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For the NEBOSH International General Certificate (IG) – October 2018 specification

Element – 5 Physical and Psychological Health

 Noise
 Vibration
 Radiation
 Mental ill health
 Violence at work
 Substance abuse at work


Element-5: Physical and Psychological Health


5.1 Noise ……………………………………………………………………………………………………………….. 3

5.2 Vibration…………………………………………………………………………………………………………… 12

5.3 Radiation…………………………………………………………………………………………………………… 20

5.4 Mental Health……………………………………………………………………………………………………. 27

5.5 Violence at Work……………………………………………………………………………………………….. 34

5.6 Substance abuse at work………………………….……………………………………………………….. 37

It is very important to keep the workplace safe and rid of various unsafe practices and substances. However, it is
very difficult to maintain such an environment. If it is not possible to eliminate such conditions, at least efforts
must be undertaken to create awareness among workers about the causes, symptoms, effects and control
measures so that ill-health effects can be minimized.

There are various such agents that can cause serious effects on human body while at work which may lead to
long lasting damages on the health, both physically and mentally. Physical occupational hazards are well known
over very long period and now recent focus has been to develop low risk methodologies and innovative tools and
workplace environments. Physical hazards lead to psychological stress which ultimately can affect the health
throughout one’s life.

5.1 Noise
Noise is an unwanted acoustic phenomenon. Worldwide
noise is the major cause of all industrial pollutants. Noise
is unavoidable in all workplaces. There are many sources
like tools and machinery that generate noise. Depending
on the power required to run these machinery, the noise
generated also will be varying. Hence noise is the major
cause of hearing loss in workplaces. Before going into
details on how hearing damages take place, one should
know something about the hearing process.

Hearing depends upon how sound waves convert into electrical signals. Our ear consists of various tiny hair cells,
nerves and muscles that take care of the hearing process. Of these, the auditory nerves play an effective role in
hearing through a complex series of steps.

Within the cochlea, the sound is transmitted to a fluid causing it to vibrate. The motion of the fluid induces a
membrane to vibrate which, in turn, causes hair cells attached to the membrane to bend. The movement of the
hair cells causes a minute electrical impulse to be transmitted to the brain along the auditory nerve. Those hairs
nearest to the middle ear respond to high frequency, while those at the tip of the cochlea respond to lower

There are about 30 000 hair cells within the ear and noise-induced hearing loss causes irreversible damage to
these hair cells.

Sound is transmitted through the air by sound waves which are produced by vibrating objects. The vibrations
cause a pressure wave which can be detected through a speaker or human ear. The ear may detect vibrations
which vary from 20 to 20,000 Hz per second. Noise normally describes loud, sudden, harsh or irritating sounds.

 Sound waves enter the outer ear and travel through a narrow passageway called the ear canal or external
auditory canal, which leads to the eardrum.

 Eardrum vibrates from the incoming sound waves and sends these vibrations to three tiny bones in the
middle ear.
 The bones in the middle ear couple the sound vibrations from the air to fluid vibrations in the cochlea,
shaped like a snail in the inner ear, filled with fluid.
 Once the vibrations cause the fluid inside the cochlea to ripple, a traveling wave forms along the tiny hair
cells on basilar membrane which are highly sensitive.
 An electric signal is then formed on the auditory nerve which sends signals to the brain that translates
into a sound wave which we recognize and understand.

Depending upon the noise level generated and the period one is exposed to in such workplace environments, the
severity of the damage caused to the ears also take place. Most Noise Induced Hearing Loss is caused by the
damage and ultimate death of these hair cells. These human hair cells do not grow and damaged forever causing
irreparable effect on the human ear. Nearly 16% of the hearing loss reported is due to occupational noise.
Occupational noise can lead to traumatic acoustic injury and also noise induced hearing loss. In many countries,
noise induced hearing loss is one of the severe occupational hazard and is the resultant effect of long term
exposure to high levels of noise in the workplace that may lead to temporary hearing loss or permanent hearing
loss which may occur gradually or even years later. Major health effects due to noise pollution are lack of
concentration, irritation, fatigue, headache, insomnia etc. Ultimately such symptoms if continued for a long time
can lead to both physical and mental stress.

Physical and Psychological effects of exposure to noise

Noise can lead to ear damage on a temporary (acute) or permanent (chronic) basis.

There are three principal acute effects:

Temporary threshold shift – caused by short excessive noise exposures and affects the cochlea by reducing the
flow of nerve impulses to the brain. The result is a slight deafness, which is reversible when the noise is removed

Tinnitus – is a ringing in the ears caused by an intense and sustained high noise level. It is caused by the over-
stimulation of the hair cells. The ringing sensation continues for up to 24 hours after the noise has ceased

Acute acoustic trauma – caused by a very loud noise such as an explosion. It affects either the eardrum or the
bones in the middle ear and is usually reversible. Severe explosive sounds can permanently damage the eardrum.

Occupational noise can also lead to one of the following three chronic hearing effects:

Noise-induced hearing loss – results from permanent damage to the cochlea hair cells. It affects the ability to
hear speech clearly but the ability to hear is not lost completely

Permanent threshold shift – this results from prolonged exposure to loud noise and is irreversible due to the
permanent reduction in nerve impulses to the brain. This shift is most marked at the 4000 Hz frequency, which
can lead to difficulty in hearing certain consonants and some female voices;

Tinnitus – is the same as the acute form but becomes permanent. It is a very unpleasant condition, which can
develop without warning.

Anatomy of human ear


• Sound pressure or acoustic pressure: The local pressure deviation from the ambient (average or
equilibrium) atmospheric pressure caused by a sound wave. In air, sound pressure can be measured using
a microphone and in water with a hydrophone. The unit of sound pressure is Pascal in the international
system of units (SI) and is equal to 1 Newton per Sq. Metre whereas 1 Newton is equal to 0.22480 lbs

• Decibel (dB): The unit used to measure the intensity of sound

• Frequency: The SI unit of audio frequency is the Hertz (Hz). It is the property of sound that determines
pitch. The generally accepted standard range of audible frequencies for humans is 20 to 20,000 Hz.

• A-weighting – dB(A): The expression of relative loudness of sound in air and perceived by human ears

• C-weighting – dB(C): The expression of noise measurement scale for impulse noise levels or Peak Sound
Pressure Level noise e.g. Single Loud Bang

• Daily Personal Noise Dose: Daily Personal Exposure Level of any worker working in noisy environment
and measured over a 8 hour exposure period

When exposure should be assessed

The employer shall administer a continuing, effective hearing conservation program, whenever employee noise
exposures equal or exceed an 8-hour time-weighted average sound level (TWA) of 85 decibels measured on the A
scale (slow response) or, equivalently, a dose of fifty percent. The employer shall establish and maintain an
audiometric testing program by making audiometric testing available to all employees whose exposures equal or
exceed an 8-hour time-weighted average of 85 decibels.

Comparison of measurements to exposure limits

The table provides an insight into the noise levels on some of actions that human beings are exposed to.

Some Noise Levels

Equipment/Noise Generation Source Noise Generated (dB)

Gunshot 150
Plane Take off 140
Pneumatic Drill 130
Chainsaw 120
Football Crowd 110
Electric Drill 100
Heavy Road Traffic 90
Hand Saw 85
Busy Street 70
Normal Conversation 60
Average Noise 50
Quiet Conversation 40

Standards and Regulations in Practice

Lot of concerns was raised on workplace noise generations and which has led to many incidents of noise induced
hearing loss while in occupation and has led to the introduction of following UK regulations.

NOISE AT WORK REGULATION ACT 1989and then revised and released in 2005 as
NOISE AT WORK REGULATIONS ACT 2005. These regulations require the employer to:

 Assess noise levels and keep records

 Reduce noise exposures to workers by using engineering controls first and resort to personal
hearing protection equipment as a last resort
 Provide information and training to employees to make them aware of the hazards and its
 Manufacturers and suppliers of equipment should provide with noise data

As per Regulation 6 of the above act the following guidelines are fixed.

1. The lower exposure action levels are:

(a) a daily or weekly personal noise exposure of80 dB(A)

(b) a peak sound pressure of 135 dB(C)

2. The upper exposure action levels are:

(a) a daily or weekly personal noise exposure of85 dB(A)

(b) a peak sound pressure of 137 dB(C)

3. The exposure limit values are:

(a) a daily or weekly personal noise exposure of87 dB(A)

(b) a peak sound pressure of 140 dB(C).

THE NOISE POLLUTION (REGULATION AND CONTROL) RULES, 2000. Central Pollution Control Board of India has
published a rule book in the Gazette of India, vide S.O. 123(E), dated 14.2.2000.In this rule book they have
divided all areas in 4 different zones and decided limits for noise level in respective zones.

(a) Industrial area: 75dBA (Day time) and 70dBA (Night time)

(b) Commercial area: 65dBA (Day time) and 55dBA (Night time)

(c) Residential area: 55dBA (Day time) and 45dBA (Night time)

(d) Silence Zone: 50dBA (Day time) and 40dBA (Night time)

Note: - 1. Day time shall mean from 6.00 a.m. to 10.00 p.m.

Night time shall mean from 10.00 p.m. to 6.00 a.m.

Silence zone is an area comprising not less than 100 metres around hospitals, educational institutions, courts,
religious places or any other area which is declared as such by the competent authority

dBA (A- weighted decibel)is unit of noise.

There are different noise limits for vehicles as well depending upon the capacity of their engines.

 75dBA for two wheelers less than 80cc engines

 77dBA for two wheelers less than 80cc-175cc engines
 75dBA for two wheelers more than 175cc engines
 74dBA for cars(less than 9 seater)
 80dBA for heavy vehicles.

These are the standard noise limits which have been accepted by Government of India.

Noise Standards is ISO 1999, Acoustics: Determination of Occupational Noise Exposure and Estimate of Noise
Induced Hearing Impairment (ISO 1990)is another widely used standard as per ILO.

HSE Guideline document L 108 gives detailed guidance on noise assessments.

As the noise levels of many activities shown above are beyond the normal permissible levels, it can lead to health
effects and hearing impairment. Hence corrective actions shall be put in place to prevent hearing damages.

Control Measures and Mitigation Requirements

As we have seen earlier that sound waves travel through air and reaches the human ear. This implies that there is
a source of noise generation which can be any machinery, tools, speakers, vehicles or any similar likes. Then
there has to be a pathway through which sound travels and finally it reaches its destination i.e. the receiver.
These three elements decide how noise can be controlled. Noise not only needs a straight travel path but it can
also reach the receiver after reflecting through any wall or structure. The following schematic demonstrates the
travel of sound from the source of noise generation to the receiver.

Having experienced various hearing disorders which can further lead to physical and psychological stress on
workers, various modes of protection measures are in place to control noise at workstations. Also, the
regulations and standards cited previously mandate the employers to introduce mitigation processes as per the
hierarchy of control measures. The management of Health and Safety regulations also stipulates non-
employment of anyone aged below 18 years to the organizations and specifically not to be exposed to works near
noise generating equipment. Even though reducing the exposure time in and near noisy environments and
machinery, the following hierarchy shall be considered as other protection techniques.

Reduction of Noise at Source

Reduction of Noise Level Received

by the Employee (Attennuation)


Reduction of Noise at Source:

There are number of ways by which the noise at the point of generation can be reduced. In most of the work
locations, the noise generating machineries are placed at a distance and away from the normal walkways or
office premises. Some of such methods are as given below:

 Change the process or equipment that generate unwanted noise

 Change the speed of the machine
 Improve the maintenance of machinery with regular lubrication of bearings, tightening of belts

Reduction of Noise Levels as received by employees (Attenuation):

Some common methods of attenuating or reducing the noise levels are summarized below.

Relocation of equipment: Changing the location of noisy equipment away from areas of workers.

Provision of Enclosures: The equipment can be surrounded by installing suitable enclosures with sound proof
insulating materials which can reduce sound levels.

Screens or absorption walls: This measure can be used very effectively where sound is reflected from walls. In
such cases, walls of the rooms or halls can be lined with sound absorbent materials viz. foam or mineral wool, or
sound absorbent (acoustic) screens placed around the walls or equipment so that the noise generated from such
equipment will not be heard outside. (e.g. movie halls, casinos, dance clubs, auditoriums etc.)

Damping: Damping is a process of noise attenuation by installing certain compounds, materials etc on the areas
where noise is generated. These materials can be damping compounds which can be pasted in between layers of
wall or floor materials or floor mountings like spring dampers placed or installed on structures or installations to
reduce the noise and vibrations through the structures, wall panels and flooring or it can be even be layers of
sound absorbing sheets or mattresses.

Lagging: Lagging is a process of insulating exterior surfaces of pipes or fluid containers or equipments to reduce
noise levels which incidentally can prevent heat loss also. Typical materials include open cell polyurethane foam,
cellular melamine, fibre glass, fluffy fabrics and certain other porous materials. These materials vary in thickness
and shape different noise absorption ratings depending upon specific sound ratings.

Silencers: These are normally fitted to engines on their exhaust outlets. Common example is that of power
generator exhaust, motor vehicles are fitted with silencers and these reduce the noise level considerably.
Silencers consist of noise absorbent materials or baffles.

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Isolation of Workers: Workers’ health is very important and hence the employers have a primary responsibility
for ensuring safe working conditions in their work locations. It should be ensured that machinery, equipment and
other tools that generate noise should be installed away from the workmen. The workrooms, rest room for
workers, eateries etc. shall be located away to prevent exposure to excessive noise level. A power station control
room is an example of worker isolation.

Personal Ear Protection: The provision of personal hearing protection should only be considered as a last resort.
There is usually resistance from the workforce to use them and they are costly to maintain and replace. They
interfere with communications, particularly alarm systems, and they can present hygiene problems.

The following factors should be considered when selecting personal ear protection:

 Suitability for the range of sound levels to be encountered

 Noise reduction (attenuation) offered by the ear protection
 Pattern of the noise exposure
 Acceptability and comfort of the wearer, particularly if there are medical problems
 Durability
 Hygiene considerations
 Compatibility with other personal protective equipment
 Ease of communication and able to hear warning alarms
 Maintenance and Storage arrangements
 Cost

There are two main types of ear protection – earplugs and ear defenders (earmuffs).

Ear Plug
Ear Defenders (Ear Muffs)
 Sound absorbent material  Better reduction of sound frequencies
 Fit into the ear  Generally more acceptable to workers
 Reusable or Disposable  More comfortable to wear and use
 Can be easily used by all  Easily visible to others
 Can be easily used with other PPEs  Less effective if wearer has long hair or wearing
 Effectiveness depends on the quality and spectacles or helmets or face shields
period of usage  Uncomfortable in warm conditions
 To be replaced at intervals  Maintenance is important
 May become loose with time  Checks should include wear and tear as well as
 Can only be detected on personal inspection general cleanliness

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Health Surveillance

The Control of Noise at Work Regulations place a duty on the employer to undertake health surveillance for
employees whose exposure regularly exceeds the upper action level irrespective of whether ear protection was

The recommended health surveillance is a hearing test at induction, followed by an annual check and review of
hearing levels. The checks may be extended to every three years if no adverse effects are found during earlier
tests. If exposure continues over a long period, health surveillance of employees is recommended using a more
substantial audiometric test. This will indicate whether there has been any deterioration in hearing ability.

Where exposure is between the lower and upper exposure action levels or occasionally above the upper action
values, health surveillance will only be required if information becomes available, perhaps from medical records,
that the employee is particularly sensitive to noise-induced hearing loss. All documents shall be kept with the
employer for such medical tests.

5.2 Vibration


Vibration is a mechanical phenomenon where

oscillations take place around an equilibrium point.
These oscillations or a force can be through holding
equipment and machinery that generate vibration or it
can be through equipment during operation. It is no
secret that all power driven equipment, due to its high
speed, are sources of vibration. When the workmen
work on such machinery, the vibration gets transmitted
through the hand or through any other parts of the
body which has direct contact with the source.

Some of the equipment that generate vibration are high power grinding machines, tile cutting machines, jack
hammer operation during road cutting or repair works, working with plate compactors or jumping compactors,
heavy duty excavators, rock breakers, operation of road rollers, driving long time on tractors or trailers.

Many workers do not think that their exposure to vibration could be health hazard. Constant exposure to
vibration can cause serious health problems such as:

 Back pain
 Carpel tunnel syndrome
 Vascular disorders
 Hands Arm Vibration Syndrome
 Vibration White Finger
 Muscle Weakening
 Joint Damage

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Vibration related injury is normally seen in occupations that require outdoor work, such as forestry, farming,
transportation and construction.

Effects on the body due to Vibration

The primary health effects due to carrying out work activities with hand-held powered tools or machinery is
Hands Arm Vibration Syndrome (HAVS) and that due to involvement of whole body is called Whole Body
Vibration Syndrome (WBVS).

Hands Arm Vibration Syndrome (HAVS)

Hand Arm Vibration Syndrome results from long term

exposure to vibration and can lead to a disease called
Vibration White Finger (VWF).The early symptoms are
tingling and numbness felt in the fingers, usually sometime
after the end of the working shift. As exposure continues,
the tips of the fingers go white and then the whole hand
may become affected. This results in a loss of grip strength
and manual dexterity. Normally during cold weather or
conditions, ‘pins and needles’ are experienced.

If the condition is allowed to persist, more serious symptoms become apparent including discoloration and
enlargement of the fingers. In very advanced cases, gangrene can develop leading to the amputation of the
affected hand or finger. VWF was first detailed as an industrial disease in 1911.The risk of developing HAVS
depends on the frequency of vibration, the length of exposure and the tightness of the grip on the machine or tool.
Hence the most appropriate treatment will be to totally avoid working with such tools.

Carpel Tunnel Syndrome

Carpel Tunnel Syndrome is a nerve disorder which

may involve pain, tingling, numbness and weakness
in parts of hand, mainly in the wrist and the main
cause can be due to activities involving vibration.

Whole Body Vibration (WBV)

Whole Body Vibration is caused from vibration from

equipment into the body either through the feet of
standing workers or the buttocks of sitting workers.
The most common ill-health affect is severe back
pain which, in severe cases, may result in
permanent injury.

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Other acute affects include reduced visual and manual control, increased heart rate and blood pressure. Chronic
or long-term effects include permanent spinal damage, damage to the central nervous system, hearing loss and
circulatory and digestive problems.

The most common occupations which cause WBV are driving fork lift trucks, construction vehicles and tractors
for agricultural or horticultural purposes and such vehicles. There is growing concern throughout the European
Union about this problem. Control measures include the proper use of the equipment including correct
adjustments of air or hydraulic pressures, seating and, in the case of vehicles, correct suspension, tyre pressures
and appropriate speeds to suit the terrain. Other control measures include the selection of suitable equipment
with low vibration characteristics, work rotation, good maintenance and fault reporting procedures.

Vascular Disorders

Vascular disease is a class of diseases that can happen to the blood vessels. Disorders in the very vast network of
blood vessels can cause a variety of health problems which can be severe or sometimes even fatal, if not checked


1. The Control of Vibration at Work Regulations 2005 Guidance on Regulations L140 for HAV

2. The Control of Vibration at Work Regulations 2005 Guidance on Regulations L141 for WBV

When Exposure should be assessed

A guide line on exposure limit for HAV is given below and if it exceeds, risk assessments shall be done and actions
taken to reduce the risk.

1. Standard IS0 5349:1986 for HAV

2. Standard IS0 2631:1997 for WBV

Comparison to Standards of Exposure Limits

Daily exposure 2.5 m/s² hand-arm vibration

Action value = 0.5 m/s² whole-body vibration

Daily exposure 5.0 m/s² hand-arm vibration

Limit value = 1.15 m/s² whole-body vibration

Preventive and Precautionary Measures

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The common measures used to control ergonomic ill-health effects due to vibration are:

 Results of task analysis and identification of repetitive actions

 The elimination of vibrating or hazardous tasks by performing the job in a different way is always
 Introduce job rotation so that workers have a reduced time exposure to the hazard
 During the design of the job ensure that poor posture is avoided
 Undertake a risk assessment
 Reports from employees and safety representatives to be addressed
 Ill-health reports and absence records
 Introduce a programme of health surveillance
 Ensure that employees are given adequate information on the hazards and develop a suitable
training programme
 Ensure that a programme of preventative maintenance is introduced and include the regular
inspection of items such as vibration isolation mountings,
 Keep up-to-date with advice from equipment manufacturers, trade associations and health and
safety sources (more and more low vibration equipment is becoming available).

Noise and Vibration are generally interconnected. Like in Noise generation, vibration is also caused by a
generating source; there is a pathway, a receiver and exposure time. These factors determine the control
measures to be adopted to reduce the hazards of vibration on human body.

Basic Vibration Control Measures

Basic vibration control measures mainly depend upon the following.

Key Information
 Eliminate the source – completely
remove the vibration source, by Control measures for vibration:
mechanizing the use of tools using a
concrete breaker mounted on an  Eliminate the source
excavator arm rather than hand-  Substitute the source
operated or changing work methods  Changing work techniques
by automation process  Maintenance

 Substitute the source – Change the vibration source with less vibration source using a low-vibration
magnitude model

 Changing work techniques – change the ways of doing the work that produce less vibration e.g.
cutting holes in masonry using a diamond tipped drill rather than a tungsten hammer drill

 Maintenance – machinery often produces vibration should be maintained appropriately and should
be kept sharp. Hence a maintenance regime shall be developed by the organization and carry out the
inspection and maintenance as per schedule. Keep a record of what has been inspected, any
replacement done and when is the next inspection due. A tag need to be placed on the equipment.

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Interrupt the pathway from source to receiver

Vibration is transmitted through solid materials by direct contact e.g. from the two-stroke of a chainsaw, to the
chassis supporting the motor, handles and hands

Isolation involves separating vibrating parts from the user’ s hands using anti-vibration mountings which breaks
transmission pathway
E.g. the suspension of a seat in a vehicle cab is isolating the driver from vehicle vibration

Limit the duration of exposure

 Duration and magnitude – Limit the duration of exposure by calculating how long a worker should
use tool, before they approach a relevant action or limit value. Suitable administrative procedures
shall be introduced to adhere to limit the exposures to vibration and strict monitoring shall be done.
 Work schedules and rest periods – e.g. through job rotation and rest periods so that vibration
exposure is shared between several workers with no one worker receiving above the relevant action
or limit value
 Personal Protective Equipment – Gloves to prevent from cold and wet hands prone to injury from
vibration and symptoms are likely to be experienced.

Protective and Control Measures for Hand Arm Vibration

 Avoid, whenever possible, the need for vibration equipment

 Undertake a risk assessment which includes a soundly based estimate of the employees’
exposure to vibration
 Develop a good maintenance regime for tools and machinery and implement to keep tools in
good condition.
 Introduce a work pattern that reduces the time exposure to vibration
 Issue employees with gloves and warm clothing as warm clothing helps with blood circulation
which reduces the risk of vibration white finger.
 Introduce a reporting system for employees to record and investigate.
 Substitute the equipment that generate vibration with some mechanized form of working
 Provide anti vibration mountings on equipment and machinery to reduce effects of vibration
 Introduce job rotation to employees who carry out high risk activities that induce vibration
 Provide proper awareness and training to workers about the hazards and risks associated with
vibration and any symptoms should be immediately reported and suitable action be taken.

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Anti vibration plate Anti vibration bearing Anti vibration mounting Anti vibration spring with nut

Protective and Control measures for Whole Body Vibration

Whole-body vibration in industry is caused mainly due to driving and operating heavy vehicles, such as tractors or
fork lift trucks or road rollers or rock breakers or excavators, over rough terrain or uneven surfaces. It is highly
unlikely that driving vehicles on smooth roads will produce WBV problems. The most common health problem
associated with WBV is back pain and this will further aggravate if the employee has already pain caused by other

The reasons for back pain in drivers include:

 Poor posture while driving

 Incorrect adjustment of driver’s seat
 Difficulty in reaching all relevant controls due to poor design of control units
 Frequent manual handling of loads
 Frequent climbing up and down from high vehicles

Corrective actions to mitigate the risks from WBV

Driver’s seat is correctly adjusted so that all controls can be reached easily and that the driver seat is placed
properly above the suspension and correctly adjusted.

 The driver seat should have a back rest with lumbar support
 Use anti-fatigue mats if the operator has to stand and operate for long periods
 Speed is one of the main causes of whole body vibration and hence speed regulators shall be in place to
prevent excessive breaking
 All vehicle controls and attached equipment are operated smoothly
 Use only designated roadways and follow traffic regulations
 Use only suitable vehicles and equipment for the work and manage the ground conditions
 Site roads shall be regularly maintained
 Proper maintenance schedule shall be maintained and undertaken for all vehicles and equipment with
particular attention being paid to tyre condition and pressures, vehicles suspension systems and the
driver’s seat
 Avoid long periods of exposure and drivers and operators get sufficient breaks in between
 Vulnerable personnel shall not be allocated with work duties that may cause whole body vibration

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 Employers shall carry out proper risk assessments and maintain ill-health reporting system
 Proper training and awareness shall be given to drivers and operators about health effects of whole body
vibration and hence to carry out works and avoid/reduce excessive vibration

Personal Protective Equipment:

Hand Arm Vibration: The following PPE can be used to prevent/reduce hand arm vibration during work activities.

 Anti vibration gloves

 Vibration Monitoring Devices
 Vibration Alarm Devices

Anti Vibration gloves Vibration Monitoring and Alarm Devices

PPEs as mentioned above shall be provided to the employees to keep the effects of vibration to the minimum.
Vibration absorbing gloves as per standards shall be procured and provided to employees. Similarly, vibration
measuring monitors also shall be arranged for employees so that they can monitor the level of exposure and
inform the supervisors.

Since vibration is linked with noise, noise attenuators like ear defenders and ear plugs also shall be provided.

Health Surveillance

Health surveillance is a process in which employees are subjected to medical checks to determine their health
condition. As construction projects and work locations are complex in nature with many activities that are
hazardous in nature, a record of employees’ health records shall be maintained by the employer. These health
monitoring can be on prefixed dates or schedule or when the employees complain about some ill-health after
their induction on to the work.

Depending upon the works executed and hazardous nature of works, qualified medical professional can carry out
such medical health check-ups. Any specialized treatments recommended by doctors shall be extended to the
employees by employer to keep the workers healthy. Any ill-health observed on the employees shall be reported

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to the management and periodical reviews shall be carried out. The health monitoring system can be in the form
of a questionnaire which may be agreed upon with the employees or their representative.

International Labor Organization (ILO) recommends on health surveillance include the following:

• Pre-employment medical examination

• Examine the worker periodically

• Examine the worker for symptoms of possible neurological effects of vibration such as numbness, pain…

• Increased awareness on sitting posture

• Rotate the workers for short intervals

• Reduce exposure time of workers involved with machinery and equipment that may generate vibration

5.3 Radiation
Radiation is the emission or transmission of energy in the form of waves or
particles through space or through a material medium. The above figure is the
International symbol for types and levels of radiation that are unsafe for
unshielded humans. Radiation in general exists throughout nature, such as in
light, sound and even ground.

This includes:

 Electromagnetic radiation such as radio waves, micro waves, infrared, visible light, ultraviolet, x-rays and
gamma radiation (ϒ)
 Particle radiation such as alpha radiation (α), beta radiation (β) and neutron radiation
 Acoustic radiation such as ultrasound, sound and seismic waves

Types of Radiation

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Radiation is basically categorized into Ionizing Radiation and Non ionizing Radiation.

Ionising Radiation

Ionizing Radiation is emitted from radioactive materials, in the form of alpha particles, beta particles and Gamma
Rays. Ionising radiation has high energy potential and ability to penetrate body tissues and organs. The word
“ionize” refers to the breaking of one or more electrons away from an atom and this action requires relatively
high energies than electromagnetic waves supply.

Alpha particles have little power to penetrate the skin and can be stopped using very thin material, such as
paper. It is not that harmful to the human body and its main route of entry into the body is by ingestion. It is used
in Smoke Detectors and in medical laboratories.

Beta particles are high speed electrons whose power of penetration depends upon their speed. But it does not
penetrate too deep into the body and its route of entry to the body is through inhalation and ingestion. It can be
stopped with an aluminium or brass foil. It is mainly used in sterilization purposes and also in thickness gauges.

X-rays are produced by bombarding a metal target with electrons at very high speed using high voltage electrical
discharge equipment.

Gamma rays which are similar to X-rays have greater penetrating power and more harmful than alpha or beta
particles. Gamma rays are mainly used in industrial radiography e.g. pipelines

Neutrons are released by nuclear fission and not normally found in manufacturing processes. It is normally found
in Nuclear Power Plants.

Radon Gas: Ionising radiations can also occur naturally and the best example is Radon which is a radioactive gas
and found in the foothills of Devon and Cornwall, U.K., where there is presence of Uranium. Radon gas enters the
buildings through cracks in the floorings or substructures or around service inlets or outlets.

Ionising radiation occurs naturally as well from man-made processes and about 87% of all radiation exposure is
from natural resources. The principal workplaces where ionising radiation is present are the nuclear industry,
medical centres, hospitals and research centres. Radioactive processes are used for the treatment of cancers and
radioactive isotopes are used for many different types of scientific research and industrial weld quality detection
purposes. X-rays are used extensively in hospitals, but they are also used in industry for Non Destructive Testing
(e.g. crack detection in welds). Smoke detectors, used in most workplaces, also use ionizing radiations.

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Harmful Effects of Radiation

Ionising radiation attacks the cells of the body by producing chemical changes in the DNA by ionizing which leads
to abnormal cell growth. The effects of ionizing depend on the following factors:

 Size or strength of the dose – the higher the dose then the more serious will be the effect
 Area or extent of the exposure of the body – the effects may be far less severe if only a part of the body
(e.g. an arm) receives the dose
 Duration of the exposure – a long exposure to a low dose is likely to be less harmful than a short
exposure to the same quantity of radiation.

Acute exposure can cause, dependent on the size of the dose, radiation sickness, blood cell changes, nausea,
vomiting, diarrhea, skin burns and blistering, hair loss, dermatitis, cataract, reduced immune system, infertility,
collapse and death. If the radiation dose is larger, the risk will be greater.

Chronic exposure can lead to anemia, leukemia, dermatitis, genetic mutation and other forms of cancer. It is also
known that ionising radiation can have an adverse effect on the function of human reproductive organs and
processes. Increases in the cases of sterility, stillbirths and deformed foetus have also been observed.

Personal radiation exposure can be measured using a film badge, which is worn by the employee over a fixed
time interval. The badge contains a photographic film which, after the time interval, is developed and an estimate
of radiation exposure is made.

Type Features Health Effects Occupational Uses

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Alpha Stopped by thin materials Outside body – Not Smoke Detectors,
Particles like paper, skin.. particularly hazardous Medical Lab
Inhalation or ingestion Inside body – Very hazardous
Beta Can penetrate skin and living Inside and outside body - Sterilisation, Thickness
Particles tissues hazardous gauges

X Rays Can be generated and Inside and outside body – very Medical Radiography,
switched off – High hazardous Baggage Security
Penetrating Power Scanning

Gamma Very Penetrating Inside body – Very hazardous Industrial Radiography

Ray - Pipelines

Neutrons Emitted by Radioactive Outside body very hazardous Nuclear Power

sources Stations
Very High Penetration

Radon Naturally occurring in Devon, Outside body – Not

Gas Derbyshire, Cornhill, UK particularly hazardous
Radioactive gas Inside body – Hazardous
Alpha Particles Inhalation/Ingestion

Non Ionising Radiation

Non ionizing radiation includes ultraviolet, visible light, infrared and microwave radiations. Visible light includes
lasers as well. Energy present is too low to ionize atoms. The action of non ionizing radiation is to heat cells rather
than change their chemical composition.

Arc Eye or welders’ eye is caused by

prolonged exposure to ultra violet rays
caused by arc welding. Eyes can be contacted
by a form of conjunctivitis. Cataracts caused
due to ultraviolet rays will be another issue
to be sorted out.

Ultraviolet radiation occurs from sunlight and also with electric arc welding. In both cases, skin and eyes are at
risk from effect of burning. The effect on eyes due to ultra violet radiation is called Arc Eye. The skin will burn on
continued exposure and can lead to skin cancer. Skin which gets exposed to sun light shall be protected with
lotions and cream and protective clothing. Many tourists from cold weather countries who often travel to
moderate climate countries often do get exposed to extreme sunlight and they fall victim to skin cancer on
frequent exposure. A good quantity of sunlight gets filtered by ozone layer, but unfortunately the global warming
as well as depletion of ozone layer in the recent times aggravates the issue of non-filtering of sunlight.

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Laser use visible light and light from the invisible wavelength spectrum (infra-red and ultra-violet). LASER stands
for LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION. This light retains concentrated throughout
its travel distance and hence its effect does not get diluted. Lasers have a wide range of applications including bar
code reading in super market checkout or airport check ins, cutting and welding of metals, measurement of
distances and surveys and also used in surgical treatment of cataract and sealing of blood vessels. The main
hazards associated with lasers are eye and skin burns, toxic fumes, electricity and fire.

Infra-red radiation is caused by fires and hot substances and can cause eye and skin damages similar to that by
ultraviolet radiation. People who work in foundry units, glass manufacturing companies, furnace operators and
fire fighters get affected by infrared radiation. Eyes and skin do get affected and hence protection is essential.

Microwaves are used in cookers and mobile telephones. Severity of any hazard is proportional to the period of
exposure as well as the power of microwaves. Main hazard with microwaves is the heating of body cells. Eye lens
are most at risk. Cookers have high risk than compared to low risk devices such as mobile phones.

Types Sources Health Effects

Ultra-violet (UV) Sunlight Skin burns
Arc welding Arc eye (photokeratitis)
Skin cancer
Visible light lasers Temporary blindness

Infra-red (IR) Red hot steel Redness and skin burns,

Glass manufacture retinal burns, cataracts

Microwaves Food preparation Internal heating

Telecommunications Organ damage
Radio waves Radio, TV Internal heating
radar Organ damage

Occupational Sources of Non ionizing and Ionising Radiation

Different fields of occupations like industrial radiography, hospitals, sun etc. all emit different forms of
radioactive rays and causes harmful effects on the human body. They are identified in the below format.

Type of Radiation Different Forms of Radioactive Occupational Source

Ionising Alpha Particles Smoke Detectors, Science Labs
Beta Particles Science Labs, Thickness Gauges
X Rays Medical Hospitals, Baggage Scanners
Gamma Rays Industrial Radiography for

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Pipelines/Structures for non
destructive testing of welds
Neutrons Nuclear Power Stations
Non Ionising UV Sunlight, Arc Welding
Infra Red Red hot steel rolling mill, Glass
Visible light Laser leveling device, Laser Pointer
Microwaves Industrial microwave oven, Mobile
Telecommunication Tower
Radiowaves Radio, TV Antenna

Basic Ways of Controlling Exposure to Radiation

Radiation has hazards and it is essential to control the employees from the effects of radiation. Basically three
factors are critical to be identified and actions taken to reduce the ill-effects of radiation. They are time, distance
and shielding.

Ionising Radiation
Employers have a duty of care to ensure that the employees shall not be exposed to radiation beyond the
permissible exposure time. So protection measure for radiography exposure is a mixture of time of exposure,
distance from the radiography source and the kind of shielding that is provided.

Shielding is the best method because it is an ‘engineered’ solution. It involves the placing of a physical shield,
such as a layer of lead, steel and concrete, between the worker and the radioactive source. The thicker the shield
the more effective it is.

Less Time spent near the radioactive source – less radiation received.

Distance works on the principle that the effect of radiation reduces as the distance between the worker and the
source increases.

Other measures include the following:

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 Emergency procedures including spillages
 Training and awareness to employees
 Eating, drinking and smoking adjacent to exposed areas to be prohibited
 Personnel hygiene and first aid arrangements
 Use of personal protective equipment including full body protection and respiratory protection
 Proper signages and information regarding radiation hazards
 Medical Surveillance of employees
 Job rotation
 Consultation with Radiation Protection Supervisor

Non Ionising Radiation

The non-ionising radiation hazards caused by arc welding are not the only hazards associated with welding
operations. The hazards from fume inhalation, trailing cables and pipes and the manual handling of cylinders are
also present. There have also been serious injuries resulting from explosions and fires during welding processes.
Many of these accidents occur on farms where welding equipment is used to make on-the-spot repairs to
agricultural machinery and also on repairs to vehicles and equipment on the roadside.

Personnel working in salt pans and other farms are exposed to severe sunlight and many people suffer heatstroke
and burns on the body. As sunlight carries ultraviolet rays which cause non iodizing radiation, body protection is
an important protection method.

Radiation Protection Measures

Ultraviolet and Infrared Goggles, Visor, Skin protection clothes in the form of full sleeves, collar,
apron, gloves etc., Barrier or Sun Protection Creams
Laser Operations Engineering Controls such as fixed shielding, use of non-reflecting surfaces
around the workstation. Special eye protection, Risk Assessment
Microwaves Engineering Controls which include enclosure of the microwave system in
a metal surround and an interlocking device that will not allow the system
to operate unless the door is closed

Radiation Protection Strategies

Whatever may be the type of radiation, irrespective of Ionising or Non ionizing radiation, there are certain basic
protection strategies to protect employees from the effects of radiation.

A per any hierarchy of controls, elimination is of top priority.

Radiation exposure should be eliminated, if possible, as far as reasonably practical.

Where it is not possible to eliminate, reduce the exposure to the lowest level reasonably practical.

Employee exposure should not exceed the relevant radiation dosage limit.
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Risk assessment should be carried out by competent person.

Information, Instruction and Training about the harmful effects of radiation must be given to people
who are affected.
Role of Competent Persons

The Ionizing radiations Regulations specify the appointment of a Radiation Protection Supervisor and a Radiation
Protection Advisor.

The Radiation Protection Supervisor must be appointed by the employer to advise on the necessary measures
for compliance with the Regulations and its Approved Code of Practice. The person appointed, who is normally
an employee, must be competent to supervise the arrangements in place and have received relevant training.

The Radiation Protection Adviser is appointed by the employer to give advice to the Radiation Protection
Supervisor and employer on any aspect of working with ionising radiation including the appointment of the
Radiation Protection Supervisor. The Radiation Protection Adviser is often an employee of a national organization
with expertise in ionising radiation. His additional responsibilities include:

 Advise employer on instruments/equipment purchase and calibrations

 Advise any requirements for specific parking/working areas including supervision where possibility of
radiation exist
 Monitoring of workers on dosimetry and violation of radiation level exposure
 Advise management on local rules including changes on environmental permits, risk assessments, control
measures and emergency arrangements
 Provision of trainings and awareness on radiation hazards
 Review radiation safety management systems particularly related to waste management policy and
 Support in the event of emergencies and incidents
 Encourage, initiate and monitor health surveillance systems

Role of Health Surveillance

It is necessary to carry out health surveillance if the workers are exposed to radiation hazards. Worksites have a
wide ranging activities and which requires exposure to radiation. Sometimes this may exceed the dosage limits
which are measured by a dosimeter which require carrying out health surveillance.

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Circumstances that require health surveillance include:

 Worker who has worked as a classified worker earlier (someone who is exposed to radiation
and who has exceeded the dosage over a specified national limit)
 Periodic reviews e.g. annually
 Special surveillance if a dose limit has been exceeded
 After ceasing work as classified worker for special consideration
 Special consider may also be applicable to pregnant women and breast feeding mothers

In health surveillance checks, the following checks are usually done.

 Skin checks to check if there are any lesions in the body through which radioactive materials
can enter the body
 Respiratory checks
 Reference to exposure records to ascertain if the dosage limits have exceeded
 Reference to sickness records to check employee’s general health and sickness rate

5.4 Mental ill-Health


Stress is a major cause of sickness absence in the workplace and costs over £5 billion a year in Great Britain. It
affects individuals, their families and colleagues by impacting on their health but it also impacts on employers
with costs relating to sickness absence, replacement staff, lost production and increased accidents. While it is to
be noted that the costs for treating mental ill-health among workers are mounting high and is difficult to assess,
the perennial stress that their families undergo cannot be estimated even and hence it would be very ideal to
prevent it happening.

Frequency and Extent of Mental Ill-Health

Mental ill-health issues are too common all over in the workplace and is the major cause for absenteeism which
affects the production and thus major revenue. As many as 38% of the British workers fear that their job will be
in jeopardy if it is revealed that they suffer from mental ill-health.

As per World Health Organisation, globally nearly 350 million people of all ages suffer from depression and is the
leading cause for suicide among 15-29 age groups. Such alarming statistics call for awareness to be raised about
depression and anxiety.

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A study conducted in India during 2016-2017 revealed that 42.5% of employees in private sectors suffer from
mental depression because of demanding schedules, high stress levels and performance-linked perks compared
to government employees with lesser levels of psychological demand at work.

Medical experts say that work is the best antidote for depression, increasingly unrealistic demands and pressures
are triggering anxiety and depression. The contributing factors that lead to depression include:

 Fear of job loss, termination, disciplinary action and enquiries

 Financial concerns and huge debts

 Unable to meet expectations, deadlines

 Feelings of failure and unfairness

 Job dissatisfaction, unhappy with job location (homesickness),

no clear job profile

 Harassment (sexual and non-sexual)

 Fatigue due to excessive burnout

 Sleep deprivation

If the mental ill-health issues are not detected and not addressed, it will affect the morale, performance and
productivity in the organization and ultimately lead to business operations.

Common Symptoms of Workers with Mental Ill-Health

There are various symptoms that points to mental ill-health on workers. But the behavior of the workers need to
be keenly observed and appropriate addressing need to be done to avoid future build up of stress. The most
common symptoms that are noticed on the workers at work locations due to stress can be classified under
Psychological, Physical and Behavioral categories.

Psychological Physical Behavioral

Anxiety Sweating Sleeplessness

Low Esteem Heart Rate Poor Concentration

Depression Blood Pressure Poor Decision making

Skin Rashes Mood Swings

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Muscle Tension Irritability

Head Ache Alcohol Consumption

Dizziness Drug Misuse

Absence from work

Some other common terms linked with mental ill-health or stress is given below.

Depression: Depression is state of low mood and aversion to do any job. It can affect a person’s thoughts,
behavior, motivation, feelings and even sense of well-being. It can further reflect sadness, difficulty in thinking,
concentration, changes in appetite, insomnia and feelings loneliness or dejection including thoughts on suicide.
This can be for short term or long term periods and depends upon correction methodology.

Anxiety/Panic Attacks: A panic attack is a sudden feeling or rush of strong fear or discomfort that is accompanied
by a cluster of physical and cognitive symptoms including heart palpitations, shortness of breath, dizziness,
shivering and fears of losing life, going crazy or losing control of situations. Further symptoms may include feeling
detached, tense muscles, muscle pain, burning skin, pins and needles, numbness and tingling sensations and
feeling shaky.

Post Traumatic Stress Disorder (PTSD): Post traumatic stress disorder ((PTSD) is a mental health condition that is
triggered by a terrifying incident or event, either by experiencing it or witnessing it. Types of events include
serious road accidents, personal assaults such as sexual assault or robbery.

Symptoms of PTSD can have significant impact on one’s day-to-day life. In most cases, symptoms develop during
the first month of the incident or traumatic event itself and in limited cases it may take few months or even years
to appear. The symptoms are generally re-experiencing the event, flash back, nightmare, distressing images,
physical sensations such as pain, sweating, feeling sick or trembling with fear etc.

Causes of Work Related Mental Health

There can be many factors that may lead to work related mental health as stated above. However, as HSE’s
Management Standards, the following six parameters play significant role in causing mental ill-health at work.

 Demands: This includes issues such as workload, work patterns and the work environment at work site. If too
many responsibilities are thrust on the employee minimum power to influence the job output, stress can
develop as one is not able to meet the management commitment or schedule. This will extend to curbing social
hours with very little work breaks, excessive overtime, inadequate welfare facilities or excessive noisy
environment or inadequate lighting etc. There can also be a fear of redundancy due to non performance from
the employee leading work related stress.

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 Control: Management, in some cases, will be over enthusiastic and give unrealistic targets to achieve with
excessive control over employees. Sometimes trainings also may not be imparted to employees leading to
unsafe practices, lack of privacy as well as no job security due to fear of not meeting targets set by
management. Here, the employee has no say in performing their job, but solely has to be heavily dependent on
 Support: If there is adequate encouragement, motivation, sponsorship and resources provided by the
management and other team members, the output will be as per the requirement of management. If there is
lack of management support and encouragement, employees will start feeling isolated which will affect his
productivity. Slowly stress will be creep into the mind of employee leading to mental ill-health.
 Relationships: Management should always promote healthy relationships with all team members to promote
positive working culture. They should ensure to avoid conflict and deal with unacceptable behavior among the
employees which will affect the performance of the employees and organization.
 Role: Management should ensure clarity among the employees about their roles and responsibilities within the
organisation and also ensure that they do not have conflicting roles and reporting. Poorly defined roles can
lead to conflicts between employees and further work related stress. This can also avoid repetitive and
monotonous working.
 Change: Management of change is n important function in the present day management of organizations. Any
changes in the organization should be communicated to employees including change of personnel, relocations,
work changes etc so that employees will be aware of the changes taking place as well getting their minds ready
to accept the changes. Delays or last minute communication causes heavy resentment among the employees
to cope with changes required. They also get sufficient time to mentally prepare for relocation or other
changes. This will avoid unnecessary stresses on employees.

The management should have adequate resources, support and foresight to implement Management Standards.

Controls for Work Related Mental Ill-Health

Work place stress is generally created by all, by both employees and the employer. Hence, it is the responsibility
of all concerned to avoid building risks and focus well on the works. However, the human tendency is to build up
stress and then to overcome the stress is a laborious process. But the management cannot afford to induce or
have employees working with stress in the long run as this will affect the performance of both the individual as
well as the organization itself. So management will have to look for control strategies to prevent as well as reduce
stress in the work locations.

By inducing stress busters, positive and safety working culture can be introduced in the organization. This can be
done through good communication among the employees and engaging the workforce fruitfully to achieve the
goals of the organization. Providing training to employees and implementing the same by effective monitoring
can bring changes in the mindset of employees.

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Some of the control strategies that are commonly adopted are:

• Take Positive Attitude to Stress

• Address Employees Concerns seriously
• Develop a policy on Stress
• Provide Relevant Training
• Employee Appraisal System
• Discourage excessive hours at work
• Introduce job rotation among employees
• Encourage lifestyle changes
• Monitor and correct actions on bullying
• Avoid blame culture
• Provide Welfare Measures
• Employee Consultation and Engagement
• Evolve policies and procedures to support and encourage employees
• Implement Health Surveillance
• Develop effective Employee Appraisal Schemes with Mutually Agreed Objectives
• Avoid Blame Culture
• Set up confidential counseling advice service

Home-Work Interface

Work-life interface is the intersection of work and personal life. Many facts and
situations prompt employers as well as employees to work extended hours or
even socializing late hours which all takes a toll on the family life. Relations may
get strained due to prolonged “working” between the family members and can
lead to unwanted arguments and even separation.

Stress thus realized is due to lack of cooperation or communication or proper understanding between the parties.
In order to avoid such situation, both employer as well as employees should not schedule any work related
activities beyond the normal working hours as well as the week days off so that every employee gets sufficient
time to spend time with their family members. This enhances good relationship and also breaks from otherwise a
very stressful work environment.

Recent research has shown that the work–life interface is becoming increasingly boundaryless especially for
technology-enabled workers. There are also other situations where employees opt for working from home. In
such cases, employers do not look for anything other than getting the output. Here also the interface between
home and work surfaces. Many suffer sleeplessness, irregular food timings causing appetite issues as well as lack

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of concentration and finally productivity. So home-work interface is a serious matter to be considered critically by
both employer as well as employee.

Commuting: Stress can be either biological or psychological terms.

Psychological stress is a relationship between the person and the
environment that is appraised by the person as taxing or exceeding
his or her resources and endangering his or her well-being.
Commuting stress also similar kind of stress results when the
commuter appraises the environment and conditions of commuting
exhausting his or her resources and endangering his or her well-
being. Employers are usually ignorant of the commuting problem.

In developed cities, residing very close to the work location is not probable for all the employees since there will
be limited residential options around workplaces. In the long run, a commuter individual is likely to change job or
to be in search of a new residence. Then the employee chooses to change job in a failure of getting proximity.

Similarly, use of personal vehicles and traveling longer distances in vain generates additional carbon emissions,
driving stress, health issues, and congestions. Long distance commuters experience problems related to the
quality of daily life and health. A study in the United States report that 48 % of working adults reported their job
dissatisfaction as an impact of commuting,32% took commuting into consideration when deciding their current
job. Similarly, 15% of the respondents reported they would change their jobs for a shorter commute.

Relocation: Any changes happening on your daily routine leads to stress.

Moving to different location disrupts the entire family. Various activities
that need to be executed include packing all belongings, transportation
to the new location, finding a reliable movement agency, travel to the
new location including various modes of travel, fixing a residence or
office and so on. It is a long list and until things are settled, employee will
be under stress. Moreover, all these incur additional expenditure and
that is additional burden which are stressful.

Such stress usually stays with employees until they are settled. Further stresses can emerge with the organization
team and with new people one has to deal, until they prove their worth including meeting productivity and
overcoming new challenges. Such types of stresses are temporary and will settle soon.

Employers need to communicate issue of relocation with the employees so that they can plan and schedule all
related matters to reduce the risks associated with stress. Also employees need to adjust with the organizational

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requirement as well as understand the need of the hour to combat subsequent stresses. Good communication
and exchange of views with the family members can tide over the crisis to an extent.

Care of frail (vulnerable) relatives: A caregiver is anyone who provides help to another person in need, such as
an ill spouse or partner, a disabled child or an aging relative. Caregiving is rewarding because one gets the
satisfaction of taking care of the vulnerable person or relative, but it is really a stressful job. Caregiver may feel
angry, frustrated, exhausted, alone or sad and can become vulnerable to changes in their own health.

Some signs or symptoms of caregiver stress are:

 Feeling constantly worried

 Feel tiring often
 Not getting enough sleep
 Gaining or losing weight
 Getting easily irritated or angry
 Lose interests in activities what you used to enjoy earlier
 Feeling sad
 Have frequent headaches, body pain or other physical problems
 Abuse of alcohol or drugs including prescription medicines
 Depression or anxiety
 Cannot eat proper diet or on time

To combat caregiver stress, accept some help or assistance to share with your job responsibilities. Join a support
group or form community members who can share some burden of your stressful job. Make an effort to stay well
connected with support members and be in frequent communication to make all aware of the need in case
needed. Never forget to consult the medical team for any assistance requirement.

Recognise the fact that most mental ill-health people can contribute and get recognized

Mental illness causes a variety of psychological problems. It often turns into a social stigma for both family
members, organization and the individuals. Persons with serious mental sickness often engage in very strange
behaviours that are frightening, troublesome, disruptive and annoying. Many caregivers control or manage or
tolerate such behaviours to maintain calm with sick people.

An analyses of their past behavior and actions, it may be seen that these mental sick victims may have been
harassed, bullied, framed on frivolous charges, accused, abused or even trapped by some team members. These
actions can trigger some symptoms to make such members mentally sick. Rehabilitation centres should be in
place to make these people feel comfortable and bring them back into the organization. It may take considerably
long periods, but sustained training and counseling can change their mindset. The management also should be
open to accept these people and provide with lighter job responsibilities and monitor their performance.

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Sometimes, it may require the assistance of caregivers to be present during their work hours which will provide
boosted confidence on such personnel. Medical attention is of paramount importance to such personnel and the
organisation’s willingness to accept such fragile people will create valuable changes in their lifestyle.

5.5 Violence at Work


Work Related Violence is defined as: “Any incident in which a person is abused, threatened or assaulted in
circumstances relating to their work”

Types of Violence

Different types of violence take place in work place. The most prominent
ones are:

 Physical
 Psychological
 Verbal
 Bullying

Physical Violence – Physical violence is the deliberate use of physical force with the potential for causing harm.
Physical violence includes, but is not limited to scratching or biting, pushing or shoving, or throwing. This is an act
by which a person gets physically abused and assaulted in a work place. Often this is the result of aggressive
verbal exchanges between more than one person or groups of person often related to job. This can result in
injuries, sometimes very severe and can even turn fatal or permanent damage to persons preventing from

Psychological Violence - Psychological abuse is also referred to as psychological violence, emotional abuse, or
mental abuse. It is a form of abuse, characterized by a person subjecting, or exposing, another person to behavior
that may result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder.

Verbal Violence - Verbal violence is most often also labeled verbal abuse. It is a common variety of violence,
which is the result of relatively a large spectrum of behaviors, including: accusing, undermining, verbal
threatening, ordering, constant forgetting, silencing, blaming, name calling, and unnecessary criticizing.

Bullying – It is usually defined as behaviour that is repeated, intended to hurt someone either physically or
emotionally, often aimed at certain groups, for example because of race, religion or gender.
Every year, millions of American workers report having been victims of workplace violence. In 2017 alone,
assaults resulted in 18,400 injuries and 458 fatalities according to Injury Facts. Healthcare industries, service
providers, taxi drivers etc. are some job categories who are more prone to violence than others. But, by and
large, workplace violence happens everywhere and anywhere.

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Violence at work can happen from dissatisfied customers, clients, patients or even from disoriented personnel. It
causes a lot of stress or in some cases injury as well. Many people face verbal and mental abuse from their
coworkers, discrimination, harassment and bullying. Violence of all sorts has risen significantly in recent years.
Violence at work causes a lot of pain, suffering, anxiety and stress leading to financial costs due to absenteeism
and higher insurance premiums to cover increased claims. Different types of Violence are Physical, Psychological,
Bullying and Verbal.

The employer is responsible under health and safety legislation to provide protection to employees at worksite,
as per The Health and Safety at Works Act, Section 2.

Jobs and Activities that increases the risk of violence

Violence can happen at any work locations and is also unpredictable about time of occurrences. However, some
of the few vulnerable works or situations where violence often happens are:

 Reception or customer service points: here the customers could be highly demanding and in some cases
verbal arguments get initiated and result in violence.
 Inspection and Enforcement personnel: people or offices where inspection or enforcement agency
actions are involved, resistance to cooperate can be expected which may lead to verbal abuse.
 Lone Working situations: the most vulnerable situation where no assistance is possible and leading to
physical violence.
 Catering and hospitality: most of the centres work late night to close and last minute customers or even
when these employees return to their residences, chances of attacks are very much present.
 Retail petrol and late night shopping operation centres: petrol outlets operating on day and night
working are bound to be under violence prone situations by robbers and other looters, because of non
availability of helping hands and also that they deal with cash
 Dealing with people under the influence of alcohol and drugs: it is highly difficult to deal with people who
are disoriented or who are under the influence of alcohol and drugs as their thinking capability may not
be proper and poor decisions can land employees in trouble
 Dealing with people under stress: minds of the such people have different thoughts than that of working
and incorrect suggestions and discussions may lead to violence
 Policing and Security: they are people who are wielding power and authority to whom trouble creators
do have a tendency to prompt such people who in turn may react violently
 Mental health units: mentally sick patients are not normal people and caregivers as well as attendants in
the hospital have to be extremely cautious as they may inflict injury for even frivolous reasons
 Manning Prison cells: notorious criminals are kept in prison cells where even the slightest provocation
can lead to altercations, may be due to precarious conditions like overcrowding in each cell or other lack
of amenities in the prisons
 Cash Handling and handling valuable goods: everyone needs cash and fast money is highly attractive,
hence those who are handling cash and valuable goods need to be under security cover as cash can be
robbed and looted

Control Measures to reduce risks from violence

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Any hazards posed in the work location should be controlled. Some of the control measures that can be adopted
for controlling violence at site are the following:

Access Control: Since intruders gain access to enter the office or work locations, access control should be
initiated. There are many modes nowadays viz. electronic swapping system, security personnel to verify the
authenticity of visitors, security coded locks, barriers, provide access passes etc. The organization has to decide
upon the layout of the building so that reception area can be located at convenient position to prevent
unauthorized entry of visitors.

Closed Circuit Television: It is one of the most effective measures that can be adopted to identify the visitors.
Expert advise would be required to decide about coverage requirement especially in large worksite and buildings.
It is an expensive mode, but can trace out the criminals effectively.

Security Alarms: Alarms can be installed in work offices and security gates whereby an intruder’s entry can be
monitored. There are three different types of alarms:

*Intruder Alarms – which monitors unlawful entry particularly after office hours
*Panic Alarms – used in reception or other vulnerable rooms where the member threatened can operate
*Personal Alarms – carried by individual to attract attention and to temporarily distract the attacker

-Improved lighting: Area to be lighted especially in vacant spaces and stairways including emergency lamps

-Mobile phones/ Walkie-Talkies: Quite useful to people working alone so that they can inform authorities
concerned in the event of a threat or attack and regular contact with workers from the base/main work location

-Queue management: Minimise waiting time at reception or other areas so that people’s behavior can be
controlled. Longer the wait, more will be the impatience that sets in the minds of visitors and which can trigger
verbal abuse and subsequent physical threats

-Improved reception and waiting facilities: Visitors can wait in visitors’ lounge when adequate lighting, proper air
circulation and reading materials are provided

-Minimise cash handling: Implement cashless transactions by encouraging to use debit cards or credit cards
instead of cash transactions and employers can directly credit to all workers and other customers to their bank
accounts and keeping the money at locations to minimum

-Safe transport: Provide safe transport and parking arrangements for vehicles to transport workers working
during late hours even though it is strongly advisable to avoid to any extended hours of working

-Assisting to overcome trauma: Organisation should ensure to set up counseling and care to employees who
have been abused or assaulted by providing adequate support to enhance their confidence and morale. Even
though only one might have been subjected to violence, team members also may get affected mentally. Hence
debriefing arrangements or legal assistance and financial assistance shall be extended to overcome such

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-Zero tolerance policy towards violence: Organisations should initiate policy against violence at work locations
inclusive of strict action against such offenses.

-Report all work abuses: Encourage workers to promptly report all abuses happening at work locations and
management has to take appropriate and quick actions against such offenses to improve the morale of the staff.

-Create a pleasant environment: Ensure engaging all workforce and create good working environment including
provision of welfare measures to all at work locations. This can reduce negative working culture and positivity can
be introduced.

5.6 Substance Abuse at Work

Risks to Health and Safety from Substance Abuse at Work

Alcohol or drug abuse is a big menace in work locations and can cause
significant problems to workers at work stations. Persons who are addicted
to alcohol or drugs are very dangerous persons for themselves and others.
Alcohol and drug abuse cause health disorders and absenteeism which
affects productivity and even business reputation. Since majority of the
workmen are involved in driving and will involve driving on public roads,
alcohol consumption is a serious issue to be addressed. Alcohol
consumption can make the person disoriented and increase accidents at
worksite and sometimes even on roads and endanger the public.

Drugs can be prescribed by medical professionals for illness or can be illegal narcotics which when consumed by
personnel give a “heavenly” feeling to those people. It is, in other words, nothing but an intoxicating effect
almost similar to consuming alcohol. The effects of consumption of drugs are also similar, with disorientation,
sensory impairment; perception gets distorted and causes fatigue and losing senses. People who attend works
after consuming drugs are troublesome and cause risks to themselves and fellow colleagues.

Solvents are some organic compounds that can produce effects similar to alcohol or anesthetics when their
vapour is inhaled. These organic compounds generally are carbon based. Some of the most commonly used
solvents are glue, paints, nail polish removers, dry cleaning detergents, degreasing compounds and varnish
materials. Most houses, factories and offices use a wide range of solvents which can be inhaled and people get an
intoxicating effect similar to having consumed alcoholic substances. Such solvents can be directly inhaled or
sniffed and are termed “solvent abuse”.

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Effects of Alcohol, Drugs and Solvent

- Increased absenteeism
- Sensory Impairment
- Skewed perception
- Fatigue and Drowsiness
- Head ache, nausea and vomiting
- Confusion
- Depression
- Irritability
- Unusual or unpredictable behavior
- Slurred speech
- Weight loss
- Poor concentration and stress
- Poor attitude
- Violation of rules
- Violence to fellow workers
- Reduced health and fitness to individuals
- Reduced productivity
- Fraudulence
- Borrowing money from friends
- Petty thefts

Prevention is better than remedial actions after a problem has occurred. Hence control measures should be
made in place by organizations. How to identify and take control of the situation?

Control Measures on Alcohol, Drugs and Solvents

- Alcohol, Drugs and Solvent policy

- Ensure no alcohol or drug are being consumed or keep in possession in worksite
- Proper awareness and training to be given to all employees including induction training
- Communicate through posters, graphics and meetings the ill effects
- Provide counseling service to addicts
- Strict disciplinary action against erring employees
- Monitoring effectiveness of the policy through supervision
- All employees shall be medically checked before induction and subsequently during employment period
- Random tests on employees to be done in during employment to check any alcohol or drug abuse
- Treat the problems in confidence and address the issues suitably
- Rehabilitation arrangements shall be in place to correct employees
- Awareness campaigns shall be organized on the ill effects of alcohol and drugs

It is important to mention here that some drugs prescribed by the medical practitioners do have side effects.
These also can affect performance and sometimes pose risks to fellow workers. Employers should encourage

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workers to inform them of any side effects of such medicines and be prepared to correct or alter for overcoming
the side effects.

The alcohol and drug policy should contain not only about statutory regulations that stipulate restrictions of
holding or consumption or influence of such substances while at work, but also non statutory regulations as
initiated by the organization for safeguarding the health conditions of the employees. The legal and ethical issues
concerning the issues shall be handled carefully and stern fully.

Regulations in UK

- Management of Health and Safety at Works Regulations Act 1999

- Road Traffic Act 1988
- Misuse of Drugs Regulation Act 2001

Possible questions:

1. Outline the physical and psychological effects of exposure to noise

2. Identify the control measures for reducing effect of noise
3. Explain the role of health surveillance in controlling the effect of vibration at work place
4. Identify the sources of radiation
5. Outline how violence at work can be controlled effectively

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