinrelationtotheupperlimbandmouseandkeyboarduse.

n Thisfocusedontheriskfactorofworkingposture;n changesweremadetothesoftwaretoreducerepetition;n themanageralteredtheworkorganisationincludingworkpatternsand

shifts.Thisrectifiedanyadverseworkpracticesandincludedcontroloverworkqualityanddeadlines.Thesecontrolsfocusedontheriskfactorsofdurationandpsychosocialfactors.

ManageanyepisodesofULDs19 Earlyreportingofindividualcasestotheoccupationalhealthdepartmentwas

encouragedsothatstepscouldbetakenbymanagerstominimisetheimpactofsymptoms.Threemainroutesofmanagementweredrawnup:

n aself-helprouteincludingarangeofphysicaltherapiesandrelaxationexercises;

n atherapeuticroutetoinvestigatesymptomsandsigns,carryoutdiagnosticandotherinvestigationsandrefer,asappropriate,fortreatmentoptions–donebytheoccupationalhealthdepartment.Treatmentcouldincludemedication,onwardreferraltoGPorspecialist,physiotherapyorcounselling;

n frominitialonsetorreportingofsymptoms,acycleoffourweekswasallowedfortheabovetobeaccomplished,afterwhichacaseconference/reviewmeetingwouldtakeplacetodetermineiftheindividualwasnowfitandcouldreturntowork,wasimprovingandcouldreturntomodifiedworkorwheretheprogrammehadfailedandajobchangewasrequired.

Carryoutregularchecksonprogrammeeffectiveness20 Afterseveralyearsfromtheinitialoutbreakthenumberoforiginalcaseshad

halved,ofwhichmorethan60%weredeemedtobecuredordormant.

21 Thisstudyshowsthattheoutlookforthemajorityofcasesshouldbegoodsolongasaprogrammeisadoptedwhichencouragesearlyreportingandmanagementofcaseswithoutfearofprejudice,inanenvironmentofmutualco-operationbetweenemployees,managers,unions,safetyofficers,ITspecialistsandoccupationalhealthprofessionals.

Case Study C: Healthcare product packing

Background22 Alargemanufacturingcompanywithseveralfactorysitesproducesand

packsawiderangeofcosmeticandskincareproducts.Theseoftenhaveshortpackingruntimes,andsomeproductlinesaredifficulttoautomate.ThecompanyrecognisedthatthehighlymanualpackagingtaskspresentedariskofULDsandtookmeasurestotacklethese.

Understandingtheissuesandcommittoaction23 ThecompanyidentifiedtheneedtotakeactiontoreducetheriskofULDs

andforaproactivesystemtomanageULDreferrals/casesacrossthedifferentfactorysites.ThiswasmetthroughthedevelopmentofacompanyULDpolicy.Acompanyergonomistwasalsorecruitedtodevelopandfacilitateanergonomicsprogramme.



Createtherightorganisationalenvironment24 ManagersandoperatorshadbeenawareofreportedsymptomsofULDsand

weresupportiveofmeasurestoreducethese.Fromthestarttheergonomistworkedcloselywithoccupationalhealthstaffandmanagement.

25 Packingteamleadersandseniorteammemberswithresponsibilityforthehealthandsafetyoftheirparticularareaweretrainedinsafetyriskassessmentandtheidentificationofpossibleriskreductionmeasures.

AssesstheriskofULDsintheworkplace26 Athree-stageriskassessmentprocesswassetup:

n detailedriskassessmentsofthepackagingtaskswereundertakenusingtherapidupperlimbassessment(RULA)method28andabodypartdiscomfortandpsychosocialsurvey.Theseformedthebasisforprioritisingriskreductionrecommendations;

n seniorteammembersregularlyassesstheriskofULDsduringroutineriskassessmentsoftheirpackinglines.Theyareencouragedtoidentifyandimplementriskreductionmeasuresandcanseekadvicefromthecompanyergonomist;

n whenanewproductistobeintroducedtoaline,a‘changecontrolassessment’isundertakentoidentifyanyspecificproblemswhichmayrelatetothepackingofthatproduct,andpossiblesolutions.

AnexampleofataskidentifiedduringapackingtrialriskassessmentasposingaULDriskwassealingatwo-pieceglassjarusingawiremetalclasp.Thetaskrequiredrepetitiveactivityandtheapplicationofforcetoclosetheclasp.Therewasalsotheriskofpressurepointsonthepalmfromthewire.TheriskofULDsassociatedwiththetaskwasreducedbyencouragingoperatorstostandratherthansittomakeiteasiertoapplyforce;providingaleatherpalmprotector;ensuringtwopeopleundertookthetasktoreducedurationofexposureandincreaserecoverytime;andprovidingguidanceontaskprocedure.Afterimplementation,noULDsymptomswerereportedfromthispackingoperation.

ReducetheriskofULDs27 Thefollowingmeasuresapplytoallpackinglines:

n allpackingemployeesrotatetoadifferenttaskevery30minutes.Wherepossible,rotatedtasksaresignificantlydifferentintermsofupperlimbmovementsrequired;

n increasedautomation,standardisationofpackaging,andwaysofreducingrepetitivemovementsaresoughtatthedesignstage(egreducingthenumberofturnsrequiredtofastenalid);

n developmentofproceduresthatencourageoperatorstoadoptgoodposturesandmovementsonpackingtasks;

n thedevelopmentandavailabilityofriskreducingaids(egtoolsandequipment);

n increasedawarenessofULDissuesamongtheworkforce,andencouragementofallemployeestoparticipateinidentifyingriskreductionmeasuresandsolutions.

Educateandinformyourworkforce28 AleafletonULDs,coveringcausesofULDs,howtoidentifysignsand

symptoms,andwhattodoiftheseareexperienced,wasissuedtoallstaffwithafollow-upissueafter18months.



29 Whereappropriate,awarenesstrainingisprovidedbythecompanyergonomisttopromotesuitableworkingtechniquesthatcanbeusedtoreduceULDrisk.

ManageanyepisodesofULDs30 ThecompanypolicyrequiresemployeestoreportanyULDsymptomsto

theirteamleaderwhorefersthemtotheoccupationalhealthservice.Theirworkstationandtasksareassessedinlightoftheproblemsexperiencedandappropriaterecommendationsgiven.Theteamleaderreviewsthesituationweekly,andoccupationalhealthstaffregularlymonitortheemployee’ssymptoms.

Carryoutregularchecksonprogrammeeffectiveness31 Regularhealthandsafetygroupmeetings(involvingseniormanagement,

occupationalhealthstaff,thecompanyergonomist,factoryengineersandsafetyrepresentatives)reviewriskmanagementissuesandtheimpactofriskreductionmeasurestaken.Theyalsoprovideeffectiveroutesofcommunicationbetweenstaffinvolved.

32 Followingtheinitialawarenessraisingcampaign(whichincludedissueoftheULDleaflet)therewasanexpectedincreaseinreferralstotheoccupationalhealthservice.Thiswasfollowedbyasteadyreductioninreferralrateoverthefollowingtwoyears.Whentheleafletwasre-issuedtheanticipatedincreaseinreferralswasnotexperienced.

33 Thereareongoingreviewsofoccupationalhealthdata,andafollow-upbodypartdiscomfortsurveyisplannedtoevaluatetheimpactoftheriskreductionprogramme.

Case Study D: New counter design for cashiers

Background34 Aleadingbookmaker’sgroupwithover11000staffand2000shops

plannedtoroll-outaradicallynewdesignofelectronicpoint-of-sales(EPOS)systemandassociatedcounter.PreventionofULDriskswasamajorconsiderationintheselectionofequipment,designofthecounter,furnitureandsoftware.Thenewdesignandmanagementprogrammehadtoaccommodatearangeofshopenvironments,staffregularlymovingbetweenpremisesanddifferentcashierworkstations.

35 Thecashier’staskforwhichthenewdesignwasspecifiedmainlyinvolvessittingattheworkstationanddealingwithtransactions(handlingbettingslipsandmoney).TheEPOSsysteminvolvessomecomputerwork(keyboardandmouseuse)tohandleandprocessbets.

Understandtheissuesandcommittoaction36 ManagementrecognisedthatULDriskfactorswerepresentinthecashier’s

taskegrepetitivelyreachingtothecountertopandawkwardstretchestoreachequipment.Seniormanagementwassupportiveoftheplantointroducenewcounterdesignguidelinesandrecognisedthepotentialimpactonoccupationalhealth.

Createtherightorganisationalenvironment37 Itwasagreedthatthenewcounterdesignandlayoutshouldbebasedon

ergonomicscriteria.Managementalsorecognisedthatprovidinginformationtoemployeesandhavingameansofidentifyinganyhealthproblemswasessentialinmanagingoccupationalhealth.Aprojectteamwasassembled



withrepresentativesfromfacilitiesmanagement,healthandsafety,ITandITdevelopment,linemanagement,andthegeneralworkforcetospecifyanddevelopthenewcounterlayoutandassociatedequipment.

AssesstheriskofULDsintheworkplace38 Ariskassessmentidentifiedthatcertainmovementsandtaskswouldbe

required(reachingtocountertop,cashdrawer,handlingmoneyetc)whichcontainedtheULDriskfactorsofrepetition,reachingandawkwardposture.Thisenabledergonomicscriteriatobespecifiedforthecounterdesign.

ReducetheriskofULDs39 ToreducetherisksofULDs:

n ergonomicsadvicewassoughtforbodydimensioncriteriaonwhichtobasethecounterdesign;

n mock-upsofcountersweretrialledbycashiers;n computerrelatedequipmentincludingscanner,printerandscreen,and

theirlayoutwerereviewedandtrialledtoreducetheriskofULDsandensuretheireaseofuse,(egscanningratherthankeyboardusewasselectedfordataentryandequipmentwasplacedwithinthezoneofcomfortablereach);

n thesoftwaredesignreducedthepressureoncashiersbyhelpingwithmanagementofdeadlines,forexample,takingbetsinrelationtowhenracesstarted;

n managementalsoensuredthatthereweresufficientstaffineachshoptoallowrestandrecoveryduringtheshift,andtocoverparticularlybusyperiods.

Educateandinformyourworkforce40 Informationonsettinguptheworkstationandchairadjustmentwasprovided

onthecompanyintranettowhichallcashiershaveaccess.Inaddition,onanongoingbasisemployeesarepromptedtocompleteanon-lineassessmentoftheirworkstationafteracertainnumberoflog-ons.Thisalsodirectsstafftorelevantguidancedocumentation.

ManageanyepisodesofULDs41 Mosthealthproblemsareidentifiedintheon-lineassessmentorthrough

theabsencemanagementsystem.Anyproblemsidentifiedarereportedtotheemployee’slinemanager,andtothesafetymanager,anditisthelinemanager’sresponsibilitytoactionchange(egreplacefaultyequipment).Whereaproblemhasbeenidentifiedtheemployeecompletesanon-lineassessment21daysaftertheinitialreport.Iftheproblemhasnotbeenresolveditisreportedtoahigherlevelofmanager,andare-assessmentiscompletedafterafurther21days.Continuingproblemsarereportedtoadirectorofthecompany.Thisprovidesanincentiveforreportedproblemstobedealtwithrapidlyandensuresthatawarenessisraisedamongallstaff.

42 Expertmedicalandergonomicssupportisavailableforanyemployeewithanongoinghealthproblem,sothatindividualworkstationscanbeassessedandappropriateadjustmentsmade.



Carryoutregularchecksonprogrammeeffectiveness

43 AnexpertergonomicevaluationofthenewcountersidentifiedthattheydidnotposeasignificantriskofULDs.Ongoingmonitoringofoccupationalhealthdatacontinues.Furtherinvestigationistakingplaceintothedesignofbettingslipstoallowmoreelectronicrecognitionofoptions(ieusingtickboxes)sothattheamountofmouseusebycashiersdealingwithtransactionscanbereduced.

Case Study E: Addressing ULDs in poultry processing

Background44 Alargepoultryprocessingcompanywithanumberofdifferentsiteswantedto

systematicallytackletheirULDproblems. Understandtheissuesandcommittoaction45 Thecompanyhadreceivedguidancefromtheirindustryfederationandwas

awareoftheextentofULDproblemsinthesector.TherehadalsobeenasignificantnumberofreferralstotheiroccupationalhealthdepartmentandclaimsforULDs,whichactedasamotivatortotackletheseissues.Althoughmanagershadbeenawareoftheissues,attitudeschangedsignificantlywhenthecostofplacingpeoplewithULDsontolighterdutieswascalculated,andfoundtobeconsiderable.

Createtherightorganisationalenvironment46 Followingareviewoftheirhealthandsafetymanagementsystems,the

companyestablishedaprogrammeforthepreventionofULDs.Policieswerewritten,arrangementsandproceduresputinplace,androlesandresponsibilitiesclarified.

47 Multidisciplinaryergonomicsteamswerecreated,involvingalllevelsofthebusinessandledbylinemanagers.Teamsweregivenanergonomicstrainingprogrammetoraiseawarenessoftheissuesandidentifywaysofreducingtherisks.Inaddition,thecompany’soccupationalhealthnursesweregivenamoreproactiveroleinmanagingULDsandworkedcloselywithfirstlinemanagers.

AssesstheriskofULDsintheworkplace48 TheULDriskassessmentswereintegratedintothesafetymanagementof

thebusiness.Generalriskassessmentsaredonebytrainedriskassessorsundertheguidanceofthelinemanagerofthedepartment.TheassessmentconsidersarangeofrisksandusesspecificchecklistsforULDs,manualhandlingandergonomicsissues.IftheseidentifyapotentialULDrisk,apersontrainedinergonomicsoranoccupationalhealthnurseundertakesamoredetailedassessment.

ReducetheriskofULDs49 Becausestaffontheshopfloorhavehadergonomicstrainingtheyhavebeen

abletogeneratemanyworkplaceimprovementsthemselves.Itisprimarilythroughtheempowermentandcommitmentofthefirstlinemanagersthattheprocesshasbeensuccessful.



‘Chicken hang on’

Oneofthepoultryprocessingactivitiesinvolveshangingchilledwholebirdsontomovingshacklelinessothattheycanbecutintochickenportionsbyamachine.Thetaskrequiresindividualbirdstobepickedfromahoppersituatedinfrontoftheoperatorandthelegsofthebirdplacedintheshackleonasuspendedconveyor.Theoperatorscarryingoutthistaskworkinteamsofthree,atarateof70birdsperminute.Adecisionwastakentoreplacethecutupmachinesand,asapartofthatproject,toredesignthe‘hang-on’workstationtoreducetheULDriskandthewastefulhandlinginvolvedintheexistingprocess.

A detailed assessment revealed the following:

Atwo-phasere-designwasimplementedtoreduce,andultimatelyeliminate,therisk.

Phase 1 Redesignedworkstation–reducedheightofshackleonconveyor;

repositionedbirddeliveryhoppersothereachdistancesrequiredwerereduced;redesignedshackletomakeattachmenteasier.Employeeswereconsultedandinvolvedinthedesignoftherevisedworkplace.

Phase 2 Directfeedofbirdsfromanothershackleline,totheshacklelineonthe

automaticcutupmachine,thuseliminatingtheneedtomanuallyhangbirds.

Outcomesinclude: Significantreductioninergonomicrisk;reductionofreportedULDsfrom

theactivity;reductioninnumberofemployeesonlighterdutiesfromthisoperation;amarkedimprovementinproductivity.

Educateandinformyourworkforce50 AllstaffreceiveinductiontrainingwhichcoverstheriskofULDs,control

measuresandreportingprocedures.Furtherinformationandtrainingaregivenonthejob.TheprofileofULDshasbeenraisedwithinthecompanyandthereisopencommunicationabouttheissue.

Taskrelatedriskfactors

Repetition: Thetaskwashighlyrepetitivewithupto25cyclesperminute.Thetaskwasalsomachinepaced.

Working postures: Workershadtoreachforwardanddowntopickupthebirds,thenuptoplacethemintheshackle.Positioningthebirdtoalignwiththeshacklealsorequiredawkwardpostures.

Force: Someforcewasrequiredtoplacebirdsintheshackle;Birdsweighupto2kgs.

Duration of exposure: Workersconductedthistaskforprolongedperiodseachday.

Environmentrelatedriskfactors

Working environment: Lowworkroomtemperature(12ºC)andlowtemperatureofproduct(3ºC)

Psychosocial factors: Theworkwasmachinepaced.



ManageanyepisodesofULDs51 IfanemployeeexperiencesULDsymptomstheyarereferredthroughtheir

linemanagertotheoccupationalhealthdepartmentwhowillassesstheirconditionandwork,andmakerecommendationsconcerningappropriateaction(workplaceortaskmodifications,rest,lighterduties).Occupationalhealthstaffundertakeon-goingsurveillanceofthosewithproblems.AphysiotherapistisavailableonsitetotreatandadvisethosewithULDs.

Carryoutregularchecksonprogrammeeffectiveness52 ThecompanyundertakesasixmonthlyauditoftheULDprogrammeto

reviewthemanagementsystemandprocedures,theireffectivenessandtheimpacttheyhavehad,andtoidentifyanyfurtherimprovements.

53 Recentexaminationofthecostofplacingpeopleonlightduties(largelyduetoULDs)identifiedthatinasampleweekin1998of2300processingstaff,60(2.6%)wereonlightduties.Followingtheergonomicsprogramme,inthesamesampleweekin2001only16staff(0.7%)wereonlightduties.Indirectlabourcostsalonethecompanyestimatethatthisreductionequatestoasavingof£500000.Inonefactory,thenumberofpeopleplacedonlightdutieshasfallenbyalmost80%inthisperiod.



Appendix 2: Risk Filter and Risk Assessment Worksheets

TheaimoftheRiskFilteristosetoutanapproximatethresholdbelowwhichtheriskofULDsislikelytobelow.TheguidelinesintheRiskFilterandWorksheetsareprovidedasanaidtoriskassessment.Theyhavebeendevelopedfromthescientificliteratureandfromexpertopinion.Assuch,theyarenotpreciseexposurelimits,butareintendedtohelpyoutoidentifythepotentialrisksandpossiblemeasurestoreducethem.

OthermethodsofassessmentareavailableandmaybeequallyappropriateinassessingthelevelofriskofULDs.27,28,29,30

Overview

1 TogethertheRiskFilterandRiskAssessmentWorksheetsprovideatwo-stageassessmentprocess,whichmaybephotocopiedforuse:

n Stageone:UsetheRiskFiltertohelpidentifysituationswhereamoredetailedassessmentisnecessary.(Pleasenotethatcertainriskfactorshavebeenpurposelyomittedinthefilterinordertoprovideauseable,firststage,screeningtool.)

n Stagetwo:UsetheRiskAssessmentWorksheetstoconductamoredetailedriskassessmentforthosetasksidentifiedbytheRiskFilter

2 Beforeundertakingyourassessment,youshouldread‘AssesstheriskofULDsinyourworkplace’(whichprovidesguidanceonriskassessmentandriskfactors)(seeparagraphs43-86).Inorderforyourassessmenttobeeffectiveyoushould:

n involveyourworkforceintheassessmentandcontrolprocesstotakeadvantageoftheirintimateknowledgeofthework;

n explaintotheworker(s)whatyouaredoingpriortoassessingatask.Youshouldalwaysemphasisethattheassessmentisofthetaskandnotthe worker’sperformance;

n walkthroughtheareaandidentifyanytasksthatrelatetodisplayscreenequipmentorinvolvemanualhandlingbecauseyoualsoneedtoreferto specificguidanceontherelevantregulationstoassessthese;

n makesurethatyouhavespentsometimeobservingthejobandwhatyouareseeingisrepresentativeofnormalworkingprocedures;

n observealltheworkersforashortperiodoftimewhereseveralpeopledothesamejob,toensurethatyouhavesomeinsightintothedemandsofthejobfromallworkers’perspectives;

n completetheassessmentintheworkplace(wherepossible,andifitissafetodoso);

n focusontheupperlimbateachstepensuringyouconsiderthefingers,hands,arms,elbows,shouldersandneck;

n wheretheRiskFilterindicatesfurtheractionmoveontostagetwooftheassessmentusingtheRiskAssessmentWorksheets.

3 Equipmentthatmaybeusefulincludes:

n stopwatchortimertomeasurecycletimes;n videocameratoallowformoredetailedanalysisofmovementcycles,and

fortheassessmenttobefinalisedawayfromtheworkplaceifnecessary;n scales/forceguage(springbalanceandstring)tomeasuretheweight/

forcesrelatedtoupperlimbactivities.



Read the following guidance in conjunction with the risk filter.

Duration: Aconsiderationofduration,orexposuretime,asariskfactorforULDs

wouldincludeboththelengthoftimethatataskisperformedinatypicalworkingdayaswellashowoftenitisrepeated(egdaily,weeklyorlessoften).Buildingsuchacomplexfactorintoasimpleriskfilterandworksheetisdifficult.‘2consecutivehours’or‘morethan2hourstotalperworkday’havebeenusedasbasicbuildingblocksofexposuretimethroughouttheguidelinesintheriskfilterandriskassessmentworksheets.‘Consecutive’inthiscontextmeansthetaskorsimilargroupsoftasksarerepeatedsuccessivelythroughoutthe2hourperiod.Itmustbeemphasisedthatthe2hourperiodisnotalimitandshouldbeappliedpragmatically.

Forexample,ifataskwasperformedfor1hourand40minutes,followedbya10minutebreak,thenforanother1hourand40minutes,followedbyanotherbreak,andsoon,throughoutan8hourworkday,theworkerhasnotstrictlyworkedmorethan‘2consecutivehours’.Thedurationofexposureforthistask,however,iscertainlyhighandwouldbeofconcerniftheotherriskfactorsforULDwerealsopresent.Conversely,ifthetaskrequirementsareexceptionallydemanding,adurationoflessthan‘2consecutivehours’maypresentanunacceptablerisk.

STAGE 1: Risk Filter procedure

Ensure you have read ‘Assess the risk of ULDs in your workplace’ and the general guidance at

the beginning of this Appendix prior to undertaking your assessment.

4 CompletingtheFilterinvolves:

n recordingthebasicdetailsofthetasksuchasthedate,nameofthetask,theassessorandtaskdescription;

n probablyusingaseparateFiltersheetforeachtask;n goingthrougheachstepinturnandplacingatickineachboxwhereyou

observeexamplesoftheserisks;n planningamoredetailedriskassessmentifanyoftheriskfactorsare

ticked;n identifyingthosetaskswiththemostriskfactors(themorethereare

thegreatertherisk)tohelpinprioritisingtasksforthesecondstageriskassessment.

5 Step 1: Signs and symptoms:Lookfor:

n actualcasesofULDsinwork:– reviewsicknessabsencerecordsandmedicalcertificatesreceived;– askyouroccupationalhealthserviceforanonymousinformationabout

casesofULDs;n complaintsofachesorpains:

– checktheaccidentbookandortreatmentbookformentionof‘sprainsandstrains’andanyothertypesofachesandpains;

– talktomanagers,supervisorsandworkers;



n improvisedchangestoworkequipment,furnitureortools:– walkthroughtheworkplacetoidentifyimprovisedchanges;– checkwithmanagers,supervisorsandworkersfor“difficult”jobsor

thosewhichhavebecomemore“difficult”recently.

6 Step 2: Repetition:Checkforfrequentmovementsforprolongedperiods.Examplesmayincluderepeatedhandpressoperations,repeatedtriggeringoperations,repeatedcuttingactions,repeatedhandlingetc.

A‘Cycle’referstoasequenceofactionsofrelativelyshortdurationthatisrepeatedoverandover,andisalmostalwaysthesame.Theyarenotnecessarilyassociatedwithonesinglejointmovement,(suchastheelbow),butwithmovementsofoneormorepartsofthelimb(suchasreaching,manipulatingandplacinganobject).Cyclesarenotalwaysclear-cut,andinsuchcasesobserversshouldlookforsimilaractionsthatarerepeated.

Asimpletaskmayconsistofasequenceofmovementswhichwouldberepeatedandthereforeformthecycle.Amorecomplextaskmayconsistofelements(asdescribedinparagraph53)someorallofwhichmaybedistinctcycles.

7 Step 3: Working postures:Checkforposturesthatareawkwardand/orheldforprolongedperiodsinastaticorfixedposition.Checkfingers,wrists,hands,arms,shouldersandnecks.Remember:Themorethejointsdeviatefromtheirneutralposition,thegreatertherisk.

8 Step 4: Force:Checkforsustainedorrepeatedapplicationofforce.

9 Step 5: Vibration: Makeanoteofthetypeofvibratingtoolsorequipmentsuchasgrinders,polishersetc.thatareusedforthestage2assessment.

Youshouldalsobeawarethatpsychosocialandworkingenvironmentfactors(suchashighjobdemandsandlackofcontrol,coldandlighting)couldfurtherincreasetheriskofULDs.Thesefactorsareexpandedinthefullriskassessment.



RISK FILTERTask: ______________________________________________________________________________________________Assessor: __________________________________________________________________________________________Date: _______________________________________ Location/work area:____________________________________

IF YOU ANSWER YES TO ANY OF THE STEPS, YOU SHOULD THEN MAKE A FULL RISK ASSESSMENT OF THE TASK. REMEMBER TO CONSIDER ALL OF THE BODY PARTS OF THE UPPER LIMBS (FINGERS, HANDS, WRISTS, ARMS, SHOULDERS AND NECK). ANSWER ALL QUESTIONS

Step 1: Signs and symptoms

Are there any: Medically diagnosed cases of ULDs in this work? Complaints of aches and pains? Improvised changes to work equipment, furniture or tools?

Are any of these present?

YES

NO

Move on to Step 2

Step 2: Repetition

Are there repetitive elements such as: Repeating the same motions every few seconds? A sequence of movements repeated more than twice per minute? More than 50% of the cycle time involved in performing the same sequence of motions?

For more than 2 hours total per shift?

YES

NO

Move on to Step 3

Step 3: Working postures

Are there any working postures such as: Large range of joint movement such as side to side or up and down? Awkward or extreme joint positions? Joints held in fixed positions? Stretching to reach items or controls? Twisting or rotating items or controls? Working overhead?

For more than 2 hours total per shift?

YES

NO

Move on to Step 4

Step 4: Force

Are there any forces applied such as: Pushing, pulling, moving things (including with the fingers or thumb? Grasping/gripping? Pinch grips ie holding or grasping objects between thumb and finger? Steadying or supporting items or work pieces? Shock and/or impact being transmitted to the body from tools or equipment? Objects creating localised pressure on any part of the upper limb?

Sustained or repeated application of force for more than 2 hours total per shift?

YES

NO

Move on to Step 5

Step 5: Vibration

Do workers use any powered hand-held or hand-guided tools or equipment or do they hand-feed work pieces to vibrating equipment?

Regularly (ie at some point during most shifts)?

YES

NO

Ifyouansweryestoanyofthesteps,youshouldmakeafullriskassessmentofthetask.



STAGE 2: Risk Assessment Worksheets procedure

ReadthefollowingguidanceinconjunctionwiththeRiskAssessmentSheetsoverleaf.Ensureyouhaveread‘AssesstherisksofULDsinyourworkplace’(seeparagraphs43-86)andthegeneralguidanceatthebeginningofthisAppendixpriortoundertakingyourassessment.

n.b. The risk factor of ‘duration’ is addressed within the guidance values for other risk factors and

therefore does not have a heading in its own right.

10 CompletingtheRiskAssessmentWorksheetsinvolves:

n usingasetofWorksheetsforeachtask;n recordingbasictaskdetailsontheWorksheets,suchashowlongthe

taskiscarriedout,ataskdescriptionetc.(Anexampletaskdescriptionis:aworkerreachesforscrews,placestheminpositionatheadheight,thenusescounterbalanceddrilltofixscrews.Thefinishedproductisthenpushedacrossthebodytothenextstation);

n goingthrougheachriskfactorinturn,observingthetask(s)inrelationtotheappropriateguidelinestoseeifariskofULDsispresent;

n recordingwhichaspectsofthetask(s)presenttherisk;n notingdownpossiblecontroloptions;n identifyingthosetaskswiththemostriskfactorstohelpinprioritising

tasksforaprogrammeofcontrol(themore‘yes’ticksthegreatertherisk).

Completing each risk factor

11 Thefollowingproceduresshouldbeobservedwhencompletingeachriskfactor:

n placeatickinthe‘Yes’boxwhereyouobserveexamplesoftheseriskfactorsandatickinthe‘No’boxwhenyoudonot;

n writedownwhatthepersonisdoinginrelationtothatriskfactorinthenextcolumn,including:– bodypartaffected;– howlongthetaskisbeingdone,forexamplenumberoftimesper

minute,numberofhoursperday.(egfivetimesperminute,fiveshiftsof7.5hours);

– whataspectsofthetaskarepresentingtherisk;– typeofworkequipment;– whetheranyreferencenumericalvaluesareexceeded(possibly

indicatinganelevatedlevelofriskforULDs)

n writedownanypossiblecontrolmeasuresthatcanbetakentominimisetheriskofinjuryinthesecondlastcolumn.Somecontroloptionsarelistedinthefinalcolumn,theseareexplainedinfurtherdetailinAppendix2:‘Suggestionsforreducingtherisk’.Thecontrolslistedrepresentsomeoptionsonlyandarenotanexhaustivelist.



Completing the action plan

12 Thefollowingproceduresshouldbeobservedwhencompletingtheactionplan:

n summariseandprioritisethecontroloptions;– examinethecompletedriskassessmentandtheidentifiedcontrol

optionstoprioritiseaction.Identifytaskswiththehighestnumberof‘Yes’ticks.Taskswithahighernumberof‘Yes’ticksmayrequiremoreimmediateaction;

– whereyouhaveestablishedthattherearediagnosedcasesofULDsorcomplaintsofdiscomfortetc.aswellasriskfactors,viewthiscombinationasahighpriorityforimplementingcontrolmeasures

n developashort,mediumandlongtermstrategytoimplementcontrols,andplacedatesagainstthese;

n enteradateforre-evaluationintheactionplantabletoensurethatimplementationdatesaremonitored.

Upper limb disorders in the workplace Page 52 of 89


RISK ASSESSMENT WORKSHEETS

Worksheet Reference Number

Task description:Date:____________________________________Name of assessor:________________________Task:____________________________________No. of employees that conduct this task_____How long is the task typically undertaken for:a) without a break________________________b) in a typical shift (excluding breaks)________________________________________________

How frequently is the task undertaken(eg. daily, weekly):___________________________Other tasks undertaken by worker that maypose risk of ULDs (include worksheet reference numbers):

___________________________________________What hand tools are used in the task:________________________________________________________________________________________________

1 Repetition

For 2 consecutive hours per work day:

Describe any problem(s) and probable cause(s):Describe what the person is doing eg. hand operation of drill 10 times per minute. Performed 3 hours per day, five days per week.

Describe any risk control options you have identified

Control options(not exhaustive list)

1.1 Does the task involve repeating the same movements every few seconds?

A ‘Cycle’ is asequence of actions of relatively short duration that is repeated over and over, and is almost always the same. A cycle is not necessarily associated with one single joint movement, but also with complex movements of one or more parts of the body.

Reduce repetition:

Mechanise or automate repetitive functions Use power ratchet tools Remove machine or other pacing Restructure task (Job design) Remove or monitor piecework schemes

Reduce duration:

Implement job enlargement Ensure adequate breaks Implement job rotation Limit/control overtime

1.2 Is there a cycle or sequence of movements that is repeated twice perminute or more

OR

More than 50% of the task involves performing a repetitive sequence of motions?

1.3 Are the wrists/hands/fingers used intensively?

1.4 Is there repetitive shoulder/arm movement (ie regular arm movement with some pauses or almost continuous arm movement?)

1.5 Are tools used that require repetitive finger or thumb action?

Yes

No



2 Working posture

Fingers, hands and wrist

Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. Static gripping posture used for up to 2 hours at a time, wrists repetitively bent sideways when drilling objects.



2.1 Is the wrist bent repetitively up and/or down?

Remember: the greater the deviation from a neutral position, the greater the risk.

Optimise working posture:

Modify operation or production method Relocate equipment or items Present work items differently Reduce amount of manipulation required Ensure equipment accounts for differences in worker size, shape and strength Ensure working heights are appropriate Ensure items are within reach distances Provide suitable (and adjustable) seating Use fixtures/jigs After tools or controls Ensure tools are suitable for task Ensure tools do not require awkward postures

2.2 Is the wrist held in a position that is bent upwards or downwards?

2.3 Are the fingers gripping or used while the wrists are bent?

2.4 Is the wrist bent repetitively to either side?

2.5 Is the wrist held bent to either side?

2.6 Are the hands repetitively turned or twisted so that the palm is facing up or downwards?

2.7 Are the hands held with the palms facing up or down?

2.8 is a wide finger and/or hand span needed to grip, hold or manipulate items?

2.9 Do static postures of the fingers, hand or wrist occur, for more than two consecutive hours per working day?

2.10 Are there tools, equipment and/or work pieces that are poorly shaped and/or do not fit the hand comfortably?

2.11 Are there any tools, hand held equipment or work pieces that are too large or small to be gripped easily?

2.12 Are tools designed for right handed use only?

Yes

No



3 Working posture

Arms and shoulders

Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. Shoulder held in fixed position with elbow out to the side for up to 2 hours at a time. This is due to the work height.



3.1 Is work performed above the head or with the elbows above the shoulders for more than 2 hours total in a working day?



Automate or mechanise Modify operation or production method Relocate equipment or items Present work items differently Reduce amount of manipulation required Ensure workplaces and equipment account for differences in worker size, shape and strength Ensure working heights are appropriate Ensure items are within reach distances Provide suitable (and adjustable) seating Use fixtures/jigs Alter tools or controls Ensure tools are suitable for task Ensure tools do not require awkward postures Provide arm support for precision work

3.2 Does the task involve repetitively moving the upper arms out to the side of the body?

3.3 Does the task involve holding the upper arms out to the side of the body without support?

3.4 Do static postures of the shoulder or elbow occur, for more than two consecutive hours per work day?

3.5 Does the work involve any other postures such as:

Awkward forward or sideways reaching? Awkward reaching behind the body? Awkward reaching across the body?

Workstation layout and working height can be a major influence on working postures

Yes

No



4 Working posture

Head and neck

Describe any problem(s) and probable cause(s):Note problem postures and identify parts of the upper limb involved. eg. neck held in fixed bending position to see screw holes.



4.1 Does the task involve repetitively bending or twisting the neck?



Ensure visual requirements are not too demanding Provide visual aids Ensure lighting is suitable Reposition items that workers are required to look at

4.2 Does the task involve holding the neck bent and/or twisted for more than 2 hours total per working day?

4.3 Do the visual demands of the task require the worker to view fine details and adopt awkward positions?

4.4 Do aspects of lighting such as dim light, shadow, flickering light, glare and/or reflections cause the worker to adopt awkward postures?

Yes

No



5 Force Describe any problem(s) and probable cause(s):eg. Drill handle is too small resulting in increased gripping force for up to 4 hours per day. Also high force applied to screws



5.1 Does the task require repetitive or static application of force?

For the hand/wrist, high-force tasks are those with estimated average individual hand force requirements of 4 kg or above.


Reduce forces necessary Use power tools Can the function be achieved differently? Use jigs to hold items Reduce weight of items Present items differently Increase mechanical advantage After task to use stronger muscles Use foot pedals If gloves used check that they are appropriate Maintain tools Ensure tools are suitable for task Improve handles Use light weight tools Use tool counterbalances Ensure tool handles fit workers comfortably

5.2 Is it a pinch grip being used repetitively or statically for more than two hours total per work day?

For example, pinching an unsupported object weighing 0.9 kg (2 lbs) or more per hand, or using a similar pinching force (eg holding a small binder clip open).

5.3 Does the worker use the grip of the finger, thumb or hand as a pressing tool?

5.4 Do tools require the application of pressure on a trigger or button?

5.5 Does the hand apply force by twisting objects/tools or squeezing items?

5.6 Is the hand or wrist used as a hammer?

5.7 Is force being applied when the wrists are bent and/or with the arms raised?

5.8 Does the task require the wearing of gloves which affect gripping?

5.9 Do any objects, work pieces, tools or parts of the workstation impinge or create localised pressure on any part of the body?

Yes

No



6 Working environment Describe any problem(s) and probable cause(s):eg. Workers exposed to hand vibration from drill up to 4 hours per day. Workers have cold air blowing on hands from exhaust.



6.1 Are vibration exposures likely to regularly exceed HSE’s recommended action level of 2.8 m/s2 A(8)?

- impulsive tools (chipping hammmers,needle guns, hammer drills, etc)may exceed HSE’s recommendedaction level after only a few secondsuse per day and are highly likely toexceed the action level after30 minutes use per day

- Rotary tools (grinders, sanders, etc may exceed HSE’s recommendedaction level after only a few minutesuse per day and are highly likely toexceed the action level after 2 hoursuse per day

Improve the working environment:

Use alternative process(es) Select alternative lower vibration equipment Use balancers/ tensioners Maintain equipment Reduce exposure time to vibration Provide information and training Conduct health surveillance Avoid working in cold Avoid handling or insulate cold items or tools Redirect blowing air Use warm clothing

6.2 Do tools create or transmit jerky actions, shock or torque (twisting)?

6.3 Does the task involve working in cold or in draughts, particularly with cold air blowing over the hands?

6.4 Does the task involve holding cold tool handles, work items or other cold objects?

Yes

No



7 Psychosocial factors (These factors are best dealt with through discussion with workers. Sensitivity may be required)

Describe any problem(s) and probable cause(s):eg. Workers are on piecework system. Support from supervision and co-workers is low.



7.1 Is the work placed?ie machine or team sets the pace, or the work rate is otherwise not under the worker’s control?

Reduce force:

Reduce monotony Ensure reasonable workload and deadlines Ensure good communication and reporting of problems Encourage teamwork Monitor and control overtime and shiftwork Reduce or monitor productivity relatedness of pay systems Provide appropriate training

7.2 Is there a system of work, or piecework, which encourages workers to skip breaks or to finish early?

7.3 Do workers find it difficult to keep up with their work?

7.4 Do workers feel that there is a lack of support from supervisors or co-workers?

7.5 Is there overtime/shiftwork that is unplanned, unmonitored and/or not organised to minimise risk of ULDs?

7.6 Do the tasks require high levels of attention and concentration?

7.7 Do the workers have little or no control over the way they do their work?

7.8 Are there frequent tight deadlines to meet?

7.9 Are there sudden changes in workload, or seasonal changes in volume without any mechanisms for dealing with the change

7.10 Do workers feel that they have been given sufficient training and information in order to carry out their job successfully?

Yes

No

8 Individual differences Describe any problem(s) and probable cause(s):eg. No system for gradual return to work



8.1 Are any workers potentially at increased risk of ULS due to:

being new employees or returning to work after a long break; differences in competence and skills; being part of vulnerable groups such as older, younger workers, new or expectant mothers; disability and health status.

Improve the working environment:

Allow for a gradual build up to full production speed Provide suitable training to develop the skills required Seek advice on special requirements

Yes

No



REMEMBER TO CONSIDER HOW THE RISK FACTORS INTERACT WITH EACH OTHER(eg are forces repetitively in awkward posture etc)

ACTION PLAN

Worksheet reference

Controls to be implemented Priority Who is responsible for implementing controls?

Target implementation date

Date ofre-evaluation



Suggestions for reducing the risk

*Thisisnotanexhaustivelist.Innovativeideasforcontrollingrisksareoftendevisedbyworkersor

thosefamiliarwiththetask.

Reducingrepetition Generally Reducethenumberofrepetitivemovementsand

therateatwhichtheyaremade,especiallywhere thesearecombinedwithapplyingforceand/orin awkwardpostures.

Limitthedurationofcontinuousworkor restructureworkmethodstoprovidegreater variety.

Automation and Canmachinerydothehighlyrepetitivefunctionsmechanisation morevariedjobsfortheworkers(Takecareto avoidcreatingrepetitive,boringandmonotonous taskstofeedthemachinerywithwork).

Avoidpacingofthework.Automatedmachinery andteamworkingcanallacttoincreasethework rate.Aimtoallowpeopletocontroltheirown paceofwork.

Tools Usepowertoolsinplaceofmanualtools. Usemanualtoolswithratchetdevicestoreduce

thenumberofmovementsrequired,eg screwdriversorspanners(seealso‘Tools’).

Job design Breakuplongperiodsoffrequentrepetitionsand staticinactivityorspreadrepetitionsacrossboth hands.

Sharerepetitiveworkthroughteamworkorjob rotation.

Distributetheworkloadoverdifferentmuscle groupsandjoints.

Job enlargement Consideraddingextraactivitiestothejobto providevarietyinpostureandspeedofwork.

Rest breaks Breaks,beforetheonsetoffatigue,areimportant. Consultationwithworkersmayhelptosetan

adequateworkrestratiooralternativelyallocate timeswhenworkersshouldrotatefroma specifictask.

Increasethefrequencyofbreaks.Frequentshort breaksarepreferabletoafewlongones.

Job rotation Rotatetheworkertoperformothertasks,which variesbodypartactionandspeed.Remember thatrotatingtoataskthatutilisesthesameparts ofthebodyandpresentsthesameriskfactorsfor injuryastheoriginaltaskwillnotproviderest periodsforthepartsofthebodythatareat

riskofULDs(seealso‘Jobrotation’in‘Reducing duration’).

Overtime Placealimitonormonitorovertimeandprovide sufficientrestbreakstoaccountforprolonged exposure.



Optimisingworkpostures

PoorworkstationandequipmentdesignisusuallyresponsibleforposturalproblemsleadingtoULDs.Thereareanumberofmethodsforreducingposturalproblems.

Generally Enableworktobedonewiththejointsatabout

themidpointsoftheirrangeofmotion. Reducethetimespentholdingand/orrepeating

awkwardpostures. Avoidusingstaticposturesforprolongedperiods.

Workstation and Considerthelocation,anglesandheightoftool design equipment,controlsorworkpiecesinrelationto theoperator.Modifytoimproveposture.

Ensureworkplacesandworkequipmentare designedorselectedtoaccountfordifferencein size,shapeandstrengthofworkers.

Altertooldesigntoimprovewristposture.

Work organisation Canchangesbemade‘upstream’ofthejob?ie and job design doesthetaskreallyhavetobelikethis,orcan alterationsintheprocesselsewheremeanthat itemsdonothavetobeassembled/presentedin thisway?

Canthesequencebechangedtomakethetask lessawkward?

Presentation/ Considerpositionofthework,andtheuseof orientation of work fixturesandjigstoangleandholdworkinmore

items accessiblepositions. Considerhowthebodywillinterfacewiththe

equipment. Arethereobjectsorattachmentsthatactas

obstaclesandleadtopoorposture?

Seating Ensureseatsareadjustable. Ensurethatthereissufficientspacetoenable

workerstomakeeffectiveuseoftheadjustable featuresoftheirchairs.

Doworkersknowhowtoadjusttheirchairs? Ensurethatthereissufficientlegspaceforthe

workertostretchandmakechangesinlegand footposture.

Confinedlegspacecanconstrainoverallbody posture.

Reach distances Placeequipmentandmaterialswithinprimary reachzoneskeepingrepetitivereachingasclose aspossibletothebodyandalwayswithin 450mmofthefrontoftheoperator.

Figure12illustrateshowthemostfrequentlyused itemshavebeenpositionedwithineaseofreach areasoftheworker.



Figure 12

Forfurtherinformationonreachdistances, workingzonesandseatingrefertoSeating at work.44

Working height Cantheheight,angleandpositionatwhichthe workisbeingconductedbechangedtoimprove visibilityofthetask?

Seated workstationtablesshould accommodatethelargestusers.Platforms, adjustablechairsandfootrestscanbeusedby smalleruserstoachieveoptimalworkingheight.

Standing workstationsshouldbeusedforjobs

thatrequirealotofbodymovementandgreater force.

Figure 13

Themostsuitableworkingheightdependsupon

thenatureofthetaskbeingperformed(See Figure13)

Manipulative tasks(involvingamoderatedegree

ofbothforceandprecision):tableheightshould be50-100mmbelowelbowheight.

Precision tasks(includingwriting):tableheight

shouldbefrom50-100mmaboveelbowheight. Heavier tasks(particularlyiftheyinvolve

downwardpressuretobeappliedonthework piece):tableheightshouldbefrom00-250mm belowelbowheight.

Thedimensionsabovearemerelygeneral guidelinesandcanbeappliedtobothseatedand standingworktasks.

Giventhatindividualsdiffersignificantlyintheir build,elbowheight,asareferencepointwillvary



considerablyfrompersontoperson.Inaddition, differenttypesoftasksmayrequiresignificantly differentworkingheight.Itistherefore recommendedthatadjustableheightsurfacesbe providedwhereverpossible.(Itisnotalwaysthe worksurfaceheightthathastobealtered; platformscanbeusedtoaltertheeffective height).

Sit/stand workstationsenableworkerstovary theirworkingposture.Forsit/standworkstations provideappropriateandadjustablechairs, adjustabletablesorstandingplatforms.

(SeeFigure14).

Figure 14

Arm support Providesupporttothearmswhentheyareraised

ifpossible,andwhenprecisionworkisbeing performed.

Providepurposebuiltsupportswhereneededto improvecomfortandworkingposture.

Vision and lighting Considerprovidingvisionaids,ifapplicable,such asmagnifyingglasses.

Ensurethatlightingissuitableandadequatefor theworkundertaken.

Reducingforce General Reduceforcesrequired,especiallywhenapplied

incombinationwithpoorpostures,eguseweaker springsintriggers,anduseotherpowersources ratherthanmusclepower.

Reducefrequencywithwhichforceneedstobe applied(seealso‘Reducingrepetition’).

Reducetimespentapplyingforce.Thisespecially relatestostaticforcesbeingappliedand sustainedforsteadyingorsupportingitemsor grippingtools.

Exertingexcessiveforceoftenresultsfrom inappropriateworkingheightforthetask.For appropriateworkingheightsreferto‘Optimising workingpostures’.

Work organisation Considerwhyhighforcesarenecessary. and job design Isitbecauseofill-fittingcomponents,lackof

maintenanceorheavyitems?Canthisbe addressed‘upstream’ofthisjob?Throughbetter maintenance?Byreducingtheweightofitems,



eventhosethatarenotlifted,butsimplymoved oracceleratedmanually.

Presentation/ Consideralteringthepositionorpiecesortools orientation of work sothatanyforcecanbeappliedmoreeasilyand

items efficientlyieimprovethepostureoftheworkers whenapplyingforces(See‘Awkwardposture’).

Distribute force and Canfootpedalsbeusedtoprovideforce? enable stronger muscle Distributeforcerequirementsoverseveralfingers

groups to be used ratherthanone.Allowoperatorstousealternate handstooperatecontrols.

Mechanical advantage Providesomemeansofincreasingmechanical advantage,suchaslongerlevers,orothermeans ofmechanicalassistance.

Gloves Selectappropriategloves.Poorglovedesignor inappropriatechoiceofglovesorglovesizingcan

leadtopoorsenseoftouchandincreasedeffort ingripping.

Tools Uselightweighttoolsorprovidesupports,jigsor counterbalancedevices.

Handtoolsshouldnotrequireexcessiveforceor havehandlesthataretoolargeorsmall.They shouldnotexertpressureordigintothehand. (Formoreinformationsee‘Tools’).

Keepcuttingedgessharpandmovingparts appropriatelylubricated.

Contact force or Iftherearesharporhardcontactpointsbetween localised pressure equipmentandworkersconsiderremoving,

flatteningorlevelling. Reducingduration Generally Allowforshortbreaksinwork. Developawork/restregimewhichprovides

sufficienttimeforrecovery. Monitorandmanageovertimeworking. Considerjobenlargement,jobrotation.

Job rotation Jobrotationhasthepotentialtoreduceduration ofexposure.Rememberthatrotatingtoatask thatutilisesthesamepartsofthebody,and presentsthesameriskfactorsforinjury,asthe originaltaskwillnotproviderestperiodsforparts ofthebodythatareatriskofULDs.

Whenjobrotationisintroducedbeawareofthe following:

n trainingmayberequiredtogivetheworkers

thenecessaryskills;n skillsusedononetaskmayinterferewith

thoseonsubsequenttasksandtherefore,timeforreadjustmentbetweentasksmaybenecessary;



n timemaybeneededtoallowworkerstogetusedtoeachjobintherotationsequence;

n rotationmayhaveonlyasuperficialimpactuponriskexposure.Inpractice,thesamelevelofphysicaldemandmayremaineventhoughitappearstobequitedifferent.

Environment Vibration Uselowvibrationequipment. Ensurethattoolsarewellmaintainedsoasto

reduceexcessvibration. Purchasetoolswithvibrationdampingoradd

vibrationdampingtoexistingtools.45

Minimisetheamountoftimethatworkersare usingvibratingtools.

Anti-vibrationglovescanbeappropriateinsome situations,howevertheirimpactongripstrength andtypemustbeconsidered.

Ensureworkersaretrainedintherisksassociated withvibration.

Vision and lighting Ensuretaskilluminationisatalevelthatallows theworkertocomfortablyviewtheworkpiece withoutsquintingoralteringtheirposture.

Shadowsorreflections,flickeringlightsandglare shouldalsobecontrolledastheyoftencause peopletoadoptawkwardpostures.

Alllightsourcesshouldberegularlymaintained.

Temperature and Thermalconditionsintheworkplaceshouldbe ventilation suchthatallworkersarereasonablycomfortable regardlessofseasonalvariance.

Avoidpositioningworkstationsinthevicinityofair ventsasdraughtsmaycausemusculoskeletal discomfort.

Wherepossibleensurethattoolsandproducts handledbyworkersarenotundulycold.

Psychosocial Job content Reducemonotonousaspects,rotateworkers

betweentasks. Ensurereasonableworkloads–assessspeedof

production. Involveemployeesindeterminingworkload. Ensureagoodclimateofcommunication. Ensuretaskclarity–clearperformance

requirements,feedbackonperformanceandlines ofreporting.

Encourageteamwork. Monitorandmanageovertimeworking.

Overtimeincreasesdurationofexposureand decreasesthetimeforrecovery.Thereshouldbe abreakbeforestartingovertime.



Work pressures Ensurepaydoesnotrelatedirectlytoproduction. Bonussystemsandjob-and-finishcanincrease therisksbecausetheyencouragepeopletowork beyondtheirnaturalcapacity.Ifthereisabonus system,trytoreducetheextentofproductivity relatedness,aimforabalancebetweenbonus systemsandworkload.

Ensureagoodclimateofcommunication. Developanappropriateworkrestschedule. Allowforshortbreaksormicropausesinwork

schedules. Allowagradualbuilduptofullproductionspeed,

forexample,whennewworkersstartandwhen peoplereturnfromabsence.

Allowtimeformaintenanceoftools,sharpening etc.

Tools Selection Inselectingtools,atrialperiodwithseveral

workersisrecommended.Thepurchasershould alsohavesomeknowledgeofthetaskforwhich thetoolwillbeusedpriortoselection.

Itshouldbepossibletousethetoolineitherhand –orprovideaspecifictoolforlefthanded workers.

Size Considerdifferencesinmaleandfemalehand sizes,andtheeffectofwearinggloves.

Toolslikepliersshouldnotrequireawidehand span,around60mmisgood.

Handle design Toolhandlesshouldenableastraightwrist

posture(handshake)andavoidawkwardhand andwristpostures.

Ensurehandlesarelongenoughtofitthewhole handinapowergrip.

Avoidrigidhardsurfacedhandles,sharpedgesor narrowhandlesthatplacelocalisedpressureon thehand.

Figure 15

Force Wherenotusedasasafetydevice(ie‘dead

man’shandle’)triggersandswitchesshould notrequirecontinuousapplicationofforce. Providetriggerlockswhereoperationissustained (formorethanabout30seconds).

Theoperatingforceshouldbeaslowaspossible. Triggersshouldenableoperationbymorethan

onefinger. Returnspringsincuttingtoolsandplierscanhelp,

butensurethespringresistanceisnottoogreat.



Weight Shouldbeminimised,especiallyforprecision work.Aimforaround1.5kgandnomorethan 2.3kgforpowertools.

Suspendthetoolorusecounterbalances.

Figure 16

Vibration Purchaselowvibrationequipment. Ensurethattoolsarewellmaintained.Asktool suppliersforvibrationdatarelatedtohowyou willusethetoolandforadviceonsafeuse,eg dailymaximumuseagetime.Keeptoolswell maintainedtoretainlowestvibrationperformance andkeepsharp.Blunttoolsarelesseffectiveand meanlongerexposuretimefortheoperator.45

Figure 17 Illustrates vibration and optimal wrist posture



Appendix 3: Medical aspects of upper limb disorders (ULDs)

1 Thissectionprovidesoutlinedetailsforarangeofdisordersthatmedicalpractitionerscommonlydiagnose.Itisnotintendedtobeadefinitivemedicalreferenceforsuchdisordersoramethodofself-diagnosis.ItalsogivesguidanceonthehealthmanagementofULDs,coveringissuessuchastreatmentandrehabilitationandoccupationalhealthsupport.HealthmanagementisanimportantaspectoftheoverallmanagementofULDsinyourworkplace.

Introduction

2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nervesorothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,arms,wrists,handsandfingers.Thelimbcanbethoughtofasamechanicalsystemmadeupofrigidlinks,(thebones),movingatjoints,whichareheldtogetherbyligamentsandsurroundingtissues(capsules).Musclesareattachedtothesebonesbytendons,whichtransmittheforceproducedduringmusclecontractionacrossajoint,resultinginmovementoftheboneandthelimbsegment,towhichthemuscleisattached.

3 Muscularactivitycanbeeitherstaticordynamic.Staticeffortisusedtosupportorpositionthelimbandholditinspace.Dynamiceffortresultsinmovement.Forexample,whencuttingapieceofwoodonearmismovedtocutthewoodandholdthesaw,whiletheotherworksstaticallyinholdingandsteadyingthewood.Movementsdependonacomplexpatternofmuscleactivation.Theenergyneededformuscleactioncomesthroughthebloodsupply,whichalsoremoveswastemetabolicproducts.Tendonsaresmoothandslipperyandinplacesarecoveredbysynovialtissue.Thisproducesafluidtolubricatemovementandisparticularlyfoundinmanyofthetendonsofthewristandhand.

4 Varioustheoriesexisttoexplainhowupperlimbdisordersarisewithinthetissuesandonerecognisedmodeldetailstheinteractionofexposure,dose,responseandcapacity.17

5 Thepathophysiologicalprocessesinvolvedmayincludedisruptionanddeformationoftissuestructuresasaresultofphysicalloadingorcompression,changesinthemetabolismofmuscleandothertissues,ortheeffectoffactorssuchasinfection,inflammation,degenerationandtheimmuneresponse.Personalfactorssuchasage,sex,pregnancy,genetics,bodyshape,medicalhistory,nutritionalstatus,personalityandbehaviouralsohaveaninfluenceonpresentation,progressandrecovery.

ULDcomplaints

6 SymptomsandsignsassociatedwithULDsincludethefollowing:

n pain;n acheordiscomfort;n tenderness;n swelling.



7 Abnormalsensationsthatmayoccurare:

n numbness;n tingling;n pinsandneedles;n burningsensation;n feelingofwarmth;n cramp.

8 Otherobservationsmayinclude:

n stiffness;n impairmentofmovement;n weakness;n reducedgrip;n musclespasms.

9 SignsofULDscanbeminimalorabsentatexaminationbutthismaydependontheexperienceofthehealthprofessionalinexaminingthemusculoskeletalsystem.Guidanceisavailabletoassistdoctorsintheassessmentofsymptomsandsigns.35

10 Signsthatcanbedetectedmightinclude:

n anappearanceofswellingordeformity;n changesinskincolour;n tendernessontouchingtheaffectedpart;n asensationof‘crackling’(calledcrepitus)whentendonsaremoved;n touchingparticularareaofskinmayprecipitatesymptoms.Iftheseare

elicitedtheareasmaybereferredtoastriggerpoints;n jointmovementmayberestrictedandpainful;n lossofmusclepowermaybeseeninfunctionssuchasgraspingand

gripping;n theresponsetostimulatingtheskinmaybereducedorlost(lossof

sensationtotouch).

11 Upperlimbdisordersfallintooneoftwobroadcategories,thoseconditionsthatarerecognisedasdiscretediseaseswithcharacteristicfeatures,andnon-specificpainsyndromeswhereitisnotpossibletodefineaspecificunderlyingcauseforthepain,whichistheprincipalcharacteristicfeatureofthedisorder.

Recognised medical diseases

12 Thesecanbegroupedbythemainanatomicalstructuresinvolvedasthefollowingexamplesshow:

n tendon-relateddisorders:tenosynovitis,DeQuervain’sdiseaseofwrist,tendinitis,triggerfinger,epicondylitis;

n nerve-relateddisorders:Peripheralnerveentrapment(median,radial,ulnarnerves);

n muscle-relateddisorders:writer’scramp;n neurovasculardisorders:Thesensorineuralandvascularcomponentsof

thehand-armvibrationsyndrome;n jointrelateddisorders:osteoarthritis,shouldercapsulitis,ganglion;n softtissuedisorders:beathand,beatelbow,Dupuytren’scontracture.



13 Theseconditionsareusuallydiagnosedbythenatureofonsetandprogressionovertime,ofcertainsymptomsandthepresenceofclinicalsignsonexamination.TheessentialdefiningfeaturesofarangeofcommonULDshavebeendetailedandthecriteriaforidentificationagreedataconsensusmedicalconference.46

14 Intheprocessofaclinicalassessment,somespecialtestsmayberequiredtocheckforgeneralmedicalconditionsortoconfirmthediagnosis,egbloodtestsforevidenceofrheumaticdiseaseorendocrinedisturbance,oraurinetestfordiabetes.Occasionallyspecialistconfirmatorytestsarerequired,egelectricaltestsofnerveconductionormusclefunction,orimagingtestssuchasX-rays,bonescan,orMagneticResonanceImaging(MRI).

Non-specific pain syndromes

15 Inmanyindividualsaspecificdiseasemightnotbeidentifiableandthentheappropriatedescriptortouseisthemainsymptomcomplaintiepainanditsanatomicallocation.Non-specificarmpaincanbecomparedwithnon-specificlowbackpain(LBP),whereitisalsonotpossibletopreciselydefineaspecificunderlyingcauseforthepain.Suchnon-specificpainsyndromesarenolessrealthanthediscreteconditionsandtheimpactonfunctionmaybeequallysevere.Medicalenquiryshouldconsidersuchfeaturesas:

n siteandtimeofonsetofpain;n character,intensity,frequency,durationandradiationofpain;n precipitatingfactors;n provoking,relievingfactors;n influenceofrestandactivity(work,home,leisure);n associatedsymptoms;n psychosocialfactors.

16 Mostofuswillexperiencearmpainatsometimeandforthemajorityitwillbeabriefself-limitingepisodeandnotindicativeofseriousharm.Howeverinsituationswherepaindoesnotimprovewithrest,ifitisdisturbingsleep,recurringorpersistinginnaturethenmedicaladviceshouldbesought.

17 Inaminorityitcanbesaidthatpainitselfbecomesthediseaseratherthanbeingsolelyasymptomofdisease.Thisisthoughttoarisebecausethestimulusofpainhasthepotentialtomakethenervoussystemmoreresponsivetofurtherstimulation,aprocessknownasneuralsensitisation.Thismechanismunderliesthedevelopmentofprolongedandprogressivesymptomsinsomepeople,wherearmpainbecomessevereandchronic,withimpaireduseofthelimbandthedevelopmentofapermanentdisability.Thismaybedifficulttotreatandislikelytorequireatrialofacombinationofinterventionsincludingbehaviouraltherapy.Therationaleofearlyassessment,advice,appropriatetreatmentwhereindicated,andadjustmentstowork,shouldassistinpreventing,oratleastreducingtheimpactofsuchcasesandreducetheburdenofillhealth.



An A-Z of upper limb disorders

* TheseassociationsarederivedfromtheNIOSHreviewoftheepidemiologicalliteratureofrelevant

authors.7

Disorder Description Association with occupational activity*

BURSITIS/CELLULITIS(beatelbow,beathand)

Adistensionofthefluidsac(bursa)and/orinfectionofthesubcutaneoustissues.Thebursaandtheoverlyingskinmayalsobecomeinfected.Beathandisaninfectioninthepalmofthehand.Redness,heat,swellingandpainatrelevantanatomicalsite.

Associatedwithrepeated(beatelbow,beathand)localtraumafromprolongedleaning,orpressure,frictionoverelbow.Useofhandtoolseghammersandshovels,togetherwithabrasionfromdirt/dust.

CARPAL TUNNEL SYNDROME

Aperipheralnervedisorderresultingfromcompressionofthemediannerveasitentersthepalmofthehand.Tingling,numbness,tendernesscanoccurseveralhoursafteractivityandappearinthepartsofthehandinnervatedbythemediannerve,(mainlyinthethumb,index,middleandsideofringfinger).Characteristicintensificationatnightandreliefgainedbyhangingthearmoverthesideofbed.Weaknessofgrippingandclumsiness.

Associatedwith;-highlyrepetitivework;-forcefulwork;-handarmvibration.Strongassociationwithacombinationofriskfactorsegforce,repetitionandposture.

CRAMP OF THE HAND Afocaldystonia,whichaffectsthecontrolandco-ordinationofmuscleactivity.Spasmofthemusclesinthehandorforearmisobserved.Thisoftenoccurswheninitiatingspecificmovementsandtheeffectmayimpairtheuseoftheentirelimb.Itgenerallypreventstheintendedactionfrombeingperformed.Duringanepisodetheremaybestiffnessortightnessinthehand.

Associatedwithprolongedperiodsofrepetitivemovementsofthefingers,handorarm.

CUBITAL TUNNEL SYNDROME

Aperipheralnervedisorder resultingfromcompressionoftheulnarnerveattheelbow. Itcausesmedialelbowpainandtendernessandnumbnessandtinglingintheringandlittlefinger.Theremaybeweaknessofmovementofthesefingers,impairedgripandclumsiness.

Associatedwithdirectpressureortrauma.

DE QUERVAIN’S DISEASE Alocalisedswellinginvolvingtwotendonsthatmovethethumbandwhichpassthroughafibroustunnelinthewrist.Activityrelateddiscomfortisexperiencedovertheradialaspectofthewristandforearm.Useofthehandandthumbforgraspingbecomesincreasinglypainful.

Associatedwith;-repetition;-force;-posture.Strongassociationwithacombinationoftheseriskfactors.Canbeassociatedwithdirecttraumaoftheradialaspectsofthewrist.



DUPUYTREN’S CONTRACTURE

Athickeningofthetissuebelowtheskininthepalmofthehandwhichresultsinaprogressivecontractureappearing,especiallyoftheringandlittlefingerofoneorbothhands.Itisapainlessthickening,possiblywithapalpablenoduleinthepalmarcrease.Oneormorefingerscancurlupandcannotbestraightened.

Nogenerallyacceptedassociations

EPICONDYLITIS (Tennis/Golfer’selbow)

Adegenerationorinflammationoftheshorttendonous.attachmentsfromtheforearmmusclestotheboneattheelbow.Ontheinsideofthearmtheseattachatthemedialepicondyleandontheoutsideatthelateralepicondyle.Localtendernessisfeltattheattachmentofthetendonandiscommonlyknownastenniselbow(lateralepicondylitis)orgolferselbow(medialepicondylitis).Paincanradiateintotheforearmandisactivitydependant.Theremaybeweaknessofgrip.

Associationswithforcefulworkactivities.Strongassociationwithcombinationsofriskfactors;force,repetition,posture.

GANGLION Acystfilledwithsynovialfluidarisingfromajointortendonsheathandusuallyfoundonthebackofthehandorwrist.Theswellingcanvaryinsizeandbetenseandfirmorsoftandsqueezableandisusuallypainless.


OSTEOARTHRITIS Adisturbanceinthesmootharticularcartilagesurfaceswhichlinejoints,withassociatedchangesinthesurroundingbone,includingbonyovergrowth.Thiscanaffectanyarticulatingjoint,whichintheupperlimbincludesthoseintheneck,shoulder,elbow,wrist,thumbandfingers.Symptomsincludestiffnessandachingpainonmovementoftheaffectedjoint.Painmayradiatefromneckintothearm(knownasreferredpain).Theremaybelimitationinthefullrangeofjointmovementandbonyswellings.Sometimesthereisagratingnoiseonmovement(crepitus).

Occupationalexposuresmaymodifythisdiseaseprocess.



ROTATOR CUFF TENDINITIS – BICIPITAL TENDINITIS

Aninflammationordegenerationofthetendonsintheregionoftheshoulderjoint.Symptomsareachingandpainintheshoulderwhichmaybeprovokedbylyingontheaffectedsideatnight.Thereislimitationofcertainshouldermovementsdependentonwhattendonisaffected.Inbicipitaltendonitispainisexperiencedinthefrontoftheshoulderandonraisingthearminfront.

Associatedwithhighlyrepetitiveworkandshoulderposturesgreaterthan60degreesflexion,abduction.

SHOULDER CAPSULITIS (Frozenshoulder)

Aninflammationordegenerationofshoulderjointtissue.Thereisagradualonsetofstiffnessandpainintheshoulderwhichismoresevereatnightandwithincreasingrestrictioninallshouldermovements.


STENOSING TENOSYNOVITIS (Triggerfinger/thumb)

Atendonsheathswellinginoneofthetendonsthatcrossthepalmofthehandandrundownthepalmarsurfaceofthefinger/thumb.Thisrestrictstendonmovementthroughafibrousringtermedapulley.Triggering,clickingorcatchingfeltonstraighteningthefingersorthumbandisoftenworseinthemorning.Atendernoduleisfeltinthepalmjustbeyondthebaseofthefinger.

Possibleassociationwithoveruse.

TENOSYNOVITIS Aninflammationoftendonsheathsatthewrist.Achingandpainisfeltintheaffectedtendonwhichisworseonmovement.Usuallythereislocaltendernessandswelling.Theoverlyingskinmayappearredandwarmwithagratingfeelingfeltoverthetendon(crepitus)duringmovement.Graspingandpinchingmaybeweakdependinguponthetendonaffected.

Associatedwith;-repetition;-force;-posture.Strongassociationwithacombinationoftheseriskfactors

VIBRATION WHITE FINGER Thisisadisorderarisingfromimpairmentofbloodcirculationinthefingersandoccursinperiodicattacksusuallyprovokedbycold.Thefinger/sturnwhite(blanch)withassociatednumbnessandtingling.Restorationofbloodflowresultsinpainfulredthrobbingfingers.Inseverecasesthereisblanchingofmostfingers,co-ordinationanddexterityisimpaired.

Associatedwithexposuretovibrationtransmittedtothehandandarmfromworkprocesses



Treatments and rehabilitation

18 AcuteULDsaregenerallycurableifrecognisedearlyandaccuratelydiagnosed.Evenwheresymptomshavebecomechronicandsevere,occupationalrehabilitationcanbesuccessful.TheapproachtomostpainfromacuteULDsistorestthelimbandreducesoft-tissueinflammation.Additionalactionsmaybeconcernedwithincreasingmusclestrength,rangeofjointmovementandfunctionalcapacity.

19 Oneofthemosteffectivemeansofrestingtheaffectedpartistoreduceoreliminateexposuretothetaskswhichmayhavecontributedtotheonsetofthecondition,whethertheseariseinoccupationalornon-occupationalactivity,orinbothsettings.Ashortperiodofcompleterestmaybehelpfulparticularlyifinflammationispresent.Protractedrestshouldbeavoidedunlessundermedicalsupervisionasthiscanleadtodeconditioningandweakeningofthemusclesandassociatedstructures.

20 Anti-inflammatorydrugsandanalgesicmedications,’painkillers,’canbetakenduringthistime.Intheshortterm,theuseofpainkillersmayallowcontinuationofwork.Thisrunstherisk,however,ofexacerbatingorprolongingtheepisodeofillhealthifworkactivityisacontributoryoraggravatingfactortoanindividual’ssymptoms.Localareasoftendoninflammationcanbetreatedwithsteroidandlocalanaestheticinjectionsduringtheperiodofrest.Theireffectivenessiscompromisedifriskfactorsinworkactivitiesarenotalsoreducedoreliminated.

21 Immobilisationbyappropriatesplintingorsupportofthesymptomaticareacanbeused,butthisneedstobecarefullysupervisedasthereisariskofweakeningthelimb.Theregularuseofsupportivebandaginginaworkplacetoassistindividualssufferingarmpainshouldhoweverbediscouraged.Thisisunlikelytobeeffectivetreatmentonitsown,anditindicatesthatthereisanunderlyingproblemwhichshouldbetackled.

22 Physiotherapyandoccupationaltherapypractitionerscanprovidearangeoftreatmentstoassistwiththerestorationoffunctionandrehabilitation.Thismightincludespecificexercisesand/orstretchingofmusclesandnerves,jointmobilisation,electrotherapy,ultrasound,coldandheatapplications.Someexpertsconsiderthatmorespecialised‘neurodynamic’techniquescanbeofbenefitwherepainisthemainproblem,althoughthisapproachremainscontroversial.Practitionersofmanipulativetherapiessuchasosteopathsandchiropractorscanalsoprovidetreatmentsandadviceonrehabilitationandprevention.

23 Specialistopinionshouldideallybeobtainedfrompractitionerswhohaveexperienceintherecognition,treatmentandmanagementofULDs.Thiscouldincludephysiciansspecialisinginrheumatology,musculoskeletalmedicine,neurology,psychology,andpaincontrol.Specialistsinoccupationalmedicinecanadviseonworkplaceissues.Specialistopinionmightinvolvereferraltospecialistsinhand,orthopaedicorplasticsurgeryor,neurosurgery.

24 Surgicaloptionsareusuallyconsideredafterlessinvasivetreatmentapproacheshavebeentried.Howquicklyaftersurgeryanemployeeisabletoreturntoworkwilldependonthesuccessofthesurgeryandthepost-operativerecovery.Theextenttowhichergonomichazardsintheworkplacehavebeenmodified,andtheresultsofanoccupationalhealthassessmentarealsorelevanttorecovery.



25 Treatmentforchronicnon-specificarmpainusuallyrequiresadetailedapproachtobetakentotheindividualsufferer.Anumberofinterventionsarelikelytobeneededtostoptheprogressionofsymptoms,givetheindividualasenseofcontrolovertheirpainandavoiddeteriorationinmentalhealth.Therapeuticmeasuresarebasedonareductionofstress,byattentiontophysicalorpsychologicalstresses,counsellingandrelaxationtherapiesandpainrelief(tricyclicmedication,triggerpointtherapy,electricalstimulation,injectionsaroundnervesandacupuncturearepossibleapproaches).

26 Complementarytreatmentsareofferedbyavarietyoftherapistsandincludeacupuncture,homeopathy,andyoga,asexamples.Thereislittleresearchonwhichtobasetheselection,orassesstheeffectiveness,ofsuchtherapiesformanagingULDs.

Occupational health provision

27 Occupationalhealthbroadlyembracestheissuesconcerningpreventionofillnessfromwork,managingtheeffectsofillnessatworkandpromotinghealth.InthecontextofULDs,occupationalhealthservicescouldassistwith:

n identificationofhealthhazards,assessmentofrisk,andadviceoncontrolmethods;

n adviceonworkplacementofemployeesandmedicalfitnessforparticularworkduties;

n provisionofappropriateon-sitefirstaidandtreatmentfacilities;n identifyingcausesofillhealthwithintheworkforceandliaisonwithother

healthcareprofessionals,takingaccountofmedicalconfidentiality,andtheneedtoobtainanindividual’sconsent;

n advisingonsuitablehealthsurveys,theanalysisandinterpretationofhealthdataandundertakinghealthrelatedinterviewsorexaminations;

n developingprotocolsforthemanagementofULDsintheworkplaceincludingrehabilitation,exerciseprogrammesandreturntoworkarrangements;

n adviceonadjustmentstowork,orworkingarrangements,tosupportandmaintainemployment.

Where to get help

28 Therearevariouswaysinwhichoccupationalhealthsupportmightbearranged,includingprovisionofanin-houseserviceoruseofexternalproviders.Thelargeroccupationalhealthserviceswillbeledbyadoctorornurseandmaybepartofamultidisciplinaryhealthandsafetyteam.Thesemaybeprivateproviders,publicproviderssuchasanNHStrust,co-operativegroups,or‘groupoccupationalhealthservices’.Otherservicescomefromindependentoccupationalhealthphysiciansandnursesorfromgeneralpractitionersandpracticenursesworkinginoccupationalhealth.Professionalbodiescanprovidelistsofpractitioners(seeFurtherinformation).

29 HSE’sEmploymentMedicalAdvisoryService(EMAS)canadviseonoccupationalhealthservicesavailableinyourlocalareaandcangivegeneraladviceonthemanagementofthehealtheffectsofULDsintheworkplace.

30 Whereanindividualhasanongoingdisability,assistancewithworkplaceassessmentandadjustmentcanbeaccessedthroughthelocalDisabilityServiceTeamattheDepartmentforWorkandPensions(DWP).



Appendix 4: Legal requirements

General

1 Employershavelegalresponsibilitiestoensurethehealthandsafetyatworkoftheiremployees,andthisincludesthepreventionofaccidentsandworkrelatedillhealthsuchasULDs.TheHealthandSafetyatWorketcAct197419placesgeneraldutiesonemployersandothers.TherearealsoanumberofRegulationswhichimposespecificrequirements,andthosemostrelevanttothepreventionofULDsinclude:

n ManagementofHealthandSafetyatWorkRegulations;20

n Workplace(Health,SafetyandWelfare)Regulations;47

n HealthandSafety(DisplayScreenEquipment)Regulations;5

n ProvisionandUseofWorkEquipmentRegulations;48

n PersonalProtectiveEquipmentatWorkRegulation;49

n ManualHandlingOperationsRegulations;50

n ReportingofInjuries,DiseasesandDangerousOccurancesRegulations1995(RIDDOR).38,39,40

2 ThefollowingparagraphssummarisethosepartsofthelawthatareparticularlyrelevanttopreventionofULDs.Theyprovidepertinentinformationontheregulationsandassociatedguidanceandapprovedcodeofpractice(whererelevant),butdoesnotattempttogiveacomprehensivegeneralsummaryofeachpieceoflegislation.

Health and Safety at Work etc Act 197419

3 TheActimposesdutiesoneveryoneconcernedwithworkactivities,includingemployers,self-employed,employees,manufacturersanddesigners.Thedutiesareimposedbothonindividualpeopleandoncorporations,companies,partnerships,localauthoritiesetc.Thedutiesareexpressedingeneraltermssothattheyapplytoalltypesofworkactivityandsituations.

4 Section2oftheActputsadutyonallemployerstoensure,sofarasisreasonablypracticable,thehealth,safetyandwelfareatworkofalltheiremployees.Themostimportantareasrelateto:

n theprovisionandmaintenanceofplant(egmachineryandequipment),andsystemsofworksuchthattheyaresafeandwithoutriskstohealth;

n theuse,handling,storageandtransportofarticlesandsubstancesatwork;

n theprovisionofinformation,instruction,trainingandsupervision,asnecessary;

n theprovisionandmaintenanceofaworkingenvironmentthatissafeandfreeofriskstohealth.

5 Inaddition,adutyisplacedonemployers,unlessexemptedbytheAct,toprepareandrevise,asappropriate,awrittenstatementoftheirgeneralpolicywithrespecttothehealthandsafetyatworkofemployees,thearrangementsforcarryingoutthepolicy,andtobringittotheattentionofemployees.Thisappliestoundertakingswithfiveormoreemployees.Suchpolicystatementsshould,whereappropriateincludereferencetoarrangementsinplaceforthepreventionofULDs.



6 Section3oftheActplacesdutiesonemployerstopreventotherpeople,whoarenottheiremployees,beingexposedtoriskstotheirhealthandsafety.

7 Section7oftheActplacesdutiesonemployeestotakereasonablecareforthehealthandsafetyofthemselvesandofotherpersonswhomaybeaffectedbywhattheydo,orfailtodo,atwork.

Management of Health and Safety at Work Regulations 199920

8 TheseRegulationssetoutbroadgeneraldutieswhichapplytoalmostallkindsofwork.Theyplaceanumberofrequirementsonemployersto:

n assesstherisktothehealthandsafetyoftheiremployeesandtoanyoneelsewhomaybeaffectedbytheiractivity,sothatthenecessarypreventiveandprotectivemeasurescanbeidentified;

n theassessmentshouldtakeintoaccountrisksrelatingtoneworexpectantmothers(thisisrelevantbecausepregnancycanaffectULDrisksduetohormonalchangeswhichaffectligaments,posture,bloodpressureandcausefatigue);

n makearrangementsforputtingintopracticethehealthandsafetymeasuresthatfollowfromtheriskassessment.Thiscoversplanning,organisation,control,monitoringandreview,iethemanagementofhealthandsafety;

n providesuchhealthsurveillanceasisappropriatehavingregardtothehealthandsafetyriskswhichareidentifiedbytheassessment;

n appointcompetentpeopletohelpdeviseandapplythemeasuresneededtocomplywithemployers’dutiesunderhealthandsafetylaw(seeparagraphs39-40);

n giveemployeesinformationabouthealthandsafetymatters;n co-operatewithanyotheremployerswhoshareaworksite;n provideinformationtopeopleworkingintheirundertakingwhoarenot

theiremployees;n makesurethatemployeeshaveadequatehealthandsafetytrainingand

arecapableenoughattheirjobstoavoidrisk;andgivesomeparticularhealthandsafetyinformationtotemporaryworkers,tomeettheirspecialneeds.

9 TheRegulationsalso:

n placedutiesonemployeestofollowhealthandsafetyinstructionsandreportdanger;

n requireemployerstoconsultemployees’safetyrepresentativesandprovidefacilitiesforthem.Consultationmusttakeplaceonsuchmattersastheintroductionofmeasuresthatmaysubstantiallyaffecthealthandsafety;thearrangementsforappointingcompetentpersons;healthandsafetyinformationandtrainingrequiredbylaw;andhealthandsafetyaspectsofnewtechnologybeingintroducedtotheworkplace.

Workplace (Health, Safety and Welfare) Regulations 199247

10 Theaimoftheregulationsistoensurethatworkplacesmeetthehealth,safetyandwelfareneedsofeachmemberoftheworkforce.Aswellasfactories,shopsandofficestheregulationscoverschools,hospitals,hotels,placesofentertainment,roadsandpathsonindustrialestates,andtemporaryworksites(butnotconstructionsitesastheyarecoveredbyseparatelegislation-Construction(Health,SafetyandWelfare)Regulations199651andTheConstruction(DesignandManagement)Regulations1994.52



11 TheRegulationsexpandonemployer’sdutiesinsection2oftheHealthandSafetyatWorketc.Act1974,andareintendedtoprotectthehealthandsafetyofeveryoneintheworkplace,andtoensurethatadequatewelfarefacilitiesareprovidedforthoseatwork.

12 Variousaspectsoftheworkplacearecoveredincluding:

n workstationsandseating:workstationsshouldbearrangedsothateachtaskcanbecarriedoutsafelyandcomfortablyintermsofheightoftheworksurfaceandaccessibilitytonecessaryitems,withfreedomofmovement

n maintenanceoftheworkplace,andofequipment,devicesandsystems. Equipmentshouldbemaintainedinefficientworkingorder

n temperatureinindoorworkplaces:duringworkinghoursthetemperatureinworkplacesinsidebuildingsshouldprovidereasonablecomfortwithoutneedforspecialclothing(specialcircumstancesapply,egforfoodhandling)

n lighting:thisshouldbesufficienttoenablepeopletoworkandusefacilities.Wherenecessary,locallightingshouldbeprovidedatindividualworkstations.

Health and Safety (Display Screen Equipment Regulations) 19925

13 TheRegulationsapplywhereworkershabituallyusedisplayscreenequipment,suchascomputers,asasignificantpartoftheirnormalwork.IntermsofpreventingULDstheyrequireemployersto:

n assessandreducerisks:themainhealthproblemsincludeupperlimbpainsanddiscomfort;temporaryvisualfatigue(possiblyleadingtotheadoptionofawkwardpostureswhichcancausefurtherdiscomfortintheupperlimbs);fatigueduetopoorworkstation,tasksorenvironmentdesign,andstress;

n ensureworkstationsmeetminimumrequirements.Inmostcasesthedisplayscreenshouldswivelandtilt,befreeofreflectionsandglareandhaveaclear,stableimage.Thekeyboardshouldtiltandbeseparatefromthescreen,withlegiblekeys.Theworkstationshouldbesufficientlylargetoallowflexibilityandcomfort.Theworkchairshouldbestable,comfortable,adjustableinheightandthebackshouldadjustinheightandtilt.Afootrestshouldbemadeavailable,ifneeded.Theenvironmentsuchasspace,lighting,heatandhumidityshouldbeadequate,andsoftwareshouldbesuitableandeasytouse;

n planbreaksorchangesofactivity.TiminganddurationofthesearenotstipulatedintheRegulationsasitdependsonthenatureofthework.Howeverbreaksshouldbeincludedintheworkingtime,preferablyshortfrequentbreaksawayfromthescreenandtakenbeforetheonsetoffatigue;

n providehealthandsafetyinformationandtraining;n provideeyetestsonrequest,andspecialspectaclesifrequiredforDSE

work.



Provision and Use of Work Equipment Regulations 199848

14 TheRegulationsplacegeneraldutiesonemployersandlistminimumrequirementsforworkequipmenttodealwithhazardsinalltypesofindustry.TheRegulationsrequireemployersinallindustriestoensurethatworkequipmentissuitableforthepurposeandsafetouse.‘Workequipment’coverseverythingfromahandtool,throughmachinesofallkinds,toaconnectedseriesofmachinessuchasaproductionline.Theterm‘use’includesstarting,stopping,programming,setting,transporting,repairing,modifying,maintaining,servicingandcleaning.TheRegulationsrequirethatworkequipmentissuitableandsafefortheworkcarriedoutanddoesnotposeanyhealthorsafetyrisk.

15 Thegeneraldutiesrequireemployersto:

n takeintoaccounttheworkingconditionsandrisksintheworkplacewhenselectingequipment;

n makesurethatequipmentissuitablefortheintendeduseandthatitisusedwithsuitablesafetymeasures;

n ensurethatitisproperlymaintainedandinspectedasnecessary;n takeaccountofergonomicriskswhenselectingworkequipment,(ie

ensurethatequipmentandoperatingpositions,workingheights,reachdistancesetc.arecompatiblewiththeintendedoperator);

n giveadequateinformation,instructionandtrainingonuseoftheequipmentbeforeuse.

Personal Protective Equipment at Work Regulations 199249

16 TheRegulationsplaceadutyonemployerstoensurethatsuitablepersonalprotectiveequipment(PPE)isprovidedtoemployeeswhomaybeexposedtoarisktotheirhealthandsafetywhileatwork,incircumstanceswheresuchriskscannotbeadequatelycontrolledbyothermeans.PPEshouldtakeintoaccountergonomicrequirementsofthepersonwhowearsitandbecapableoffittingthewearercorrectly.

17 AnexampleofPPEishandandarmprotectionwhichisusedtoprovideprotectionagainstarangeofindustrialhazards,butwhichmayalsoreducetheabilitytogripandcontributetoULDs.

Manual Handling Operations Regulations 199250

18 Theseregulationsapplytoallmanualhandlingtasks,ietaskswhichinvolvetransporting,suchaslifting,pushing,pullingorsupportingaload.Inworkplaces,thereareawiderangeofhandlingandtransportingprocessestakingplace,rangingfromassemblylinework,liftingboxes,bagsandcomponents,tohelpingpeoplewithlimitedmobilitywiththeirdaytodayactivities.TheRegulationsapplytooperationswhichcancauseinjurynotonlytothebackbutmayalsoaffectallpartsofthebodyincludingtheupperlimbs.

19 Theregulationsplacedutiesontheemployerto:

n avoidtheneedforundertakinganymanualhandlingoperationsatworkwhichinvolveariskofbeinginjured,sofarasisreasonablypracticable;

n whereitisnotreasonablypracticabletoavoidriskofinjury,carryoutanassessmentoftheriskstotakeintoaccountthetask,load,workingenvironmentandtheworker’sindividualcapabilitytocarryoutthetask.



HSEguidanceontheregulationsprovidesguidelinesforliftingloads;themaximumweightdependsonfactorssuchasheightofthelift,thedistancethattheobjectisextendedfromthebody,whethertheemployeeismaleorfemale,andwhethersittingorstanding;

n whereitisnotreasonablypracticabletoavoidriskofinjury,totakeappropriatestepstoreducetheriskofinjuryfromhazardousmanualhandlingtothelowestlevelreasonablypracticable.

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR)38

20 RIDDORplacesadutyonemployers,ontheself-employedandonthoseincontrolofworkpremisestoreportcertainwork-relatedaccidents,diseases,anddangerousoccurrencestotheenforcingauthorities(HSEorlocalauthorities).Ifadoctordiagnosesandreportstoanemployerthatanemployeeissufferingfromareportablework-relateddisease,andthepersonconcernediscurrentlyemployedinanassociatedworkactivity,thentheemployermustsend,eitherbypostorelectronicallyviatheHSEwebsite,acompleteddiseasereportformtotherelevantenforcingauthority.

21 IntermsofULDs,thediseaseswhichinspecifiedcircumstancesarereportablearecrampofthehandorforearm,subcutaneouscellulitisofthehand,bursitisorsubcutaneouscellulitisarisingatorabouttheelbow,traumaticinflammationofthetendonsofthehandorforearm,carpaltunnelsyndromeandhand-armvibrationsyndrome(althoughthelatterisoutsidethescopeofthisguidance).



ReferencesReferences Cited in Text

1 Securing health together: A long term occupational health strategy for England, Scotland and WalesMisc225HSEBooks2000

2 Revitalising Health and Safety: Strategy Statement June 2000TheStationeryOffice2000.FurthercopiesareavailablefromDepartmentoftheEnvironment,TransportandtheRegions,FreeLiteratureService,POBox236,Wetherby,WestYorkshireLS237NB.

Tel:08701226236Fax:08701226237Website:http://www.detr.gov.uk/pubs/index.htm

3 Hand-arm vibrationHSG88HSEBooks1994ISBN0717607437

4 Mechanical Vibration: Guidelines for the measurement and assessment of human exposure to hand-transmitted vibration. Part 2: Practical guidance for measurement at the workplaceFirstEditionISO5349-22001

5 Display screen equipment work. Health and Safety (Display Screen Equipment) Regulations 1992. Guidance on RegulationsL26HSEBooks1992ISBN0717604101

6 Working with VDU’sLeafletINDG36(rev1)HSEBooks1998(singlecopyfreeorpricedpacksof10ISBN0717615049)

7 BernardBPandPutz-AndersonV(editors)Musculoskeletal disorders and workplace factors. A critical review of epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity and lower backNationalInstituteforOccupationalSafetyandHealthDHHS(NIOSH)PublicationNo.97-1411997

8 HunterDThe Diseases of Occupations(Ninthedition)ArnoldLondon2000 ISBN0340677503

9 CherryNetal‘Surveillanceofwork-relateddiseasesbyoccupationalphysiciansintheUK:OPRA1996-1999’Occupational Medicine200050(7)496-503.

10 CherryNetal‘Thereportedincidenceofwork-relatedmusculoskeletaldiseaseintheUK:MOSS1997-2000’Occupational Medicine200151(7)450-455

11 MackayCetalMusculoskeletal disorders in supermarket cashiersHSEBooks1998ISBN071760831X

12 Work-Related Upper Limb Disorders: A Review of the EvidenceNationalResearchCouncilWashingtonDCNationalAcademyPress1998ISBN0309063272

13 JonesJRandHodgsonJTSelf reported work related Illness in 1995: Results from a household surveyHSEBooks1998ISBN071761509XandJonesJR,HodgsonJTandOsmanJSelf reported working conditions in 1995HSEBooks1997ISBN0717614492



14 Information sheet 2/99/EMSU Economic Impact: Revised data from Self-reported Work-related Illness survey in 1995 (SWI95)AvailablefromHSE’sEpidemiologyandMedicalStatisticsUnitandHSE’swebsitewww.hse.gov.uk

15 ChaffinDandAnderssonG(editors)Occupational biomechanics(Thirdedition)Wiley1999ISBN0471246972

16 WhitingWandZernickeR(editors)Biomechanics of musculoskeletal injuryLeedsHumanKinetics1998ISBN0873227794

17 ArmstongT,BuckleP,FineLetal.‘Aconceptualmodelforwork-relatedneckandupper-limbmusculoskeletaldisorders.Scandinavian Journal of Work Environment & Health19931973-84

18 BucklePandDevereuxJWork related neck and upper limb musculoskeletaldisordersEuropeanAgencyforSafetyandHealthatWorkLuxembourg1999ISBN9282881741

19 Health & Safety at Work etc Act 1974Ch3TheStationeryOffice1974ISBN0105437743

20 Management of health and safety at work. Management of Health and Safety at Work Regulations 1999. Approved Code of Practice and guidanceL21(Secondedition)HSEBooks2000ISBN0717624889

21 Work related upper limb disorders; the development of an interactive databaseHSEContractresearchreport.(Tobepublished).Forfurtherinformationsee‘otherwebsites’.

22 A guide to the Health and Safety (Consultation with Employees) Regulations 1996. Guidance on RegulationsL95HSEBooks1996ISBN0717612341

23 Safety representatives and safety committeesL87(Thirdedition)HSEBooks1996ISBN0717612201

24 A guide to the Offshore Installations (Safety Representatives and Safety Committees) Regulations 1989. Guidance on RegulationsL110(Secondedition)HSEBooks1998ISBN0717615499

25 HainesHMandWilsonJRDevelopment of a framework for participatory ergonomicsCCR174HSEBooks1998ISBN0717615731

26 Handle with care. Assessing musculoskeletal risks in the chemical industryHSEBooks2000ISBN071761770X

27 LiGandBucklePEvaluating change in exposure to risk for musculoskeletal disorders: A practical toolCRR251HSEBooks1999ISBN071761722X

28 McAtamneyLetalReducing the risks of work related upper limb disordersInstituteofOccupationalErgonomicsNottinghamUniversity1992.

29 BucklePTUC Guide to assessing WRULD risksTradeUnionCongress,CollegeHillPressLondon1994ISBN1850062773

30 LiGandBuckleP(editors)‘Currenttechniquesforassessingphysicalexposuretowork-relatedmusculoskeletalrisks,withemphasisonposturebasedmethods’Ergonomics199942(5)674-695



31 Lighting at workHSG38(Secondedition)HSEBooks1997ISBN0717612325

32 New and expectant mothers at work: A guide for employersHSG122HSEBooks1994ISBN0717608263

33 A pain in your workplace? Ergonomic problems and solutionsHSG121HSEBooks1994ISBN0717606686

34 WoodsVandBucklePResearch into practice – the value of case studies in reducing musculoskeletal problems in the cleaning industry. Proceedings Premus 2001,FourthInternationalScientificConferenceonPreventionofWork-RelatedMusculoskeletalDisorders

35 GravesRJ,SinclairDTetalDevelopment and evaluation of diagnostic support aids for upper limb disordersCRR280HSEBooks2000ISBN0717618242

36 Access to Medical Reports Act 1988 (c.28)TheStationaryOfficeISBN0105428884.

37 CoxRAetalFitness for Work: The Medical Aspects(Thirdedition)OxfordUniversityPress2000ISBN0192630431

38 A guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995L73(Secondedition)HSEBooks1999ISBN0717624315

39 RIDDOR Reporting: Information about the new incident centreMISC310HSEBooks2001

40 RIDDOR ExplainedHSE31(rev1)HSEBooks2001

41 Social Security (Industrial Injuries)(Prescribed Diseases) Regulations 1985TheStationeryOfficeISBN0110564679

42 Health surveillance at workHSG61(Secondedition)HSEBooks1999ISBN071761705X

43 Health and safety benchmarking – Improving together: Guidance for thoseinterested in applying benchmarking to health and safetyLeafletINDG301HSEBooks1999(singlecopyfreeorpricedpacksof10ISBN0717624943)

44 Seating at workHSG57(Secondedition)HSEBooks1997ISBN0717612317

45 Vibration solutions: Practical ways to reduce the risk of hand-arm vibration injuryHSG170HSEBooks1997ISBN0717609545

46 HarringtonJMetal‘Surveillancecasedefinitionsforworkrelatedupperlimbpainsyndromes’Occupational and Environmental Medicine199855(4)264–271

47 Workplace health, safety and welfare. Workplace (Health, Safety and Welfare) Regulations 1992. Approved Code of PracticeL24HSEBooks1992ISBN0717604136



48 Safe use of work equipment. Provision and use of work equipment regulations 1998. Approved code of practice and guidance(Secondedition)HSEBooks2001ISBN0717616266

49 Personal protective equipment at work. Personal Protective Equipment at Work Regulations 1992. Guidance on RegulationsL25HSEBooks1992ISBN0717604152

50 Manual handling. Manual Handling Operations Regulations 1992. Guidance on RegulationsL23(Secondedition)HSEBooks1998ISBN0717624153

51 A guide to the Construction (Health, Safety and Welfare) Regulations1996LeafletINDG220HSEBooks1996(singlecopyfreeorpricedpacksof10ISBN0717611612)

52 Managing construction for health and safety. Construction (design and management) regulations 1994. Approved code of practiceHSEBooks1995ISBN0717607925

Whileeveryefforthasbeenmadetoensuretheaccuracyofthereferenceslistedinthis

publication,theirfutureavailabilitycannotbeguarenteed.



HSE publications

JacksonPRandParkerSK(editors)Change in manufacturing: How to manage stress-related risksHSEBooks2001ISBN0717620867

Enforcement policy statementMISC030HSEBooks2001

SinclairDT,GravesRJetalFeasibility of developing a prototype decision aid for initial medical assessment of work-related upper limb disordersCRR279HSEBooks2000ISBN0717618234

General ventilation in the workplace: Guidance for employersHSG202HSEBooks2000ISBN0717617939

Health risks from hand-arm vibration: Advice for employersLeafletINDG175(rev1)HSEBooks1998(singlecopyfreeorpricedpacksof10ISBN0717615537)

CoxT,GriffithsA,BarlowCetalOrganisational interventions for work stress: A risk management approachHSEBooks2000ISBN0717678382

Power tools: How to reduce vibration health risks - Guide for employersLeafletINDG338HSEBooks2001(singlecopyfreeorpricedpacksof15ISBN0717620085)

Stating your business: Guidance on preparing a health and safety policy document for small firmsLeafletINDG324HSEBooks2000(singlecopyfreeorpricedpacksof5ISBN0717617998)

Successful health and safety managementHSG65(Secondedition)HSEBooks1997ISBN0717612767

McCaigRandHarringtonM(editors)The changing nature of occupational healthHSEBooks1998ISBN0717616657

Thermal comfort in the workplace: Guidance for employersHSG194HSEBooks1999ISBN0717624684

Upper limb disorders: Assessing the risksLeafletINDG171HSEBooks1994(singlecopyfreeorpricedpacksof10ISBN0717607518)



General Texts

HelanderMA Guide to the Ergonomics of ManufacturingTaylor&Francis1997ISBN0748401229

MoonSDandSauterSL(editors)Beyond Biomechanics: Psychosocial aspects of musculoskeletal disorders at workTaylorandFrancis1996ISBN0748403213

PheasantSBodyspace: Anthropometry, Ergonomics and the Design of Work(Secondedition)Taylor&Francis1996ISBN0748400672

SluiterJK,RestKM,Frings-DresenMHWCriteria document for the evaluation of the work-relatedness of upper extremity musculoskeletal disordersCoronelInstituteforOccupationalandEnvironmentalHealth,UniversityofAmsterdam,Netherlands2000

Putz-AndersonVCumulative trauma disorders: A manual for musculoskeletal diseases of the upper limbsTaylor&Francis1998ISBN0850664055

DulJandWeerdmeesterB(editors)Ergonomics for beginners – A quick reference guide(Thirdedition)Taylor&Francis2000ISBN0748400796

PheasantSErgonomics, Work and HealthMcMillanPress1991ISBN0309072840

O’NeilREurope Under Strain: A report on Trade Union initiative to combat workplace musculoskeletal disordersTUTBBrussels1999ISBN2930003294

WilsonJRandCorlettEN(editors)Evaluation of Human Work: A practical ergonomics methodologyTaylor&Francis1995ISBN0748400842

KroemerKHEandGrandjeanE(editors)Fitting the Task to the Human(Fifthedition)Taylor&Francis1997ISBN0748406654

ParkerSKandWallTDJob and work design: organising work to promote well-being and effectivenessSageLondon1998ISBN0761904204

Musculoskeletal disorders and the workplace: Low back and upper extremities NationalResearchCouncilNationalAcademyPress2001ISBN0309072840

KasdanML‘Occupational hand injuries’ Occupational Medicine: State of the Art Reviews19894(3)395-574

HadlerNMOccupational Musculoskeletal Disorders(Secondedition)LippincottWilliamsandWilkins1999ISBN0781714958

ClarkTSandCorlettEN(editors)The ergonomics of workspaces and machines: A design manual(Secondedition)Taylor&Francis1995ISBN0748403205

DiMartinoVandCorlettN(editors)Work organisation and ergonomicsInternationalLabourOfficeGeneva1998ISBN9221095185

KuorinkaIandForcierL(editors)Work related musculoskeletal disorders (WMSDs): A reference book for preventionTaylor&Francis1995ISBN0748401318

HutsonMAWork-related upper limb disorders: Recognition and management Butterworth-Heinmann1999ISBN0750645482



Government bodies

HealthandSafetyExecutive:www.hse.gov.uk

HSEEmploymentMedicalAdvisoryService–lookfordetailsofyourlocalHSEofficeinthetelephonedirectoryorHSEwebsite.

DepartmentofHealth:www.doh.gov.uk

DepartmentforWork&Pensions/Disabilityserviceteam:www.disability.gov.uk

LocalAuthorityEnvironmentalHealthOfficers’:contacttheEnvironmentalHealthOfficeofyourLocalAuthority

Professional and Other Associations

BritishChiropracticAssociationBlagraveHouse,17BlagraveStreetReading,Berkshire.RG11QBTel:01189505950Web:www.chiropractic-uk.co.uk

BritishInstituteofMusculoskeletalMedicine34TheAvenueWatford,Herts.WD13NSTel:01923220999 Web:www.bimm.org.uk

CharteredSocietyofPhysiotherapy14BedfordRowLondonWC1R4EDTel:02073066666ScottishOfficeTel:01312261441,WelshOfficeTel:02920382428Web:www.csphysio.org.uk

CollegeofOccupationalTherapists106-114BoroughHighStSouthwarkLondonSE11LBTel:02073576480www.cot.co.uk

FacultyofOccupationalMedicineoftheRoyalCollegeofPhysicians6StAndrew’sPlaceRegent’sPark,LondonNW14LBTel:02073175890Web:www.facoccmed.ac.uk

GeneralOsteopathicCouncil176TowerBridgeRoadLondonSE13LUTel:02075376655Web:www.osteopathy.org.uk

InstituteofOccupationalSafetyandHealthTheGrange,HighfieldDriveWigston,LeicestershireLE181NNTel:01162573100Web:www.iosh.co.uk



OccupationalTherapyinWorkPracticeandProductivityc/oSpecialistSectionsOfficerCollegeofOccupationalTherapists106-17BoroughHighStreetSouthwarkLondonSE11LBhttp://www.cot.co.uk/special/otwpp.htm.

RoyalCollegeofNursing20CavendishSquareLondonW1M0AB.Tel:02074093333Web:www.rcn.org.uk

SocietyofOccupationalMedicine6StAndrew’sPlaceRegent’sPark,London,NW14LBTel:02074862641Web:www.som.org.uk

TheAssociationofCharteredPhysiotherapistsinOccupationalHealthandErgonomics(ACPOHE)POBox121LondonE17Tel:01964534376http://www.acpoh.co.uk

TheErgonomicsSocietyDevonshireHouse,DevonshireSquareLoughborough,LeicestershireLE113DWTel:01509234904Web:www.ergonomics.org.uk

TheRSIAssociation380-384HarrowRoadLondonW92HUTel:02072662000Web:www.rsi-uk.org.uk

Other Websites

EuropeanAgencyforSafetyandHealthatWorkGranVia33E-48009BilbaoSpainTel:+34944794360Email:[email protected]:http://agency.osha.eu.int/andhttp://europe.osha.eu.int/good_practice/risks/msd/

NationalHealthServicehttp://www.nhsplus.nhs.uk

NationalInstituteforOccupationalHealthandSafety(NIOSH)(USA):http://www.cdc.gov/niosh/homepage.html

Workrelatedupperlimbdisorders:adatabaseofcourtjudgementshttp://www.lboro.ac.uk/wruld-db

Further informationForinformationabouthealthandsafetyringHSE’sInfolineTel:08453450055Fax:08454089566Textphone:08454089577e-mail:[email protected],CaerphillyBusinessPark,CaerphillyCF833GG.

HSEpricedandfreepublicationscanbeviewedonlineororderedfromwww.hse.gov.ukorcontactHSEBooks,POBox1999,Sudbury,SuffolkCO102WATel:01787881165Fax:01787313995.HSEpricedpublicationsarealsoavailablefrombookshops.

BritishStandardscanbeobtainedinPDForhardcopyformatsfromtheBSIonlineshop:www.bsigroup.com/ShoporbycontactingBSICustomerServicesforhardcopiesonlyTel:02089969001e-mail:[email protected].

TheStationeryOfficepublicationsareavailablefromTheStationeryOffice,POBox29,NorwichNR31GNTel:08706005522Fax:08706005533e-mail:[email protected]:www.tso.co.uk(Theyarealsoavailablefrombookshops.)StatutoryInstrumentscanbeviewedfreeofchargeatwww.opsi.gov.uk.

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