The purpose of a medical examination carried out by an occupational health doctor is to assess the employee’s health and the suitability of their working conditions for the employee and to ascertain a potential illness caused by work or an occupational disease.
The second objective of the medical examination, which is to detect such health disorders that may be caused by the working environment as early as possible, is no less important.
Detecting a problem early on helps to avoid further damage to an employee’s health.
Organisation of medical examination
The employer organises a medical examination for the employee within four months as of the commencement of the employee’s employment. If within the past six months the employee has had a medical examination for the same working environment hazards and the same nature of work while working for another employer, the employer may organise a medical examination at the time stated in the medical examination decision provided by the employee.
An employer shall organise a medical examination for an employee whose health may be affected by the following environment hazards or nature of work:
- electromagnetic fields;
- artificial optical radiation;
- ionising radiation;
- dangerous chemicals and materials containing such chemicals, including carcinogens and mutagens;
- biological hazards;
- work with display screen equipment;
- manual handling of loads;
- work involving repetitive movements or work in a constant forced position, including in a sitting or standing position;
- work in a constant forced position, including in a sitting or standing position;
- other hazards or nature of the work.
Regardless of the risk assessment results, an employer shall organise a medical examination for a night worker. A night worker is any employee who works at night for at least three hours of his or her daily working time or at least one third of his or her annual working time. In addition, regardless of the risk assessment results, the medical examination shall be organised for an employee who is exposed to lead and its compounds and asbestos dust.
The medical examination of an employee is carried out by an occupational health doctor, involving other specialists, if necessary.
The employer shall organise a medical examination of the employee within four months as of the commencement of the employee's employment.
An employer shall organise the medical examination of:
- an employee who is exposed to biological hazards;
- an employee who is exposed to carcinogens and mutagens;
- an employee who is exposed to lead and its compounds;
- an employee who is exposed to asbestos dust;
- a night worker.
Periodic medical examination shall be organised at the interval set by the occupational health doctor but at least once every three years and, in case of an employee who is a minor, at least once a year.
The employer shall bear the costs of the medical examination. The medical examination is performed during working hours and the employee is paid an average working day wage for that time.
When organising a medical examination for their employee, the employer consults an occupational health doctor as well as the working environment specialist and working environment representative or another representative of the employees.
The employer provides the occupational health doctor with the results of the working environment risk assessment, including information on such working environment risk factors to which the employee is exposed at work, as well as the results of the latest analysis of the company’s occupational health situation and, at the request of the occupational health doctor, the employee’s previous medical examination decisions and information on investigations into occupational accidents and occupational diseases.
Carrying out a medical examination
When carrying out a medical examination, the occupational health doctor:
- evaluates the employee’s state of health;
- evaluates the suitability of the working environment or organisation of work for the employee;
- identifies potential work-related illnesses or occupational diseases of the employee.
The employee fills in the part of the health declaration on the medical examination chart and confirms the accuracy of the information with their signature. The occupational health doctor forwards to the employer information on the employee’s health that is strictly necessary for the employer to improve the working environment and working conditions as well as promote the health of employees and which is directly related to the aforementioned activities. The employer is not entitled to data on diagnoses.
The occupational health doctor, having reviewed the working environment risk assessment and, if necessary, the employee’s working environment and organisation of work as well as the employee’s health data, orders the necessary examinations and analyses, involving other specialists as needed.
The occupational health doctor enters the results of the examinations and analyses, a decision on the suitability of the working environment or organisation of work for the employee and proposals to the employer and the employee on the medical examination chart.
Decision of the medical examination
The occupational health doctor informs the employee of the results of their health examinations and analyses and issues the medical examination decision.
The medical examination decision must include the risk factors and types of work for which the health examination was performed (e.g. work with a monitor, exposure to noise, work with hazardous chemicals, manual handling of loads) and a decision on the suitability of the working environment or organisation of work for the employee (i.e. whether the employee can or cannot work in these working conditions or can work if certain restrictions or additional conditions are fulfilled; e.g. can work, but needs glasses or can work, but cannot lift loads of more than 10 kg).
As the results of the examinations may impose restrictions on the work performed by the employee, the doctor has to explain the results of the examinations and the restrictions to the employee. No one but the doctor who made the decision can do it. After introducing the decision to the employee, the doctor asks for a signature from the employee to confirm this. If the decision is made digitally, the employee can also give a digital signature.
The occupational health doctor issues to the employer a formal health examination decision, in which, if necessary, they provide proposals for changes in the employee’s working environment or organisation of work and for the promotion of the employee’s health.
The date of the next medical examination is also written on the medical examination decision. If the occupational health doctor sets a different period for the medical examination than prescribed by law, i.e. shorter than three years or, in the case of a minor, one year, the occupational health doctor will add a reason for it.
The provider of occupational health services keeps records related to the provision of occupational health services for 30 years after the provision of the service. The employer keeps records related to the organisation of occupational health services for ten years after the provision of the service.
Decision and proposals of an occupational health doctor
The decision of the occupational health doctor is mandatory for the employer. For example, the occupational health doctor has made the following decision: cannot work in an environment with excessive noise; the employee shall not manually handle loads of more than 10 kg; cannot work with raised hands. If, for example, the occupational health doctor makes the decision that an employee’s work should be reorganised and he or she should work part time (no more than 6 hours per day) because of his or her health, the employer shall follow this decision. The occupational health doctor does not make such suggestions to the employer without good reason and they are aimed at maintaining the employee’s capacity for work and preventing illnesses related to work.
The employer is to apply the occupational health doctor’s proposals for improving the working environment and working conditions and promoting the health of employees, unless this brings about disproportionately high costs for the employer.
However, if the doctor writes in the decision a proposal recommending physiotherapy or neck and shoulder massage ten times twice a year, it is considered a recommendation for the employer and the employer and employee have to decide together when these recommendations are followed and who incurs the costs. However, the employee has to draw their own conclusions, think about their health and find a way to follow the doctor’s recommendations.
Manual for occupational health doctors
In 2022, the Estonian Society of Occupational Health Physicians completed a manual commissioned by the Ministry of Social Affairs, which helps occupational health doctors to carry out medical examinations. The manual contains guidelines for occupational health doctors on the practical use of all groups of risk factors (physical, physiological, biological, chemical and psychosocial) when conducting medical examinations. The manual is a tool that occupational health doctors can use in their daily work.
The manual helps to make more optimal use of the limited time allotted for medical examinations and standardise their performance and quality, as the manual allows the health effects of working environment risk factors to be treated in accordance with a common standard. The manual serves as input for the harmonisation and improvement of the quality of occupational health services. This means that the effects of working environment risk factors are assessed in the same way regardless of the service provider and in accordance with agreed rules, which are based on scientific research, relevant treatment guides and codes of conduct, international standards and relevant legislation.
The manual also provides explanations for better understanding of occupational health services and for good cooperation for other primary care physicians and medical specialists as well as other healthcare professionals who are an integral part of the work of occupational health doctors when it comes to cooperation on differential diagnosis, treatment, rehabilitation and approach to health.
Videos on how to read the manual are available at: http://ettas.ee/kasitlusjuhend/Käsitlusjuhend töötervishoiuarstidele 2022.pdf (4.69 MB)
Medical examination of crew members and persons who study at maritime educational institutions
The following persons shall undergo the medical examination of crew members which establishes the state of health of students and crew members and suitability for work on board a ship:
- students at a maritime educational institution while studying and
- crew members during employment.
Persons who commence studies at a maritime educational institution in the formal educational system shall, before commencing their studies, undergo a medical examination and persons wishing to enter into a seafarer's contract of employment shall, before entry into the seafarer's contract of employment, undergo a medical examination.
A person who commences studies or studies a specialty which does not presume working on board a ship need not undergo a prior medical examination or a regular medical examination.
The regular medical examination of crew members and students at a maritime educational institution in the formal educational system shall be conducted by medical practitioners approved by the Health Board for the conduct of medical examination.
Analysis of the company’s occupational health situation
From 1 January 2023, the employer is required to organise an analysis of the company’s occupational health situation on a regular basis as needed, but no less than once every three years.
Upon analysing the company’s occupational health situation, the occupational health doctor assesses the company’s occupational health situation as a whole and makes proposals to the employer for improving the occupational health situation of the company, including adapting the working environment, changing the working conditions and promoting the health of employees.
In the analysis, the occupational health doctor identifies the greatest problems in the company’s occupational health situation. Proposals can be company-based as well as specific to an employee or position. The precise content, structure and form of the analysis should be agreed between the occupational health doctor and the employer.
If available, the occupational health doctor will base the analysis of the company’s occupational health situation on the following:
- the results of the working environment risk assessment
- employees’ health data, including the results of medical examinations, records on illnesses caused by work, records on temporary incapacity for work and data from questionnaires describing the employees’ state of health
- records on investigations of occupational accidents or diseases
The occupational health doctor provides the results of the analysis of the occupational health situation to the employer in a form reproducible in writing. The exact form and the method of submission of the analysis are agreed between the employer and the occupational health doctor.