Last reviewed 22 December 2015

In the summer of 2015, the Construction Industry Advisory Committee (CONIAC) launched new guidance “to encourage better management of occupational health risks” in the construction sector. CONIAC is a tripartite committee of trade unions, employer representatives and Health and Safety Executive (HSE) construction specialist inspectors. The HSE co-operated with the Institution of Occupational Safety and Health (IOSH) to produce the guidance. Health and safety consultant, Nigel Bryson, comments on the key points.

In a press release promoting the guidance, the HSE drew attention to “the hundreds of construction workers that die of occupational diseases every month”, and indicated that in the recent Intensive Inspection (during September/October 2015) that 200 health related enforcement notices were issued. During this period over 2200 refurbishment sites were visited.

The scale of the challenge to the construction sector was highlighted by Ian Strudley, Chair of the CONIAC Health Risks Working Group and HSE Principal Inspector, as he stated:

“When figures show that construction workers are at least 100 times more likely to die from a disease caused or made worse by their work as they are from a fatal accident, the industry must take action.”

In other words, around 3500 construction workers are likely to die annually from work-related ill-health, based on the HSE Statistics from 2014/15. The new guidance aims to give a comprehensive overview of how occupational health risks should be managed. This article outlines the main points.

Misunderstanding “occupational health”

When the HSE examined the reasons related to the issuing of the 200 enforcement notices in their Intensive Inspection, there were two features that were noted.

  • There was a widespread “misunderstanding” of what occupational health actually means.

  • Many employers had a “misguided” perception that health is more difficult to manage than safety.

In the new guidance, the HSE makes it clear that when occupational health is being referred to, it relates only to diseases or conditions that are caused directly by work or made worse by work activities. Those companies who provide support for more general health improvement — stopping smoking, healthy eating, pay for workers to use swimming pools or gymnasiums — may help workers to be healthier but not address occupational ill-health causes. For example, a healthy diet will be of no assistance to workers exposed to excessive concentrations of asbestos fibres.

Hence, a key aim of the guidance is show employers how to identify occupational ill-health causes and then manage the risks.

“Risks to health can be managed by modifying the process to eliminate the risk, controlling and minimising exposures, and taking precautions to prevent adverse effects.”

The guide identifies common health risks linked with construction and establishes a framework through which the risks can be eliminated or adequately controlled. By the use of tables, the HSE have tried to show employers what control measures should apply and how employers identify what services they may need from occupational health service providers. In this way they are trying to show that health risks can be managed in a similar way to safety risks. Employers should not be put off by health risks: control measures are well known and just need to be thought through.

What are the main health risks in construction?

In their guide the HSE identify the main occupational health risks in construction as:

  • exposure to asbestos, dusts including silica and lead, chemicals, sunlight, diesel engine exhaust emissions

  • frequent loud noise

  • frequent or excessive use of vibrating tools

  • frequent or excessive manual handling of loads

  • stress and fatigue.

In specific sectors, there may be other hazards to consider during construction and commissioning activities. For example, in the nuclear industry, exposure to ionising radiation may need to be eliminated or adequately controlled. However, the ill-health risks identified by the HSE are the most common in the construction sector.

Risk management cycle

At the heart of the HSE’s guide is the risk management framework. It follows a common model and should be familiar to most managers. The key stages are as follows.

  1. Identify hazards.

  2. Assess risks of occupational ill-health and eliminate the risk if possible.

  3. Select controls, stating with the most effective measures. Personal Protective Equipment is a ”last resort” and its use should only be tolerated until more effective control measures are identified and adopted.

  4. Implement and record findings.

  5. Monitor and review.

Where work-related ill-health risks exist, the employer may decide to or may be required to provide health surveillance. This is different from medical assessments where medical professionals undertake testing. Health surveillance is specific to the ill-health risks.

For example, as part of a monitoring regime someone trained and competent to check hands/fingers for the signs of Vibration White Finger (VWF) may monitor workers who use vibrating equipment regularly. This is not to replace other preventative measures but to check that the control measures are effective. If the control measures are thought to be adequate and workers develop VWF, the measures would need to be reviewed.

There may be occasions where employers need the specialist help of an occupational health provider. As well as guidance, the HSE have provided a checklist to assist for putting occupational health service arrangements in place. This is important. If employers get involved with occupational health providers without properly understanding what their occupational health needs are, costly mistakes may be made. The guide helps identify what employers should consider before they get in discussions with occupational health providers.

Worker involvement

In line with the HSE’s priority of underpinning worker involvement, there is a comprehensive section on this issue. Stressing that workers must be consulted “in good time” about health risk matters, the reasons the HSE give are:

  • they can help employers spot workplace risks;

  • they can assist ensure that health risk controls are practical; and

  • it can increase the level of commitment of workers to working in a safe and healthy manner.

Of course, employers are required by law to consult with their workforce, either through trade union Safety Representatives where trade unions are recognised or representatives of employee safety or the workforce directly in non-union organisations.

Work or lifestyle well-being?

As the HSE have made clear, occupational health provision is about those hazards that directly relate to the work. However they do identify the benefits of promoting a healthier lifestyle.

“Make sure you [employer] don’t lose sight of the hazards to health you are exposing workers to. However, having a workforce interested in looking after its health is likely to bring benefits not only to the workers themselves but also to the business through:

  • workers being present at work, not off sick

  • workers being fit and healthy to perform the work required of them

  • increased productivity

  • safer working practices and fewer accidents.

Remember: a happier, healthier workforce makes good business sense.”

The guide also has a health record template; points on when health surveillance may be needed; what employers can do without using doctors or nurses; and what to do if worker’s health is affected to the extent they are limited in undertaking their work.


The guide provides a useful summary of the issues that need to be addressed by employers when dealing with work-related ill-health risks in construction. For those with well-defined control measures, it may provide a useful checklist to ensure all aspects have been covered. See

For those employers not sure about the issues, it provides a useful base from which to develop effective controls.

Doing nothing is not an option.