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Preventive Occupational Medical Care with Physical Workload

Benefit from preventive occupational medical care!

Employees have a right to offers of preventive occupational medical care if they are exposed to higher physical workload. Here, we provide information on the rules, methods and exact procedure.

Musculoskeletal diseases (MSDs) are among the most important groups of diseases and have a significant share of cases of work absence. While MSDs occur frequently and have various causes, it is undisputed that typical occupational workload, motor requirements and physical effects play a major role in the development MSDs. Work-related factors include repetitive manual work processes, working in forced postures and/or with increased exertion, lifting and carrying heavy loads, or working exposed to mechanical vibrations.

Successful prevention of these diseases is becoming more important in terms of the ageing workforce, and must start by reducing work-related causes. One important instrument for this is statutory preventive occupational medical care concerning physical workload, which is the subject here.

Which inappropriate physical workload lead to employees being offered preventive occupational medical care?

In accordance with the Ordinance on Occupational Healthcare ("Verordnung zur arbeitsmedizinischen Vorsorge", ArbMedVV), employees are entitled to medical advice and examinations. An offer of preventive occupational medical care is mandatory for activities with considerably increased physical workload that are associated with risks to health for the musculoskeletal system through:

  1. handling of heavy load (lifting, holding, carrying, pulling or pushing loads),
  2. highly repetitive manual activities or
  3. work in constrained postures kneeing, in protracted stooping or twisting or in comparable forced postures

Who offers preventive occupational medical care?

Employers must inform employees about the physical workload in the workplace and actively offer preventive occupational medical care at regular intervals. Employees may accept this offer of preventive medical care but are not obliged to do so.

Is this preventive occupational medical care offered to all employees who are exposed to physical workload?

No, employers only have to offer preventive occupational medical care if the carried out work is associated with "considerably increased" physical workload. The Occupational Medicine Rules ("Arbeitsmedizinische Regeln", AMR) 13.2 defines this term: considerably increased physical workload is load that occur regularly or permanently at the workplace that can lead to overstrain resulting in discomfort, functional disorder or damage, in particular to the musculoskeletal system. AMR 13.2 designates acceptable scores for each of workload types:

  • Preventive occupational medical care is to be offered for the workload types "lifting, holding and carrying", "pulling and pushing" and "manual work" if the corresponding key indicator method verifies at least considerably increased workload. These are workloads with a total risk score of 25 points or more.
  • Preventive occupational medical care is to be offered for work in stooped positions, kneeing or work above shoulder height if the workload lasts longer than one hour per shift.
  • Preventive occupational medical care is to be offered for forced seated positions with workload duration from 2 hours and with extended standing (in each case without effective possibilities for movement) from four hours per shift.

What is to be done if you are exposed to physical workload but the limits are not exceeded?

In this case, employees may be given occupational medical advice at their own request. However, the employer does not have to inform employees actively about this "prevention on request" (s. 11 ArbSchG and s. 5a ArbMedVV).

Who carries out preventive occupational medical care?

Preventive occupational medical care is carried out by an occupational health practitioner appointed by the company.

What is the aim of preventive occupational medical care in cases of inappropriate physical workload?

As part of preventive care, employees are primarily given advice. The aim of preventive care is to detect and prevent work-related diseases at an early stage, including occupational diseases that can occur through workload to the musculoskeletal system. Preventive care is also aimed at diseases that can develop through non-occupational factors, conditions and influences, and can be boosted by inappropriate occupational workload and work overload, or occur earlier and more frequently.´

The knowledge that the company doctor gains from the consultations (and where applicable from examinations as well) with the employees, generally also serves the risk assessment as well as other measures for safety in the workplace and the further development of health protection in the workplace. The duty of medical confidentiality is complied with in all cases. Doctors may only pass findings and information from check-ups to the employer with the consent of the employee.

The offer of preventive care is not an appraisal of aptitude for the job or a fitness assessment and must not be associated with these!

Is there a standard that the company doctor uses to carry out the offer of preventive care?

Yes, the medical standard for carrying out a preventive occupational medical care examination is principle G 46 of the German regulations for occupational insurance schemes: Strains on the musculoskeletal system ("Berufsgenossenschaftlicher Grundsatz G 46: Belastungen des Muskel- und Skelettsystems"). This principle comprises a detailed anamnesis, i.e. a record of the medical history and the state of the employees in an interview, an examination of the musculoskeletal system and a consultation.

You can find principle G 46 of the German regulations for occupational insurance schemes and further reading below under the heading "Publications and documents".

How often must an employer offer a preventive occupational medical care examination with physical workload?

Occupational Medicine Rule AMR 2.1 defines the time limits for the offer of preventive occupational medical care examinations.

  • First preventive examination: within 3 months before the start of work
  • Second preventive examination: no later than 12 months after the start of work
  • Further preventive examinations: at the latest after 36 months

The company doctor can recommend shorter periods for the further preventive examinations in dependence on the employee's health, the situation in the workplace or other aspects.

What will preventive occupational medical care examination with physical workload do for me as an employee?

The company doctor can advise employees on the following aspects taking account of individual workload at the workplace and the findings on the individual health situation:

  • documentation, diagnosis and consultancy on the prognosis of disorders and diseases and, where applicable, their relevance to work (where applicable on reasonable suspicion, cosultation on the existence of occupational diseases);
  • where applicable, references to the necessity of an in-depth diagnosis and treatment by a specialist (with regard to non-work-related diseases as well, e.g. arterial hypertension);
  • individual advice on workplace design and work organisation;
  • suggestions for individual safety measures at the workplace;
  • where applicable, suggestion for workplace change (the employer may only be notified of this with the consent of the employee);
  • referring to and arranging individual offers of workplace health promotion (WHP) or prevention measures by statutory health insurers, e.g. advice on recreational sport, dietary advice, fitness offers and other prevention offers;
  • advice and support on occupational rehabilitation measures;
  • individual information and support for occupational integration management (OIM) after diseases
  • other

What results can the employer expect as the result of the offer of preventive medical examinations?

In accordance with the ArbMedVV, the company doctor has to evaluate the findings of preventive occupational medical care examinations in a summarised (aggregated) form and advise the employer on this basis. Examples of aggregated findings are:

  • frequency of cases of illness (accidents, diseases),
  • prevalence of disorders (for example, annual prevalence of lumbar spine complaints),
  • incidence (rate of re-occurrence) of diseases,
  • changes to the prevalence and incidence of diseases and disorders over time, e.g. in conjunction with changes to technology, organisation, personnel structure, etc., preferably in a comparison to non-exposed employees.

Advice for the employer by the company doctor on the basis of offers of preventive medical examinations can refer to the following aspects:

  • information on workplace design taking account of the TOP principle (technical, organisational, personnel measures),
  • information on workplace organisation (deployment of personnel, intensity/volume of work, recuperation periods/breaks, training/instruction),
  • participation in workplace evaluation (e.g. with key indicator methods, surveys),
  • training for employees ("back-friendly patient transfer"),
  • advice on workplace health promotion (WHP) (sport offers, dietary advice, inter alia, implementation of the various prevention offers from the statutory health insurers and pensions providers in accordance with the Prevention Act ("Präventionsgesetz")),
  • support on occupational rehabilitation measures (e.g. RehaBau - special courses for the construction industry),
  • support on integration management (OIM),
  • implementation of prevention campaigns (e.g.

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Occupational Medicine Committee (AfAMed)

AfAMed develops and supervises the Occupational Medical Rules (AMR) for the Ordinance on Occupational Health Care (ArbMedVV).

Find out more : Occupational Medicine Committee (AfAMed) …

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