Occupational medicine

Medicina rada

Occupational medicine is a branch of medicine that deals with conditions and diseases caused by factors to which a person is exposed during his daily working hours. These factors are, for example: noise, vibrations, heat, chemicals, electromagnetic radiation, radiation …
In its essence and operation, this multidisciplinary field of medicine is focused primarily on: achieving physical, mental and social well-being of employees, protection and improvement of employee health, risk assessment at work and their elimination, maintenance and development of workers’ ability to work and control occupational diseases and injuries at work ..The competence of this branch of medicine includes:
– Participation in medical risk assessment and health conditions within the drafting of the Risk Assessment Act (for jobs with increased risk)
– Providing professional assistance and counseling to employers in situations when temporarily or permanently incapacitated workers need to change jobs
– Providing professional assistance to companies within the professional selection
– Providing assistance in professional orientation, in choosing a future profession.

The Occupational Medicine Service issues medical certificates:

– for enrollment in secondary schools at the request of the Ministry of Education
– for enrollment at the faculty
– to go abroad, when this document is required
– at the request of the court, state bodies, etc.
– during employment (administrative affairs)
– for employees who work longer than 4 hours behind the screen
– for work at the workplace without increased risk
– for work in a workplace with increased risk

The Occupational Medicine Service also issues medical certificates of working ability for previous and periodic health examinations for persons at workplaces with increased risk:

– for security officers (carrying weapons)
– for security officers (without carrying weapons)
– for natural persons for possession and carrying of weapons
– for work in the zone of non-ionizing radiation
– for work in the zone of ionizing radiation
– for seafarers
– for the management of river vessels, motor boats and other vessels

The Occupational Medicine Service also performs preliminary examinations when hiring workers at increased risk, which are performed according to the Rulebook on previous and periodic examinations of employees (“Official Gazette of RS”, No. 120/2007 and 93/2008 and 53/2017), such as:

– jobs with increased risk due to noise
– jobs with increased risk due to vibration
– jobs at heights
– jobs of construction machine operators: forklifts, excavators …
– jobs that qualify for medium or heavy physical work
– jobs with chemical hazards
– workplaces with non-ionizing radiation
– jobs in unfavorable microclimatic conditions

Preliminary medical examinations are performed in order to determine and assess special health conditions, ie the ability of the employee to work at a workplace with increased risk in relation to the risk factors determined by the Risk Assessment Act with the employer.

Preliminary medical examinations of employees are performed:
– before starting work at a workplace with increased risk
– before transferring an employee to a job with increased risk
– during each determination of new risks in the workplace with increased risk on which the employee works
– if the employee was assigned to a job with increased risk, and during the performance of work at that random position he had a break in work for more than 12 months

Periodic examinations of workers working in high-risk workplaces are performed according to the valid Rulebook on previous and periodic examinations of employees (“Official Gazette of RS”, No. 120/2007 and 93/2008 and 53/2017). Such jobs are:
– jobs with increased risk due to noise
– jobs with increased risk due to vibration
– jobs at heights
– jobs of construction machine operators: forklifts, excavators …
– jobs with medium or heavy physical work
– jobs with chemical hazards
– workplaces with non-ionizing radiation
– jobs in unfavorable microclimatic conditions

Periodic medical examinations are performed in order to monitor and assess the health condition, ie the ability of the employee to perform work at a workplace with increased risk, and in relation to the risk factors of that workplace and within the deadlines prescribed by this Ordinance.
The employer refers the employee to a periodic medical examination:
– no later than 30 days before the expiration of the deadline determined by this Ordinance
– after concluding sick leave on the basis of a serious injury at work
– and after an illness or injury not related to work – if there is a suspicion of reduced working capacity
If the employee’s examination shows that he is no longer able to perform the previous job, according to the Labor Law, the employer is obliged to find a new job for his employee.

Eyesight examination for employees in workplaces with a screen
Eyesight examinations are performed for the purpose of safe and healthy work of those employees who use equipment behind the screen while performing their work tasks (“Official Gazette of RS”, no. 106/2009, 93/2013 and 86/2019). Such examinations are performed in accordance with the Rulebook on Preventive Measures and are:
– examination before starting to work with the screen
– eyesight examination during the use of screen work equipment

Medical examination is performed for employees who use screen equipment for at least 4 hours a day (part-time). The employer is obliged to provide a eyesight examination at intervals not longer than 3 years, in accordance with the regulations on health care, for all those employees who use the equipment for working with the screen for at least 4 hours a day.
If an employee has a eyesight problem, the occupational medicine service informs the employer, who is obliged to refer the employee to a targeted ophthalmological examination (more detailed eye examination).

Medical examination for motor boat management
– laboratory analyzes (complete blood count with leukocyte formula, sedimentation, glycemia, urine examination)
– examination by an ophthalmologist
– spirometry and ECG
– ENT examination with audimetry
– examination by a neuropsychiatrist
– examination by an occupational medicine specialist

MEDICAL EXAMINATIONS OF INLAND SAILING MEMBERS

They are performed as regular and supervisory examinations.
Regular inspections are performed before the issuance of the ship’s book, ie boarding permit. A member of the ship’s crew who has reached the age of 60, regular medical examinations are performed during the next three months, and then at the age of 5, and when he reaches the age of 70, regular medical examinations are performed every two years. 
Surveillance inspections are performed when changing the type of work on the ship, as well as after a navigation accident that endangered or could have endangered the health of members of the broad crew. This type of examination is performed after illnesses, injuries or surgical interventions that could adversely affect the health of the employee and his further quality work on board.
Examination and assessment of seafarers’ medical fitness is performed by an authorized occupational medicine specialist.

MEDICAL EXAMINATIONS OF SEAFARERS
• Preliminary seafarers’ inspections (before issuing a seaman’s book or boarding license)
• Program of regular medical examination of seafarers (every other year, ie every year for the age of 16-18)
• Extraordinary medical examination of a crew member

Examination and assessment of seafarers’ medical fitness is performed by an authorized occupational medicine specialist.

Amateur medical examination for a driver’s license (categories A and B)
It is performed in accordance with the Rulebook on detailed health conditions that must be met by drivers of certain categories of motor vehicles. The Rulebook was published in the “Official Gazette of RS”, No. 83/2011 of November 9, 2011.
The program:
– examination by an ophthalmologist
– examination by a neuropsychiatrist
– examination by a psychologist – reaction meter
– examination by a general practitioner or an occupational medicine specialist

Medical examination for driving license professionals (categories A, B, C, D, E)
It is performed in accordance with the Rulebook on detailed health conditions that must be met by drivers of certain categories of motor vehicles. The Rulebook was published in the “Official Gazette of RS”, No. 83/2011, dated November 9, 2011.
The program:
– laboratory analyzes (complete blood count with leukocyte formula, blood sugar sedimentation, urine)
– ECG
– examination by an ophthalmologist
– examination by a neuropsychiatrist
– audiometry – hearing examination
– examination by a psychologist – reaction meter
– examination by a general practitioner or an ECG specialist

MEDICAL EXAMINATION FOR HOLDING AND CARRYING WEAPONS

It is performed in accordance with the Rulebook on Determining the Medical Ability of Natural Persons to Hold and Carry Weapons (“Official Gazette of RS”, No. 25 of March 9, 2016 and No. 79 of September 23, 2016)
The program:
– laboratory analyzes (complete blood count with leukocyte formula, blood sugar sedimentation, urine ()
– ECG
– examination by an ophthalmologist
– examination by a neuropsychiatrist
– audiometry – hearing examination
– examination by a psychologist – reaction meter
– examination by an ECG specialist

MEDICAL CERTIFICATE FOR WORK IN THE ZONE OF IONIZING RADIATION

Examinations are performed in accordance with the Rulebook on previous and periodic medical examinations of those employees who are engaged in jobs with increased risk (Official Gazette of RS 120/2007 and 93/2008 and 53/2017).

Preliminary medical examination includes:

– examination by a doctor specializing in occupational medicine, ECG, BMI…
– basic laboratory blood tests (SE, leukocyte count, erythrocyte count, hematocrit, glucose concentration) and examination of urine and urine sediment
– examination of eyesight function: visual acuity at near and far, deep vision, examination of the eye lens
– tonal liminal audiometry
– spirometry with flow and volume curve
– neuropsychiatric and psychological examination
– gynecological examination and breast examination
– analysis of structural chromosomal aberrations and determination of the number of micronuclei
– specific examinations and / or tests depending on the determined harmfulness and danger, ie special health conditions for performing certain tasks at the workplace, in accordance with the Act on Risk Assessment.

Periodic examinations

They are obligatory once a year, and the scope of examinations differs according to working conditions and levels of exposure to ionizing radiation, ie. whether exposed workers are classified in category “A” or “B”

Periodic medical examination of group “A” includes:

– examination by an occupational medicine specialist, ECG, BMI
– basic laboratory blood tests (SE, leukocyte count, erythrocyte count, hematocrit, glucose concentration) and examination of urine and urine sediment
– spirometry with flow and volume curve
– determination of the number of micronuclei (every year)
– examination of the thyroid gland for occupationally exposed persons working with the radioactive isotope J-1317.
– specific examinations and / or tests depending on the determined harmfulness and danger, ie special health conditions for performing certain tasks at the workplace, in accordance with the Act on Risk Assessment.

Periodic medical examination of group “B” includes:

– examination by an occupational medicine specialist, ECG, BMI
– basic laboratory blood tests (SE, leukocyte count, erythrocyte count, hematocrit, glucose concentration) and examination of urine and urine sediment
– spirometry with curve flow volume
– determination of the number of micronuclei (at least once in three years)
– examination of the thyroid gland for occupationally exposed persons working with the radioactive isotope J-131
– specific examinations and / or tests depending on the determined harmfulness and danger, ie special health conditions for performing certain tasks at the workplace, in accordance with the Act on Risk Assessment.