1. JZU DOM ZDRAVLJA PODGORICA Centar za medicinu rada
MEDICAL ASPECTS
OF RISK ASSESMENT
Dr Cvetana Vukajlović
oktobar 2017

2. Safety and health at work
According to the MOR definition, safety and health at work is a discipline that addresses the improvement of working and working conditions, the prevention of occupational injuries, occupational diseases and diseases related to the work, protection and improvement of the health of employees.
The basic process on which the implementation and improvement of safety and health at work is based is the assessment of health risks from occurrence of occupational injuries, occupational diseases and occupational diseases and diseases. and / or minimizing the risk to the very least, which is actually a risk management process.
The EU promotes the concept of “well being at work", which implies physical, moral and social well-being, and not something measured by the absence of an injury at work or occupational diseases.

3. International standards in the field of safety and health at work
The system of legislation in the field of occupational health and organized occupational safety and health applications began to develop in the second half of the twentieth century when the EC of coal and steel producers adopted measures to improve the health of workers.
Treaty establishing the EEZ from Article 100 brings a number of directives in this field.
The unique European Act of 1987, adopts directives containing minimum standards of safety and health at work.
The EU Treaty 1992 extended the obligations of Member States regarding safety and health at work. General Directive 59/391 / EEC prescribes the introduction of measures to achieve safety and health at work.
MOR adopts conventions that have been ratified after the ratification, incorporated into national strategies and legislation in the field of safety and health at work in a large number of countries. Particularly important are the: Occupational Safety and Health Convention, z.z okolice br. 155 from 1981 and the Convention on the Occupational Health Services, No. 161 from 1985.
The risk assessment at the workplace, as an obligation of EU member states, was introduced by the Directive 89/391/EEZ.

4. National regulations in the area of safety
and health at work
The Constitution of Montenegro guarantees the right to respect for the dignity of the person at work, safe and healthy working conditions, the necessary protection at work.
The Labor Law is a systemic law; refers to all employees and employers, provides basic guidelines governing rights, obligations and responsibilities arising from employment, which implies secured conditions and work arrangements for the protection of safety and health at work.
The Occupational Safety and Health System is regulated by the Law on Safety and Health at Work. This law with the relevant by-laws introduced a complete legal framework for the functioning of the occupational health and safety system.
The Law on Safety and Health at Work complies with the provisions of Directive 89/391 / EEC, the employer's obligation to carry out an assessment of the risk of damage to health (injuries, occupational diseases, work-related illnesses) arises from Article 6 paragraph 3 of that Directive.

5. National regulations in the area of safety
and health at work
Pursuant to Article 17 of the Law on Safety and Health at Work, the employer is obliged to pass a risk assessment act in writing for all workplaces in the working environment, to determine the method and measures for their elimination and to amend the risk assessment act in the event of the occurrence of each new threats and changes in the level of risk in the work process.
The Risk Assessment Act, according to the definition of the Law on Safety and Health at Work, is an act containing a description of the work process, assessing the risk of injury and / or damage to health at the workplace and in the workplace.
Pursuant to Article 48, paragraph 1 of the Law on Occupational Safety and Health, a Rulebook on the manner and procedure for risk assessment at the workplace and in the working environment has been prepared. According to the Rulebook, risk assessment is systemic recording and assessment of all factors in the work process that can cause injury at work, damage health or sickness of the employee and determining the possibilities, ie the manner of prevention, removal or reduction of risks at the workplace and in the working environment.
The law is based on the obligations and responsibilities of the employer. The employer is obliged to provide employees with work in the workplace and in the work environment where, on the basis of risk assessment, safety and health measures have been implemented.

6. Obligations and responsibilities of the employer
to pass an act on risk assessment in written form for all working places in the working environment,
to determine the method and measures for their elimination,
to amend the risk assessment act in the event of any new danger and change in the level of risk,
to establish a workplace with an increased risk, on which, in addition to fully or partially applied measures, there are dangers that could compromise the safety and health of an employee,
to provide prescribed medical examinations of employees,
to issue a means and / or equipment for personal protection at work,
to draw up a special program on the progressive elimination of deficiencies and to determine the deadlines for the implementation of the program if the act on risk assessment determines deficiencies in the field of safety and health at work,
in the course of training for safe and healthy work, informs an employee of all types of risks in the jobs he or she determines and with specific measures for safety and health at work,
to periodically check the ability for safe and healthy work of an employee working at an increased risk workplace.

7. PERSON IN CHARGE OF SECURITY AND HEALTH AT WORK
According to the Law, the person in charge of safety and health at work is a person who performs occupational safety and health work, who has passed the professional qualification exam and who is appointed by the employer in writing to perform these tasks.
The tasks of the person in charge of safety and health are defined in detail in Article 38, which states that it participates in the preparation of the risk assessment act, as well as to cooperate and coordinate work with the occupational health service on all matters related to occupational health and safety.
The law stipulates the rights and obligations of employees' representatives for safety and health at work. He is provided with an insight into all acts related to safety and health at work, and can participate in the resolution of all issues in the field. In accordance with the law, the employer, employee representatives and trade unions are obliged to cooperate with one another in terms of safety and health at work .

8. Tasks of the Labor Medicine Service
The protection of employees' health implies the implementation of preventive health and safety measures that are in the domain of the occupational medicine service. The law defines the occupational medicine service as a service entrusted by the employer with the work of protecting the health of employees.
Article 49 of the Law on Safety and Health at Work states that
the Labor Medicine Service is obliged to perform duties in accordance with the law, and in particular :

9. Tasks of the Labor Medicine Service
1.Učestvuje u procjeni rizika na poslovima i u radnoj okolini prilikom sastavljanja akta o procjeni rizika,
2.Upoznaje zaposlene sa rizicima po zdravlje koji su povezani sa njihovim radom i obavlja poslove zdrastvenog vaspitanja zaposlenih,
3.Utvrđuje i ispituje uzroke nastanka profesionalnih bolesti i bolesti u vezi sa radom,
4.Ocjenjuje i utvrđuje posebne zdravstvene uslove koje moraju da ispunjavaju zaposleni za obavljanje određenih poslova na radnom mjestu., u procesu rada ili za upotrebu,odnosno rukovanje određenim sredstvima za rad,
5.Vrši predhodne i periodične zdravstvene preglede zaposlenih u skladu sa propisima o zaštiti i zdravlju na radu,
6.Izdaje izvještaj o zdravstvenom pregledu o ispunjavanju zdravstvenih uslova za rad na radnom mjestu sa povećanim rizikom,
7.Sprovodi zdravstvenu zaštitu profesionalno oboljelih zaposlenih,
8.Organizuje prvu pomoć, spašavanje i evakuaciju u slučaju povređivanja zaposlenih ili havarija,
9.Utvrđuje uzroke nastanka invalidnosti zaposlenih na radu i predlaže mjere za njihovo otklanjanje,učestvuje u procesu profesionalne rehabilitacije, i daje savjete pri izboru drugog odgovarajućeg posla prema preostaloj radnoj sposobnosti,
10.Predlaže poslodavcu mjere za poboljšanje zdravlja zaposlenih,a popsebno onih koji su izloženi povećanim opasnostima od povrede na radu ili oštećenja zdravlja,
11.Savjetuje poslodavca pri izboru i testiranju novih sredstava za rad,i sredstava i opreme za ličnu zaštitu na radu sa aspekata zaštite i zdravlja zaposlenih,
12.Učestvuje u analizi povreda na radu,profesionalnih bolesti i bolesti u vezi sa radom i o tome vodi odgovarajuću evidenciju,
13.Neposredno sarađuje i koordinira po pitanjima iz zaštite i zdravlja na radu sa stručnim licima,odnosno sa stručnom službom,
14.I druge poslove.

10. Tasks of the Labor Medicine Service
Rulebook on Preliminary and Periodic Inspections of Workers in Workplaces
with increased risk as a by-law, regulates tasks in more detail
occupational medicine related to performing preventive medical examinations
and determining the special health capacities of employees.
In this Ordinance it is stated that "in the process of performing a preliminary and periodic medical examination, the occupational medicine service uses data from the employer's risk assessment-risk factors at the workplace with an increased risk and the special health conditions that must be met by employees.“
The above mentioned tasks are performed by the Labor Medicine Service in accordance with the principles of assessment of working ability.
The data collected in connection with the health check of the employee's trust are of a nature and under the supervision of the authorized institutions for health care of employees.
The report on the medical examination of the employee on the medical fitness for performing certain tasks shall be submitted to the employer in a way that does not violate the principle of confidentiality of personal data.

11. The role of Medicine in manufacturing of
 Risk assessment Act
Teamwork is required for a quality workplace risk assessment
with the involvement of experts from various fields. Participation is essential
the occupational medicine service or the occupational medicine specialist in the multidisciplinary the risk assessment team.
In the previous period, prior to the adoption of the Law on Safety and Health at Work in the year 2005, within the specific health care of workers, risk assessment was carried out in establishing jobs with special working conditions. Special working conditions were determined by the only work-medicine service according to the methodologies used at that time. Working places with special conditions were declared by the RO, based on the finding of med.rada. Unlike such general approach to the Law on Safety and Health at Work, the obligation of risk assessment at all jobs.

12. The role of Medicine in manufacturing of Risk assessment Act
From the aspect of the occupational health service, the health risk assessment at the workplace represents the basis for work in the following jobs :
1. When establishing special health conditions for workplaces with increased risk,
2.In case of identification and risk assessment at the workplace and in the workplace.
When it comes to the process of risk assessment, a certain dilemma creates a legal imprecision about the involvement of the occupational medicine service. Article 49 of the Law on Occupational Safety and Health specifies the aforementioned tasks of the Medical Labor Office when drafting a risk assessment act. However, the Rulebook (2) does not explicitly specify the obligation of engaging the occupational medicine service at the stage of identifying and determining the harmfulness and danger, nor in the risk assessment process.
The Office of Labor Medicine officially does not have any specific instructions from the legislator regarding the risk assessment under the Rulebook (2).

13. The role of Medicine in manufacturing of Risk assessment Act
Without the participation of the Labor Office, there is no quality risk assessment.
Risk Assessment Act, which did not take part in the Labor Medicine Service
in the case of identification and identification of harmfulness and danger, an act has been worked out in an unprofessional manner.
Namely, the most important elements of qualitative workplace risk assessment,
refer to identifying and identifying harmfulness, hazards and breeding.
It is precisely at these stages that the occupational medicine service can give the greatest contribution.
Risk assessment of identified harmfulness and danger, which is done in the following
Phase drafting is more a matter of applying the chosen method that allows
unique assessment.
This is also supported by the provisions of the Rulebook which define in detail the procedure for drafting the act
about risk assessment.
Article 4 states that in the phase of evaluation of the existing state of safety and health at work, reports on preliminary and periodic reviews, injuries, occupational diseases, work-related illnesses are analyzed; and this is the data that only the occupational medicine service has.

14. The role of Medicine in manufacturing of Risk assessment Act
Unfortunately, in the everyday life of the occupational medicine service, they are insufficiently represented in the risk assessment procedure at the RM, as evidenced by the fact that some employers for risk assessment sometimes hire organizations whose primary activity is not safety and health at work, which calls into question the overall approach to injury prevention at work, professional illnesses and work-related illnesses.
It is often the case that the employer refers to the occupational health service only to assess the special health conditions for work in high-risk workplaces, on the basis of the already existing act in which the medicine did not participate.
The employer is obliged to apply only those measures specifically specified in the risk assessment act. If new hazards and hazards arise, ie there is a change in the level of risk in the work process, the risk assessment act is subject to changes and amendments. The Safety Data Sheet is obliged to continuously monitor and verify the effectiveness of the implementation of the implemented measures in terms of elimination and reduction of risks. If, despite the applied preventive measures, there is no reduction in occupational injuries, occupational diseases and work-related illnesses, or that there is a higher level of risk than the assessed, the person for safety and health at work is obliged to propose correction of these measures and amend the act on risk assessment.

15. The role of Medicine in assessing and determining specific health abilities
One of the important problems is the discrepancy between the way in which the medical service redefines the health conditions that must be met by employees in workplaces with increased risk and a specific part of the program of prior and periodic examination of employees at a workplace with an increased risk.
Requirements for work in high-risk workplaces must be defined in a way that allows them to be directly checked based on the elements of preventive examinations of employees.
This means that health conditions must be defined in accordance with the Rulebook, and not in the form of general formulas such as "good hearing". "Preserved sight" and the like. Adequate ORS can be given only with precisely formulated health conditions, which are directly checked the examinations provided by the screening program.

16. The role of Medicine in assessing and determining specific health abilities
It is clear that the specs of the work that wrote these conditions were the easiest way to prescribe the health conditions and to provide, to the maximum extent possible, the possible lawsuits of the injured and ill. But if all the facts are realistically considered, a person rarely is employed after the age of fifty who does not have any illness or diminished function of an organ. For example, why they do not meet the health conditions of a person with chronic obstructive lung disease accompanied by minor damage to the fungal functions for workplaces such as: butcher, fisherman, mason, etc. Or arterial hypertension is often a disease for the patient with hypertension of the first stage (systolic and / or diastolic 90-99mmHg), we can not say that it has a nervous function of the cardiovascular system. However, the percentage of employees with this or a higher stage of arterial hypertension is over 15% versus different studies. Its frequency with production workers is "blue collar" in the United States rose from 18 to 64 years old. is 17.3%, and in Serbia, on the basis of 2270 workers exposed to professional harm, it was found in 39.9% of workers. It is clear that a large percentage of employees would be deemed not to meet the specific health conditions for their workplace if the Risk Assessment Act was "a normal function of the respiratory system", "a normal function of the cardiovascular system and the like".

17. The role of Medicine in assessing and determining specific health abilities
Requirements for work in high-risk workplaces must be defined in a way that enables their direct examination based on the elements of preventive medical examinations of employees.
Health conditions must be defined in accordance with the Rulebook on the manner and procedure of risk assessment, not in the form of generalized "good hearing", "preserved vision", and the like. An adequate ORS can be given only in relation to precisely formulated health conditions that must be directly tested by the examinations provided by the screening program.

18. Conclusions
An incomplete Risk Assessment Act compromises the overall idea of a new approach to preventing work-related injuries, occupational diseases and work-related illnesses. It is necessary to introduce mechanisms that will ensure an adequate risk assessment and elaboration of a quality risk assessment act.
In the assessment of health risks, the participation of the Labor Medicine Service is mandatory, which plays a key role in identifying and determining the harmfulness, hazards and workload in the workplace.
When determining the special health conditions of the specific medicine, the conditions must be precisely formulated and they must be directly verifiable.
Adopt a unique methodological approach in assessing health risks in the workplace, in order to ensure uniform results.
Determine the necessary criteria and requirements regarding the equipment of institutions and teams that are given the opportunity to evaluate health risks in the workplace.
Provide training to risk assessors and innovations of knowledge of occupational medicine specialists for the application of a standardized risk assessment method.
Constant quality control of the adopted risk assessment act; It is a living document that is constantly checked in practice. The appearance of new harmfulness and hazards, or changes in the level of risks in the process of work, requires amendments to the act.

19. Thanks for your attention