For official information on the COVID-19 outbreak in South Africa, go to

General Code of Practice for Medical Surveillance

By Yvette Montalbano on 24 October 2016

Have you been looking for an example of a standard operating procedure for medical surveillance? Here we go – this will be a useful guideline to help you set up your procedure.

General Code of Practice for Medical Surveillance


1. Definition

  • Medical surveillance is a risk-based set of planned medical examinations:
    o Prior to placement in a risk area (part of the pre-placement medical examination)
    o Prior to leaving a risk area (exit)
    o Periodical: after having been exposed to a risk for a certain time or when the employer is suspicious of the employee’s fitness for work.

2. Purpose

  • Safe and hygienic placement of a person in the job.
  • Establishment of pre-existing conditions and the ensuing recommendations to the employee and to the employer.
  • Detect disease at an early stage.
  • Assist in taking action to reverse early effects or to slow the progression of the disease.
  • Assess the effectiveness of workplace control measures.
  • Establish any effects the employment may have had on the health of an employee (during employment –periodical medical examination- or at termination of employment –exit medical examination).
  • Establish and implement preventative measures for which the employer is responsible: vaccination, medical test schedules.


3. Legal status

  • Occupational Health and Safety Act, Basic Conditions of Employment Act and guidelines, codes or regulations in terms of these statutes.


4. Employer policies

  • Occupational Health and Safety policy, which must include reference to the practice and procedures of medical surveillance.
  • Recruitment, Selection and Placement Policy.
  • Fitness for work policy.


5. Standards

  • Statutory: Occupational Health and Safety Act; Mine Health and Safety Act
  • As determined by the occupational medicine practitioners.


6. Timing

  • Pre-employment: medical examination: after a conditional offer of employment has been given to the applicant and within 2 weeks of starting to work.
  • Pre-placement medical examination: prior to or within 2 weeks after a transfer from one risk area to another.
  • Periodical medical examination: employees are subjected to a risk-based medical examination by an occupational medicine practitioner, at intervals determined by the occupational exposure. See attached schedule
  • Exit medical: before, or as soon as possible after, termination of employment. Any pre-placement or periodical medical examination performed within a 6 month’s period prior to the employee’s exit, may be regarded as an exit medical examination, if acceptable to the Occupational Medical Practitioner.


7. Contents

  • A general medical questionnaire.
  • An occupational history questionnaire.
  • A hazard-specific questionnaire.
  • A physical examination, including vision evaluation by an Occupational Medical Practitioner.
  • Special tests: blood tests, audiometry, lung function testing, PA full plate chest X-ray, electrocardiogram, urine tests, swab test


8. Testing standards

  • A general medical questionnaire.
  • An occupational history questionnaire.
  • A hazard-specific questionnaire (night and shift, dangerous and heights work, chemical, biological).
  • A physical examination, including vision evaluation:– certain anthropomorphic measures are done by the occupational nursing practitioner, the overall examination is to be done by an occupational medicine practitioner
  • Special tests:
    o Blood tests: glucose, haemoglobin, biological indicators, immunisation status control
    o Urine test: Combur Stix, cannabis, biological indicators
    o Swab tests: biological requirements
    o Audiometry: NIHL Regulations of the OHS Act, SABS 083 and COIDA
    o Chest X ray
    o Lung Function Testing: Mine Occupational Health Advisory Committee Guidance No 2, 1998
    o ECG: standard 12 lead ECG


9. Outcomes:

        An applicant or employee may be:

  • Fit for the work.
  • Fit, but required to return for re-examination within a shorter period of time.
  • Fit, provided certain special precautions are taken.
  • Temporarily or permanently unfit for the job.


10. Medical reports:

  • The Occupational Medical Practitioner or Occupational Health Practitioner will communicate the result of the occupational medical examination to the employee; where applicable, the consent for communication with management will be obtained at the same time.
  • For every occupational medical examination, the responsible Occupational Medical Practitioner will issue a written (hard- or soft copy) report.
  • If the occupational medical examination identifies an occupational non-conformance, the Occupational Medical Practitioner or Occupational Health Practitioner will communicate directly with the manager in charge of the employee.
  • The contents of the information released to the NMBMM and to management will be relevant to the medical surveillance and will only be released with the informed consent of the employee.
  • The employee may receive a copy of all medical reports, if requested.
  • The employee’s private medical practitioner may receive a copy of all medical files, provided the employee consents in writing.
  • A trade union representative may receive a copy of the medical reports, provided the employee consents in writing, to release the information.


11. If the employee refuses to be examined:

  • The duty to perform medical surveillance is placed on the employer.
  • The employer will impose the duty of medical surveillance on all relevant employees. As every employee must co-operate with the employer in order to enable the employer’s duty or requirement to be performed or complied with and every employee has to carry out any lawful order given, obey the health and safety rules and procedures laid down by the employer in the interest of safety and health, it is accepted that an employee may not refuse to undergo medical surveillance.
  • Occupational medicine and health practitioners may not issue a fitness for work statement, where no medical examination has been performed. The employer may not permit an employee who is required to be under medical surveillance to work in an area where such testing is mandatory, without a medical certificate of fitness.


12. If the employee does not agree with the medical findings:

  • An employee who does not agree with the finding of a medical surveillance examination may request a second opinion.
  • This dispute will require resolution in terms of the employer’s policies and procedures (Recruitment, selection and placement, fitness for work policies, disciplinary and grievance procedure).


13. Assessment of fairness

The fairness of medical surveillance protocols, of the distribution and execution of the examinations and of the management of the outcome protocols must be assessed against the background of what is considered ‘reasonably practicable’.