Addressing occupational exposures in the cement industry Recommended good practices for the management of health risks from occupational exposure to dust, respirable crystalline silica and noise Health Management Handbook Cement Sustainability Initiative (CSI)2 Table of content 1. Basic principles 2 2. Scope 3 3. Understanding hazards and management tools 4 4. Dust, respirable crystalline silica and noise 5 4.1. Identification of critical areas 5 4.2. Assessment of personal exposure 5 4.3. Good prevention practices 7 4.4. Personal protective equipment 8 5. Health surveillance protocols 10 5.1. General considerations 10 5.2. Protocol for workers exposed to dust and respirable crystalline silica 11 5.3. Protocol for workers exposed to noise 11 6. Key performance indicators (KPIs) 13 7. Glossary 14 8. References 173 1. Basic principles The objectives of this document and the consequent actions that will be taken by Cement Sustainability Initiative (CSI) members shall be compliant with all applicable legal requirements on health, safety, privacy and discrimination and will also obey competition laws and regulations. Consequently, any recommendation or good practices suggested that are specifically not allowed by locally enforced legal schemes shall not be performed. The document drafting process has been open, transparent and non-discriminatory. Internal and external stakeholders have been consulted during the development of this document. The ultimate objective of this document is to protect employees by fostering appropriate health management practices. Good health management practices are grounded on two complementary pillars : proactive assessment and mitigation of the risk of exposure to identified agents in the workplace and careful implementation of a correct protocol for health surveillance. Only trained and experienced professionals should perform both exposure measurements and medical surveillance, providing appropriate elements of guidance to perform the risk assessment, which remains a clear responsibility of line management. This entire document is intended as a compilation of recommendations and good practices in the framework of a proactive approach to occupational health beyond locally enforced legislation. It is recommended that CSI member companies implement the good practices described in this document across all activities under their management control as soon as practicable and seek to have them implemented in all activities within five years. When a CSI member acquires management control of another company, the good practices described in this document are expected to be implemented within five years from the acquisition. While members should start implementing this document upon issuance, reporting requirements for agreed key performance indicators will become mandatory only after inclusion in the CSI Charter. The recommendations in this document are basically intended for CSI member company employees, while fostering the extension to contractors as much as feasible and as allowed by locally enforced legislation.4 2. Scope Promoting the health and enhancing the well-being of workers is as vital as protecting their safety. In this respect, the CSI strives to share good practices, creating tools and providing recommendation to foster the prevention of occupational illnesses by assessing the risks of exposure at the workplace, implementing suitable medical surveillance for employees and, more generally, improving working conditions by mitigating risks. These combined elements shape the good practices of health management adopted by CSI member companies. The scope of this document covers all business sectors related to the building materials part of member companies. The reporting responsibilities relating to the degree of management control are as follows : The CSI member with a controlling position in a company (greater than 50% shareholding) is required to report for 100% of that company ; CSI members with minority positions should not double report that company. In a 50/50 joint venture where both parent companies are members of the CSI, only the company with health and safety management responsibility should report the related figures for 100% of that company in order to avoid double reporting. In a 50/50 joint venture where only one parent company is a CSI member, but does not have management responsibility, that CSI member is not obliged to report data for that company. If the controlling shareholder is not a CSI member, then the CSI member(s) in minority position(s) is (are) not obliged to report data for that company. In cases where management/technical agreements effectively give management control to a minority shareholder, then the reporting provisions of the controlling position apply as outlined above. 5 1 2 3 4 3. Understanding hazards and management tools Like in any industrial process, workers may be exposed to physical, chemical and biological agents or materials representing health risks. In the cement sector, dust, dust containing respirable crystalline silica and noise are three recurring risk exposures. While it is the responsibility of individual companies to address potential health risks, CSI values a common approach to the management of occupational exposure to dust and noise. Materials and processes in the sector (cement, aggregates, ready-mix concrete and others) may generate airborne dust. Significant exposure to dust may cause chronic obstructive pulmonary disease (COPD). In the limited cases in which airborne dust may contain a significant amount of respirable crystalline silica (RCS), exposure may lead to pneumoconiosis and silicosis, a nodular progressive fibrosis caused by the deposit of fine respirable particles of crystalline silica in the lungs. Machines and processes in industrial facilities may generate noisy working environments. Significant exposure to noise may induce progressive hearing loss. The risk increases with the intensity of noise, the length of exposure intervals and the total exposure time. High-peak impulse noise (e.g. air shocks, blasting) may cause acute and permanent hearing damage. This document provides useful information to understand the basic pillars of health management :Identification of areas with high potential risk Assessment of personal occupational exposure to dust, respirable crystalline silica and noise Selection of control techniques to reduce the risks, including the effective use of adequate personal protective equipment Design of adequate medical surveillance for the early identification of ill health and further defining of corrective actions 6 4. Dust, respirable crystalline silica and noise 4.1. Identification of critical areas All CSI member company workplaces and premises that are considered to be potentially at risk for exposure to dust or noise should be identified against reference levels for dust, respirable crystalline silica levels or noise. Each CSI member company defines the reference levels individually based on the best internationally or nationally recognized references. These areas are designated as “dusty areas” or “noisy areas” respectively. A preliminary assessment could be done by site managers checking the status of equipment and facilities and performing a precautionary identification of non-acceptable workplaces against the following non-quantitative basic evaluation schemes : Dust Noise Visible airborne or settled dust, significant spills or leakage, unpaved yards, dusty open stockpiles, dusty loading/unloading operations. Presence of high-noise equipment, difficulties in understanding people speaking, etc. However, dust concentration and noise levels are to be measured using proper techniques and devices rather than evaluated through non-quantitative and therefore subjective assessments. In any case, this is the only means to assess airborne crystalline silica. It is also recommended that CSI member companies analyze settled dust in plants as a useful cross-check of airborne data. Sampling and measuring devices must be calibrated and comply with any local or international standards and must be carried out by competent personnel and entities. Laboratories analyzing respirable crystalline silica content should be accredited. General recommendations may be taken from country or international legislation. In the absence of local legislation, CSI members define and adopt their own directives and procedures. Critical areas, especially in closed buildings and confined spaces, are conveniently marked with permanent or, if applicable, temporary signage and must indicate which type of personal protective equipment (PPE) has to be worn. Dust Wear mask !7 4.2. Assessment of personal exposure Identification of dusty and noisy areas in workplaces is not always sufficient to protect workers. Selected occupations or tasks should be periodically assessed for their personal exposure to dust, respirable crystalline silica or noise. The evaluation is site specific and should be performed under the responsibility of site managers. As an option, this duty could be delegated to an occupational health service. In all cases, each CSI member company individually defines relevant procedures and record keeping. Dust Noise Dust and crystalline silica monitoring should be performed through personal samplings to measure actual exposure levels, with sampling time up to full shift, adjusted depending on job variability and dust concentration in the work area. Noise monitoring should be performed through the integration of sound pressure levels at the site and the duration of exposure in each relevant site facility. Before any of the measurements commence, exposure times have to be evaluated, preferably in consultation with the site occupational physician and after informing employee representatives. Direct exposure measurement through portable integrating sound dosimeters is feasible but can be misleading if not managed properly. Phase 1 : Selection of employees for personal exposure assessment In principle, all occupations entailing significant time spent in dusty or noisy areas or workplaces should be assessed for personal exposure to dust, respirable crystalline silica and noise. Some types of jobs may be excluded if they are considered by default to not be significantly exposed to dust or noise or in all cases where exposure levels are not hazardous for the vast majority of individuals (e.g. head office and administration, warehouse, spare parts distributors, laboratory, workshops, etc.). Additionally, some types of jobs may be excluded if they are considered by default to not be significantly exposed to respirable crystalline silica or in all cases where exposure levels are not hazardous for the vast majority of individuals (e.g. well-designed shipment gate, quarry where exploited material shows less than 1% crystalline silica, etc.). Phase 2 : Clustering workers in homogeneous exposure groups It is neither recommended nor necessary to measure the personal exposure of each selected employee. Selected employees and/ or occupations are better clustered in groups (homogeneous exposure group HEG) with similar duties, working environment and a similar exposure level range. An HEG should be homogeneous in terms of type of employment (permanent or temporary, daily or shift based), while exposure should be categorized by similarity of working environment. Phase 3 : Quantitative measurement of personal exposure Within each HEG, the number of individuals to be measured depends on the expected variation of the exposure levels (high intra-job variation suggests higher number of samples ; low intra-job variation may require only one sample). In any case, the level of exposure for all the individuals belonging to the same HEG is determined as the average (logarithmic for noise) of the levels measured.8 4.3. Good prevention practices CSI member companies should adopt the hierarchy of controls to reduce dust, respirable crystalline silica concentrations and noise levels as follows. 1. At source, through material selection and adequate technologies, such as : Dust Noise Change of raw materials and their fineness, equipment emitting low dust levels, de-dusting systems, enclosed machinery, separated production and control rooms, etc. Low-noise equipment, sound insulation of machinery, silencers on air intakes, segregation of multiple-machine facilities, etc. 2. At the workplace in general, through technical measures such as : Dust Noise Reducing or mitigating dust generation or propagation (paving of roads and surfaces, road wetting, de-dusted air conditioning for vehicles and mobile equipment, automated production lines, etc.) Sound absorbing panels, waffles, sound screens, automated production lines, etc. When it is not technically or economically viable to reduce noise, dust or dust containing RCS below reference levels : Workers and people potentially exposed should be provided with suitable PPE, and/or Organizational measures such as a reduction of personnel exposure time should be undertaken to limit the exposure of workers in these areas. As guidance, the following links provide references to technical solutions to reduce occupational exposure. Hierarchy of Controls Most eective Physically remove the hazard Replace the hazard Isolate people from the hazard Change the way people work Protect the worker with personal protective equipment Least eective ELIMINATION SUBSTITUTION ENGINEERING CONTROLS ADMINISTRATIVE CONTROLS PPE9 Dust Noise European Network on Silica (NePSi), Good Practice Guide on Workers Health Protection through the Good Handling and Use of Crystalline Silica and Products Containing it nepsi.eu/agreement-good- practice-guide/good-practice-guide.aspx World Health Organization (WHO), Hazard prevention and control in the work environment : Airborne dust who.int/occupational_health/ publications/airdust/en/ United States Occupational Health & Safety Administration (OSHA), OSHA Technical Manual (OTM), Section III : Chapter 5 Updated 15/08/2013 osha.gov/dts/osta/otm/ new_noise/index.html Health and Safety Executive (HSE), United Kingdom, extensive index of noise control case studies hse.gov.uk/noise/casestudies/ index.htm World Health Organization (WHO), noise control with multiple examples of designs of various noise controls : Occupational exposure to noise : evaluation, prevention and control who.int/occupational_health/ publications/occupnoise/en/ Engineering noise control who.int/occupational_health/ publications/noise10.pdf 4.4. Personal protective equipment All employees working in dusty or