All construction employees require an occupational medical certificate of fitness from August 2015. Occupational health nurses may perform the medicals.
Conrad Pienaar asked; The Construction Regulations 2014 require medical certificatesfor all on site, by an Occupational Health Nurse Practitioner registered with the SANC, with an additional qualification in Occupational Health; or by an Occupational Health Practitioner, which is a doctor with an additional occupational health qualification, and registered with HPCSA as OHP.
Could an Occupational Health Nurse Practitioner who is registered with SASOHN for Audiometry, and qualified for Spirometry, perform these medicals, including physical assessment?
Should the organisation or company employing an OH Nurse also be registered somewhere, if they use a mobile unit? The mobile unit has medical equipment and an audio booth which is calibrated as required.
Occupational medical certificate law
Steam Sheq legal consultant Shavanya Subramoney answers; The new Regulations require that an occupational health practitioner, either a specialist doctor, OR an occupational health nurse, perform and sign occupational medicals.
The definition of an Occupational Health Practitioner in the OHS Act is; “an occupational medicine practitioner [a specialist doctor]; OR a person who holds a qualification in occupational health recognised as such by the South African Medical and Dental Council [Health Professions Council SA]; OR the South African Nursing Council (SANC) as referred to in the Nursing Act.”
The Construction Regulations form in Annexure 3 provides for an OH nurse to sign medical certificates. In consideration of the above, a nurse with a qualification in occupational health may also perform the relevant medical examination.
However, check the requirements of the relevant medical body. There may be rules relating to how long the person should be practicing before they may perform certain functions.
About mobile units, there is no requirement in the OHS Act or the National Health Act, but the HPCSA may shed more light on the laboratory equipment aspect. -Shavanya Subramoney.
Occupational medical certificate changes on 6 August
Karin Meyer of the SASOHN Construction Portfolio responded; The Construction Regulations Amendment of February 2014 requires the certificate of fitness to be in a specific format, as per Annexure 3 of the Regulation.
It can now be signed by an Occupational Medical Practitioner, or an Occupational Nursing Practitioner.
An Occupational nursing practitioner is a Professional Nurse with an additional qualification in Occupational health nursing, that is registered with the South African Nursing Council.
If you check the Nursing Council receipt of the OH Nurse, it must state that she is registered for Occupational Health Nursing.
There was an exemption issued for construction that started before 7 February 2014, to still comply with the old Construction Regulations until 6 August 2015.
Construction started after 7 February 2014 has to comply with the new Regulations. Your clients therefore need to let you know if they are working under the old or new Regulations. That will determine who may do the medicals. -SASOHN.
Occupational Health Medical practitioners, doctors registered with SASOHM, do not agree with the nursing body (see http://www.sasom.org/component/content/article/30-general/164-sasom-position-on-medical-certificates-of-fitness-issued-by-occupational-medicine-practitioners)
Health Act defines practitioners
Consulting body Nioccsa executive member Rudy Maritz replied; The National Health Act defines health care practitioners.
The Health Professions Act in Section 17 provides for non-HPCSA registered health care practitioners to perform examinations, diagnosis, and prescribe medicines, provided it is done in terms of another Act, such as the Nursing Act.
The OHS Act defines an Occupational Health practitioner as a person registered with the HPCSA OR the Nursing council. The regulations up to 2015 contradicted this definition by reference to the HPCSA only.
Regarding the amended Nursing Act, only certain sections were promulgated in 2008. The old sections thus still stand, perhaps leaving some issues unresolved.
Regarding medica companies, professional registration applies to individuals. The only employers that may be required to register under the OHS Act are lifting equipment trainers, lifts and escalator testers, electrical contractors, diving operators, and approved inspection authorities (AIAs) for asbestos and a few specific functions. -Rudy Maritz.
• Shavanya Subramoney is an attorney of the High Court of SA, and a Sheq legal consultant.
• This post refers to some of the relevant legislation listed below. It is not a legal register, and does not constitute legal advice.
• Sources: SANC. Conrad Pienaar. SASOHN. Rudy Maritz.
• Below follow some attachments to supplement the context of the questions and answers above.
Occupational health legal context
Occupational Health and Safety Act, 85 of 1993
Compensation for Occupational Injuries and Diseases Act, 130 of 1995
Basic Conditions of Employment Act, 75 of 1997
Labour Relations Act, 66 of 1995
Mine Health and Safety Act, 29 of 1996
Occupational Diseases in Mines and Works Act, 78 of 1973
National Health Act, 61 of 2003
Nursing Act, 33 of 2005
Employment Equity Act, 55 of 1998
Medicines and Related Substances Act, 101 of 1965 (as amended)
Road Traffic Act, 93 of 1996
Occupational medical test context
Assessment of medical fitness to work impacts directly on health and safety risk, and has to take industrial, site, and job factors and assessments into account.
Employers have to assess occupational health stressors such as heat, noise, dust, ergonomics, and shift hours; as well as requirements such as visual acquity, colour perception, hearing, lung function, and other health factors.
Occupational health practitioners use site and job information from employers, from employees, from medical history, and from direct examinations. Among theior functions are patient confidentiality and record-keeping.
Nursing competencies context
The South African Nursing Council, under the provisions of the Nursing Act of 2005 (firstname.lastname@example.org web: www.sanc.co.za or 012 420 1000) circulated this memo in 2013;
COMPETENCIES FOR OCCUPATIONAL HEALTH NURSE SPECIALIST (OHN)
1. OCCUPATIONAL HEALTH NURSING
Occupational Health Nursing (OHN) is a specialist field that provides for and delivers health and safety programmes and services to workers and worker populations in their place of employment. It focuses on the promotion and restoration of health, the prevention of illness and injury and the protection from work-related and environmental hazards.
OHNs have a sound knowledge and understanding of the risk to which each worker and homogenous worker populations are exposed. Their healthcare expertise is combined with their knowledge of business, which enables them to balance the requirements for a safe and a healthy work environment and the interests of the employees with that of the employer.
As an integral part of the occupational health team, the Occupational Health Nurse focuses on the direct care of healthcare users, as well as assessing and managing common ailments facing the working adult. Their further focus is on programmes aimed at preventing occupational illnesses and injuries, managing disability, assessing and preventing risks, providing consultation with employers and employees as well as providing worker education and training.
These focus areas all derive from the overall aims of occupational health, namely creating a healthy and safe working environment and a functional working community; preventing work-related diseases and accidents; and promoting the working ability of individuals and work populations.
Occupational Health Nursing derives its theoretical and conceptual framework from a multidisciplinary base which, amongst others, includes:
 nursing science;
 medical science;
 public health sciences such as epidemiology and environmental health;
 occupational health sciences such as toxicology, safety, industrial hygiene and ergonomics;
 social and behavioural sciences; and
 business management and administration principles.
The plan highlights the following strategic objectives:
 Mapping current situations at national level and the readiness to take action;
 Promoting and supporting the development of a preventive safety and health culture;
 Improving the occupational safety and health conditions in small and medium-sizedenterprises as well as in the informal economy; and
 Overcoming shortcomings in the implementation of ratified protocols and conventions.
2. CONTEXT (WORK SETTING)
The premise of Occupational Health Nursing is the International Labour Organisation’s (ILO) Plan of Action which supports, amongst others, the efforts of the World Health Organisation (WHO) to attain a reduction in the unacceptable levels of human suffering and economic losses caused by work-related accidents and illnesses worldwide.
The Occupational Health Nurse, as part of the occupational healthcare team, is therefore found in work environments that subscribe to the above objectives.
The OHN therefore focuses on the relationship between work, the work environment and the worker’s health with an aim of improving, protecting and restoring the health of the worker, thereby influencing the health of the organisation.
The focus is on the individual worker/employee, groups of employees and the organisation as a whole.
Central to the OHN’s job is the ability to make a judgement call about the worker’s suitability to work, based on his health status.
The onsite healthcare facility is the first point of entry into the healthcare system. For vulnerable groups of workers, such as construction workers and temporary employees, this may be the only access to a healthcare service. At this point theOHN has to make a determination if causation of a disease or illness is occupational in nature.
This will allow for the correct referral within the healthcare service for effective healthcare management. Such referrals may be to a family practitioner, community health nurse or various levels of care facilities, depending on the seriousness of the injury or illness.
3. OVERLAPS AND COMMONALITIES WITH OTHER SPECIALISATIONS
Commonalities with other specialisations, such as the Community Health Nurse, are found threading through all the domains and subdomains of the framework, but the application and the knowledge base associated with these are different.
The OHN’s training of the epidemiology of occupational diseases creates an understanding of how causation of the disease may call for a different approach to healthcare and management of the same condition.
The OHN has to look at how the disease causation may be related to work exposure and how its management may necessitate an intervention like job relocation.
Unlike a Community Health Nurse or a Primary Care Nurse, the Occupational Health Nurse will need to understand how the work environment contributes to or exacerbate the illness as well as how the treatment may influence the worker’s ability to safely perform his duties.
The specific competencies are tabulated in; “Competencies – Occupational Health Nurse Specialist: April 2013,” -SA Nursing Council.
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