(Last amendment on December 11, 2013)
7.1 OBJECTIVE
7.1.1 This Regulatory Standard (NR) lays down the obligation to establish and implement an Occupational Health Examination Program (PCMSO) by all employers and institutions who hires workers as employees, with the objective of promoting and preserving the health of all their employees.
7.1.2 This NR establishes the minimum standards and guidelines to be followed in implementing the PCMSO, which can be extended by collective bargaining agreement.
7.1.3 It will be the contracting company to inform the contracted company of existing risks and assist the preparation and implementation of the PCMSO in the workplaces where the services are being provided.
7.2 GUIDELINES
7.2.1 The PCMSO is part of the broader set of the company’s initiatives in the field of workers’ health and shall be articulated with the other provisions of NR.
7.2.2 The PCMSO shall consider individual and collective issues, focusing on clinic-epidemiological methods in approach of relationship between workers’ health and the work.
7.2.3 The PCMSO shall be preventive, screen and early diagnosis of work-related health problems, including sub-clinical nature, beyond finding the cases of occupational illness or irreversible damages to the workers’ health.
7.2.4 The PCMSO shall be planned and implemented based on the health risks of workers, particularly those identified in the evaluations of other NRs.
7.3 RESPONSIBILITIES
7.3.1 It is for the employer to:
a) ensure the development and the effective implementation of PCMSO, as well as its effectiveness;
b) bear the cost of all procedure related to PCMSO without charge to the employees;
c) appoint a coordinator responsible for the execution of the PCMSO from amongst the doctors of the Specialized Services in Occupational Health and Safety Engineering (SESMT);
d) if the company is not obliged to have an occupational physician according to NR4, the employer shall name an occupational physician, who may or may not be employed by the company, to coordinate the PCMSO.
e) in the absence of occupational physician in the workplace, the employer may hire a doctor in other specialties to coordinate the PCMSO.
7.3.1.1 The companies in risk level 1 and 2, according to Table 1 in NR4, with up to 25 (twenty-five) employees and those in risk level 3 and 4, according to Table 1 in NR4, with up to 10 (ten) employees shall not bound to appoint a coordinator.
7.3.1.1.1 The companies with employees between 25 (twenty five) and 50 (fifty) in risk level 1 or 2 according to Table I in NR4 may be relieved of appointing a coordinator as a result of collective negotiation.
7.3.1.1.2 The companies with employees between 10 (ten) and 20 (twenty) employees in risk level 3 or 4 according to Table I in NR4 may be relieved of appointing a coordinator as a result of collective negotiation, assisted by a professional of regional body responsible for health and safety at work.
7.3.1.1.3 As determined by the Regional Labor Delegate, based on conclusive technical opinion of the regional authority responsible for health and safety at work, or as a result of collective negotiation, the companies specified in item 7.3.1.1 and earlier sub-items may have the obligation to appoint a coordinator doctor when their conditions pose potential serious risk to the workers.
7.3.2 It is for the coordinator doctor to:
a) carry out medical examinations referred in item 7.4.1 or instruct the medical practitioners with the principles of occupational pathology and its causes, as well as the environment, working conditions and the risks, to which each employees of the company is or will be exposed;
b) instruct professionals and/or properly trained, equipped and qualified entities with additional examinations provided in the items, tables and annexes of this NR.
7.4 DEVELOPMENT OF PCMSO
7.4.1 The PCMSO shall include, among others, mandatory medical examinations:
a) admissional;
b) periodically;
c) upon return to work;
d) upon change in job;
e) demissional.
7.4.2 The examinations mentioned in item 7.4.1 include:
a) clinical evaluation, including occupational history and physical and mental examination;
b) Additional tests performed in accordance with the specific terms in this NR and annexes.
7.4.2.1 For workers whose activities involve risks detailed in the Tables I and II of NR, additional medical examinations shall be performed and interpreted based on the criteria contained therein tables and annexes. The frequency of the evaluation of biological indicators in Table I shall be at least every six months, which can be reduced at the discretion of the medical coordinator or by the notification of the doctor in the labor inspections, or upon collective bargaining agreements.
7.4.2.2 For workers exposed to chemical agents not shown in Table I and II, other biological indicators may be monitored, depending on prior study in aspects of toxicological validity, analytics and the interpretation of these indicators.
7.4.2.3 Other complementary examinations commonly used in clinical pathology to assess the functioning of organs and organ systems can be performed at the discretion of the medical coordinator or by the notification of the doctor in the labor inspections, or upon collective bargaining agreements.
7.4.3 The clinical evaluation referred in item 7.4.2, paragraph “a”, with part of the medical examination listed in item 7.4.1 shall meet the periods and frequency as provided in the sub-items listed below:
7.4.3.1 The admissional medical examination shall be performed before the workers take their activities;
7.4.3.2 the periodical medical examination shall be performed in accordance with the minimum time intervals shown below:
a) for workers exposed to risks or work situations that involve the onset or worsening of occupational disease, or even, for those who are suffering from chronic diseases, the examinations shall be repeated:
a.1) every year or shorter intervals at the discretion of the doctor in charge, or if notified by the doctor of labor inspection, or as a result of collective bargaining agreement;
a.2) for workers exposed to hyperbaric conditions in accordance with the frequency specified in Annex 6 of NR15.
b) for other workers:
b.1) yearly, for those who are younger than 18 (eighteen) years and older than 45 (forty five) years of age;
b.2) every two years, for workers between 18 (eighteen) years and 45 (forty five) years of age.
7.4.3.3 The medical examination upon return to work shall be obligatorily performed in the first day of back to job after a period equal to or exceeding 30 (thirty) days due to any accident or illness, or childbirth.
7.4.3.4 The medical examination upon change in job shall be performed before the date of change.
7.4.3.4.1 For purposes of this NR, any change in activity, job or sector position which involves risks different from what they had been exposed to before the change is considered as change in job.
7.4.3.5 The demissional medical examination shall be performed until the date of approval, provided that the last occupational medical examination has been conducted for more than:
– 135 (hundred and thirty five) days for the companies in risk level 1 and 2, according to Table I in NR4;
– 90 (ninety) days for the companies in risk level 3 and 4, according to Table I in NR4.
7.4.3.5.1 The companies classified in risk level 1 or 2, according to Table I of NR4, may extend the deadline for the completion of layoff demissional examination more than 135 (hundred and thirty-five) days as a result of collective negotiations, assisted by a professional appointed by mutual agreement between the parties or by the regional body responsible for health and safety at work.
7.4.3.5.2 The companies classified in risk level 3 or 4, according to Table I of NR4, may extend the deadline for the completion of layoff demissional examination more than 90 (ninety) days as a result of collective negotiations, assisted by a professional appointed by mutual agreement between the parties or by the regional body responsible for health and safety at work.
7.4.3.5.3 As determined by the Regional Labor Delegate, based on conclusive technical opinion of the regional authority responsible for health and safety at work, or as a result of collective negotiation, the companies may have the obligation to perform demissional medical examination regardless of the time of performing any examination when their conditions represent potential serious risk to the workers.
7.4.4 For each performed medical examination as provided in item 7.4.1, the doctor shall issue an Attestation of Occupational Health (ASO) in 2 (two) copies.
7.4.4.1 The first copy of the ASO will be archived in the workplace, including work front or construction site, at the disposal of labor inspection.
7.4.4.2 The second copy of the ASO will be delivered to the worker upon receipt on the first copy.
7.4.4.3 The ASO shall contain at least:
a) full name of the worker, registration number and his/her unction;
b) existing specific occupational hazards, or their absence, in the activity of employee according to the technical instructions issued by the Secretary of Health and Safety at Work (SSST);
c) indication of medical procedures to which the worker has been undergone, including
d) name of the coordinating doctor, if any, with CRM;
e) definition of fit or unfit for the specific function that an employee will exercise, exercises or exercised;
f) name of the doctor in charge of the examination and an address or contact information;
g) date and a signature of the doctor in charge of the examination and a stamp containing doctor’s registration number in the Regional Council of Medicine.
7.4.5 The data obtained from medical examinations, including clinical evaluation and complementary examinations, the findings and the implemented measures shall be registered in individual clinical record, which will be the responsibility of the medical coordinator of PCMSO.
7.4.5.1 The records referred in item 7.4.5 shall be maintained for a minimum of 20 (twenty) years after the termination of the employment.
7.4.5.2 If there is replacement of the doctor as referred in the item 7.4.5, the files shall be transferred to his successor.
7.4.6 The PCMSO shall comply with a schedule in which they provided health-care actions to be performed during the year, which shall be subject to an annual report.
7.4.6.1 The annual report shall state, by sectors of the company, the number and nature of medical examinations, including clinical and complementary examinations, statistical results considered abnormal, as well as planning for next year, based on the model proposed in Table III of NR.
7.4.6.2 The annual report shall be presented and discussed in the CIPA, when exists in the company, according to NR5, with a copy attached to the minutes book that committee.
7.4.6.3 The annual report of PCMSO can be stored in the form of digitalized file, provided that it is kept so as to provide immediate access by the agent of labor inspection.
7.4.6.4 The company that is not obliged to appoint a medical coordinator shall be exempt from preparing the annual report.
7.4.7 As overexposure (EE or SC+) to the risk is observed by clinical evaluation of the worker and / or examinations listed in Table I of this NR, even without any clinical signs or symptoms, the worker shall be removed from the workplace, or the risk, until the standard biological indicator of exposure and control measures in the workplace have been adopted.
7.4.8 As the occurrence or worsening of occupational diseases is found through medical examinations including those defined in this NR; or alterations that reveal any kind of organ or biological system dysfunction are verified through the examinations shown in Tables I (only those with interpretation SC) and II, and in item 7.4.2.3 of this NR, even without symptomatology, it will be up to the medical coordinator or designee to:
a) request to issue a Communication of Occupational Accident (CAT) from the company;
b) indicate, where necessary, the withdraw of worker from the risk exposure, or work;
c) direct the employee to Social Security to establish a causal nexus, disability evaluation and definition of social security in relation to work;
d) guide the employer regarding the need to adopt the control measures in the workplace.
7.5 FIRST AID
7.5.1 Every establishment shall be equipped with materials necessary for provision of first aid, considering the characteristics of the activity performed; and shall keep this material stored in a suitable place under the care of people trained for this purpose.
TABLE I
Parameters for Biological Control of Occupational Exposure to Some Chemical Agents
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TABLE II
Parameters for Monitoring Exposure to Some Health Hazards
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TABLE III
Occupational Health Examination Program
Annual Report
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