Exami ner s Repor t

NEBOSH Nat i onal Di pl oma i n

Occupat i onal Heal t h and Saf et y

Januar y 2006 exami nat i ons













UNIT B

2006 NEBOSH, Dominus Way, Meridian Business Park, Leicester LE19 1QW
tel: 0116 263 4700 fax: 0116 282 4000 email: info@nebosh.org.uk website: www.nebosh.org.uk

The National Examination Board in Occupational Safety and Health is a registered charity, number 1010444

T(s):exrpts/D/D-0106 GP/RJ /PM/J S/RCC/REW


UNIT B Hazardous agents in the workplace



General comments
This was the second time that a Unit B paper had been set for the Diploma in its present form and 498
candidates presented themselves for the examination. All questions were based clearly on the content of
the published syllabus and a balance was achieved between questions that required specific technical
knowledge relating to occupational health risks, their measurement and control and those that addressed
workplace health issues in a more general way. In the event, performance on the two types of question was
mixed for instance, Questions 7 relating to specific technical knowledge and Question 11 which looked at
broader workplace issue both performed well. It became apparent to the Examiners that a significant
number of candidates lacked much of the specific knowledge that was required to achieve high marks on the
paper overall. Of particular concern was an inability to carry out simple calculations involving WELs, Q 2.

However, the fact that all six questions in Section A attracted answers that gained full marks demonstrates
that high marks are not only achievable but were actually achieved. There were some similarly excellent
answers in Section B. This should provide some reassurance to those who were unsuccessful on this
occasion. But a prerequisite for success is the accumulation of knowledge in order to gain a high level of
understanding that can be demonstrated in the examination. This requires a significant amount of study on
the part of candidates, together with structured revision and practice in writing examination answers. It was
apparent on this occasion that a large number of candidates were unprepared for the examination, which
hopefully they will be able to address for the future.








Section A all questions compulsory

Question 1 (a) Compare and contrast the following epidemiological methods:

(i) Retrospective Cohort Study and (3)

(ii) Prospective Cohort Study. (3)

(b) Outline factors that may affect the reliability of these epidemiological
methods. (4)


In answering this question many candidates showed confusion in their understanding of the
meaning of retrospective and prospective studies. Compare and contrast was not reflected
in most answers. Both methods involve looking for a link between cause (exposure) and
effect (disease); using two cohorts in order to compare those that have been exposed
against those that were unexposed and looking for a dose/response link. In contrast a
retrospective cohort study starts at a point in the past and follows cohort forward in order to
determine past exposure histories and health outcomes from records; a prospective cohort
study starts at the present time and follows cohort forward and enables monitoring of
exposure and health outcomes.

Many candidates were able to provide reasonable answers to the second part of the
question, recognising that reliability may be affected by factors such as: the cohort size; the
accuracy of historical data on exposure and health effects; the accuracy of diagnosis; there
may be non-occupational exposure; long latency periods for the effect; the frequency of
disease in unexposed cohort; lifestyle factors such as alcohol consumption, diet, smoking
etc; there may be selection bias (cohort may not be representative of exposed population);
the healthy worker effect (sick people leave); and the difficulty in following all of cohort for
instance a geographic move, non co-operation etc.



NEBOSH 2006 2 Unit B J anuary 2006

Question 2 (a) The term Workplace Exposure Limit (WEL) is defined in the Control of
Substances Hazardous to Health (COSHH) Amendment Regulations
2004.
Explain what this term means in practice. (3)

(b) Use the data below to calculate the 8 hour TWA exposure to flour dust for
a bakery operative. Your answer should include detailed working to show
your understanding of how the exposure is determined. (7)

Working Period Tasks undertaken by
bakery operative
Exposure to Flour dust
(mg/m
3
) (Total shift time = 8hours)

8.00 10.30 Weighing ingredients 20

10.45 12.45 Charging the mixers 30

12.45 - 13.45 Lunch

13.45 15.45 Cleaning equipment 25

15.45 - 16.15 Assisting maintenance staff 0 (assumed)

Assume that exposure is zero during break times.


These Amendment Regulations brought some significant changes to the COSHH
Regulations: introducing a single new workplace exposure limit for substances hazardous to
health which replaces occupational exposure standards and maximum exposure limits; and
introducing requirements to observe principles of good practice for the control of exposure to
substances hazardous to health set out in Schedule 2A, to ensure that workplace exposure
limits are not exceeded, and to ensure in respect of carcinogens and asthmagens that
exposure is reduced to as low a level as is reasonably practicable. Keeping abreast of new
legislation is a requirement for any health and safety practitioner and this question provided
an opportunity for candidates to demonstrate this. A number of candidates correctly
identified that the term Workplace Exposure Limit (WEL) as the maximum concentration of
an airborne substance, averaged over a reference period, to which employees may be
exposed by inhalation. A surprising number of candidates thought that it referred to the time
exposed, rather than the concentration of hazardous substance in the air. Better responses
went on to explain that concentrations are usually expressed in mg/m3 or ppm; that the WEL
is set at a level below which there is evidence of no adverse effect.

There were many reasonable responses to the second part of the question which stated that
each time period and exposure need to be multiplied together, then added, then divided by 8
and included the time of zero exposure in the workings of the calculation producing the
correct 8 hour TWA of 20 mg/m3.
Or numerically:

(20 x 2.5) +(30 x 2) +(25 x 2) +(0 x 0.5) +(0 x 1) )/8
( (20 x 2.5) +(30 x 2) +25 x 2) +(0 x 1.5) )/8

=(50 +60 +50 +0 +0) /8
=160/8
=20 mg/m3



Question 3 Hand-Arm Vibration Syndrome (HAVS) can be caused by frequent and
prolonged use of hand-held power tools.

(a) Identify the symptoms of Hand-Arm vibration syndrome. (2)

(b) Outline a hierarchy of control measures that could be used to minimise
the risks to employees of developing HAVS when using such power tools. (8)


Although knowledge of the Control of Vibration at Work Regulations 2005 was not required
in answering this question, Examiners were pleased that many candidates demonstrated
their familiarity with these recently introduced regulations. Symptoms of Hand-Arm vibration
syndrome identified by candidates were: loss of feeling, numbness, tingling and dexterity in
the finger tips; blanching (white finger); that the symptoms are generally worse during cold
weather; and that the condition can be progressive, affecting more fingers or parts of fingers,
leading possibly to gangrene.
NEBOSH 2006 3 Unit B J anuary 2006

Candidates tended to focus on either organisational or technical control measures when
answering this question. The best responses considered both types of control measure,
relevant to the use of small hand tools and presented them in an appropriate hierarchy.
Starting with : consideration of alternative work methods to eliminate the task; automating, or
mechanising, the work; avoiding tools that are too small and not powerful enough as these
prolong the task; replacing the equipment with a lower vibration model along with regular
maintenance to reduce vibration in tools and use of tools with heated handle grips to
improve circulation. Organisation control measures would be to ensure the organisations
purchasing policy takes account of vibration emissions (as well as other requirements);
change work station design to minimise loads on hand, wrists and arms for instance by use
of jigs/ or suspension systems to grip heavy tools; planning work schedules to limit time of
exposure to vibration; provide warm clothing and a warm environment to encourage good
blood circulation; refer those experiencing early symptoms to Occupational Health as well as
having a surveillance programme in place and a final control measure is to ensure that
employees receive adequate information and training on risk, control and recognising
symptoms.



Question 4 The risk of contracting Weils Disease (Leptospirosis) is a concern to
windsurfers at a local water sports centre. Provide advice to these windsurfers
which outlines:-

(a) the ill-health effects associated with this disease (2)

(b) why windsurfers might be at risk (2)

(c) practical steps that instructors can take to minimise the risks to
themselves. (6)


In most cases the infection causes a flu-like illness with severe headaches and myalgia
(lower back, and legs). The severe form of the disease (called Weils Disease after the
doctor who first identified it) causes jaundice and liver damage and carries a reported death
rate anywhere between 4 and 40 per cent. Only about 10 to 15 per cent of affected people
suffer this more dangerous form.

Other symptoms include fever, vomiting, abdominal pain, skin rashes, conjunctival
haemorrhage, uveitis, and Leptospirosis may present as aseptic meningitis.

The most common carriers are rats, but other rodents can do this (but less frequently). It is
generally assumed that across the developed world, 1 in 5 wild rats are carriers of
pathogenic leptospires. Rats are such efficient hosts because they live in close proximity to
water and they are incontinent. Carrier-state rats emit bacteria in their urine, and this is
distributed everywhere they go. Normally this is inactivated once it dries out, but if it enters
water the bacteria can remain viable for longer periods. The bacteria can then enter the
windsurfers bodies via cuts to the skin, nose, mouth or other mucous membranes.

A killed vaccine is only available for humans in Asia (China, J apan and Viet Nam), immunity
is restricted to the serovars in the particular vaccine, is of short duration and there are a
number of side effects. In the scenario set out in the question , practical steps that can be
taken are to prevent the bacteria getting into the body. Many candidates correctly outlined
measures such as maximising dry training ( to limit the potential contact time); showering
after being in water and washing hands thoroughly before eating; avoid swallowing water;
wearing protective footwear and minimising skin contact by wearing full-body wet suit;
protecting all existing cuts and abrasions with waterproof dressings; seeking medical advice
and treatment for any cuts or bites received whilst in the water (advising their GP of their
occupation to aid in early diagnosis); washing down equipment and wet suits and reporting
any sighting of rats to ensure effective rodent control in and around the water.

Although infection is virtually zero in salt water, responses advising this course of action did
not attract marks as it was not a practical solution in this scenario.

NEBOSH 2006 4 Unit B J anuary 2006

Leptospirosis is rare in the UK, and Weils disease extremely rare. Weils disease is however
a very serious illness, and must be swiftly diagnosed and treated.

For anyone with a particular interest in this topic, in-depth information can be found at:
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=230
http://www.patient.co.uk/showdoc/40000444/
http://www.leptospirosis.org/medical/precautions.php
http://www.who.int/csr/don/en/WHO_CDS_CSR_EPH_2002.23.pdf



Question 5 Low Power lasers are widely used to read bar-code labelled products at
checkouts in retail premises. There is no specific regulatory legislation relating
to the use of laser products.

(i) Identify statutory legislation that should be considered by retailers in
relation to the use of these laser products. (2)

(ii) Outline the design features and the procedural controls that should be in
place to ensure the safe operation and the maintenance of this
equipment. (8)


Most candidates were able to identify sufficient relevant statutory legislation to gain full
marks for this part of the question. A number of candidates did make some strange
references to The Consumer Protection Act; COSHH, DSE and CDM Regulations and some
even invented legislation (such as the Non-Ionising Regulations). The legislation correctly
identified included: HASAWA S2 - to provide safe equipment, S3 - protecting others
(customers); MHSWR Regulation 3 - requirement to undertake a risk assessment for the
operation and maintenance of this equipment; Examiners also accepted PUWER Regulation
5 - maintenance and The Electricity at Work Regulations where relevant reference was
made. The best responses made reference to EN60825-1 and its requirements.

Candidates who answered the second part of the question in two parts (design features and
procedural controls) achieved better marks. Design features could include reference to
features such as : in retailers lasers should be no greater power than Class 1; use of
embedded systems; protective housing; incorporating a key control with interlock to power
source; signage and appropriate positioning of the laser to avoid eye-level exposure,
including any hand-held equipment.

Procedural controls included ensuring that: manufacturers guidance is available and
followed; employees trained in safe use: having arrangements and safe systems of work in
place for maintenance: where maintenance requires removal of casing, the risk of exposure
to the beam is properly controlled; control of the key used to gain access to housing; only
using competent person; and a robust system for the reporting of defects.


















NEBOSH 2006 5 Unit B J anuary 2006

Question 6 Here is an audiogram for an adult worker



(a) Explain what is meant by threshold shift. (2)

(b) What does the shape of the audiogram show? (2)

(c) Identify the benefits and limitations of audiometry as part of a hearing
conservation programme. (3 + 3)


Threshold shift is the difference between the hearing threshold of the subject and the
hearing threshold of an average young adult with healthy, disease-free ears.

A number of candidates described the shape of the audiogram, rather than what the shape
shows. Good responses identified that the shape, with the 4kHz notch is typical of noise
induced hearing loss (NIHL); that the threshold is reduced at all frequencies; the high
frequency loss shows age related hearing loss (presbyacusis); and the dip beyond 12kHz is
expected as it is outside the normal hearing range.

Part (c) provided the best responses, with most candidates able to identify some benefits
and limitations. Against benefits candidates correctly identified that audiometry: provides
evidence of effectiveness of hearing conservation programme; pre-employment screening
identifies those with existing problem; enables identification of susceptible individuals and/or
early signs of hearing loss; provides opportunities to educate workers about NIHL and
prevention; may lead to reduced insurance premiums and provides information that may be
used to defend civil claims.

Limitations identified were that audiometry: is not preventive since some damage has to
occur before problem identified; may actually encourage claims; diverts resources away
from noise control; is subject to inaccuracy and abuse; and that it detects hearing loss but
not the source of NIHL.














NEBOSH 2006 6 Unit B J anuary 2006








Section B three from five questions to be attempted
Question 7 A slightly corrosive solution is used as a treatment in part of a manufacturing
process. The solution is applied by hand brushing. Alternative methods of
application have been found to be impracticable.

(i) Outline the factors that should be considered in the selection of personal
protective equipment. The equipment should ensure that the skin and
the eyes of those involved in the process are adequately protected. (10)

(ii) Identify the content of a training programme that will assist employees to
use the PPE correctly. (5)

(iii) List a range of practical measures (other than training) that can be taken
to encourage the use of the protective equipment and maintain its
effectiveness. (5)


This was a popular question which was well answered by many candidates, especially those
who took a logical head-to-toe approach.

For the selection of protective gloves candidates considered factors such as: the appropriate
chemical resistance for the solution and the chemical breakthrough time; the length of time
the gloves can be worn for before they require replacing; the level of dexterity required for
the task; the length of glove for adequate protection; durability of gloves; ensuring a suitable
range of sizes for the various users is available; any allergies to the glove material or other
skin problems. In the selection of eye protection candidates considered: the risk of
splashing the face as well as eyes; advised to consider the use of goggles or a face shield
with the appropriate level of chemical resistance; and its compatibility with other PPE (if
required). Against selection of body protection candidates considered appropriate chemical
resistant apron and overalls and appropriate footwear. The best answers then concluded by
considering factors such as consultation and user trials; comfort factors; that all PPE meets
appropriate standards (eg Gloves - BS EN 374 chemical 420 / 388; eye protection - BS EN
166 and that everything purchased is CE marked.

Good responses to the second part of the question identified that employees should receive
training prior to issue in topics such as: the health risks of chemical; the PPE to be used and
why; the method of putting on and removing PPE without contamination, including
decontaminating or discarding of gloves after use; not to contaminate other parts of the body
whilst wearing gloves; how to examine PPE for damage or degradation (particularly gloves)
and how to report any defects and obtain replacements; how to store the PPE correctly; and
training in self examination of the skin and action to take if any problems occur.

For the third part of the question, candidates correctly identified other practical measures to
encourage the use of PPE such as: Management leading by example; staff being involved in
the selection; ensuring a range of sizes of gloves available and that shields are fully
adjustable; employees signing for PPE and maintaining records of issue; providing adequate
storage facilities; personal issue of PPE with an adequate supply; use of propaganda, signs
and posters; supervision and monitoring of use; measures taken for non-use (eg
disciplinary); and monitoring the effectiveness of PPE.









NEBOSH 2006 7 Unit B J anuary 2006

Question 8 In a manufacturing process workers use a range of solvents.

(a) Outline the issues that should be considered and the information which
should be consulted when preparing a Control of Substances Hazardous
to Health (COSHH) risk assessment for this situation. (6)

(b) Describe an overall monitoring strategy that could be used to assess the
actual exposure of the process workers to solvent vapours. (6)

(c) Explain how the range of data obtained might be interpreted in order to
determine the acceptability of such exposures and the adequacy of
current controls. (8)


This was not a popular question, although those candidates who attempted it generally
provided reasonable answers. Relevant factors candidates included were: reference to
COSHH Regulations and ACOP, HSG173 (Monitoring strategies for toxic substances),
material safety data sheets; background information on solvents (types, health effects, target
organs, synergistic/additive effects, etc); working practices, exposure patterns, efficiency of
existing controls; need for monitoring (eg deterioration of controls) and health surveillance;
current exposure limits (EH40); route/s of entry (inhalation / skin absorption) relevant to how
the substance is used and who is exposed (including any vulnerable groups).

The better responses considered atmospheric and biological monitoring within their answers
and referred to the three-stage approach in HSG 173. Suitable monitoring strategies
included consideration of: personal versus static monitoring; biological monitoring (total body
burden v inhalation); who to monitor, for how long and when; how to monitor: grab sampling
stain tubes versus integrated sampling (pump, passive, adsorption tubes etc); examples
of analytical methods; and reference to appropriate MDHSs.

Many answers were limited to comparison of data against WELs, whereas better responses
included the following points in explaining how data might be interpreted: measurements
obtained versus work practices (representative, cyclical, etc); comparisons with exposure
standards: calculations for mixtures, taking into account synergistic/additive effects, etc;
comparisons with biological standards; comparisons with previous results; measurements
reviewed against LEV performance tests, or PPE selection and usage, or results of health
surveillance.



Question 9 A parcel sorting depot is experiencing a high number of manual handling related
injuries. The employees handle a large number of different parcels and
packages each day.

(a) Identify the different types of hazard that may be inherent in the loads
being handled. (6)

(b) In order to reduce the manual handling the employer has decided to
invest in a range of non-powered handling devices, (eg trolleys, trucks,
etc). Explain what steps should be taken when selecting such devices
and introducing their use. (10)

(c) Outline a range of other control measures that could be introduced to
further minimise the risks associated with manual handling. (4)


This was a very popular question which produced some excellent answers. The different
types of hazard that candidates identified included: weight of load and the fact that the
weights would be unknown; parcels may be difficult to grasp, as they are likely to be smooth
with no hand holds with unstable contents which are likely to move or with the centre of
gravity not in the centre of the parcel; awkward shapes would be common or parcels that are
too large for the handler to see over; sharp edges or corners and their contents may spill out
(and may have hazardous contents).
NEBOSH 2006 8 Unit B J anuary 2006

Better answers spilt this into two sections, dealing with selection and introduction separately.
Selection of such devices requires: consulting employees and safety representatives in
selection and trials; seeking advice on suitability from suppliers; request equipment on trial
basis, if possible to check it solves the problem without creating new problems; seeing it in
use at other organisations; consideration of maintenance requirements; ensuring the
proposed use will be within the safe working load of the device; ensuring there is sufficient
room to manoeuvre; suitability regarding the terrain in terms of stability and ground surface
(eg type of wheels); appropriate braking controls; adjustable handle height between waist
and shoulder; correct design to prevent parcels falling off. Introduction requires
consideration of operator training; storage; maintenance arrangements and ensuring there
are a sufficient number available.

Other control measures candidates could have considered were: changing the workplace
layout to reduce carrying distances, twisting and stooping and avoiding lifting from floor level
or above shoulder height; varying the work, duration and pace; marking up loads with
information (weights/heavy end, etc); introduction of mechanical assistance (conveyers, fork
lifts, etc); using team lifting where appropriate and manual handling training.



Question 10 Drug and alcohol misuse can adversely influence performance at work, even
when the misuse takes place outside of the workplace.

(a) Outline specific signs that an employer can look for when attempting to
identify if an employee has a drug or alcohol misuse problem. (7)

(b) As a health and safety advisor you have been asked to prepare a
company policy on drug and alcohol misuse. Outline the key points that
such a policy should include. (10)

(c) Identify the types of circumstances in which an employer may consider
using drug screening and testing as part of their approach to managing
drug and alcohol misuse. (3)


This was another popular question which produced good answers from many candidates.
Signs that an employer could look for include: sudden mood change, unusual irritability,
aggression or erratic behaviour; a tendency to become confused; abnormal fluctuations in
concentration and energy; impaired job performance and increased accidents; poor time-
keeping; increased short term sickness absence; deterioration in relationships with
colleagues, customers or managers; dishonesty or theft; smell of alcohol; slurred speech
and poor coordination; change in appearance (becoming scruffy, where previously the
employee had been well groomed); appearance of needlestick marks (or covering of limbs to
hide them).

Candidates who concentrated their answer on alcohol limits of a policy produced narrowly
focused answers in the second part of the question. However, many candidates produced
reasonable answers that considered points such as: a general statement of aims, for
instance the employer expects all employees to ensure that drug misuse does not have a
detrimental effect on their work; responsibilities for carrying out the policy (managers,
employees, occupational health counsellors etc and who is covered by the policy
(employees, contractors, visitors etc); a definition of drug misuse that includes misuse of
prescription drugs as well as prohibited drugs; statement of rules such as: no lunch time
drinking, with any exceptions such as Christmas or other celebrations included; any support,
or help, that will be available to employees who have a drug or alcohol problem; recognition
that treatment may result in absence which will be treated as normal sick leave; statement
assuring confidentiality; clear statement when disciplinary action may result (for instance if
help is refused, if impaired performance continues, or in cases of gross misconduct; the
Companys response to possession or dealing illegal drugs in the workplace; and the
Companys approach to drug screening.


NEBOSH 2006 9 Unit B J anuary 2006
The third part of the question was generally well answered with relevant circumstances
identified including: where drug misuse has been identified as a problem, which could be via
signs identified in (a) or whistleblowing; as part of the job selection process; in a safety
critical role; after an accident which shows drugs or alcohol might be a factor; or as art of a
rehabilitation or return work programme.



Question 11 A soft drinks manufacturer employs 400 people undertaking a range of different
jobs including production, warehousing, delivery and administration. It has
been noted that there are significant risks to staff from noise, manual handling /
ergonomic issues and pressure of work and also high levels of sickness
absence.

(a) Outline the benefits, composition, role and possible functions of an
Occupational Health Service within this organisation. (12)

(b) What contribution could an Occupational Health specialist make in
addressing the risks to staff from stress, manual handling / ergonomic
issues and noise? (8)


Candidates who produced specific, structured answers were able to gain high marks for this
question. Benefits of an Occupational Health Service include: legal compliance where health
surveillance is required; sick absence management leading to a reduction and therefore
saving money; contributing to risk assessment process; providing advice on occupational
health controls and competent advice in specialised areas; and it is often seen as
independent from the employer. The composition will depend on the actual activity of the
organisation but might include: an occupation health physician and nurse; a screening
nurse; physiotherapist; occupational hygienist; counsellor or psychologist; manual handling
trainer; and an ergonomist. The role and function includes: training on occupational health
controls; pre-employment screening; health surveillance and record keeping; fitness to work
assessments; sick absence reviews; counselling; rehabilitation; testing and monitoring (eg
audiometry); immunisation; liaison with GP, or enforcing agency; and health promotion.

The contribution the specialist could make in relation to:

stress include: rehabilitation; counselling; and in carrying out risk assessment and
ensuring control measures are reasonable
manual handling / ergonomic issues include: assessment and control; physical
competency of workers; eye sight screening and rehabilitation
noise includes: noise assessment, control and audiometry.

In all cases the specialist could contribute to training, monitoring and managing sickness
absence.


NEBOSH 2006 10 Unit B J anuary 2006