Do any of your workers face a health risk that builds over time?
Noise, vibration, dust, fumes, repetitive work or sustained pressure
Why occupational health matters
An accident is obvious. Someone falls, and everybody knows within the hour.
Occupational ill health is not like that. A worker exposed to noise does not notice their hearing going. Someone using vibrating tools does not feel the damage accumulating. By the time symptoms are unmistakable, the harm is usually permanent and no longer treatable.
Work-related ill health accounts for the large majority of working days lost in Great Britain — far more than workplace injury. It is also, in most cases, entirely preventable, because the exposures that cause it are known, measurable and controllable.
That difference in visibility is exactly why the law handles health differently. For safety, you control the risk. For health, you control the risk and you check whether the control is working.
The main occupational health risks
What to look for, and what it causes
| Exposure | Harm it causes | Key legislation |
|---|---|---|
| Noise | Permanent hearing loss, tinnitus | Control of Noise at Work Regulations 2005 |
| Hand-arm vibration | HAVS, carpal tunnel syndrome | Control of Vibration at Work Regulations 2005 |
| Dust, fumes and vapours | Occupational asthma, COPD, cancer | COSHH 2002 |
| Repetitive work and poor posture | Upper limb disorders, back injury | Management Regs 1999, MHOR 1992 |
| Sustained work pressure | Work-related stress, anxiety, depression | Management Regs 1999 |
| Skin contact with substances | Occupational dermatitis | COSHH 2002 |
Every one of these is a risk assessment matter first. Health surveillance does not replace controlling the exposure — it checks whether your controls are actually working.
Health surveillance
Health surveillance is the ongoing checking of workers for early signs of work-related ill health. It is required where a risk to health remains after you have applied your controls.
It is generally required where all of the following apply:
- There is an identifiable disease or adverse health effect linked to the exposure
- There are valid techniques for detecting it
- There is a reasonable likelihood it will occur in your conditions
- Surveillance is likely to benefit the worker
Health surveillance is
- •Targeted at a specific known exposure
- •Ongoing and repeated at set intervals
- •A check on whether controls are working
- •Required by law in defined circumstances
- •Something you must act on
Health surveillance is not
- •A general health check or medical
- •A wellbeing benefit or perk
- •A substitute for controlling exposure
- •A one-off at recruitment
- •A record to file and forget
The failure that costs employers most is not skipping surveillance — it is commissioning it, receiving a report showing early hearing loss or vibration symptoms, and changing nothing about the work. That is documented evidence that you knew.
Noise
Two action levels drive the duties, both measured as daily or weekly personal exposure:
- Lower action value — 80 dB(A): assess the risk, provide information and training, make hearing protection available on request
- Upper action value — 85 dB(A): reduce exposure so far as is reasonably practicable, mark hearing protection zones, enforce use, and provide health surveillance
- Exposure limit value — 87 dB(A): must not be exceeded, taking hearing protection into account
Hearing protection is a control of last resort here in the same way PPE is elsewhere. Reaching straight for earplugs without first considering quieter equipment, isolation or reduced exposure time does not meet the duty to reduce exposure at source.
See L108 — Controlling noise at work for the Approved Code of Practice.
Hand-arm vibration
Vibrating tools — grinders, breakers, sanders, chainsaws — cause hand-arm vibration syndrome. It is irreversible.
- Exposure action value — 2.5 m/s² A(8): introduce controls and provide health surveillance
- Exposure limit value — 5 m/s² A(8): must not be exceeded
Because exposure is measured over eight hours, a high-vibration tool used briefly can breach the action value long before anyone thinks of it as a full day's work.
Practical ways to reduce it are set out in HSG170 — Vibration solutions.
Work-related stress
Stress is a health and safety risk, and it is assessable in the same way as any other. The HSE's Management Standards cover six areas: demands, control, support, relationships, role, and change.
Treating stress purely as an individual resilience problem misses the legal point. The duty is to assess the risk arising from the work, which means looking at workload, autonomy, clarity of role and how change is handled — not only at how individuals cope.
HSG218 — Managing the causes of work-related stress sets out the approach.
Substances and exposure limits
Workplace exposure limits are published in EH40 and are the reference point for COSHH assessments involving airborne substances.
- EH40 — Workplace exposure limits
- L5 — Control of Substances Hazardous to Health
- HSG53 — Respiratory protective equipment at work
Respiratory protective equipment must be face-fit tested for the individual wearing it. A tight-fitting mask that has not been fit tested, or that is worn over facial hair, provides materially less protection than assumed — and the assessment that relies on it is wrong.
Full guidance on substances is on our COSHH topic page.
Upper limb disorders
Repetitive work, sustained awkward postures and forceful movements cause upper limb disorders. They develop gradually and are frequently dismissed as ordinary aches until they become chronic.
HSG60 — Upper limb disorders in the workplace covers assessment and control. Where lifting and carrying are involved, see also our manual handling topic.
Shift work and fatigue
Fatigue impairs judgement and reaction time, and long-term shift work carries its own health effects. Where you run shifts, the pattern itself is part of what you should be assessing — see HSG256 — Managing shift work.
Common mistakes
Recording injuries but not illness. If your only health and safety data is an accident book, you are measuring the smaller problem.
Providing protection without checking outcomes. Issuing hearing protection is not the same as knowing whether anyone's hearing is deteriorating.
Confusing surveillance with a medical. Health surveillance is targeted at a known exposure. A general health check is not surveillance and does not satisfy the duty.
Treating stress as a personal failing. The duty is to assess the risk created by the work.
Not acting on results. Surveillance that changes nothing is a cost, not a control — and it documents what you knew.