The frequency of passing medical examinations of the operator of the gas boiler. Mandatory psychiatric examination
The company employs car drivers, truck drivers and personal car drivers. Car drivers, incl. freight, carry out the delivery of goods (raw materials and materials) and the distribution of products (bakery products). Drivers of official cars deliver employees on official needs. The company also has a boiler room operator (dangerous production facility). Is it necessary to conduct a psychiatric examination in relation to the above categories of workers? To what extent is a psychiatric examination of the above categories of workers carried out? Which administrative responsibility can be applied to an enterprise if these categories of employees have not passed a psychiatric examination?
Answer
All car drivers are required to undergo a mandatory psychiatric examination at least once every five years (part of article 213 of the Labor Code of the Russian Federation).
Psychiatric examination takes place, as a rule, in a psycho-neurological dispensary. But not any psychiatrist can conduct it, but only a medical commission. Usually it consists of three psychiatrists.
To undergo a psychiatric examination, the employer issues the employee a referral indicating the type of activity and working conditions contained in the List. The commission is obliged to conduct an examination within 20 days from the date of application. If necessary, she may request additional information about the health of the employee in other medical institutions.
Purpose of the examination:
- determine if an employee has a mental disorder;
- to establish a connection between the nature of the disorder and the ability to successfully and safely perform the type of activity indicated in the direction of the employer.
The commission takes a decision by a simple majority of votes and issues it in writing to the employee against signature within three days after adoption. Within the same period, a message is sent to the employer about the date the decision was made by the commission and the date it was issued to the employee.
The date of the next re-examination is indicated in the conclusion of the commission. If necessary, it can be carried out ahead of schedule at the initiative of the employee or employer. The conclusion on unfitness for work associated with a source of increased danger is issued for a period of not more than five years.*
Does an employee have the right to refuse a psychiatric examination?
Psychiatric examination is carried out voluntarily, except in cases expressly specified in the legislation. For example, when a person poses an immediate danger to himself and others. In other cases, the psychiatrist will ask the employee to sign his consent to the examination.”
“There are situations when an employee is not embarrassed by the absence wages, he is in no hurry to undergo an examination and continues to be registered in the organization. Such behavior may be regarded by the employer as disciplinary offense and announce a remark to the employee. In case of repeated refusals, reprimand and dismiss the employee for repeated non-performance without good reasons job duties if it has a disciplinary action ().
To avoid legal action, it is necessary to follow the procedure for applying disciplinary sanctions ():
- The condition for the mandatory passage of a psychiatric examination should be spelled out in employment contract employee or in a collective agreement, internal labor regulations or other local normative act employer, with whom the employee is familiarized against signature. If there is no such condition in the documents, it is impossible to prove that the employee does not fulfill the requirements of the employer.
- You must ask the employee for a written explanation. If it is not provided in two days, draw up an act about this.
- It is necessary to issue an order for the application disciplinary action and announce it to the employee against signature within three working days from the date of its publication, not counting the time the employee was absent from work (a suspended employee is obliged to come to work, despite the fact that he is not allowed to work). If the employee refuses to read the order, then an act is also drawn up about this.
Answers to your questions.
Should students be referred for a psychiatric evaluation?
Is it obligatory to send for psychiatric examination of students who are undergoing industrial practice? Anna NEMTSOVA, Human Resources Specialist (Kirovsk)
Yes, it is necessary if they will perform work for which appropriate contraindications have been established. You can find them in the List of medical psychiatric contraindications for exercise. certain types professional activity and activities associated with a source of increased danger 3 .
Professional reference system for lawyers, in which you will find the answer to any, even the most difficult question.
IN last years a large number of regulations have been issued that define the obligations of employers and health care institutions to provide medical care workers in hazardous industries. However, in a number of cases, the employer's statutory obligations to protect the health of workers in hazardous industries are not fulfilled and their function is transferred to the territorial health authorities.
Currently, a system of stepwise provision of medical care to employees is being implemented. hazardous industries. This system includes three links: 1) outpatient clinic, 2) inpatient (treatment and diagnostic, treatment and rehabilitation / stage I of rehabilitation /, 3) sanatorium / stage II of rehabilitation /.
The main tasks of the Center's outpatient department are the prevention of occupational and work-related diseases, as well as the medical and social rehabilitation of workers with initial signs of occupational diseases that are not accompanied by disability. The only effective way to accomplish these tasks is to conduct effective (high-quality) preventive medical examinations of these contingents. However, the creation of a truly effective system for conducting medical examinations is associated with certain organizational difficulties.
Currently periodic medical examinations are carried out by the forces of territorial medical institutions and are of a screening nature. According to annual reports Medical facilities %% coverage of employees with periodic medical examinations in the region is 88-90% annually. At the same time, it should be noted the extremely low efficiency of periodic medical examinations by specialists of healthcare facilities. The reasons for the low efficiency of the work of the primary link is that the local therapist does not have special knowledge regarding the clinical manifestations of diseases arising from exposure to harmful factors modern industrial and agricultural production, does not have data on the intensity of harmful factors at a particular workplace, does not have information on the prevalence of occupational diseases in specific working conditions and is also not focused on identifying early signs of occupational diseases.
In order to overcome the difficulties that inevitably arise in the organization and conduct of preliminary and periodic medical
inspections, the following approach is convenient:
Acquaintance with the legal framework necessary for conducting professional examinations
General requirements for the organization of professional examinations
The procedure for conducting professional examinations
Legal basis for professional examinations
The legal framework for conducting professional examinations is based primarily on Article 254 of the Labor Code of the Russian Federation, which states that workers employed in hard work and work with harmful or dangerous working conditions undergo mandatory preliminary upon admission to work and periodic medical examinations to determine their suitability for the assigned work. and prevention of occupational diseases.
181 of the Federal Law of the Russian Federation of June 23, 1999 establishes the conduct at the expense of own funds employer the following types medical activities: mandatory preliminary upon admission to work and periodic medical examinations (examinations) of employees, extraordinary medical examinations (examinations) of employees at their request in accordance with medical recommendations while retaining their place of work (position) and average earnings for the period of passing these medical inspections; as well as exclusion (by employers) of workers; to the performance of their labor duties without passing by them the mandatory: medical examinations and in case of medical contraindications. Comments to Ch. X Labor Code of the Russian Federation (2000) states:
Employers and officials guilty of violating legislative and other normative acts on labor protection, in failure to fulfill obligations established by collective agreements or agreements on labor protection, or hindering the activities of representatives of state supervision and control bodies, as well as public control, are subject to administrative, disciplinary or criminal liability in the manner prescribed by law Russian Federation and republics in the composition. Russian Federation. For violation of the requirements of legislative and other regulations on labor protection, employees of enterprises are subject to disciplinary, and, in appropriate cases, to material and criminal liability.
In cases where the production activities of enterprises pose a danger to the life and health of workers and the public, their activities may be suspended by order of the head of the Center for State Sanitary and Epidemiological Surveillance, or state labor protection inspectors
The main document, according to which preliminary and periodic medical examinations are carried out, is the order of the Ministry of Health of the Russian Federation No. 405 of December 10, 1996, due to the fact that it is he who has the agreement with the Ministry of Justice of the Russian Federation. According to order No. 405, the scope of medical examinations is carried out in accordance with order No. 90 dated March 14, 1996. Further, we are talking about the order (August 2004 No. 83.)
General requirements for the organization of preliminary and periodic medical examinations:
TO general requirements relate
Availability of a full package of regulations on the protection of the health of workers; on conducting preliminary and periodic medical examinations of employees;
Opportunity to interact with social security authorities, social insurance and employers in this area.
Ensuring the possibility of familiarizing with the specified documents the specialists of the medical institution participating in the organization and conduct of preliminary and periodic medical examinations,
Fulfillment of the requirements of Decree of the Government of the Russian Federation No. 967 dated December 5, 2000, order of the Ministry of Health of the Russian Federation No. 405, order of the Ministry of Health of the Russian Federation No. 90,
Participation in the examination of the attending physician,
Sufficient technical equipment of health facilities,
The presence of specialists (their own or attracted) who have a document (certificate, certificate) on the availability of special training in occupational pathology no more than five years ago.
Preliminary and periodic medical examinations, as well as an examination of professional suitability can be carried out by healthcare facilities of any organizational and legal forms that provide primary medical care to the population and have a license for this type of activity. Medical examinations can be carried out by the Centers and departments of occupational pathology, subject to the availability of an appropriate license with the issuance of a conclusion on the results of the examination and suitability for professional activity. Certain aspects of the examination of professional suitability are allowed to be carried out by some specialized medical institutions (dermal and venereal, narcological, neuropsychiatric dispensaries).
The main person conducting medical examinations is the attending physician.
In accordance with Article 58 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, an attending physician is a doctor who provides medical care to a patient during his observation and treatment in an outpatient or hospital institution. The attending physician may be a general practitioner of a health center, shop or territorial area, a general practitioner working in a medical and preventive organization, or a doctor of the Trade Union Center, who performs a medical examination with the involvement of all current medical documentation necessary to assess the health status of an employee in dynamics.
Without the involvement of the attending physician, conducting preliminary and periodic medical examinations is methodically incorrect. As experience shows, it is during medical examinations carried out by permanent commissions for professional examinations, prevention departments, professional examination polyclinics or other medical and preventive institutions without the participation of the attending physician that numerous errors occur associated with the admission to professional activities of persons who have contraindications to work with harmful production factors. . The procedure for conducting medical examinations
According to Order 405, contingents subject to preliminary and periodic medical examinations are determined by the centers of the State Sanitary and Epidemiological Supervision of the constituent entities of the Russian Federation together with the employer (by workshops, professions, dangerous, harmful substances and production factors) no later than December 1 of the previous year. The timing of inspections should correspond to the established frequency.
Preliminary and periodic medical examinations of employees working on a rotational basis, carry out medical and preventive organizations / institutions / at the place of permanent medical care or at the place of deployment of shifts, when the administration of shift organizations decides on their financing.
Measures to prepare the institution for conducting preliminary and periodic medical examinations.
Heads of health care facilities:
1. To study the list of harmful substances and production factors affecting the employees of supervised enterprises (according to the lists of contingents subject to periodic medical examinations approved by the SSES).
2. Determine the composition of the medical team for conducting preliminary and periodic medical examinations, taking into account the list of harmful substances and production factors at supervised enterprises (Appendix No. 1, 2 of Order No. 90 of the Ministry of Health of the Russian Federation).
3. Determine the set of necessary laboratory research methods, taking into account the list of harmful substances and production factors at supervised enterprises (Appendix No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation).
4. Determine the complex of necessary functional research methods, taking into account the list of harmful substances and production factors at supervised enterprises (Appendix No. 1 and 2 of Order No. 90 of the Ministry of Health of the Russian Federation).
5. Ensure the availability of research equipment in the medical facility, chemicals, x-ray film and other component materials for carrying out relevant laboratory and functional research methods.
6. Draw up a schedule for referral to special training in occupational pathology for doctors of all specialties involved in conducting preliminary and periodic medical examinations.
7. To carry out training of laboratory assistants on the issues of conducting special laboratory tests.
Planning.
Heads of health care facilities:
1. Conclude an agreement with the employer or conduct preliminary and periodic medical examinations.
2. Receive before December 1 of the year preceding the periodic medical examination name lists contingents subject to periodic medical examinations. The lists must be certified at the center of the State Sanitary and Epidemiological Supervision and contain information on the number of professions examined by workshops, harmful substances and production factors (in accordance with appendices No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation), work experience, the frequency of medical examinations and the date of the last medical examination.
3. Issue an order to conduct preliminary and periodic medical examinations of employees of supervised enterprises in healthcare facilities. Appoint a person responsible for conducting preliminary and periodic medical examinations at health facilities, indicate the composition of the medical team that performs medical examinations, and determine the working hours of the medical team. The person responsible for conducting preliminary and periodic medical examinations in health facilities must have a certificate in the specialty "Occupational Pathology".
4. Draw up a schedule for the work of the team of doctors.
5. Make a schedule for the work of laboratory assistants.
6. Make a schedule for the work of functionalist doctors.
7. In the absence of a medical specialist in a medical facility, conclude an agreement with another medical facility to involve a specialist of this profile in conducting preliminary and periodic medical examinations. The timing of the examination of workers should coincide with the work schedule of the main medical team.
8. Ensure that each specialist doctor participating in periodic medical examinations has contingents subject to periodic medical examinations in the current year. It is necessary to provide 3 additional columns in the lists: diagnosis, conclusion (fit, not fit), medical and recreational activities.
9. Draw up a schedule for the work of the clinical expert commission (CEC) to issue a conclusion on contraindications to continue work during harmful conditions pile and conflict resolution.
Carrying out preliminary medical examinations.
Under an agreement with the employer (head of the organization), the medical facility is obliged to ensure a preliminary medical examination of the employee.
Scheme of conducting a preliminary medical examination in a health facility:
Registration of the employee's appearance at the medical facility for the preliminary medical examination.
Registration of an employee in a medical facility for a preliminary medical examination is carried out in a special journal. The registration form must include the date of application, passport data, the name of the enterprise that sent the employee, harmful production factors at the future place of work and a conclusion on the compliance of the state of health with the intended work.
During the registration of an employee, the documents required for a preliminary medical examination are checked:
A referral from the personnel department of the enterprise (organization), which contains a list of harmful substances and production factors at the future place of work in accordance with appendices No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation,
Passport or other identity document, military ID,
An outpatient medical record from a place of permanent medical care. In the absence or incomplete compliance of documents with the requirements (for example, there is no outpatient card, harmful substances and production factors are not indicated in the referral), a medical examination is not carried out.
Filling in the worker's professional route sheet in the outpatient card.
The sheet of the professional route of the employee indicates the name of the enterprise, workshop, section, profession, work experience at this place work,
harmful substances and production factors at this place of work, the final conclusion on the compliance of the state of health with the assigned work. IN free form data on the composition of the medical team carrying out a medical examination in accordance with the order of the Ministry of Health of the Russian Federation No. 90, and the volume of necessary laboratory and functional studies are entered on the sheet of the professional route.
Examination by medical specialists. Each doctor enters the data of an objective examination into the employee's outpatient card and gives his opinion on the compliance of the state of health with the assigned work. In the referral sheet for a preliminary medical examination, the main specialist doctor makes a final conclusion on the compliance of the state of health with the intended work. The conclusion, signed by the main medical specialist, is sealed by the health care facility. In the sheet of the professional route, the main specialist doctor duplicates the final conclusion on the compliance of the state of health with the intended work.
The main person conducting the preliminary medical examination is the general practitioner, indicated in the first place in the medical team, according to column 5 (“participation of specialist doctors”) of Annexes No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation. During the medical examination, an appointment with the primary physician must complete the medical examination. The doctor makes his conclusion taking into account the data of laboratory and functional methods of examination of the employee, which are pasted into the outpatient card. In the referral sheet for a preliminary medical examination, the conclusion signed by the doctor is sealed by the medical institution.
We remind you that regardless of the place of work, the person being examined is required to undergo a blood test (hemoglobin, leukocytes, ESR), an X-ray of the chest organs in a direct projection, women are examined by an obstetrician-gynecologist with a bacteriological (for flora) and cytological (for atypical cells) examination .
In case of inconsistency of the state of health with the assigned work, the employee is sent to a meeting of the clinical expert commission of the medical facility. The clinical expert commission, based on the results of the examination of the employee, makes a conclusion about his unsuitability for work in hazardous areas. working conditions. The first copy of the conclusion is handed over to the employee, a copy of the conclusion is sent to the employer who issued the referral within three days.
Registration of preliminary medical examination results
The result of the conclusion of the preliminary medical examination is entered in the register of preliminary medical examinations.
When an employee is transferred to another place of work with similar working conditions and production factors, the documents are drawn up by the attending physician based on the data of the previous preliminary or periodic medical examination. The referral indicates the date for the second medical examination.
When transferring an employee to another place of work with other harmful working conditions and production factors, a preliminary medical examination is carried out at common grounds in accordance with the list of harmful production factors at the new place of work
Carrying out periodic medical examinations.
Periodic medical examinations are carried out in accordance with the schedule approved by the head physician of the health facility and agreed with the employer.
Registration of employees' attendance for periodic medical examinations.
The attendance of employees for periodic medical examinations is provided by the employer in accordance with the approved plan. Registration is carried out for the purpose of checking required documents for periodic medical examination: referral from the employer for periodic medical examination, passport or other identity document, military ID, outpatient medical card from the place of permanent medical care. In the absence or incomplete compliance documents to the requirements of a medical examination is not carried out.
During registration, the order of examination by specialist doctors and the time for passing tests, passing functional methods of examination, X-ray examination are determined. Note! In order of the Ministry of Health of the Russian Federation No. 90, chest X-ray is indicated as a mandatory method of examination, and not a fluorographic examination.
Completing a professional itinerary sheet.
Entering the date of inspection, work experience, and in the event of a change in place of work - information about the name of the enterprise, workshop, section, profession, work experience at the new place of work, harmful substances and production factors at the new place of work. Data on the composition of the medical team that performs a medical examination in accordance with the order of the Ministry of Health of the Russian Federation No. 90, and the volume of necessary laboratory and functional studies are being corrected.
Examination by medical specialists.
Each doctor enters the data of an objective examination into the employee's outpatient card and gives his opinion on the conformity of the state of health. In the event that an employee has a disease that prevents the continuation of work in harmful conditions, a decision is made to send the patient to a meeting of the clinical expert commission of the medical facility. The list of general medical contraindications to work related to harmful substances and production factors is indicated in Appendix 4 of Order No. 90 of the Ministry of Health of the Russian Federation. A list of additional medical contraindications, depending on the specific harmful factor, is given in column 7 of Appendix No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation.
If an employee has signs of a general illness that prevents continued contact with harmful substances and production factors, a set of therapeutic and preventive measures is developed. (In the event that medical examinations are not carried out at a medical facility for permanent observation, notifications of all cases of newly diagnosed general diseases are transferred to the health facility at the place of permanent medical care for the employee. Notification forms are prepared at the expense of the employer).
If an employee is found to have deviations from individual organs and systems of the body, the doctor prescribes a set of additional diagnostic measures. The examination plan is entered into the patient's outpatient card for further in-depth examination of the employee at the place of permanent medical care (the employer does not pay for a range of additional medical services, not included in applications No. 1,2 of the order of the Ministry of Health of the Russian Federation No. 90). The final diagnosis is established by the specialists of the health care facilities of permanent medical care and is included in the list of updated diagnoses.
Primary person conducting the periodic medical examination. is the doctor listed in the first place in the medical team, according to column 5 (“participation of specialist doctors”) of Annexes No. 1 and 2 of Order No. 90 of the Ministry of Health of the Russian Federation. During the medical examination, the main doctor must complete the medical examination. The doctor makes his conclusion taking into account the data of laboratory and functional methods of examination of the employee, which are pasted into the outpatient card.
If an employee shows signs of an occupational disease, he is sent to a meeting of the clinical expert commission of a medical institution that conducts a periodic medical examination in order to resolve the issue of further examination at the Trade Union Center. Further actions of doctors are regulated by Decree of the Government of the Russian Federation of December 15, 2000 No. 967 "On approval of the Regulations on the investigation and registration of occupational diseases."
For each person with deviations in the state of health, the doctor conducting the medical examination prescribes medical and recreational measures: diet, referral to outpatient treatment, inpatient treatment, sanatorium treatment, in a sanatorium-dispensary, rest homes.
The work of the clinical expert commission.
The clinical expert commission, based on the results of the examination of the employee, makes a conclusion about his suitability for work in hazardous working conditions. All conclusions of the commission are recorded in the journal of the KEC meetings. The first copy of the conclusion is handed over to the employee, a copy of the conclusion is sent to the employer who issued the referral within three days. The terms of examination of an employee at a meeting of the clinical expert commission should not exceed 3 days in relation to the schedule for conducting a periodic medical examination of an employee.
By decision of the CEC, an employee can be eliminated from continuing to work in hazardous working conditions (the presence of general and additional medical contraindications), transferred to work in lighter working conditions, sent to MSEC due to a general illness.
If an employee has signs of an occupational disease, by decision of the EEC, he is sent to the regional center of occupational diseases. The doctor responsible for conducting preliminary and periodic medical examinations at the medical facility sends an emergency notice to the Center for Sanitary and Epidemiological Supervision to draw up a sanitary and hygienic description of the working conditions of the employee.
Making a final conclusion on the compliance of the state of health with the work performed.
In the list of referrals for periodic medical examinations (forms of referrals for periodic medical examinations are made at the expense of the employer), the main specialist doctor makes a final conclusion on the compliance of the state of health with the intended work. The conclusion, signed by the main medical specialist, is sealed by the seal of the health facility.
Registration of the final act
The results of periodic medical examinations of employees are summarized in the form of final acts. The final act is drawn up within 2 weeks from the date of completion of the periodic medical examination. At the end of the periodic inspection, the person responsible for its conduct is provided with information for drawing up the final act. The official form of the final act, indicated in the notes to appendices No. 1, 2 of the order of the Ministry of Health of the USSR No. 555, has been legally canceled, although a new one has not been developed.
The final act must contain the following data;
The composition of the commission for the preparation of the final act;
The composition of the medical team conducting the examination of workers. For each specialist doctor, the date of the last improvement in occupational pathology is indicated;
Number of persons subject to periodic medical examination in the current year, including women;
Number of people examined (percentage of examination coverage), including women;
Number of unexamined (with indication of the reason);
The number of persons with newly diagnosed common disease;
The number of persons included in the dispensary observation groups due to chronic general diseases (according to the examination data and outpatient card data);
- (the number of persons with deviations in the state of health, requiring further examination at the place of residence;
The number of persons referred to KEK HCI,
The number of people in need temporary transfer for other work for health reasons (general diseases, occupational diseases);
The number of persons in need of permanent transfer to another job for health reasons (general diseases, occupational diseases);
Number of persons referred for MSEC (general diseases);
Number of identified persons with suspected occupational disease (including women), list of names;
Number of persons referred to the regional center of occupational diseases, list of names;
Number of persons to be referred for outpatient treatment.
Number of persons to be referred for inpatient treatment;
The number of persons to be referred for sanatorium-and-spa treatment;
The number of persons to be sent to a sanatorium-dispensary;
The number of persons in need of diet and special nutrition;
The final act is drawn up in 4 copies and submitted to the TsGSEN, adm. enterprises, trade union committee, health care facilities.
The health care facility bears full legal responsibility for the quality of the medical examination, as an extrabudgetary activity, on the basis of existing legislation.
Control over the quality of preliminary and periodic medical examinations is entrusted to the bodies of the SSES and the Trade Union Center.
Order No. 90
Unfortunately, order No. 90 contains a number of defects that significantly complicate the work.
Order No. 90 does not contain requirements for the preparation of medical certificates and the final act.
Compared to order 555, there is no third column: earlier - the nature of the work being carried out, which makes it difficult to select contingents for PMO. An example - work in contact with ultrasound - in order 555, work with medical equipment was indicated as jobs, there are no instructions in order No. 90, as a result of which jobs in health care facilities are not submitted to the SSES bodies and are not subject to preliminary and PMO in the scope of the order .
The column "participation of medical specialists" contains the term: "according to indications". Indications can be either a long experience or the presence of clinical signs of a disease. The indications must be determined by a general practitioner. It is known that chronic occupational diseases in the early stages have a few symptoms and cannot be identified by complaints.Therefore, the order itself provides for the possibility of diagnosing these occupational diseases only in the later stages.Example: exposure to high temperature in contraindications indicates cataracts.And the participation of an ophthalmologist according to indications.But the first 3 stages of thermal cataract are not accompanied by a decrease in visual acuity and, therefore , complaints of patients.
In addition to the optional participation of some specialist doctors in PMO (according to indications), in column 7 there are references to medical contraindications in addition to general honey. contraindications. In particular, in column No. 7, in contact with fluoroplastics (p. 30), chronic diseases of the nervous system are indicated as contraindications for work, but the participation of a neurologist in the commission is not provided. A similar situation is observed in contact with cyanide compounds (p. 22): diseases of the anterior segment of the eyes are indicated as contraindications, but there is no oculist in the commission. Contraindications to work with acrylonitrile (p. 22) are allergic skin diseases, dystrophic changes in VDP, diseases of peripheral nervous system, but an ENT doctor does not participate in the commission. dermatologist and neurologist. In case of vibration disease, high and complicated myopia are indicated as contraindications, but there is no oculist in the commission (in order No. 555, the oculist was a mandatory specialist doctor).
With a number of harmful factors in the same column No. 7 of order No. 90, there are no contraindications previously approved by order No. 555. Such inconsistencies impede the work of medical specialists and lead to the development of injuries and occupational diseases in the workplace with the fact of high-quality medical examinations.
Column No. 6 indicates laboratory and functional studies carried out during PMO. But even here there are inaccuracies. It is mandatory to conduct a blood test with the number of erythrocytes, leukocytes, ESR. In the tables, reference is made to general analysis blood (p. 22, chromium), and in part - on the leukocyte formula (p. 22, acrylonitrile). If in the first case it meant a study on the number of reticulocytes and platelets, then it is not clear the indications for these studies in contact with aromatic hydrocarbons (p. 16). with lead (page 12). Even more incomprehensible is the indication to conduct a study on the leukocyte formula according to indications (p. 9, copper), on a general blood test according to indications (p. 10, lithium). In order No. 555, contact with welding aerosol containing Mn, Mg. Ti, Zn, Si, implied a study of the leukocyte formula, this study is not indicated in order No. 90.
In case of contact with abrasive dusts, the period for carrying out Rg-graphy of the lungs (p. 36) with an experience of more than 15 years is not indicated, although in the future there is a reference to this paragraph repeatedly.
Separately, it is necessary to dwell on the conduct of periodic medical examinations of workers in the conditions of occupational pathology centers. These medical examinations are regulated by order No. 90 of the Ministry of Health of the Russian Federation once every 3-5 years, depending on the harmful and dangerous substances and production factors, but are not carried out almost everywhere. Medical examinations should be carried out in a consultative polyclinic or hospital of the occupational pathology center.
Previously, there were standard objections from employers to conducting these medical examinations. As a rule, they relied on clause 2.9. Order No. 405: ""... inspections may be carried out under the conditions of the HRC ... ", meaning by this it is not necessary to fulfill the requirements of column No. 4 of the order of the Ministry of Health of the Russian Federation No. 90. However, since the adoption of order No. 83, the situation has changed radically. Workers with more than 5 years of experience will be examined at the Trade Center once every 5 years .
Carrying out medical examinations at enterprises by field forcesbrigades.
This approach significantly reduces the costs of enterprises, avoids labor losses and the associated lost profits of enterprises, while maintaining the quality of surveys.
One mobile team is able to conduct more than 5,000 examinations per year. At the same time, the benefits are obvious not only for enterprises, but also for the Trade Union Center.
Brigades kit:
1. Mobile fluorograph (Large frame 100 mm or, better, digital, allowing you to get images of 38 * 38 cm, 41 * 41 cm)
2. Car for the medical team
3. UAZ car equipped with the following equipment:
1. spiro analyzer (Chest, Microspiro, etc.)
2. ECG machine
3. vibration tester
4. tuning forks,
5. laboratory assistant's kit: hemoglobinometer, binocular microscope, calillaries, test tubes, glasses, ESR meters, tripods, scarifiers, Goryaev cameras, reagents, automatic micropipettes, bixes, packing case
6. ophthalmologist's kit: straight ophthalmoscope, Govin-Sivtsev table, trial set of glasses, trial spectacle frames, arc perimeter, Maklakov's tonometers, or IOP indicator, Rabkin's tables;
7. set of an otorhinolaryngologist: audiometer, ear funnels, nasal mirrors, spatulas, intralaryngeal mirrors, nasopharyngeal mirrors, kidney trays, ear tweezers, Janet syringe (reusable),
8. blood pressure monitors, stethophonendoscopes, thermometers.
The average daily workload of a medical team staffed by doctors and paramedical personnel is at least 50-60 people with a guarantee of maintaining the quality of work. The detectability of signs of occupational diseases in comparison with medical examinations conducted by medical facilities at the place of residence increases by 10-12 times, and reaches 1.1% of the number of those examined (during medical examinations by the medical facilities at the place of residence - only 0.1% or less) . At the same time, the primary disability due to occupational diseases is significantly reduced due to the fact that they are detected in a functionally reversible stage and can be effectively treated using a sick leave.
Attention should be paid to the fact that with this approach, the employer actually pays for the detection of general somatic diseases, which reduces the costs of healthcare budgets.
In case of detection of signs of a deviation in the state of health, employees are sent to the Center for Occupational Pathology for medical examination according to column "4" of order No. 90 of the Ministry of Health of the Russian Federation (stationary examination).
The above system of organizing medical care for workers in hazardous industries makes it possible to carry out at the outpatient stage:
* high-quality periodic medical examinations,
* detection of occupational diseases in a functionally reversible phase
* early detection of general somatic diseases in workers of hazardous industries
* identification of persons with individual signs of exposure to harmful production factors (control groups) and dynamic monitoring of them in the conditions of the Trade Union Center
* development for each patient of an individual scheme of treatment and rehabilitation measures aimed at maintaining health in hazardous working conditions,
* if necessary - timely removal from exposure to harmful factors.
Thus, the modern concept of l
— production instructions for the operation of the main and auxiliary equipment;
- instructions on labor protection for the operator of the boiler room and other instructions on labor protection;
1.4.3. Repeated briefing on labor protection of the operator is carried out at least once every three months.
1.4.4. Unscheduled briefing is carried out at:
— upon introduction of new or amendment of legislative and other regulatory legal acts containing labor protection requirements, as well as instructions on labor protection;
- when it changes technological processes, replacement or modernization of equipment, fixtures, tools and other factors affecting labor safety;
- in case of violation by employees of labor protection requirements, if these violations created a real threat of serious consequences (accident at work, accident, etc.);
- on demand officials bodies of state supervision and control;
- during breaks in work (for work with harmful and (or) dangerous conditions - more than 30 calendar days, and for other works - more than two months);
- by decision of the employer (or a person authorized by him).
1.4.5. Targeted briefings the employee is carried out when performing one-time work, during the elimination of the consequences of accidents, natural disasters and work for which a work permit, permit or other special documents are issued, as well as when mass events are held in the organization.
1.5. The operator is obliged to comply with the internal labor regulations:
- do not smoke at the workplace;
- do not allow the drinking of alcoholic beverages during working and non-working hours in the boiler room;
- follow the duty schedules approved by the head of the section.
1.6. The duration of the working time of operators according to the schedule is no more than 12 hours. Eating is allowed at the workplace.
1.7. Periodic medical examinations of operators are carried out once every 2 years.
1.8. When performing work, the operator may be exposed to dangerous and harmful production factors:
- hazardous production factors - factors, the impact of which on a worker under certain conditions can lead to injury or to a sudden deterioration in health;
- harmful - to a decrease in efficiency or to diseases.
1.9. The boiler room operator must be aware of possible contact with harmful and dangerous production factors.
Physical factors:
- a dangerous voltage level in the electrical circuit on the control panels (blocks) of thermal power plants;
- falling from height;
— roughness, burrs, sharp edges on equipment surfaces;
- gas contamination of the air in the working area (in case of gas leakage, leaks in gas ducts, lining of boilers, lack of ventilation);
- elevated temperature of the equipment surface (in the absence or violation of equipment insulation);
- increased vibration during equipment operation;
- the microclimate of the premises;
- increased noise (when not using anti-noise headphones);
Psychophysiological - labor intensity.
1.10. There are 4 classes of conditions and nature of labor according to the degree of harmfulness and danger: optimal, permissible, harmful and dangerous.
Optimal working conditions (class 1) - the conditions under which the health of the employee is preserved and the prerequisites are created for maintaining high level performance.
Permissible working conditions (class 2) are characterized by such levels of environmental factors and the labor process that do not exceed the established hygienic standards for workplaces, and possible changes in the functional state of the body are restored during a regulated rest or by the beginning of the next shift and do not have an adverse effect in the near and remote period on the health status of workers and their offspring. Permissible working conditions are conditionally classified as safe.
Harmful working conditions (class 3) are characterized by the presence of harmful factors, the levels of which exceed the hygienic standards and have an adverse effect on the worker's body and / or his offspring.
1.11. When performing work in accordance with the type of hazardous and harmful production factors, the boiler room operator is obliged to use the means personal protection(overalls, special footwear and safety devices: goggles, respirator, headphones, etc.).
1.12. According to the “Regulation for the provision of personal protective equipment for workers, the operator must use:
– Cotton suit for protection against general industrial pollution and mechanical impacts – 1 per year.
- Leather boots - 1 pair per year.
— Combined mittens or knitted gloves with polymer coating - 4 pairs per year.
- Goggles - to wear.
In winter additionally:
– Jacket with insulating padding – 1 for 3 years.
– Leather insulated boots – 1 pair for 3 years.
1.13. The operator must report equipment malfunctions to the site manager and dispatcher before starting work or during the working day after the malfunction is discovered and make an entry in the log of equipment defects and malfunctions.
1.14. In case of an accident, the boiler room operator can provide first aid to the victim, report the incident to management and the dispatcher, call a doctor and, if possible, save the situation at the scene for investigation.
1.15. In addition to these requirements, the boiler room operator must comply with:
— the requirements set out in the tariff and qualification characteristics for the level of theoretical and practical knowledge of the operator of the corresponding category;
- requirements of the Production Instructions for the operation of boilers;
- regulations technical operation equipment, fixtures, tools with which he works or which serves;
- internal labor regulations.
1.16. Labor protection requirements are mandatory for the employee. Failure to comply with these requirements is considered as a violation of labor discipline.
2. Labor protection requirements before starting work
2.1. Before accepting a shift, the boiler room operator must:
- Arrange your uniform. Sleeves and floors of overalls should be fastened with all buttons, hair should be removed under a helmet. Clothing must be tucked in so that there are no hanging ends or fluttering parts. Shoes must be closed. IT IS FORBIDDEN to roll up the sleeves of overalls;
- make a bypass of the serviced equipment along a certain route, check the safe condition of the equipment, fences, rotating mechanisms, the presence of numbers on the equipment and pipeline fittings;
- check the availability and serviceability of tools and fixtures and their compliance with the expiration date, as well as the presence of emergency lighting, fire extinguishing equipment, posters or safety signs;
- check in the service area that there are no unnecessary objects blocking the aisles, that the working area and on the equipment being serviced are adequately illuminated (no burnt out lamps);
- report to the ODS dispatcher about all the identified comments and obtain permission to ignite the boiler.
- lean and stand on the barriers of the sites, walk along pipelines, as well as on structures and ceilings that are not intended for passage through them;
- start-up and short-term operation of mechanisms or devices in the absence or malfunction of enclosing devices;
- to clean near the mechanisms without safety fences or with poorly fixed fences;
- operate faulty equipment, as well as equipment with faulty or disabled emergency shutdown devices, interlocks, protections and alarms;
- repair equipment without performing technical measures that prevent its erroneous start-up (engine start, steam or water supply, etc.), spontaneous movement or movement;
- to come to the shift in a state of intoxication or drink alcohol during working hours.
3. Labor protection requirements during work
3.1. During operation, the boiler room operator must:
- do not leave running boilers unattended, both during the operation of the boiler and after it has stopped (until the combustion in the furnace has completely stopped and the coolant temperature has dropped to 45 degrees C),
- do not block passages and approaches to devices, fittings and fire shields,
- do not allow unauthorized persons into the boiler room without a representative of the administration of the enterprise,
- do not allow untrained and uncertified persons to operate,
- in case of deterioration of health, stop work, bring workplace to a safe state, notify the immediate supervisor, contact a medical institution,
- during accidents, take part in the elimination of the consequences and not carry out the transfer and acceptance of the shift until they are completely eliminated.
3.2. Conduct the boiler operation mode in accordance with the “boiler mode chart”.
3.4. The boiler should be purged in accordance with the regime chart and the production instructions for the operation of the boilers at least once per shift.
3.5. Check the operation of pressure gauges, safety valves at least once a shift.
3.6. To increase the forcing of the boiler, it is necessary to increase the gas pressure, then air, with a decrease - vice versa.
3.7. In case of deviations in the operating mode of the boiler from the norm, act in accordance with the “Plan for Localization and Elimination emergencies in the boiler room, production instruction for the operation of the boiler.
3.8. Provide access to maintenance personnel repair work according to the permit, prepare the workplace, conduct targeted briefing.
3.9. During a break in the operation of equipment for troubleshooting, replacement of working bodies, etc. put up safety posters.
3.10. Wear overalls and safety shoes.
3.11. The operator of the boiler room during the operation of the boiler is prohibited from:
- leave the boilers unattended until the complete cessation of combustion in the furnace, removal of fuel residues from it and pressure reduction to zero;
- commissioning of boilers with faulty: fittings, feeders, safety automation, emergency protection and alarm systems;
- ignite the extinguished gas in the furnace without preliminary ventilation of the furnace and gas ducts;
- light a gas torch from a nearby burner;
- jam safety valves or additionally load them;
- purge when the purge valve is faulty, open and close the valve with blows from a hammer or other objects;
- lubricate bearings and tighten seals during pump operation;
- use boxes and other temporary fixtures and devices instead of stairs and platforms;
- lengthen wrenches (put pipes on them, etc.), as well as hit on wrench to avoid breakage of bolts and thread breaking.
4. Labor protection requirements in emergency situations
4.1. The boiler room operator is obliged to emergency stop the boiler in accordance with the Production Instructions for the Operation of Boilers and.
4.2. To provide medical assistance to victims of injury, poisoning and sudden illness, act in accordance with the "Instructions for first aid in case of an accident at work."
4.3. In case of accidents:
- Immediately organize first aid to the victim and, if necessary, take him to medical organization;
— Take urgent measures to prevent the development of an emergency or other emergency and the impact of traumatic factors on other persons;
- Preserve the situation before the start of the investigation of the accident, as it was at the time of the incident, if this does not threaten the life and health of other persons and does not lead to a catastrophe, accident or other emergency circumstances, and if it is impossible to maintain it, record the current situation (draw up schemes, conduct other activities);
5. Labor protection requirements at the end of work
5.1. During the round-the-clock operation of the boiler house, the boiler house operator is obliged:
- pass the shift, in accordance with the "Industrial instruction for the operation of boilers";
- sign in the operational log on the delivery of the shift, if the shifter does not appear, inform the dispatcher of the DS that it is forbidden to leave the boiler room unattended.
5.2. Notify the immediate supervisor of any deficiencies in the operation of the equipment.
Put away work clothes in a specially designated place, wash your hands with soap and water, if possible, take a shower.
The boiler house operator is obliged to comply with the requirements of the labor protection instruction for the boiler house operator.
Every year, during the heating period, we receive boiler room operators. They undergo medical examinations when they are hired. According to 302 n and a special assessment for harmfulness, a medical examination should take place 1 time in 2 years. Tell me, can we use last year's medical board when hiring operators or not?
Answer
Answer to the question:
No, in this situation, before hiring employees, you need to send them to preliminary medical examination again. This is due to the fact that there was a layoff. During the time that employees did not work, they could have contraindications to work. Moreover, the requirement for preliminary honey. examination is mandatory requirement that must be completed every time you apply for a job.
Therefore, workers can be accepted only after passing a preliminary medical examination.
Details in the materials of the System Personnel:
1. Answer: Is it necessary to conduct a mandatory medical examination if an employee is hired for a short period of time for temporary substitution absent employee (for the period of illness, vacation, etc.). According to the position for which the employee is hired, a medical examination is provided
N.Z. Kovyazin
Yes need.
The need for a medical examination is caused by the presence of dangerous and (or) harmful factors and work in the labor process (Appendices No. 1, 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n). Since such factors objectively exist for a temporarily occupied position, a temporary employee is subject to all medical examinations provided for by law in the general manner (Article 213 of the Labor Code of the Russian Federation). The term of the contract with the conscript does not matter.
With respect and wishes for comfortable work, Ekaterina Zaitseva,
Expert Systems Personnel