Referral for a medical examination of a gas boiler operator. Mandatory psychiatric examination

List of doctors for periodic medical examinations depends on what position the employee being surveyed occupies, as well as his gender. In our article you will find information about the standard list of doctors who will need to see you to confirm that your health status meets the stated requirements, and about the procedure for undergoing medical examinations.

Which categories of workers are required to undergo periodic medical examinations?

Caring for the health of workers is one of the most important responsibilities employer. In accordance with Art. 213 Labor Code Russian Federation, are required to undergo a medical examination (both before entering work and subsequently, at certain intervals):

• workers engaged in work characterized by the presence of harmful and/or dangerous production factors;
• specialists working in the field related to transport traffic;
• workers working in the field Catering, medical and children's institutions, as well as some other organizations closely related to the provision of services to the population;
• employees who are under 21 years of age;
• other categories of workers, the list of which is established by federal and local legislation.

In accordance with Part 3 of Art. 5.27.1 of the Code of Administrative Offenses of the Russian Federation, failure by the employer to comply with this requirement entails a fine, the amount of which can reach 130,000 rubles.

The procedure for preparing for mandatory periodic medical examination

The sequence of actions of the employer aimed at organizing and conducting periodic medical examinations is as follows:

What documents are drawn up during a periodic medical examination, who pays for it?

Unlike the initial medical examination, which an employee undergoes before concluding an employment agreement with the employer, when undergoing a periodic medical examination, a certificate drawn up in form No. 086/u or No. 001-GS/u is not required. According to the results periodic inspection An employee in a medical organization draws up a report containing the following information:

• date of issue of the document;
• Full name of the person who underwent the inspection;
• name of the employing organization;
• Name structural unit where the employee works, as well as the exact name of his position;
• a list of harmful and dangerous production factors that have a direct impact on his health;
• the result of the examination and the doctor’s conclusion based on its results, indicating the presence or absence of contraindications for the employee to perform the declared type of work.

This document must be signed by the chairman of the medical commission and certified with the seal of the healthcare institution. Also, the results of the completed medical examination are indicated in the health passport, which is kept by the employer.

Don't know your rights?

All costs for employees undergoing examinations by doctors, as well as conducting laboratory and functional tests, in accordance with the provisions of Art. 213 of the Labor Code fall on the employer. Regardless of which medical institution (public or private) the medical examination will be carried out, the employer must enter into an agreement with it for the provision of relevant services, the cost of which depends on the number of workers examined and the prices established by the management of the clinic.

Passing a medical examination under order 302n - which doctors need to be visited

The procedure for conducting periodic medical examinations of enterprise employees is determined by the provisions of the order of the Ministry of Health and Social Development of the Russian Federation “On approval of lists...” dated April 12, 2011 No. 302n. In accordance with Art. 5 of Section I of the said normative act, the medical examination must be carried out by members of a permanent medical commission, which includes:

• occupational pathologist;
• medical specialists who have completed an advanced training course in the specialty “occupational pathology”, or doctors who have a valid certificate in this specialty.

The composition of this commission is approved by order of the chief physician of the health care institution that provides medical examination services for employees of the enterprise.

Wherein list of doctors for medical examination depending also on the sphere in which the employee works and the conditions for his implementation labor activity. Appendix No. 1 to Order No. 302n lists a list of harmful and dangerous production factors, in the presence of which the employee must have his health checked by medical specialists. The same appendix contains a list of doctors who must examine workers working in certain conditions, as well as the frequency of such examinations. In addition, in the document you can find an exact list of laboratory and functional studies, the conduct of which allows you to make the most objective and accurate conclusion about the employee’s state of health.

List of doctors for repeated medical examination at work

The list of doctors that an employee of an enterprise needs to visit when undergoing a medical examination is provided to him directly at the enterprise by the person responsible for carrying out the medical examination and coordinating the process of its implementation. Depending on the worker’s position, this list may include:

• otorhinolaryngologist;
• dermatovenerologist;
• ophthalmologist;
• allergist;
• oncologist;
• urologist;
• gynecologist;
• surgeon;
• endocrinologist;
• neurologist;
• orthopedist;
• dentist;
• infectious disease specialist;
• mammologist (for women over 40 years of age), although in some cases a visit to this specialist is replaced by a mandatory mammography procedure followed by presentation to a gynecologist.

IMPORTANT! The link to the 3rd list, specified in Appendix 1 to Order No. 302n, establishes the employee’s obligation to undergo examination by a therapist, psychiatrist and narcologist. The legality of this norm was confirmed by the decision Supreme Court RF “On refusal to recognize...” dated December 18, 2012 No. AKPI12-1363.

The list of mandatory tests that every employee undergoing a medical examination must undergo includes:

• general analysis urine and blood;
• fluorography.

Note: this list may be supplemented with other types of examinations and analyzes (depending on the position held by the employee).

Who conducts a medical examination before starting a working day or shift?

In accordance with clause 4, part 2, art. 46 of the Law “On the Fundamentals of Health Protection...” dated November 21, 2011 No. 323 in order to identify the impact of dangerous and harmful production factors, as well as the presence of diseases that interfere with the normal performance of work, certain categories of workers (for example, drivers Vehicle transporting passengers) are required to undergo daily inspection before going to work. Unlike periodic medical examinations, this event does not take much time. It is carried out, in accordance with part 8 of the appendix to the order of the Ministry of Health of the Russian Federation “On approval of the procedure...” dated December 15, 2014 No. 835n, by a medical worker with a higher or secondary medical education, or a healthcare institution licensed to provide medical services(including medical examinations).

So, some categories of workers are required to undergo both initial and periodic medical examinations, during which their health status is checked by both doctors general practice, and highly specialized specialists. List of doctors whose examination is prerequisite for the employee to carry out further work activities, laboratory tests and other studies, as well as a description of working conditions, the influence of which entails the need for regular examinations, are established by the provisions of Order of the Ministry of Health and Social Development No. 302n. Based of this document For each position, a list of doctors is formed that the employees occupying it must visit.

Every year during the heating season we receive boiler house operators. They undergo medical examinations when hired. According to 302 n and a special assessment of harmfulness, a medical examination must be carried out once every 2 years. Tell me, can we use last year’s medical examination when hiring operators or not?

Answer

Answer to the question:

No, in this situation, before hiring, employees must be sent for a preliminary medical examination again. This is due to the fact that there was a dismissal. During the time that employees did not work, they could develop contraindications to work. Moreover, the requirement for preliminary medical inspection is a mandatory requirement that must be met with every hire.

Consequently, workers can be hired only after undergoing a preliminary medical examination.

Details in the materials of the Personnel System:

1.Answer: Is it necessary to carry out mandatory medical examination, if an employee is hired for a short period of time to temporarily replace an absent employee (for a period of illness, vacation, etc.). The position for which an employee is hired requires a medical examination.

N.Z. Kovyazina

Yes need.

The need for a medical examination is caused by the presence of dangerous and (or) harmful factors and work during the labor process (Appendices No. 1, 2 to the order of the Ministry of Health and Social Development of Russia dated April 12, 2011 No. 302n). Since such factors objectively exist for the temporarily filled position, the temporary employee is subject to all medical examinations provided for by law. general procedure(Article 213 of the Labor Code of the Russian Federation). The term of the contract with the conscript does not matter.

With respect and best wishes comfortable work, Ekaterina Zaitseva,

HR System expert

In recent years it has been released big number regulations defining the responsibilities of employers and health care institutions to provide medical care to workers in hazardous industries. However, in a number of cases, the employer’s legally established obligations to protect the health of workers in hazardous industries are not fulfilled and their function is transferred to the territorial health authorities.

Currently, a system of stepwise provision of medical care to workers in hazardous industries is being implemented. This system includes three links: 1) outpatient clinic, 2) inpatient (therapeutic and diagnostic, treatment and rehabilitation /I stage of rehabilitation/, 3) sanatorium-resort /II stage of rehabilitation/.

The main objectives of the outpatient clinic of the Center are the prevention of occupational and work-related diseases, as well as medical and social rehabilitation of workers with initial symptoms occupational diseases, not accompanied by loss of ability to work. The only effective way to accomplish these tasks is the effective (high-quality) implementation of preventive medical examinations the specified contingents. However, creating a truly effective system for conducting medical examinations is associated with certain organizational difficulties.

Currently, periodic medical examinations are carried out by territorial medical institutions and are of a screening nature. According to the annual reports of health care facilities, the percentage of coverage of workers with periodic medical examinations in the region is 88-90% annually. At the same time, it should be noted that the effectiveness of periodic medical examinations by healthcare facility specialists is extremely low. The reasons for the low efficiency of primary care are that the local therapist does not have special knowledge regarding the clinical manifestations of diseases arising from exposure to harmful factors of modern industrial and agricultural production, does not have data on the intensity of harmful factors in a specific workplace, and does not have information on the prevalence of occupational diseases in specific production conditions, and is also not focused on identifying early signs occupational diseases.

In order to overcome the difficulties that inevitably arise when organizing and conducting preliminary and periodic medical

The following approach is convenient for inspections:

Getting to know legal framework required for medical examinations

General requirements for organizing medical examinations

The procedure for conducting medical examinations

Legal basis for conducting medical examinations

The legal basis for conducting medical examinations is based primarily on Article 254 of the Labor Code of the Russian Federation, which states that workers employed in hard work and work with harmful or dangerous working conditions, undergo mandatory preliminary upon entry to work and periodic medical examinations to determine their suitability for the assigned work and prevent occupational diseases.

181 Federal Law of the Russian Federation dated June 23, 1999 establishes the conduct at the expense of the employer’s own funds the following types medical activities: mandatory preliminary upon entry to work and periodic medical examinations (examinations) of workers, extraordinary medical examinations (examinations) of workers at their requests in accordance with medical recommendations with preservation of their place of work (position) and average earnings for the duration of the said medical examinations; as well as exclusion (by employers) of workers; to their implementation labor responsibilities without undergoing mandatory medical examinations and in case of medical contraindications. Comments to Ch. X Labor Code of the Russian Federation (2000) states:

Employers and officials guilty of violating legislative and other regulations on labor protection, failure to fulfill obligations established by collective agreements or agreements on labor protection, or interfering with the activities of representatives of bodies state supervision and control, as well as public control are brought to administrative, disciplinary or criminal liability in the manner prescribed by law Russian Federation and republics in its composition. Russian Federation. For violation of the requirements of legislative and other regulations on labor protection, enterprise employees are subject to disciplinary and, in appropriate cases, financial and criminal liability.

In cases where the production activities of enterprises pose a danger to the life and health of workers and the population, their activities may be suspended by order of the head of the Center for State Sanitary and Epidemiological Surveillance or state labor protection inspectors

The main document according to which preliminary and periodic medical examinations are carried out is order of the Ministry of Health of the Russian Federation No. 405 dated December 10, 1996, due to the fact that it is the one that has approval from the Ministry of Justice of the Russian Federation. According to Order No. 405, the scope of medical examinations is carried out in accordance with Order No. 90 dated March 14, 1996. Below we will talk about the order (August 2004 No. 83.)

General requirements for organizing preliminary and periodic medical examinations:

TO general requirements relate

Availability of a full package of regulations on the protection of workers' health; on conducting preliminary and periodic medical examinations of workers;

Possibility of interaction with social protection authorities, social insurance and employers in this area of ​​activity.

Providing the opportunity for specialists of a medical institution taking part in the organization and conduct of preliminary and periodic medical examinations to familiarize themselves with these documents,

Compliance with the requirements of the Government of the Russian Federation No. 967 dated December 5, 2000, order of the Ministry of Health of the Russian Federation No. 405, order of the Ministry of Health of the Russian Federation No. 90,

Participation in the examination of the attending physician,

Sufficient technical equipment health care facilities,

Availability of specialists (our own or external ones) who have a document (certificate, identification) indicating special training in occupational pathology issues no more than five years old.

Preliminary and periodic medical examinations, as well as examination of professional suitability can be carried out by health care facilities of any organizational and legal forms that provide primary medical care to the population and having a license for the specified type of activity. Medical examinations can be carried out by Centers and departments of occupational pathology, subject to the availability of an appropriate license with the issuance of a conclusion on the results of the examination and suitability for professional activity. Certain aspects of the examination of professional suitability are allowed to be carried out by some specialized health care facilities (dermatovenerological, drug addiction, psychoneurological dispensaries).

The main person conducting medical examinations is the attending physician.

In accordance with Article 58 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, the attending physician is a doctor who provides medical care to the patient during the period of his observation and treatment in an outpatient clinic or hospital institution. The attending physician can be a general practitioner at a health center, workshop or territorial site, a general practitioner working in a medical and preventive organization, or a doctor at a Trade Union Center who carries out a medical examination using all current medical documentation necessary to assess the employee’s health over time.

Without the involvement of the attending physician, conducting preliminary and periodic medical examinations is methodologically incorrect. As experience shows, it is during medical examinations carried out by permanent medical examination commissions, prevention departments, medical examination clinics or other medical and preventive institutions without the participation of the attending physician that numerous errors arise related to the admission to professional activities of persons who have contraindications to work with harmful production factors . Procedure for medical examinations

As Order 405 states, the contingents subject to preliminary and periodic medical examinations are determined by the State Sanitary and Epidemiological Supervision centers of the constituent entities of the Russian Federation together with the employer (by workshop, profession, hazardous, harmful substances and production factors) no later than December 1 of the previous year. The timing of inspections must correspond to the established frequency.

Preliminary and periodic medical examinations of employees working on a rotational basis, are carried out by treatment and preventive organizations / institutions / at the place of permanent medical care or at the location of the shifts, when the administration of the rotation organizations decides on the issue of their financing.

Measures to prepare the institution for preliminary and periodic medical examinations.

To the heads of health care facilities:

1. Study the list of harmful substances and production factors affecting employees of supervised enterprises (according to the lists of contingents subject to periodic medical examinations approved by the State Sanitary Inspectorate).

2. Determine the composition of the medical team for conducting preliminary and periodic medical examinations, taking into account the list of harmful substances and production factors at the supervised enterprises (Appendix No. 1, 2 of the order of the Ministry of Health of the Russian Federation No. 90).

3. Determine the set of necessary laboratory research methods, taking into account the list of harmful substances and production factors at supervised enterprises (Appendix No. 1, 2 of Order No. 90 of the Ministry of Health of the Russian Federation).

4. Determine a set of necessary functional research methods, taking into account the list of harmful substances and production factors at supervised enterprises (Appendix No. 1 and 2 of Order No. 90 of the Ministry of Health of the Russian Federation).

5. Ensure the availability of research equipment in health care facilities, chemical reagents, X-ray film and other components for carrying out relevant laboratory and functional research methods.

6. Draw up a schedule for sending doctors of all specialties involved in preliminary and periodic medical examinations to special training in occupational pathology.

7. Provide training to laboratory doctors on how to conduct special laboratory tests.

Planning.

To the heads of health care facilities:

1. Conclude an agreement with the employer to conduct preliminary and periodic medical examinations.

2. Receive, by December 1 of the year preceding the periodic medical examination, the named lists of contingents subject to periodic medical examinations. The lists must be certified by the State Sanitary and Epidemiological Supervision Center and contain information on the number of occupations examined by workshop, hazardous substances and production factors (in accordance with Appendices No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation), length of service, frequency of medical examinations and the date of the last medical examination.

3. Issue an order to conduct preliminary and periodic medical examinations of employees of supervised enterprises in health care facilities. Appoint someone responsible for conducting preliminary and periodic medical examinations at health care facilities, indicate the composition of the medical team performing medical examinations, and determine the working hours of the medical team. The person responsible for conducting preliminary and periodic medical examinations in health care facilities must have a certificate in the specialty "Occupational Pathology".

4. Create a work schedule for the medical team.

5. Create a work schedule for laboratory doctors.

6. Create a work schedule for functionalist doctors.

7. If there is no specialist doctor in the health care facility, enter into an agreement with another health care facility to attract a specialist of this profile to conduct preliminary and periodic medical examinations. The timing of employee examinations must coincide with the work schedule of the main medical team.

8. Ensure that every medical specialist participating in periodic medical examinations of contingents subject to periodic medical examinations in the current year is available. The lists must include 3 additional columns: diagnosis, conclusion (pass, fail), therapeutic measures.

9. Draw up a work schedule for the clinical expert commission (CEC) to make an opinion on contraindications to continue working in harmful conditions pile and solutions to conflict situations.

Conducting preliminary medical examinations.

Under an agreement with the employer (head of the organization), the health care facility is obliged to ensure a preliminary medical examination of the employee.

Scheme of preliminary medical examination in health care facilities:

Registration of the employee’s attendance at the health care facility to undergo a preliminary medical examination.

Registration of an employee in a health care facility for a preliminary medical examination is carried out in a special register. The registration form must include the date of application, passport data, the name of the company that sent the employee, harmful production factors at the future place of work and a conclusion about the suitability of the health status for the proposed job.

During the registration of an employee, the documents required to undergo a preliminary medical examination are checked:

A referral from the personnel department of the enterprise (organization), which contains a list of harmful substances and production factors at the future place of work in accordance with Appendices No. 1 and 2 of Order No. 90 of the Ministry of Health of the Russian Federation,

Passport or other identification document, military ID,

Outpatient medical record from the place of regular medical care. If documents are missing or do not fully comply with the requirements (for example, there is no outpatient card, the referral does not indicate harmful substances and production factors), a medical examination is not carried out.

Filling out the employee’s professional route sheet in the outpatient card.

The employee’s professional route sheet indicates the name of the enterprise, workshop, site, profession, length of service at this place of work,

harmful substances and production factors at a given place of work, a final conclusion on the suitability of the state of health for the work assigned. In free form, data on the composition of the medical team performing the medical examination in accordance with Order No. 90 of the Ministry of Health of the Russian Federation and the volume of necessary laboratory and functional tests are entered on the professional route sheet.

Examination by medical specialists. Each doctor enters the data of an objective examination into the employee’s outpatient record and gives his opinion on the suitability of the state of health for the work assigned. On the referral sheet for a preliminary medical examination, the primary medical specialist issues a final conclusion on the suitability of the health status for the proposed job. The conclusion, signed by the main medical specialist, is sealed by the health care facility. In the professional route sheet, the main medical specialist duplicates the final conclusion on the suitability of the health status for the intended job.

The main person conducting the preliminary medical examination is the general practitioner, indicated in first place in the medical team, according to column 5 (“participation of medical specialists”) of appendices No. 1 and 2 of order No. 90 of the Ministry of Health of the Russian Federation. During the physical examination, the primary physician must complete the physical examination. The doctor makes his conclusion taking into account the data from laboratory and functional examination methods of the employee, which are pasted into the outpatient card. In the referral sheet for a preliminary medical examination, the conclusion signed by the doctor is sealed by the health care facility.

We remind you that, regardless of the place of work, the person being examined in mandatory a blood test is performed (hemoglobin, leukocytes, ESR), an X-ray of the chest organs in a direct projection, women are examined by an obstetrician-gynecologist with a bacteriological (for flora) and cytological (for atypical cells) examination.

If the health status does not correspond to the work assigned, the employee is sent to a meeting of the clinical expert commission of the health care facility. Based on the results of the employee’s examination, the clinical expert commission makes a conclusion that he is unsuitable for work in hazardous conditions. working conditions. The first copy of the report is handed over to the employee; a copy of the report is sent to the employer who issued the referral within three days.

Registration of preliminary medical examination results

The result of the preliminary medical examination is entered into the register of preliminary medical examinations.

When transferring an employee to another place of work with similar working conditions and production factors, documents are drawn up by the attending physician based on the data of the previous preliminary or periodic medical examination. The referral specifies the date for the second medical examination.

When an employee is transferred to another place of work with other harmful working conditions and production factors, a preliminary medical examination is carried out on a general basis in accordance with the list of harmful production factors at the new place of work

Conducting periodic medical examinations.

Periodic medical examinations are carried out in accordance with the schedule approved by the chief physician of the healthcare facility and agreed upon with the employer.

Registration of employees' attendance for periodic medical examinations.

The attendance of employees for periodic medical examinations is ensured by the employer in accordance with the approved plan. Registration is carried out for verification purposes necessary documents for a periodic medical examination: a referral from the employer for a periodic medical examination, a passport or other identification document, a military ID, an outpatient medical card from the place of permanent medical care. If documents are missing or do not fully comply with the requirements, a medical examination will not be carried out.

During registration, the order of examination by medical specialists and the time of taking tests, undergoing functional examination methods, and x-ray examination are determined. Note! Order No. 90 of the Ministry of Health of the Russian Federation specifies chest radiography as a mandatory examination method, and not fluorographic examination.

Filling out the professional route sheet.

Entering into the sheet the date of inspection, work experience, and in case of a change of place of work - information about the name of the enterprise, workshop, site, profession, work experience at the new place of work, harmful substances and production factors at the new place of work. The data on the composition of the medical team performing the medical examination in accordance with the order of the Ministry of Health of the Russian Federation No. 90, and the volume of necessary laboratory and functional studies are adjusted.

Examination by medical specialists.

Each doctor enters the data of an objective examination into the employee’s outpatient record and gives his opinion on the suitability of the health status. If an employee is diagnosed with a disease that prevents them from continuing to work in harmful conditions, a decision is made to send the patient to a meeting of the clinical expert commission of the health care facility. The list of general medical contraindications for work involving hazardous substances and production factors is indicated in Appendix 4 of Order No. 90 of the Ministry of Health of the Russian Federation. A list of additional medical contraindications depending on the specific harmful factor is given in column 7 of Appendix No. 1.2 of Order No. 90 of the Ministry of Health of the Russian Federation.

If an employee detects signs of a general disease that prevents continued contact with harmful substances and production factors, a set of treatment and preventive measures is developed. (If medical examinations are not carried out in a medical facility for continuous observation, notifications of all cases of newly diagnosed general diseases are transferred to the medical facility at the place of permanent medical care of the employee. Notification forms are prepared at the expense of the employer).

If an employee detects abnormalities in individual organs and systems of the body, the doctor prescribes a set of additional diagnostic measures. The examination plan is entered into the patient’s outpatient record for further in-depth examination of the employee at the place of permanent medical care (the employer does not pay for the range of additional medical services not included in appendices No. 1 and 2 of Order No. 90 of the Ministry of Health of the Russian Federation). The final diagnosis is established by specialists from continuous medical care facilities and included in the list of updated diagnoses.

The primary person conducting the periodic medical examination. is the doctor indicated in the first place in the medical team, according to column 5 (“participation of medical specialists”) of appendices No. 1 and 2 of the order of the Ministry of Health of the Russian Federation No. 90. During the medical examination, the main doctor must complete the medical examination. The doctor makes his conclusion taking into account the data from laboratory and functional examination methods of the employee, which are pasted into the outpatient card.

If an employee detects signs of an occupational disease, he is sent to a meeting of the clinical expert commission of a medical institution, which conducts a periodic medical examination in order to decide on further examination at the Trade Center. Further actions of doctors are regulated by Decree of the Government of the Russian Federation of December 15, 2000 No. 967 “On approval of the Regulations on the investigation and recording of occupational diseases.”

For each person with health problems, the doctor conducting a medical examination prescribes therapeutic and health measures: diet, referral to outpatient treatment, inpatient treatment, sanatorium-resort treatment, in a sanatorium, rest home.

Work of the clinical expert commission.

Based on the results of the employee’s examination, the clinical expert commission makes a conclusion about his suitability to work in hazardous working conditions. All conclusions of the commission are recorded in the journal of KEC meetings. The first copy of the conclusion is given to the employee, a copy of the conclusion is sent to the employer who issued the referral within three days. The period for examining an employee at a meeting of the clinical expert commission should not exceed 3 days relative to the schedule for conducting a periodic medical examination of the employee.

By decision of the CEC, an employee can be removed from continuing to work in hazardous working conditions (the presence of general and additional medical contraindications), transferred to work in easier working conditions, or referred to MSEC due to a general illness.

If an employee has signs of an occupational disease, by decision of the CEC, he is sent to the regional center for occupational diseases. The doctor responsible for conducting preliminary and periodic medical examinations at the health care facility sends an emergency notification to the Center for State Sanitary and Epidemiological Surveillance to compile a sanitary and hygienic description of the employee’s working conditions.

Making a final conclusion about the suitability of the health status for the work performed.

On the referral sheet for periodic medical examination (referral forms for periodic medical examination are prepared at the expense of the employer), the main medical specialist makes a final conclusion on the suitability of the health status for the proposed job. The conclusion signed by the main medical specialist is sealed by the health care facility.

Registration of the final act

The results of periodic medical examinations of employees are summarized in the form of final reports. The final report is drawn up within 2 weeks from the date of completion of the periodic medical examination. Upon completion of the periodic inspection, the person responsible for its conduct is provided with information for drawing up a final report. The official form of the final act, specified in the notes to appendices No. 1 and 2 of order No. 555 of the USSR Ministry of Health, has been legally canceled, although a new one has not been developed.

The final act must contain the following data;

Composition of the commission for drawing up the final act;

The composition of the medical team examining workers. For each medical specialist, the date of the last improvement in occupational pathology is indicated;

The number of persons subject to periodic medical examination in the current year, including women;

Number of people examined (percentage of examination coverage), including women;

Number of uninspected (indicating the reason);

Number of people with newly diagnosed general disease;

The number of persons included in dispensary observation groups in connection with chronic general diseases (according to examination data and outpatient records);

- (the number of persons with health problems who require further examination at their place of residence;

Number of persons referred to KEC health care facilities,

The number of people who need temporary transfer to another job for health reasons (general diseases, occupational diseases);

Number of people in need permanent translation to another job due to health reasons (general diseases, occupational diseases);

Number of persons referred to MSEC (general diseases);

Number of identified persons suspected of having an occupational disease (including women), list of names;

Number of persons sent to the regional center of occupational diseases, list of names;

Number of persons to be referred for outpatient treatment.

Number of persons subject to referral for inpatient treatment;

Number of persons subject to referral for sanatorium treatment;

The number of persons to be sent to a sanatorium;

Number of people in need of diet and special nutrition;

The final act is drawn up in 4 copies and submitted to the TsGSEN, adm. enterprises, trade union committees, health care facilities.

Health care facilities bear full legal responsibility for the quality of medical examinations, as extra-budgetary activities, on the basis of existing legislation.

Control over the quality of preliminary and periodic medical examinations is entrusted to the bodies of the SSES and the Trade Union Center.

Order No. 90

Unfortunately, Order No. 90 contains a number of defects that significantly complicate the work.

Order No. 90 does not contain requirements for the preparation of medical certificates and the final act.

Compared to Order 555, there is no third column: previously - the nature of the work being carried out, which makes it difficult to select contingents for conducting PMO. Example - work in contact with ultrasound - in order 555, work with medical equipment was indicated as workplaces, in order No. 90 there are no instructions, as a result of which workplaces in health care facilities are not submitted to the SSES bodies and are not subject to preliminary and preliminary medical examinations in the scope of the order .

In the column “participation of medical specialists” the term appears: “according to indications”. Indications can be either a long work experience or the presence of clinical signs of the disease. The indications must be determined by a general practitioner. It is known that chronic occupational diseases in the early stages have an asymptomatic course and cannot be identified through complaints. Consequently, the order itself provides for the possibility of diagnosing these occupational diseases only in late stages. Example: exposure. high temperature Contraindications include cataracts. and the participation of an ophthalmologist as indicated. But the first 3 stages of thermal cataract are not accompanied by a decrease in visual acuity and, therefore, patient complaints.

In addition to the optional participation of some medical specialists in PME (according to indications), in column 7 there are references to medical contraindications in addition to general honey. contraindications. In particular, in column No. 7, when contacting fluoroplastics (p. 30), chronic diseases of the nervous system are indicated as contraindications to work, but the participation of a neurologist in the commission is not provided. A similar situation is observed with contact with cyanide compounds (p. 22): diseases of the anterior segment of the eyes are indicated as contraindications, and there is no ophthalmologist on the commission. Contraindications to working with acrylic nitrile (p. 22) are allergic skin diseases, dystrophic changes in the V.D.P., diseases of the peripheral nervous system, but an ENT doctor does not participate in the commission. dermatologist and neurologist. For vibration disease, high and complicated myopia are indicated as contraindications, but there is no ophthalmologist on the commission (in Order No. 555, an ophthalmologist was a mandatory medical specialist).

For a number of harmful factors, in the same column No. 7 of Order No. 90 there are no contraindications previously approved by Order No. 555. Such inconsistencies complicate the work of medical specialists and lead to the development of injuries and occupational diseases in the workplace, despite the fact that medical examinations are carried out in a high-quality manner.

Column No. 6 indicates laboratory and functional studies carried out during the PME. But here, too, there are inaccuracies. It is mandatory to conduct a blood test with the number of red blood cells, white blood cells, and ESR. In some of the tables there is a link to a general blood test (p. 22, chromium), and in part - to the leukocyte formula (p. 22, acrylonitrile). If in the first case a study on the number of reticulocytes and platelets was meant, then the indications of study data on contact with aromatic hydrocarbons are unclear (p. 16). with lead (page 12). Even more incomprehensible is the indication to conduct a study on the leukocyte formula according to indications (page 9, copper), and a general blood test according to indications (page 10, lithium). In order No. 555, contact with welding aerosol containing Mn, Mg. Ti, Zn, Cu, implied a study of the leukocyte formula, this study is not specified in order No. 90.

In case of contact with abrasive dusts, the period for performing Rg-graphy of the lungs (p. 36) is not indicated for people with more than 15 years of experience, although in the future this paragraph is referred to repeatedly.

Special attention should be paid to conducting periodic medical examinations of workers in occupational pathology centers. These medical examinations are regulated by Order No. 90 of the Ministry of Health of the Russian Federation once every 3-5 years, depending on the harmful and hazardous substances and production factors involved, but are not carried out almost everywhere. Medical examinations should be carried out in a consultative clinic or inpatient occupational pathology center.

Previously, there were standard objections from employers to conducting these medical examinations. As a rule, they relied on clause 2.9. order No. 405: ""... inspections can be carried out in the conditions of the PC...", implying that it is not necessary to fulfill the requirements of column No. 4 of Order No. 90 of the Ministry of Health of the Russian Federation. However, since the adoption of Order No. 83, the situation has changed radically. Employees with more than 5 years of experience will be examined at the Trade Union Center once every 5 years .

Carrying out medical examinations at enterprises by on-site personnelbrigades

This approach significantly reduces the costs of enterprises, avoids labor losses and the associated lost profits of enterprises, while maintaining the quality of surveys.

One mobile team per year is capable of conducting more than 5,000 examinations. At the same time, the benefits are obvious not only for enterprises, but also for the Trade Union Center.

Team composition:

1. Mobile fluorograph (Large-frame 100 mm or, better, digital, allowing you to obtain images of 38 * 38 cm, 41 * 41 cm)

2. Car for the medical team

3. A UAZ vehicle equipped with the following equipment:

1. spiro analyzer (Chest, Microspiro, etc.)

2. ECG machine

3. vibration tester

4. tuning forks,

5. laboratory assistant’s kit: hemoglobinometer, binocular microscope, ca-lillaries, test tubes, glasses, ESR meters, stands, scarifiers, Goryaev chambers, reagents, automatic micropipettes, bins, packing suitcase

6. ophthalmologist’s kit: straight ophthalmoscope, Govin-Sivtsev table, trial set of glasses, set of trial spectacle frames, arc perimeter, Maklakov tonometers, or IOP indicator, Rabkin tables;

7. otorhinolaryngologist kit: audiometer, ear specula, nasal speculum, spatulas, intralaryngeal speculum, nasopharyngeal speculum, kidney-shaped trays, ear tweezers, Janet syringe (reusable),

8. tonometers, stethophonendoscopes, thermometers.

The average daily workload of a medical team, staffed by doctors and paramedical personnel, is at least 50-60 people with a guarantee of maintaining the quality of work. The detection of signs of occupational diseases in comparison with medical examinations carried out by medical institutions at the place of residence increases by 10-12 times, and reaches 1.1% of the number of those examined (when medical examinations are carried out by medical institutions at the place of residence, it is only 0.1% or less) . At the same time, the initial incidence of disability due to occupational diseases is significantly reduced due to the fact that they are detected at a functionally reversible stage and can be effectively treated using sick leave.

Attention should be paid to the fact that with this approach, the employer actually pays for the detection of general somatic diseases, which reduces the costs of healthcare budgets.

If signs of deviation in health status are detected, workers are sent to the Center for Occupational Pathology to undergo medical examination according to column “4” of order No. 90 of the Ministry of Health of the Russian Federation (inpatient examination).

The above system for organizing medical care for workers in hazardous industries allows for the following to be carried out at the outpatient clinic stage:

* high-quality periodic medical examinations,

* detection of occupational diseases in a functionally reversible phase

* early detection of general somatic diseases among workers in hazardous industries

* identification of individuals with individual signs of exposure to harmful production factors (control group) and dynamic monitoring of them in the Trade Union Center

* development for each patient of an individual scheme of treatment and rehabilitation measures aimed at maintaining health in hazardous working conditions,

* if necessary, timely removal from exposure to harmful factors.

Thus, modern concept l

The company's staff includes car drivers, truck drivers and personal car drivers. Car drivers, incl. cargo, carry out delivery of goods (raw materials) and distribution of products (bakery products). Drivers company cars transport employees for official purposes. The company also has a boiler room (hazardous production facility) operator on its staff. Is it necessary to carry out psychiatric examination? To what extent is psychiatric examination of the above categories of workers carried out? What administrative liability can be applied to an enterprise if these categories of employees have not undergone a psychiatric examination?

Answer

All car drivers are required to undergo mandatory psychiatric examination at least once every five years (Article 213 of the Labor Code of the Russian Federation).

Psychiatric examination usually takes place in a psychoneurological dispensary. But not any psychiatrist can carry it out, but only a medical commission. It usually consists of three psychiatrists.

To undergo a psychiatric examination, the employer issues the employee a referral indicating the type of activity and working conditions contained in the List. The commission is obliged to conduct an examination within 20 days from the date of application. If necessary, she may request additional information about the employee’s health in other medical institutions.

Purpose of the examination:

• determine whether the employee has a mental disorder;
• establish a connection between the nature of the disorder and the ability to successfully and safely perform the type of activity specified in the employer’s direction.

The commission makes a decision by a simple majority of votes and issues it to writing to the employee against signature within three days after acceptance. Within the same period, the employer is sent a message about the date the decision was made by the commission and the date it was issued to the employee.

The date of the next re-examination is indicated in the commission’s conclusion. If necessary, it can be carried out ahead of schedule at the initiative of the employee or employer. A conclusion on unsuitability for work associated with a source of increased danger is issued for a period of no more than five years.*

Does an employee have the right to refuse a psychiatric examination?

Psychiatric examination is carried out voluntarily, except in cases expressly specified in the legislation. For example, when a person poses an immediate danger to himself and others. In other cases, the psychiatrist will ask the employee to sign consent to the examination.”

“There are situations when an employee is not bothered by the absence wages, he is in no hurry to undergo examination and continues to be registered in the organization. The employer may regard such behavior as a disciplinary violation and reprimand the employee. In case of repeated refusals, reprimand and dismiss for repeated failure to comply an employee without good reasons labor duties if he has a disciplinary sanction ().

To avoid a lawsuit, you must follow the procedure for applying disciplinary sanctions ():

1. Condition about compulsory passage psychiatric examination must be prescribed in employment contract employee or in a collective agreement, internal rules labor regulations or other local normative act employer, with whom the employee is familiarized with signature. If there is no such condition in the documents, it is impossible to prove that the employee does not comply with the employer’s requirements.
2. A written explanation must be requested from the employee. If it is not provided after two days, draw up a report about it.
3. It is necessary to issue an application order disciplinary action and announce it to the employee against signature within three working days from the date of its publication, not counting the time the employee is absent from work (a suspended employee is required to report to work, despite the fact that he is not allowed to work). If the employee refuses to familiarize himself with the order, then a report about this is also drawn up.

Answers to your questions.

Should students be referred for psychiatric evaluation?

Is it mandatory to send students undergoing practical training for a psychiatric examination? Anna NEMTSOVA, HR specialist (Kirovsk)

Yes, it is necessary if they perform work for which appropriate contraindications have been established. You can find them in the List of medical psychiatric contraindications for exercise individual species professional activities and activities associated with a source of increased danger 3.

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