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METHODS AND TOOLS IN PUBLIC HEALTH

A Handbook for Teachers, Researchers and Health Professionals

Title Workplace Risk Assessment (WRA)

Module: ECTS (suggested): 0,5

Author(s), degrees,

institution(s)

Elisaveta Stikova, MD, PhD, Professor

National Public Health Institute, Faculty of Medicine,

University “Ss. Cyril and Methodius”, Skopje, R. Macedonia

Neda Milevska-Kostova, MSc, MCPPM, Program Director

Centre for Regional Policy Research and Cooperation

“Studiorum”, Skopje, R. Macedonia

Petar Bulat, MD, PhD, Professor

University of Belgrade, School of Medicine, Occupational

Health Department, Belgrade, Serbia

Doncho Donev, MD, PhD, Professor

Institute of Social Medicine, Institutes, Faculty of Medicine,

University “Ss Cyril and Methodius”, Skopje, R. Macedonia

Address for

Correspondence

Elisaveta Stikova, MD, PhD, Professor

Faculty of Medicine, University “Ss. Cyril and Methodius”,

Skopje, R. Macedonia

50 divizija 6, 1000 Skopje, R. Macedonia

Tel: +389 70 230 183

e-mail: estikova@ukim.edu.mk or estikova@gmail.com

Keywords Workplace, risk assessment, risk analysisis, risk

management

Learning objectives After completing this module students and public health

professionals should be able to:

understand and define the terms risk, risk analysis - risk

assessment, risk communication and risk management;

understand the concept and elements of workplace risk

assessment;

understand the team work for workplace risk assessment;

perform workplace risk assessment using elaborated

techniques.

Abstract Workplace risk assessment is a new approach in the

traditionally oriented occupational health, practiced to date in

the SEE countries. Current techniques for recognising and

managing occupational safety and health risks were mainly

oriented and defined as “workplace analysis” and they lack a

risk management and risk quantification component. This

module introduces a modern approach to risk quantification

that incorporates recent scientific and legal advances in

occupational safety and health, consistent with the

Framework Directive 89/391/EEC, the ILO conventions and

other relevant binding documents that are part of the

International and EU regulations. Teaching methods In the introductory lecture the students will be introduced

with the concept of risk assessment at the workplace, with

special focus on the four key steps of the risk assessment:

hazard identification, exposure assessment, dose-response

assessment and risk characterization. The theoretical

knowledge will be supported by a presentation of a case

study.

After the theoretical lecture, the students will be required to

assess the risk at a given workplace, while referring to the

recommended readings. The findings will be presented and

shared with other students in the class.

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Specific recommendations

for teachers ECTS: 0,5;

work under teacher supervision/individual students’ work

proportion: 30%/70%;

facilities: lecture room;

equipment: LCD projection equipment, flip chart;

training materials: recommended readings and

matrices/chart tables;

target audience: undergraduate and master degree students

according to the Bologna process.

Assessment of students Multiple choice questionnaire, seminar paper, oral exam.

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WORKPLACE RISK ASSESSMENT (WRA) Elisaveta Stikova, Neda Milevska-Kostova, Petar Bulat, Doncho Donev

THEORETICAL BACKGROUND

Introduction – Workplace risks

According to the estimations of the International Labour Organization (ILO), every year there are

approximately 2.2 million deaths, or on average 6,000 die every day as a result of work-related accidents or

diseases. Also, every year, there are about 270 million reported injuries at the workplace that lead to absences

from work for 3 days or more, and about 160 million incidents of work-related disease, as a result of exposure

to hazardous physical, chemical or biological agents, as well as improper working conditions. About 30-40%

of them become chronic and irreversible conditions, and 10% lead to complete and permanent loss of working

ability (1,2,3).

Hazardous substances kill about 438,000 workers annually, and 10% of all skin cancers are estimated

to be attributable to workplace exposure to hazardous substances. There are more than 150 registered physical

and chemical agents, classified as occupational cancerogens, and to which about 20-30% of the male and 5-

20% of the female professionally active population are exposed (4).

Occupational malignant diseases are cause of about 146,000 deaths or 1,4 million disability adjusted

life years (DALYs). Occupational exposure is cause of death for 10% of all cases of malignant diseases of the

lungs, bronchi and trachea, and to 24% of all cases of leukaemia. Asbestos alone claims about 100,000 deaths

every year and the figure is rising annually. Although global production of asbestos has fallen since the 1970s,

increasing numbers of workers are now dying from past exposure to asbestos dust (5).

Another occupational disease, silicosis - a fatal lung disease caused by exposure to silica dust – still

affects tens of millions of workers around the world.

There are 35 million health workers in the world. Significant occupational risk for them represents

the percutaneous injury with sharp objects with which they work, such as needles, scalpels, peans, etc. The

analyses show that every year nearly 3 million injuries at work are registered, where health professionals have

come in contact with contaminated blood. In 2 million of the cases, they have been exposed to Hepatitis B, in

0,9 million of the cases with Hepatitis C, and in 170,000 cases they have been exposed to the HIV virus. As a

consequence, every year, there are 85,000 cases of professionally contracted infectious diseases in the health

professionals’ community (6).

The analysis of the influence of the professional exposure in the total burden of disease shows that 5 -

18% of all cases of asthma and 14% of cases of Chronic Obstructive Pulmonary Disease (COPD) are related

to work. Every year, 234,000 deaths are reported due to COPD with occupational ethiology, which represents

0.4% of the total number of deaths from this cause. This is related to 3 million disability adjusted life years

(DALYs).

Occupational exposure to noise is a cause for hearing loss of 16% of those that have hearing

impairment. In the total burden of disease, the professionally acquired deafness accounts for 0.3% or 4.2

millions of DALYs (7).

Although these figures represent basis for serious concern, the problem is additionally aggravated, if

we take into account the large number of occupational diseases that remain undiagnosed or unaccounted for.

The direct costs for diagnosis, treatment and rehabilitation of the work-related injuries and

occupational diseases represent a significant burden to the healthcare system. The indirect costs related to the

absence from work, loss of working ability or decreased productivity represents a further burden to the

national budgets of each country.

Occupational safety and health is one of the European Union's most important social policy areas: every

three and a half minutes, somebody in the EU dies from work-related causes; this means almost 167,000 deaths a

year as a result of either work-related accidents (7500) or occupational diseases (159,500).

According to European Statistics on Accidents at Work (ESAW), about 4 million accidents at work

resulting in more than three days off work occurred in EU-15 in 2004. If accidents causing no absence from

work or an absence of up to 3 days are added, the estimated total number rises to more than 7 million every year.

It means that every four-and-a-half seconds, a worker in the EU is involved in an accident that causes three or

more days absence from work (8,9).

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According to the data from the European Agency for Safety and Health at Work (EU-OSHA),

occupational diseases and work-related injuries that are consequence of improperly organized system for

protection at work cost each country between 2.6-3.8% of GDP.

In the EU about 1 250 million working days are lost each year due to health problems in general. Within

the structure by causes (Fig. 1) about 210 million days are lost due to accidents at work and 340 million due to

work-related diseases (10,11).

Figure 1. Causes for the sickness absence in EU

The consequences of accidents at work and of work-related ill health are multiple and complex. The total costs

of accidents at work and work-related ill health are not equally divided between the different players. The total

labour costs attributable to accidents at work in EU-15 in the year 2000 were estimated at around 48 billion

euros. Other costs were estimated at around 6.6 bilion euros (12).

Thus, the safety and health of workers represents not only a legal requirement and obligation, but also

substantial need for improvement of the productivity and economic progress of each country. At the same

time, that means a possibility for establishing a balance between the economic interest, productivity and the

health and working ability of the working population. The occupational safety and health is economically

oriented category, which is aimed at protection of the interests of the workers, companies, health insurance

companies, health workers, and finally of the country and European community as a whole (13).

Workers’ safety and health is protected in Europe by an approach based on assessing and managing

the risk. In order to carry out effective workplace risk assessement, all those involved require a clear

understanding of the legal context, the roles of the main actors involved in the process, as well as the concepts

and the process of assessing the risk (14, 15).

Legal Context and the role of the main players The legal context of the risk assessment is set out in the EU Framework directive and other related so-called

sisters’ directives (16).

All European Union countries have legislation that set out measures to protect worker safety and health

in order to improve quality in safety and security in the workplace. These laws are based on European Directives

that lay down minimum obligations for employers and workers, covering the prevention of all types of risks and

each activity or sector where risks exist. This legislation is in place to protect workers against occupational

accidents and diseases and to assist in the prevention of occupational hazards (17).

Employers have a general duty to ensure the occupational safety and health in every aspect related to

work and carry out a risk assessment. The EU framework directive highlights the key role played by risk

assessment and sets out basic provision and measures that must be followed by every employer.

Every employer is responsible for taking the appropriate measures such as ensuring the availability of

sufficient resources, carrying out a risk assessment, preventing occupational risk, informing, training and

consulting workers.

The employer has a duty to:

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Organise risk assessment

Select the person (s) to carry out risk assessment and ensure they are competent

Assess the risk and implement protective measures

Consult the employees or their representatives about the organisation of the risk assessment

Ensure all affected workers are informed of any hazard and any harm to which they may be

at risk and the all protective measures taken to prevent such harm.

The employer has a duty and responsibility to make a final decision and to designate the people who

carry out risk assessment. They can be:

The employer

Employees designated by the employer

External assessor and/or services if there is a lack of competent person within the company

(16).

Among the most important characteristics of designated or nominated person/company should be

competence. They don’t need to be occupational safety or health experts, but they should demonstrate their

competencies. They should have competencies to understand the general approach to the risk assessment and

capabilities to apply this understanding, knowledge and skills to the workplace. But, they should have ability to

identify the situations that overwhelmed their competencies in terms to ask for proper help and further assistance

.They should demonstrate their competencies by showing they would be able to:

Identify safety and health problems,

Assess and prioritise the need for action,

Suggest options available to eliminate or minimise risk,

Evaluate their effectiveness and

Promote safety and health good practices.

The last but not the least point in the risk’s chain are workers and their representatives. They have a

right to be consulted for organisation of the risk assessment, to participate in the risk assessment, to alert the

designated person for perceived risk and to be informed about the risk on the work place and their safety and

health.

What is risk? According to WHO (1993) risk represents a likelihood of an occurrence of hazardous event and the likelihood of

an occurence of injury or damage to the health of people caused by this event. Risk is a combination of the

likelihood of an occurrence of a hazardous event and the severity of injuries or damage to the health of people

that might be caused by this event.

Thus, the term professional risk embeds the probability of occurrence of negative effects on the

workers' health and life, as a result of presence of certain hazards at work or exposure of the workers to

hazardous agents in the working environment (17, 18).

Occupational risk is expected frequency of occurrence of occupational diseases and work-related

injuries or death, that are consequential to the exposure to different hazardous events or substances, and physical,

chemical or biological factors of the working environment. A risk is a chance, higher or low, that somebody may

be harmed by the hazard. A hazard can be anything –work materials, equipment, work methods or practices that

have potential to cause harm.

Bearing in mind that it is practically impossible to eliminate the probability of occurrence of hazardous

agents in the working environment, it is clear that the risk is always present. From expert point of view, it is

inevitable to assess the actual and real level of risk, and furthermore important – to define the acceptable levels

of risk (19).

Acceptable risk level means that the likelihood of occurrence of hazardous health effects can

justifiably be considered as insignificant, and that the occurring effects are so minimal that can not be further

minimized, neither through increased regulatory mechanisms nor through further investment for risk elimination.

Usually, acceptable risk level is agreed between all participants in the decision-making process –

scientists, public health professionals, policy makers, administrative and legislative structures.

Risk analysis is a process that enables insight into the correlation between the exposure, dose and

effects from one side, and the measures for mitigation and elimination of the risk and the ways of informing the

stakeholders.

Risk analysis consists of 3 consecutive and interrelated processes, i.e. procedures:

risk assessment,

risk management and

risk communication.

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Phases of risk analysis and interrelatedness of its segments are presented in the Figure 2 below.

Figure 2. Interrelatedness of the phases of risk analysis

The starting key point in the risk analysis is the risk assessment. Risk assessment is quantitive measure

of the likelihood of occurrence of hazardous health effects as a result of existing hazards at the workplace

(20,21).

Workplace risk assessment is the process of evaluating risk to workers’ safety and health from

occupational hazards. It is a systematic examination and evaluation of all aspects of work that consider:

What could cause injury or harm,

Whether the hazards could be eliminated, and if not

What preventive or protective measures are, or should be, in place to minimise and control the

risk.

Workplace risk assessment means quantification of the likehood of an occurrence of hazardous event at

the workplace and related negative effects (injuries at work or work related diseases)

Next phase in the risk analysis process is the risk management. The risk management represents

assessment of the successfulness of the preventive and mitigation measures (22).

Risk management includes the following activities:

control of the decision made during the risk assessment,

determination of the acceptable risk level,

implementation of mitigation (corrective) measures and

monitoring of the management.

Risk management is a process in which direct responsibility falls with those that participate in the

decision-making process and creating policies for safety and health – from the level in the company where the

risk assessment is made to the highest national structures (15). The elements for decision making are taken from

the scientific research and expert opinions, standards and good practices established on national or international

level (23, 24).

Risk communication represents interactive exchange of information and opinions/forecasts related to

the confirmed risk. The information is exchanged between those that participate in the risk assessment and risk

evaluation, those that manage the risk and those responsible for making the decisions related to the whole

process (25).

Information obtained through monitoring of the working environment in the process of health

professional risk assessment are combined with the information from other sources, such as epidemiological

studies for the impact of a certain professional exposure, referent values for the maximum allowed

concentrations in the workplace, etc.

The strategy for risk communication should be determined, established and agreed at the beginning of

each risk analysis. That should be a continuous process in which at first, the stakeholders as well as key

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responsible persons and methods of communication are identified. At the same time, the most appropriate ways

of communication should be defined. The most often used ways of risk communication are:

public gatherings,

technical and expert meetings,

written and published documents,

written and published results of related research and

establishment of website.

Risk communication represents a legal obligation for the employers to inform the employees about the

identified and confirmed level of risk to which they are exposed during their work as well as about the measures

and procedures that they, both employer and employees, have to comply with in order to achieve successful risk

management.

The interrelatedness of the processes and activities of risk analysis and risk assessment, as well as risk

management are shown on the Figure 2.

What is risk assessment? As already shown, the starting and key point of the risk analysis is the risk assessment.

Risk assessment is an important step in the overall process for protecting the workers and business as

well as complying with the low. It should be focused on the level of risk with potential to cause harm (17, 26). In

addition, risk assessment is quantitive measure of the likelihood of occurrence of hazardous health effects as a

result of existing hazards at the workplace.

Risk assessment is based on the quantification of the probability that the hazardous event will occur

during the working process and on the assessment of the severity of the hazardous effects that those events will

have on the health of the exposed workers (27). Risk assessment represents obligation of the employers, and has

the aim to enable them to:

make easier identification of the dangers and hazards at the workplace,

determine measures for occupational safety and health,,

check the efficiency of the measures undertaken and

manifest responsibility in front of the authorities and workers in undertaking necessary preventive

measures.

Risk assessment consists of several groups of consecutive activities (Figure 3) that have to be

undertaken in the proper order, in magnitude and timeframe that are consistent with the determined objectives

(28,29). Those are:

hazard identification,

exposure assessment,

dose-response assessment, and

risk characterization.

Hazard identification

Hazard identification is a procedure of recognition of hazardous factor in the working environment and

defining its physical, chemical and other properties. In the course of hazard identification, the "fate" of

hazardous agent is determined, either in the external environment or in the organism, but also its properties to

cause negative health effects or disease.

Exposure assessment

The assessment of the exposure means determination of the level of hazardous substances that are

present in the working environment and their internalization/intake into the organism of the professionally

exposed workers.

According to the intake route of the substance into the human organism, the exposure can be:

direct and

indirect.

Dose-response assessment

Dose response assessment is process of making a conection between the data of the exposure

assessment and occurence of the work-related diseasses and other harm of the health of the exposed workers.

Risk characterization

The last step in the risk assessment process means characterisation of the actual risk on the examined

workplace. It is essential and most visible phase of the quantification of the percived risk. It means establismnet

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of the interrelation among all information, data and results obtained from the previous steps. For practical use of

the whole risk assessment proces in this phase the quantification of the probability of the occurence of the hazard

and the severity of the harm caused by respective hazard is made.

Figure 3. Group of activities that form the risk assessment

Methodological approach to risk assessment Preconditions for commencement of risk assessment are:

Existence of appropriate legal framework (obligation, responsibility and conditions),

Existence of national standards, guidelines, technical guides, agreed best practices, determined

levels of maximum allowed concentrations (levels), manufacturer's guidelines, professional

associations' standards, etc. and

Existence of legally and professinally defined hierarchy for risk prevention:

o avoidance of hazards (modernization and automatization of the technology process),

o replacement of hazardous with harmless or less hazardous substances (substitution),

o combating hazards at their source (separation, hermetization),

o applying collective protection measures,

o adjustment to the new technological knowledge and their appliance into practice and

continuous promotion of the care for safety and health at work.

Workplace risk assessment begins with the decision of the employer for commencement of the

procedure and appointment of expert person from the pool of employees that will be responsible for the overall

process of risk assessment (30,31). At the same time, depending on the size of the company, the employer

appoints representative or representatives of the workers that are participating in the process of risk assessment,

or the Committee for safety and health at work might be established.

The flow chart of the risk assessment and control consists of several procedures, as follows:

Preparation of Action Plan and monitoring of its implementation,

Data collection about the working environment and workplace (access, safety of working

surfaces, safety of equipment and tools, microclimate conditions, lighting, chemical and

biological hazards, etc.),

Identification of working processes and operations with description and/or identification of

hazards and dangers,

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Data collection on occurence of hazards and/or dangers during the working process,

Data collection on the employees,

Analysis of the recorded effects and/or diseases related to the working conditions,

Quantification of the likelihood of occurence of hazardous effects,

Quantification of the severity of the expected hazardous effects and/or diseases and injuries at

workplace,

Defining priorities for prevention, reduction and elimination of workplace-related hazards,

Implementation of the control measures and assessment of their effectiveness,

Review of the risk assessment in pre-determined conditions (change of the technological

process, occurence of severe, death or group injuries, etc.).

Starting point in the risk assessment is preparation of the action plan, which preparation,

implementation and monitoring is under the responsibility of the employer.

The action plan should include:

Organization and coordination of the risk assessment,

Appointment of competent persons that will work on the risk assessment,

Appointment of representatives of the workers that will be involved in the risk assessment

process,

Defining the flow of information and conditions under which the necessary data for risk

assessment will be used (confidentiality),

Defining the monitoring of the preventive and/or corrective measures and undertaking

responsibility for their implementation by signing written act,

Informing the employees about the identified conditions during the risk assessment and the

preventive and corrective measures undertaken.

According to the European directives, and depending on the conditions in one company, the risk

assessment can be made by (16):

The employer,

Employed expert personnel appointed by the employer or

External professional services.

The defining criterion regarding the selection of the responsible party that will undertake the risk

assessment is the size of the company, working conditions and the competence of the appointed person for risk

assessment in the company. In practice, very often a need is imposed for engaging a team of different specialties

from various fields (outsourcing).

The persons involved in the risk assessment process are confirming their competencies by showing

evidence of formal education in the field (if they have such education), as well as by showing competency and

capability to:

Understand and be familiar with the general concept of risk assessment;

Have and apply their professional knowledge in particular conditions and workplaces for which the

risk assessment is conducted.

Such approach requires that the persons involved in the risk assessment have knowledge and

information based on which they will be able to:

Recognize the problems related to the occupational safety and health ,

Prioritize accordingly the activities related to the occupational safety and health,

Predict the potential dangers and hazards, as well as consequences that can be expected in case of

their occurence, based on relevant evidence,

Identify conditions that surpass their competencies, in order to seek additional expert opinions and

Know the methodologies for risk assessment, including as much as necessary the complex logic

analyses and technical simulations.

Key elements in risk assessment

Risk assessment is in fact reconsideration of all aspects of the work and work process, in order to

identify and quantify the hazards that can inflict injury, professional disease or injury at workplace, for the

purpose of reducing or removing them, or if possible, to introduce as much as justifiable, preventive and

protection measures with which the risk will be eliminated or decreased and controlled.

The risk assessment should embed all predictable dangers and hazards at work in all aspects of work

process. It is conducted with participation and consultation of all those involved in the work process – from

workers to their employers.

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Risk assessment is applicable to all workers and work positions that are in direct or indirect relation and

interaction with the hazards present in the working environment, and special attention should be paid to the

particularly vulnerable groups of workers – young people, pregnant and lactating women, disabled, etc.

Risk assessment is a set of procedures during which an analysis of the available information is

undertaken. During the risk analysis, the appointed person or team does not conduct any measurements, analyses

or medical check-ups, but rather makes overview and analysis of the existing situation and available

documentation (32,33).

The information necessary for conducting risk assessment can be obtained through (but not limited to):

Analysis of the work opreations and procedures,

Filling stadndardized or adjusted check lists and questionnaires for workers,

Consultation and conversation with workers and their representatives (interviews),

Overview of the technical specifications and guidelines provided by the manufacturers or

distributers of the equipment, tools and substances,

Databases of relevent information for safety and health at work and other scientific and technical

literature,

Guidelines, directives and good practices given by national referent bodies in the field of

standardization, scientific institutes or professional assocaitions,

Data for recorded accidents and injuries at work,

Data for the recorded morbidity (professional and other work-related diseases),

Data from undertaken mesurements of the factors in the working environment and

National standards, criteria and lists of maximum allowed concentrations and biological exposure

tests, etc.

The official and recorded data are used available from the records of the company, and, in the same

way, all of the procedures would be recorded as part of the risk assessment.

Methodology for risk assessment can be semi-quantitative or numerically quantitative, and that depends

on the national legislation, as well as of the type of certain working process at the workplace.

Regardless of the methodology chosen for undertaking risk assessment, each of the methodologies is

based on defining the potential spectrum, i.e. severity of the potentially hazardous effects and the probability for

their occurrence.

The spectrum, i.e. the severity of potentially hazardous effects on the health of professionally exposed

workers falls into the following categories:

Insignificant consequences,

Accedent without injury,

Light injury,

Severe injury, acute poisoning or chronic professional disease,

Death,

Death of more workers at the same time.

The probability (likelihood) for occurrence of these hazardous effects as a result of professional

exposure can be:

Very unlikely (practically improbable)

Likely (moderate probability)

Very likely (high probability)

In combination of these possibilities and with the use of risk assessment matrix, the result is semi-

quantitative risk assessment (20). In this case the result can be low, medium or high, or a numerical scale can be

used (for example, scale with values from 1-10 with pre-defined criteria about the interpretation of the meaning

of each of the values on the scale).

Below is a sample for semi-quantitative matrix for risk quantification. This matrix is recommended by

European Agency for safety and Health at Work (34).

Table 1. Likelihood for severity of damage/level of risk in 3x3 matrix

Severity of damage / level of risk

Likelihood Low Moderate High

Very unlikely Low risk (1) Low risk (1) Moderate risk (2)

Likely Low risk (1) Moderate risk (2) High risk (3)

Very likely Moderate risk (2) High risk (3) High risk (3)

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Legend:

Frequency of occurence Severity of the expected negative health effects

Very unlikely: Not expected to occur during the

whole working lifetime

Low severity: injuries and diseases that do not cause prolonged/long-

term health problems (e.g. small injuries, eye irritation, headache,

etc.)

Likely: IT can occur several times during the

working lifetime

Moderate severity: injuries or disease that cause moderate but

prolonged/long-term and periodically repetitive health problems (e.g.

wounds, simple fractures, burns of second degree to a limited part of

the body, skin allergies, etc.)

Very likely: It can occur repetitively during the

working lifetime

High severity: injuries or diseases that cause severe and permanent

health problems or death (e.g. amputations, complex fractures with

disability, cancer, burns of 3rd degree covering large part of the

body, etc.)

Below is a more complex quantification of the risk assessment by using the Risk matrix 5x5 (35).

Table 2. Likelihood for severity of damage/level of risk in 5x5 matrix

Consequences

1 – Insignificant

Dealt with by in-house first aid, etc

2 – Minor

Medical help needed. Treatment

by medical

professional/hospital outpatient, etc

3 – Moderate

Significant non-permanent

injury.

Overnight hospitalisation

(inpatient)

4 – Major

Extensive permanent

injury

(eg loss of finger/s)

Extended

hospitalisation

5 – Catastrophic

Death. Permanent

disabling injury

(eg blindness, loss of hand/s,

quadriplegia)

Lik

elih

oo

d

A - Almost certain to occur in most

circumstances High (H) High (H) Extreme (X) Extreme (X) Extreme (X)

B - Likely to occur

frequently Moderate (M) High (H) High (H) Extreme (X) Extreme (X)

C - Possible and

likely to occur

at some time Low (L) Moderate (M) High (H) Extreme (X) Extreme (X)

D - Unlikely to occur but could

happen Low (L) Low (L)

Moderate

(M) High (H) Extreme (X)

E -

May occur but

only in rare and exceptional

circumstances

Low (L) Low (L) Moderate

(M) High (H) High (H)

How to Prioritise the Risk Rating Once the level of risk has been determined the following table may be of use in determining when to act to

institute the control measures. Table 3. Risk rating and prioritization of measures

Risk rating Immediate measures Interim measures

Extreme Act immediately to mitigate the risk.

Either eliminate, substitute or implement

engineering control measures.

Remove the hazard at the source. An identified

extreme risk does not allow scope for the use of

administrative controls or PPE, even in the short

term.

High Act immediately to mitigate the risk.

Either eliminate, substitute or implement

engineering control measures.

If these controls are not immediately

An achievable timeframe must be established to

ensure that elimination, substitution or

engineering controls are implemented.

NOTE: Risk (and not cost) must be the primary

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accessible, set a timeframe for their

implementation and establish interim risk

reduction strategies for the period of the

set timeframe.

consideration in determining the timeframe. A

timeframe of greater than 6 months would

generally not be acceptable for any hazard

identified as high risk.

Medium Take reasonable steps to mitigate the

risk. Until elimination, substitution or

engineering controls can be

implemented, institute administrative .

…or personal protective equipment

controls. These “lower level” controls

must not be considered permanent

solutions. The time for which they are

established must be based on risk. At

the end of the time, if the risk has not

been addressed by elimination,

substitution or engineering controls a

further risk assessment must be

undertaken.

Interim measures until permanent solutions

can be implemented:

Develop administrative controls to limit the

use or access.

Provide supervision and specific training

related to the issue of concern.

(See Administrative Controls below)

Low Take reasonable steps to mitigate and

monitor the risk. Institute permanent

controls in the long term. Permanent

controls may be administrative in nature

if the hazard has low frequency, rare

likelihood and insignificant consequence.

Table 4. Hierarchy of control in order to minimize occupational exposure

Elimination Eliminate the hazard.

Substitution Provide an alternative that is capable of performing the same task and is

safer to use.

Engineering Controls Provide or construct a physical barrier or guard.

Administrative Controls Develop policies, procedures practices and guidelines, in consultation

with employees, to mitigate the risk. Provide training, instruction and

supervision about the hazard.

Personal Protective

Equipment

Personal equipment designed to protect the individual from the hazard.

There are many other methodologies for quantification of the likehood of occurrence of the hazardous

event at the workplaces as well as a consequences of those events to the workers’ health (like AUVA’s or BG

methodologies), but it seams that matrix’s approach is the most applicable one.

The documentation which is a part of the process of risk assessment should be made available to:

Experts responsible for implementing the measures for occupational safety and health

Persons – representatives of workers, involved in the process of occupational safety and health.

It is especially important to predict the time and conditions under which every employer is obliged to initiate the

revision of the once undertaken risk assessment, but also there should be a legal obligation established for

revision of risk assessment at any occasion when there are changes in the technological process or collective

injury/death at work.

Process of risk assessment - case study There are a lot of resources in which it is possible to find a case studies and examples for good

practices (23,36). The usefulness and applicability of such case study or good practice depend of the sector,

size of the company, age, gender and other characteristics of workforce in the company, technological

improvement, management and organization of the work etc. Many case studies should be find on the web -

site of the EU-OSHA or other agencies.

Process of risk assessment - exercise Theoretical approach to the risk assessment seems to be very complicate and inapplicable. But, it is so

simple process if basic tools and essentials are accepted (34). According to the European Agency for

Occupational Health and Safety, workplace risk assessment consists of 5 simple steps (Fig. 4):

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Figure 4. Five steps to the workplace risk assessment (34)

Step 1 – What information should be collected and how?

What information are collected? For the workplace risk assessment it is necessary to have the following information at hand:

location of the workplace,

characteristics of the equipment, materials and processes,

description of work operations,

identified hazards and their sources,

potential consequences,

protection measures,

number of exposed workers,

number of workers from vulnerable groups (pregnant women, young workers, workers with

disabilities),

occurrence of professional diseases, work-related diseases and injuries at work (32,37).

How information are collected? Possible sources of information are:

technical data on the equipment, materials and substances that are used in the production process,

technological procedures and work protocols,

results of measurements about the hazards at the workplace (workplace analysis),

specification of the properties of chemical substances (registry),

legal framework and technical standards,

scientific and technical literature,

observing the working environment

observing the task performed at workplace,

Interviewing the workers,

data on workplace injuries and professional diseases (registry), (33).

Step 2 – How hazard can be identified?

1.1. The identification of the hazards in all aspects of work should be approached by:

walking around the workplace and looking at what could cause harm

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consulting workers and/or their representatives about any problems they have encountered. Often

the quickest and surest way to identify the details of what really happens is to ask the workers

involved in the activity being assessed. They will know what process steps they follow, whether

there are any short cuts, or ways of getting over a difficult task, and what precautionary actions

they take

examining systematically all aspects of the work,

considering long-term hazards to health, such as high levels of noise or exposure to harmful

substances, as well as more complex or less obvious risks such as psychosocial or work

organisational risk factors

looking at company accident and ill-health records

The hazard identification is usually performed by using hazard specific check lists. These are adjusted to the

need and aim of the investigation/assessment itself. EU-OSHA on its website gives one general check list that

can be used as model for design of own check lists for every particular company or workplace for which a risk

assessment needs to be conducted. But, at the same time other additional check lists exist that are related to the

most common hazards and dangers that occur at the workplace and for which a risk assessment is required and

necessary. The check lists can be of a general type and specific type, where particular and specific professional

hazards and very particular technological processes and workplace are assessed. In general, the check lists are

aimed at fast and simple orientation in the process of hazard identification, frequency of its occurrence and

severity of the damage that can be caused by it.

Usually, the check lists are prepared in cooperation with all workers involved in the working process in

question (38). Besides the general, there are also specific check lists for the hazards and sectors (Table 5).

Table 5. Check lists for workplace hazards and related sectors

Check lists – hazards Check lists – sectors

1) Uneven slippery surface;

2) Vehicles and moving machines;

3) Machines with movable parts;

4) Electric installations;

5) Fire;

6) Explosion;

7) Chemical substances;

8) Noise;

9) Vibrations;

10) Lighting.

- administrative (office) work;

- food production;

- wood processing;

- agriculture;

- small and surface mining.

*Additional info and specific check lists are

available at: www.osha.europa.eu

1.2. The identification of all those who might be exposed to the hazards

For each hazard it is important to be clear about who could be harmed; it will help in identifying the best way of

managing the risk.

Account should be taken of workers interacting with the hazards whether directly or indirectly, e.g. a

worker painting a surface is directly exposed to solvents, while others workers in the vicinity, engaged in other

activities, are inadvertently and indirectly exposed. This doesn’t mean listing everyone by name, but identifying

groups of people such as ‘people working in the storeroom’ or ‘passers-by’. Cleaners, contractors and members

of the public may also be at risk.

Particular attention should be paid to groups of workers who may be at increased risk or have particular

requirements: workers with disabilities, migrant workers, young and old workers, pregnant women and nursing

mothers, untrained or inexperienced staff and temporary and part-time workers.

Step 3 – How to assess the risk araising from identified hazard?

The next step is evaluating the risk arising from each hazard. This can be done by considering:

how likely it is that a hazard will cause harm;

how serious that harm is likely to be;

how often (and how many) workers are exposed.

Based on the likelihood of the hazard or danger to occur and on the severity of the expected

consequences on the health of professionally exposed workers, a decision on the level of professional risk should

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be performed. As previously said in the part on methodology, the matrices 3x3 and 5x5 can be used for this

purposes; or other semi quantitative or numerical matrices (for risk quantification).

The next very important step is to decide whether risk arising from a hazard is acceptable or

unacceptable. In general:

high risk is unacceptable,

small and medium risk is acceptable,

If legal requirements are not complied with, risk is not acceptable!

The risk assessment should always be carried out with the employees’ active involvement. When

deciding on the acceptability of risk, bear in mind their input, and take into account gender, age, and also health

of the employees for whom assessment is conducted.

A straightforward process based on judgement and requiring no specialist skills or complicated

techniques could be sufficient for many workplace hazards or activities. These include activities with hazards of

low concern, or workplaces where risks are well known or readily identified and where a means of control is

readily available. This is probably the case for most businesses (mainly small and medium-sized enterprises —

SMEs). Risks should then be prioritised and tackled in that order.

Step4 – How the actions to eliminate or reduce the risk arising from hazard can be planed?

It is essential that any work to eliminate or prevent risks is prioritised. How should the activities for risk

elimination or reduction be prioritised? The basic principles are:

if the risk is high and assessed as unacceptable, the measures for its reduction should be

undertaken immediately,

if the risk is moderate and assessed as acceptable, it is recommended to plan the activities for

reduction of the risk level,

if the risk is low and assessed as acceptable, it is essential to ensure that it will be reduced or at

least remain on the same level.

When preventing and controlling risks, the following general principles of prevention have to be taken

into account:

avoiding risks (elimination of hazard/risk) by modernization and automatization of the

technical process;

substituting the dangerous by the non-dangerous or the less dangerous substances;

combating or isolating the risks at source (separation, hermetization);

minimization of the hazard/risk with organizational measures

minimization of the hazard/risk with collective protection measures;

minimization of the risk through appropriate personal protective means

applying collective protective measures rather than individual protective measures (e.g. control

exposure to fumes by local exhaust ventilation rather than personal respirators);

adapting to technical progress and changes in information;

seeking to improve the level of protection

The next group of activities is to put in place the preventive and protective measures. It is important to

involve the workers and their representatives in the process. Effective implementation involves the development

of a plan specifying:

the measures to be implemented;

who does what and when;

when it is to be completed.

Step 5. How to document, monitor and review the process?

The risk assessment for each workplace should be documented in the appropriate record for risk assessment. The

record should contain the following sections of information:

Basic information: name of the company and address, name of the workplace, number and

names of workers on the assessed workplace, date of the assessment and name of the person

conducting the assessment;

Name of the hazard if identified;

For every identified hazard should be noticed:

Preventive/protection measures used for alleviation and limitation of the risk,

Results of risk assessment/evaluation,

Planned activities for reduction of the risk.

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The risk assessment has to be reviewed regularly depending on the nature of the risks, the degree of

change likely in work activity or as a result of the findings of an accident or ‘near miss’ investigation. Risk

assessment is not a once-and-for-all activity.

Risk assessment tools are available at the web-page of the EU-OSHA and they should be used and

modified in accordance with specific condition and needs of the company. The translation and modification of

the check list and final report is necessary (34).

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