1 Purpose

Accompanying the aging of society, etc., there has been an increase in the number of workers diagnosed with cerebral and cardiovascular diseases such as hypertension and ischemic heart diseases. Accordingly, the situation over the past few years indicates that some 40 percent of workers are diagnosed with some kind of positive results in these areas. At the same time, while there have been changes in the format of work due to changes in the structure of industry, progress in technological innovations, etc., the number of workers who feel fatigue and stress is increasing. Moreover, the incidence of "death caused by overwork" has become a major social problem.

Under these circumstances and in order to enable workers to work throughout their entire working life with good health, it is indispensable for the employer to accurately understand the health condition of workers, and to appropriately implement worker health preservation based on the results of such understanding and medical knowledge. Therefore, for those workers diagnosed with some abnormality as the result of medical examination (including voluntary medical examination by workers engaged in late-night work based on the provisions of Article 66-2 of the Industrial Safety and Health Law; hereinafter called "voluntary medical examination"), employer need to take steps in consideration of the actual situation of said workers, such as changing the place of work, changing work assignments, reducing working hours, reducing the frequency of late-night work, transfers to daytime work, etc., and otherwise take appropriate steps such as implementing work environment measurements, installing or improving facilities or equipment (hereinafter these steps that the employer needs to take are called "occupational steps") in case it is deemed necessary in full consideration of the opinions of physician or dentist (hereinafter called "physician, etc.") concerning the necessary steps to preserve the health of said workers.

In order for the occupational steps based on the results of medical examination to be appropriately and effectively implemented, these guidelines stipulate the matters requiring attention with respect to implementing medical examination, obtaining the opinion of physician, etc., on the results of medical examination, and determining occupational steps, etc., in accordance with the procedures of determining and implementing occupational steps.

2 Procedures for determining and implementing occupational steps and matters requiring attention

(1) Implementing medical examination

The employer shall implement medical examination by physician, etc., for workers in accordance with the provisions of Paragraphs 1~4, Article 66 of the Industrial Safety and Health Law (Law No. 57, 1972), and receive judgments by physician, etc., concerning diagnosis classification (i.e., normal, need observation, need medical care, etc.) for each of said workers.

In implementing medical examination, it is necessary for the employer to make efforts to publicize and provide guidance to workers so that the ratio of those taking medical examinations is improved.

In workplace that is required to appoint an industrial physician, it is necessary for the employer to seek advice from the industrial physician in charge of worker health preservation at said workplace with respect to the planning of medical examination and matters requiring attention in the implementation of the same.

(2) Obtaining the opinion of physician, etc., concerning the results of medical examination

A. Physician, etc., from whom opinion is obtained

In workplace that is required to appoint an industrial physician, it is appropriate for the employer to elicit the opinion of the industrial physician, as the industrial physician is in a position of better understanding more details concerning the health condition, work contents and work environment of each worker.

In workplace that is not required to appoint an industrial physician, it is appropriate to elicit opinion from physician, etc., who have the medical knowledge necessary to deal with worker health preservation, etc., and it is appropriate to make efforts to utilize the regional industrial health center where such physicians provide consultation, etc., concerning worker health preservation, etc.

B. Providing information to physician, etc.

In order to obtain appropriate judgments, the employer shall provide the physician, etc., from whom opinion is elicited with such information as the worker work environment, working hours, work intensity, frequency and hours of late-night work, work format, work load situation, past medical examination results, as well as an opportunity to patrol the workplace, as necessary. In addition, in case sufficient information on which to judge worker physical or mental conditions is not provided by the medical examination results alone, it is appropriate to provide opportunities for interviews with worker.

C. Contents of opinion

Concerning those workers diagnosed with abnormalities as the results of medical examination, the employer needs to ask the physician, etc., their opinions concerning the necessity of taking occupational steps and the contents of the occupational steps that should be taken.

(a) Opinion on work classification and its contents

The judgment by physician, etc., concerning the work classification and its contents for any worker shall be elicited according to the following classification (example).

(b) Opinion on work environment control and work control

In case it is necessary to review work environment control and work control as the results of medical examination, opinion shall be elicited concerning the necessity of appropriate steps such as implementing work environment measurements, installing or improving facilities or equipment, and improving working methods.

D. Methods to ask for opinion

The employer shall ask the physician, etc., to fill in this opinion concerning occupational steps in the physician, etc., opinion column on the individual medical examination forms as based on the provisions of the Ordinance on Industrial Safety and Health, etc. In the event the written contents are unclear, etc., it is appropriate to confirm the contents, etc., with said physician, etc.

In addition, it is desirable to ask for opinion promptly; in particular, it is appropriate to ask for opinion concerning voluntary medical examination as promptly as possible.

(3) Determining occupational steps

A. Asking workers for opinion

In case of determining the occupational steps in accordance with the work classification based on the opinion of the physician, etc., in (2) above, it is appropriate for the employer to ask for the opinions of said worker in advance and to make efforts to obtain the consent of the worker through adequate discussion.

In workplace that is required to appoint an industrial physician, it is appropriate to ask for the opinion of worker in the presence of the industrial physician as necessary.

B. Holding industrial health committee meetings, etc.

In matters involving the determination of appropriate steps such as implementing work environment measurements, installing or improving facilities or equipment, and improving working methods among occupational steps in workplace that is required to establish an industrial health committee or a safety and health committee, it is appropriate for the employer to investigate and deliberate such matters by holding a health committee or a safety and health committee meeting as necessary.

C. Matters requiring attention in implementing occupational steps

In implementing occupational steps or in changing or canceling said steps, it is necessary for the employer to fully pay attention to not only the matter of cooperation between the physician, etc., and other industrial health staff, but also to cooperation between the health preservation department and the personnel and labor management department of said workplace. As it is indispensable to obtain understanding particularly from the workplace management supervisor where the worker is assigned in implementing occupational steps, it is appropriate for the employer to provide the necessary explanations to said management supervisor so that full understanding can be obtained concerning the purpose, contents, etc., of the occupational steps, while still giving full consideration to the protection of privacy.

Incidentally, as the occupational steps are aimed at preserving the health of said worker, steps that go beyond those necessary to preserve worker health should not be taken. A careless dismissal or lay-off based on the opinion of physician, etc., should be avoided.

In addition, in case improvements in the health condition of said worker is observed after taking occupational steps, it is necessary to take appropriate steps such as putting his back to normal work after eliciting the opinion of the physician, etc.

(4) Other matters requiring attention

A. Notice of medical examination results

In order for worker to understand his own health status and to be able to carry out health preservation voluntarily, the employer must notify worker who undergoes general medical examination of the results without delay, regardless of the presence of abnormalities, based on the provisions of Article 66-6 of the Industrial Safety and Health Law.

B. Health guidance

In order to promote voluntary health preservation by worker on the basis of the provisions of Paragraph 1, Article 66-7 of the Industrial Safety and Health Law, the employer must make efforts to encourage these worker for whom it is deemed particularly necessary to make efforts to preserve health as a result of the general medical examination through receiving health guidance by a physician or a public health nurse. Health guidance in such cases shall include guidance on everyday lifestyles, information on health preservation, recommendations to take reexamination, and detailed examination or treatment consultation based on the medical examination, as necessary.

In addition, in consideration of the fact that worker engaged in late-night work is required to have a lifestyle that differs from that of worker engaged in daytime work, it is necessary to make efforts to provide health guidance that stresses the importance of sleep guidance and dietary guidance.

In workplace that is required to appoint an industrial physician, it is appropriate to implement such guidance with the industrial physician as the core, as the industrial physician is in a better position of fully understanding more details concerning the health status, work contents, work environment, etc., of individual worker.

C. Handling reexamination or detailed examination

As it is appropriate for the employer to determine occupational steps based on as detailed information as possible, employers should recommend that workers who need to have reexaminations or detailed examinations to take said reexaminations or detailed examinations, as well as to ask the physician, etc., from who said opinion are elicited to submit the results of said examination.

Incidentally, as reexamination or detailed examination are intended to clarify a diagnosis and the extent of the symptoms, it is not generally required that they be implemented by the employer. However, it is necessary to pay attention to the fact that the employer is required to implement any special medical examinations stipulated under the provisions of the Ordinance on Prevention of Organic Solvent Poisoning (MOL Ordinance No. 36, 1972), the Ordinance on Prevention of Lead Poisoning (MOL Ordinance No. 37, 1972), the Ordinance on Prevention of Hazards Due to Specified Chemical Substances, Etc. (MOL Ordinance No. 39, 1972) and the Ordinance on Safety and Health Concerning Work in High-Pressure Environments (MOL Ordinance No. 40, 1972).

D. Protection of privacy

As information on individual worker health is the private information of such individual, it is necessary for the employer to pay particular attention to its protection. In implementing occupational steps in particular, it is necessary to limit the scope of information provided to those concerned to the minimum necessary for the intended purposes.

Example