Last reviewed 31 October 2019

Directors play a vital role in ensuring that their organisation maintains good health and safety practices in order to avoid employees being made ill by their work.

This briefing will give you the essential background information and advice on when a health surveillance programme is required and how to implement the programme.


Essentially, a health surveillance programme is a series of ongoing checks on employees to establish a baseline and ensure that their work is not adversely affecting them. Health surveillance aims to provide early identification of potential ill health. The data collated enables employers to implement better controls to prevent the development or exacerbation of pre-existing conditions. The data can also be used to further inform and train employees on the ill-health effects they are exposed to and the importance of protection.

The Health and Safety Executive (HSE) recommends that health surveillance is required in work-related circumstances where:

  • a particular disease or health condition is known to be related to the work undertaken

  • it is likely that the disease or condition may occur

  • valid techniques are available to detect the early signs of the disease or health issue

  • these techniques do not pose a risk to employees.

Legal requirements

Under the Health and Safety at Work, etc Act 1974, employers have a duty to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees. In addition, the Management of Health and Safety at Work Regulations 1999 require employers to assess the risks related to the work undertaken by their organisation.

Health surveillance is a requirement of Control of Substances Hazardous to Health Regulations 2002, Control of Lead at Work Regulations 2002, Control of Asbestos at Work Regulations 2012 and the Ionising Radiations Regulations 2017.

Establishing the need for health surveillance

Managers are responsible for carrying out risk assessments for their team members to establish the risks and potential ill-health effects on those who carry out particular work tasks. Relevant activities could include anything involving hazardous substances, the use of vibrating equipment or work in noisy environments. Additional information, such as from the following sources, can also be used to assess the risks and confirm whether a health surveillance programme is needed:

  • safety data sheets

  • warning labels

  • EH40 Workplace Exposure Limits

  • the Department of Health website

  • trade associations.

Type of health surveillance programme and set up

The risk assessment will determine the level of health surveillance required. A programme can be anything from employees carrying out self-assessments (eg visual checks for signs of dermatitis for those who do wet work) on a regular basis to annual lung function assessments carried out by a medical practitioner for employees who are likely to be exposed to asbestos-containing materials.

If the skills to design and set up a programme are not present in the organisation, competent assistance can be sought through a certified medical practitioner or external consultancy. However, the programme will require an internal stakeholder to assist in its management and roll-out.

Programmes should take into consideration elements such as shift patterns, annual and sick leave to ensure all at risk of exposure can be assessed equally and consistently assessed.

The programme should be implemented for employees who have been identified as at risk and regularly reviewed to assess its progress. Outcome records must be kept and recommendations actioned. Adding health surveillance to the health and safety committee agenda is a good way of ensuring it is kept on the radar.

Strategic leadership

Directors must ensure that the health and safety legislation and best practice is fully implemented across an organisation. It is also the responsibility of the company directors to ensure the appointment of one or more competent persons to assist in carrying out health risk assessments and health surveillance.

Managers must be aware of the role that they play in ensuring that the organisation discharges its duty of care in keeping migrant workers informed on how to work safely.

Directors should ensure that appropriate policies and procedures relating to risk assessments and health surveillance are in place. This will provide the necessary guidance and information to managers, as well as the necessary resources, enabling them to implement the programme.

Relevant case law examples

Relevant cases relating to health surveillance include the following.

  • In 2019, Devon-based Celtic Rock Services Limited pleaded guilty to breaching s.2(1) of the Health and Safety at Work, etc Act 1974 after three employees developed symptoms of hand–arm vibration syndrome (HAVS) but no action was taken.

    The employees regularly conducted cliff stabilisation work that involved the use of jack hammers and rock drills. Symptoms of pins and needles and aches and pains were reported as far back as 2000. However, the ill-health effects of their work were only identified in 2016 when an occupational health nurse was employed to conduct assessments.

    The company was fined £36,667 and ordered to pay costs of £3560. The company’s director pleaded guilty to breaching s.37 of the Act. He was given a 12-week custodial sentence, suspended for 1 year, a 12-week curfew and ordered to pay costs of £3560. The HSE cited a lack of health surveillance as a cause for the development of HAVS.

  • Fibreline Ltd, a specialist foam and feather furnishings company based in Keighley, West Yorkshire, was fined £15,000 and ordered to pay £4547 in costs in 2014, when they pleaded guilty to breaching s.2(1) of the Health and Safety at Work, etc Act 1974, for failing to protect workers from excessive noise levels produced by production machinery.

    An investigation showed that the company had not made a suitable assessment of the noise levels in the factory between 2006 and 2013. An assessment would have identified the need for suitable hearing protection and controls. A health surveillance programme was only introduced in 2013.