Occupational medical check-ups (legal situation until October 31, 2013)

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Police ordinance on medical berthing examinations in mining of 23 May 1940

The occupational medical check-ups served the early detection or prevention of work-related illnesses or occupational diseases . Every employer is obliged to provide health care to its employees ( Occupational Safety and Health Act ). This also includes preventive occupational health care , which derives professional recommendations from a detailed assessment of the working conditions - for example, the need for preventive medical check-ups.

Laws and regulations

  • Preventive occupational medical examinations in the event of exposure to hazardous substances are required by the Hazardous Substances Ordinance .
  • In the event of potentially dangerous handling of biological agents, the Biological Agents Ordinance prescribes appropriate preventive examinations. In the area of ​​genetic engineering, the genetic engineering safety ordinance applies accordingly .
  • The prevention of noise-related illnesses, in particular noise-induced hearing loss, as well as illnesses caused by whole-body or hand-arm vibrations, are subject to the regulations of the Noise and Vibration Occupational Safety and Health Ordinance .
  • The Ordinance on Occupational Health Care (ArbMedVV) regulates in detail the risks for which occupational health check-ups are to be carried out or offered.
  • For preventive examinations in the event of exposure to ionizing radiation, the provisions of the X-ray Ordinance (Section 37 "Requirement for preventive occupational medicine") and the Radiation Protection Ordinance (Section 60 requirement for preventive occupational medicine) apply .
  • Preventive occupational medical examinations for medical professions are laid down in the accident prevention regulations of the employers' liability insurance association for health and welfare.

Compulsory, offer, request and aptitude tests

  • There are compulsory examinations for a number of work-related stresses : the employer must arrange preventive examinations for these activities. Without the availability of a harmless test result, he may not employ the employee in a workplace where he is exposed to the relevant stress (e.g. by hazardous substances).
  • For other activities, the ArbMedVV stipulates that the employer must offer the employees preventive medical check-ups. Participation is voluntary for employees, however, and a doctor's certificate is not a prerequisite for the activity ( "offer examinations " ).
  • In addition, according to the Occupational Safety and Health Act, employees must be given the opportunity to be examined by a specialist with regard to health hazards at work - regardless of whether there are special regulations for this or not: This is called "requested examinations" (ArbMedVV) or often from general occupational medical check-ups.
  • In addition to examinations for the prevention or early detection of health disorders, there are those that determine the suitability for certain activities. is detected. This should also minimize the risk to work colleagues, third parties or essential property - for example during driving or steering activities.

Initial, follow-up and follow-up examinations

In principle, an initial examination must be carried out before commencing a hazardous activity. Follow-up examinations should take place during the hazardous activity in accordance with the investigation principles. In the case of an activity with carcinogenic substances, follow-up examinations should also take place after the end of the hazardous activity up to the age of seventy-fifth.

Investigation principles

Over the years, the statutory accident insurance carriers , in particular the trade associations (BGen), have issued a series of recommendations that are intended to formulate minimum standards for special examinations and reflect the current state of science. The determination of the scope of the examination always remains the responsibility of the doctor, who is therefore required to have a special professional qualification. These recommendations are published under the title of the employer's liability insurance association principles for preventive medical check- ups. In this publication they are designated with the letter “G” and a sequential number. The principles previously published by the Main Association of Commercial Employers' Liability Insurance Associations (HVBG) also apply to public bodies after the merger with the accident insurance funds to form the German Statutory Accident Insurance (DGUV). Other, additional studies such as the "H principles" will continue to be published by the Agriculture BG. Not all G-principles are represented in the ArbMedVV. The following also applies: The BG principles are a scientific standard and must be observed, however, deviations from them may be made for medically justified reasons. In the case of principles based on state guidelines (such as G 31), this may be the case. a. for forensic reasons, however, not advisable.

Quality requirements

Most occupational medical examinations let the employer must of academically especially qualified doctors perform, that is, specialists for occupational medicine or otherwise sufficiently trained physicians with the additional designation industrial medicine . Examinations that are exclusively regulated by BG law may also be carried out by other doctors authorized by the BG.

The German Society for Occupational Medicine and Environmental Medicine e. V. has issued guidelines that offer good reference points for appropriate occupational medicine based on the current state of knowledge.

Selection criteria

The decision as to which preventive medical check-ups are to be carried out or at least offered to employees always requires a careful, professional assessment of the working conditions (so-called risk assessment ). A first orientation besides providing ArbMedVV by the professional associations published selection criteria for occupational medical examinations (BGI 504-0 -General partial) and the selection criteria for the special occupational health care (BGI 504-xx).

Personal knowledge of the workplaces and processes is essential for the examining doctor. For this reason, the employer should the priority according ASiG ordered occupational physician an order for the checkups.

General investigation rules

The check-ups usually include

  1. the inspection or knowledge of the workplace by the doctor,
  2. the occupational medical questioning and examination of the employee,
  3. assessing the state of health of employees taking into account the workplace conditions,
  4. individual occupational medical advice and
  5. the documentation of the test results.

Biomonitoring is part of the preventive medical examinations provided that recognized procedures and values ​​for assessment, in particular biological limit values , are available.

In the case of preventive medical examinations

  1. record the examination results in writing,
  2. to inform the employee about the examination results,
  3. to issue a certificate to the employee stating whether and to what extent there are health concerns against the performance of the activity and
  4. to hand over a copy of the certificate of the examination results to the employer a
    ) if it is a "compulsory examination " (cf. ArbMedVV ) or
    b) if this has been previously agreed in the company (e.g. in the case of aptitude tests for driving, control and monitoring activities or breathing apparatus wearer)

Medical confidentiality

As with any medical examination, all findings and information are subject to medical confidentiality. The communication of the results to the employer has to be limited to the statement whether there are health concerns (possibly limited) or not, or whether certain conditions have to be observed during the activity.

If the examined person prohibits the disclosure of this medical certificate, the doctor must limit himself to informing the entrepreneur that the examination has taken place.

If ( in the case of aptitude tests ) the protection of work colleagues or third parties or of essential property must be taken into account, the doctor must weigh up legal interests. He is authorized to reveal if the legal interest to be protected is to be granted the higher rank.

When it comes to health aspects of the person being examined, the right to self-determination goes so far that the person being examined does not need to be protected from harm against his will, provided that he is sufficiently aware of the possible consequences of an unchanged continuation of the activity been instructed.

The investigations

designation regulation purpose Assessment criteria Standards
Acrylonitrile, alkyl mercury, aromatic nitro and amino compounds, arsenic / compounds, asbestos, benzene, beryllium, lead / compounds, cadmium / compounds, chromium VI compounds, dimethylformamide, fluorine / compounds, glycerol trinitrate / glycol dinitrate, hardwood dust, Carbon disulfide, carbon monoxide, flour dust, methanol, nickel / compounds, polycyclic aromatic hydrocarbons, white phosphorus, platinum compounds, mercury / compounds, hydrogen sulfide, silicogens and other dusts, styrene, tetrachloroethane, toluene, trichloroethene, vinyl chloride, xylene ArbMedVV prevention Biomonitoring , early detection of damage. Investigation and assessment are based on the hazardous substance or mixture various BG principles
n- hexane, n- heptane, 2-butanone, 2-hexanone, ethanol, 2-methoxyethanol, dichloromethane, 1,1,1-trichloroethane, trichloroethene, tetrachloroethene ArbMedVV prevention Biomonitoring , early detection of damage. Investigation and assessment are based on the hazardous substance or mixture. various BG principles
Wet work ArbMedVV prevention Examination of the skin G 24
welding ArbMedVV prevention Lungs, airways, X-rays, possibly biomonitoring G 39
Grain / feed dust ArbMedVV prevention Lungs, respiratory tract, X-rays, possibly allergological examination G 23, H 6
Laboratory animal dust ArbMedVV prevention Lungs, respiratory tract, X-rays, possibly allergological examination G 23
Isocyanates ArbMedVV prevention Lungs, respiratory tract, X-rays, possibly laboratory values G 27
Natural rubber latex gloves ArbMedVV prevention Skin, lungs, respiratory tract, possibly allergological examination G 23, 24
uncured epoxy resins ArbMedVV prevention Skin, lungs, respiratory tract, possibly allergological examination G 23, 24
Pest control, fumigation ArbMedVV Suitability, prevention, wearing respiratory protection Smell, color perception, skin, lungs, respiratory tract, cardiovascular system, possibly laboratory TRGS 512, 513, 522, 523
G 26, H 2, possibly G 40
Carcinogenic or mutagenic substances or preparations ArbMedVV prevention Biomonitoring , early detection of damage G 4, 40, 44
noise ArbMedVV prevention Early detection of hearing damage G 20, H 1
Whole body and hand-arm vibrations ArbMedVV prevention Early detection of spinal or joint damage or circulatory disorders Leaflets for medical examinations.
Cold work ArbMedVV Prevention, fitness Heart / circulation, respiratory organs, skin, nervous system, joints, kidneys, exclusion of addictive diseases, possibly laboratory values, etc. G 21
Acid damage to teeth not applicable prevention Teeth, gums, oral cavity G 22
Obstructive respiratory diseases due to allergens, chemical-irritative or toxic substances not applicable prevention Lungs, respiratory tract, possibly X-rays, possibly allergological diagnostics, etc. G 23
Skin diseases (with the exception of skin cancer) ArbMedVV prevention Examination of the skin, possibly dermatological-allergological diagnostics G 24
Driving, controlling and monitoring activities Work instructions, inland navigation patent ordinance, Rheinschifferpatentverordnung etc. fitness Heart / circulatory system, nervous system, psyche, taking medication, excluding addictions, vision and hearing, laboratory values ​​(urine, possibly blood tests), a perimetric test is required for industrial trucks G 25
Respirators ArbMedVV Prevention, fitness Performance or resilience of the heart, circulation and breathing. Nervous system, psyche, taking medication, excluding addictions, vision and hearing, possibly x-rays, possibly laboratory values ​​and other parameters. The scope of the examination and the assessment depend on the type of breathing apparatus (groups 1–3) and the exposure to use G 26
Heat work ArbMedVV Prevention, fitness Performance or resilience of the heart, circulation. Internal organs, eyes, nervous system, psyche, taking medication, excluding addictions, possibly x-rays, possibly laboratory values ​​and other parameters G 30
Overpressure Compressed Air Ordinance Prevention, fitness Performance or resilience of the heart, circulation and respiratory organs. Internal organs, eyes, ears, nervous system, psyche, taking medication, excluding addictions, laboratory values, possibly X-rays and other parameters G 31, officially authorized doctors
Work abroad under particular climatic and health stresses ArbMedVV Prevention, fitness Information about special climatic and health loads at the place of use. Malaria and vaccination prophylaxis. Early detection of diseases. Laboratory values, also with regard to infectious diseases. Heart, circulation, internal organs, skin, eyes, ears, nervous system, psyche, taking medication, excluding addictive diseases, possibly x-rays, other parameters, possibly supplementary tropical medicine examinations G 35
Screen work ArbMedVV prevention Visual acuity (distance, proximity, workplace-related), two-eye visual functions, central field of vision, possibly color sense. Musculoskeletal system, nervous system, etc. a. G 37
Working with a risk of falling Operational work instructions Prevention, fitness Performance or resilience of the heart, circulation. Balance functions, eyesight and hearing, internal organs, nervous system, psyche, taking medication, excluding addictive diseases, laboratory values, possibly other parameters G 41
Activities with a risk of infection ArbMedVV Prevention, fitness Early detection of illnesses, taking medication, immune and vaccination status, laboratory values, vaccination, possibly other parameters. Examination and assessment are based on the biological agent or pathogen. G 42
biotechnology Genetic Engineering
Safety Ordinance		 prevention Early detection of illnesses, taking medication, immune and vaccination status, laboratory values, vaccination, possibly other parameters. Examination and assessment are based on the biological agent or pathogen. TRBA 310
G 43
Stresses on the muscular and skeletal system ArbMedVV, Lastenhandhabungs-
Regulation 		prevention Early detection of diseases, the musculoskeletal system, nervous system, blood circulation, joints, if necessary laboratory values, if necessary other parameters G 46
Pesticides UVV of the agricultural BGs Prevention, wearing respiratory protection Early detection of diseases, skin, internal organs, reproduction, nervous system, psyche, laboratory values, possibly other parameters H 2
Working in the forest UVV of the agricultural BGs Prevention, fitness Early detection of diseases. Performance or resilience of the heart, circulation and breathing. Balance functions, eyesight and hearing, internal organs, nervous system, psyche, taking medication, excluding addictions, laboratory values, possibly X-rays and other parameters H 8, GUV-I 8520
Tree work UVV of the agricultural BGs Prevention, fitness Early detection of diseases. Performance or resilience of the heart, circulation and breathing. Balance functions, eyesight and hearing, internal organs, nervous system, psyche, taking medication, excluding addictions, laboratory values, possibly X-rays and other parameters H 9
Working in composting plants UVV of the agricultural BGs, ArbMedVV Prevention, fitness Early detection of diseases. Lungs, respiratory tract, immune system, skin, X-rays, laboratory values, other parameters if necessary H 10
Occupational radiation exposure or X-ray exposure Radiation Protection Ordinance , X-ray Ordinance prevention Early detection of damage. Investigation and assessment depend on the type of exposure. officially authorized doctors

See also

literature

Web links

Individual evidence

  1. ↑ Accident Prevention Regulation (DGUV Regulation 1 Principles of Prevention) Version dated October 1, 2014, accessed on March 2, 2020