Direction to the medical examination of the operator gas boiler room. Mandatory psychiatric examination

List of doctors for passing a periodic medical examination it depends on what position is occupied by the surveyed worker, as well as on its sexuality. In our article, you will find information and about the standard list of doctors who will need to seem to confirm the compliance of its health status with the claims, and on the procedure for passing medical examinations.

What categories of employees are required to undergo a periodic physical examination

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

• workers engaged in the performance of work characterized by the presence of harmful and / or hazardous production factors;
• specialists working in the field associated with the implementation of 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;
• workers who were not 21 years old;
• other categories of workers whose list is established by federal and local legislation.

In accordance with Part 3 of Art. 5.27.1 Code of Administrative Offenses of the Russian Federation, non-compliance with the employer of this requirement entails the imposition of a fine, whose size can reach 130,000 rubles.

The procedure for preparing for mandatory periodic dispensarization

The sequence of employer actions aimed at organizing and conducting a periodic medical examination, as follows:

What documents are issued when conducting a periodic medical examination, who pays it

Unlike the initial medical examination, which the worker passes before entering into an employment agreement with the employer, when passing a periodic dispensarization, a certificate compiled in form No. 086 / y or No. 001-GS / y, not required. Based on the results of periodic inspection The employee in the medical organization is drawn up a conclusion containing the following information:

• date of issuance of the document;
• F. I. O. Persons who have passed inspection;
• the name of the employer's organization;
• name structural unitin which the worker works, as well as the exact name of his position;
• a list of harmful and hazardous production factors that direct influence on its health;
• the result of the inspection and the conclusion of the doctor with an indication of the presence or absence of an employee of contraindications to the execution of the stated type of work.

This document must be signed by the Chairman of the Medical Commission and is certified by the seal of health institutions. Also, the results of the medical examination passed in the health passport, which is stored with the employer.

Do not know your rights?

All costs of passing examinations in doctors, as well as laboratory and functional research, in accordance with the provisions of Art. 213 Labor Code, fall on the employer. Regarding how a medical institution (public or private), a medical examination will be conducted, the employer must conclude an agreement with him for the provision of relevant services, the cost of which depends on the number of workers' surveyed and rates established by the leadership of the clinic.

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

The procedure for holding a periodic medical examination of the 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 12.04.2011 No. 302n. In accordance with Art. 5 Section I of the specified regulatory act, the medical examination should be carried out by members of the permanent medical commission, which includes:

• profitologist;
• specialist doctors who have passed a course of advanced training in the specialty "Profitology", or doctors who have a valid certificate for this specialty.

The composition of this commission is approved by the order of the chief physician of the Health Institution, providing services for conducting a medical examination of employees of the enterprise.

Wherein list of physicians for medical examinationdependence is also from the sphere in which the employee works, and the conditions of implementation of them labor activity. In Appendix No. 1 to Order No. 302n lists a list of harmful and hazardous production factors, if there are a worker to undergo his health from medical professionals. In the same appendix, a list of doctors, which should inspect workers who workers in certain conditions, as well as the frequency of implementation of such inspections are indicated. In addition, in the document, you can find an accurate list of laboratory and functional studies, which allows you to make the most objective and accurate conclusion about the state of the employee's health.

List of doctors when re-medical examination at work

A list of doctors who need to visit the employee of the enterprise during the passage of medical inspection is provided to him directly at the enterprise by a person responsible for the implementation of the medical examination and coordinate the process of its conduct. Depending on the office of the worker in this list, may include:

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

IMPORTANT! The reference of the 3rd list specified in Appendix 1 to the order No. 302n establishes the obligation of the employee to pass the examination from the therapist, psychiatrist and narcologist. The legality of this norm is confirmed by the decision Supreme Court RF "On the refusal to recognize ..." of December 18, 2012 No. Akpy12-1363.

The list of mandatory analyzes that each employee undergoing medical examination includes:

• general analysis of urine and blood;
• fluorography.

Note: The specified list can be complemented by other types of surveys and analyzes (depending on the position held by the employee).

Who conducts a medical examination before the start of the working day or shift

In accordance with paragraph 4 of Part 2 of Art. 46 of the Law "On Fundamentals of Health Protection ..." of 11/21/2011 No. 323 in order to identify the impact of hazardous and harmful production factors, as well as the presence of diseases that impede the normal implementation of employment, some categories of workers (for example, drivers vehicleCarrying out passengers) are required to pass a daily inspection before going to work. Unlike a periodic medical examination, this event does not take much time. Conducts it, in accordance with Part 8 of the annex to the Order of the Ministry of Health of the Russian Federation "On Approval of Procedure ..." of December 15, 2014 No. 835n, a health worker who has higher or secondary medical educationor health care facility licensed medical services (including conducting medical examinations).

So, some categories of workers are obliged to pass and primary, and periodic medical examinations, during which their health is checked as doctors common practiceand narrow-profile specialists. The list of doctors whose inspection is mandatory condition For the employee of further work, laboratory analyzes and other studies, as well as a description of working conditions, the influence of which entails the need for regular surveys, established by the provisions of the Order of the Ministry of Health and Social Development No. 302. Based this document For each position, a list of doctors is formed, which should be visited by employees.

We annually at the time of the heating period are carried out by boiler room operators. They pass medical examinations when taking a job. 302 N and special origin in harm of the physical examination should take 1 time in 2 years. Tell me, can we use last year's medical examination when taking the work of operators or not?

Answer

The answer to the question:

No, in this situation, before admission, workers should be sent to a preliminary medical examination. This is due to the fact that there was a dismissal. During the time workers did not work, they could have contraindications to work. Moreover, the requirement of preliminary honey. An inspection is a mandatory requirement that must be performed at each reception.

Consequently, employees can be taken only after passing a preliminary medical examination.

Details in the framework of the personnel system:

1. The answer: whether to conduct mandatory medical examinationIf the employee accept for a short time for temporary replacement of the missing employee (for a period of illness, vacation, etc.). According to the employee, a medical examination is provided

N.Z. Kovyzin

Yes need.

The need for a medical examination is caused by the presence of dangerous and (or) harmful factors and work in the process of labor (Appendices number 1, 2 to the order of the Ministry of Health and Social Development of Russia of April 12, 2011 No. 302n). Since such factors according to the temporarily replaced position objectively exist, the temporary officer is subject to all stipulated medical examinations in common order (Art. 213 of the Labor Code of the Russian Federation). The term of the contract with a conspicuous thing does not matter.

With respect and wishes for comfortable work, Ekaterina Zaitseva,

expert system of personnel

In recent years, a large number of regulatory acts have been issued, which determine the responsibilities of employers and health care institutions to provide medical care for harmful industries. However, in some cases, the legislatively fixed duties of the employer for the protection of harmful production workers are not fulfilled and their function is transferred to the territorial health authorities.

Currently, a system of stepped medical care for harmful production workers is being carried out. This system includes three links: 1) Ambulatory-polyclinic, 2) stationary (therapeutic-diagnostic, treatment-rehabilitation / I stage of rehabilitation /, 3) Sanatorium-resort / II stage of rehabilitation.

The main tasks of the ambulatory-polyclinic center of the Center are the prevention of professional and industrialized diseases, as well as the medical and social rehabilitation of workers who have initial signs professional diseasesnot accompanied by disability. The only effective way to perform these tasks is effective (qualitative) conducting preventive medical examinations specified contingents. However, the creation of a truly effective system for conducting medical examinations is associated with certain difficulties of an organizational nature.

Currently, periodic medical examinations are carried out by the territorial medical and preventive institutions and are screened. According to the annual reports of the LPU %% coverage of employees by periodic medical examinations in the region is 88-90% annually. At the same time, it should be noted the extremely low efficiency of periodic medical examinations by LPU specialists. The reasons for the low efficiency of the primary level is that the district therapist has no special knowledge regarding clinical manifestations of diseases arising from the impact of harmful factors of modern industrial and agricultural production, does not have data on the intensity of harmful factors at a particular workplace, does not own information about the prevalence of professional Diseases in concrete production conditions, as well as not focused on identifying early signs Professional diseases.

In order to overcome difficulties that inevitably arise with the organization and conduct of preliminary and periodic medical

inspections are convenient the following approach:

Acquaintance S. legal Basenecessary for carrying out professional

General Requirements for Professor's Organization

Procedure of vocational schools

Legal database

The legal database of the professional workers is based on the 254 article of the Labor Code of the Russian Federation, which states that employees engaged in hard work and work with harmful or dangerous working conditions undergo compulsory preliminary when entering work and periodic medical examinations to determine the suitability of them to the entrusted work. and warnings of occupational diseases.

181 of the FZ of the Russian Federation of July 23, 1999 establishes the following types of medical activities at the expense of its own funds of the employer: mandatory prior when entering work and periodic medical examinations (surveys) of employees, extraordinary medical examinations (surveys) of workers at their requests in accordance with medical recommendations with the preservation of the place of work (positions) and the average earnings at the time of the passage of these medical examinations; as well as the prevention (employers) of employees; To the fulfillment of labor duties without passing mandatory: medical examinations and in the case of medical contraindications. Comments to ch. X KZOT RF (2000) say:

Employers and officials guilty of violating legislative and other regulations on labor protection, in non-compliance with the obligations established by collective agreements or labor protection agreements, or preventing the activities of representatives of the authorities state Supervision and control, as well as public control attracted to administrative, disciplinary or criminal liability in the manner prescribed by law Russian Federation And the republics in the composition. Russian Federation. For violation of the requirements of legislative and other regulations on labor protection, employees of enterprises are involved in disciplinary, and in appropriate cases - to material and criminal liability.

In cases where the production activities of enterprises represent a danger to the life and health of employees and the population, their activities can be suspended to prescribe the head of the Center for Gossennadzor, or state labor protection inspectors

The main document according to which preliminary and periodic medical examinations are conducted, is the order of the Ministry of Health of the Russian Federation No. 405 of December 10, 1996, due to the fact that it is he who has coordination with the Ministry of Justice of the Russian Federation. According to the order No. 405, the volume of medical examinations is carried out in accordance with Order No. 90 dated March 14, 1996. Further we are talking about the order (August 2004 No. 83.)

General requirements for organizing preliminary and periodic medical examinations:

TO general requirements relate

Availability of a complete package of regulations on the health of workers' health; to conduct preliminary and periodic medical examinations of employees;

The possibility of interaction with social protection authorities, social insurance and employers in this area of \u200b\u200bactivity.

Ensuring the possibility of familiarizing with these documents of the medical and preventive institution involved in organizing and conducting preliminary and periodic medical examinations,

Performing the requirements of the Decree of the Government of the Russian Federation No. 967 from G5.12.2000, the order of the Ministry of Health of the Russian Federation No. 405, the order of the Ministry of Health of the Russian Federation No. 90,

Participation in inspection of the attending physician,

Sufficient technical equipment LPU,

The presence of specialists (of their or attracted), having a document (certificate, certificate) on the presence of special training on vocational relations not more than five years ago.

Preliminary I. periodic medical examinations, as well as the examination of professional benefits can be carried out by LPU of any organizational and legal forms that provide primary medical care population and licensed on the specified activity. Medical inspections can be carried out by centers and branches of tradecores, subject to the availability of an appropriate license with issuing a conclusion about the results of the survey and suitability professional activity. Separate aspects of the examination of professional benefits are allowed to carry out some specialized LPU (skin-venereological, drug treatment, psychoneurological dispensaries).

The main face conducted by medical examinations is the attending physician.

In accordance with Article 58 of the Founded of the Legislation of the Russian Federation on the Protection of Citizens, the attending physician is a doctor who has a patient's medical care during its observation and treatment in an outpatient polyclinic or hospital institution. The doctor of a health care professional, a medical and prophylactic organization, or a physician doctor who exercises a medical examination with the involvement of the entire current medical records necessary to assess the health of the employee in the dynamics required to assess the health of the employee in the dynamics required to evaluate the entire current medical records.

Without the attraction of the attending physician, preliminary and periodic medical examinations are misunderstood. As experience shows, it is with medical examinations carried out by the permanent commissions on the trademarks, prevention offices, vicinities of virtue or other medical and preventive institutions without the participation of the attending physician, many errors associated with the admission to the professional activities of persons who have contraindications to work with harmful production factors arise . The procedure for conducting medical examinations

As the 405 orders, contingents that are subject to preliminary and periodic medical examinations are determined by the centers of state-poidnadzor of the constituent entities of the Russian Federation together with the employer (on workshops, professions, dangerous, harmful substances and production factor) no later than December 1 of the previous year. The timing of inspections should correspond to the established periodicity.

Preliminary and periodic medical examinations of workers working watch method, Certification and preventive organizations / institutions / at the place of permanent medical care or at the place of the Vakht deployment, with solving the administration of the Watch, organizations of the issue of their financing are carried out.

Events on the preparation of the institution to conduct preliminary and periodic medical examinations.

LPU leaders:

1. To study a list of harmful substances and production factors influencing employees of supervised enterprises (according to the lists of contingents subject to periodic medical examinations approved by the GSEN).

2. To determine the composition of the medical team for preventive and periodic medical examinations, taking into account the list of harmful substances and production factors in supervised enterprises (Appendix No. 1.2 of the Order of the Ministry of Health of the Russian Federation No. 90).

3. Determine the complex of necessary laboratory methods of the study, taking into account the list of harmful substances and production factors in supervised enterprises (Appendix No. 1.2 of the Order of the Ministry of Health of the Russian Federation No. 90).

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

5. Ensure the availability of research equipment in the LPU, chemical reagents, X-ray film and other component materials for the relevant laboratory and functional research methods.

6. Create a schedule for special training on vottheology of doctors of all specialties involved in conducting preliminary and periodic medical examinations.

7. To prepare laboratory technicians on special laboratory research.

Planning.

LPU leaders:

1. Conclude an agreement with the employer neither holding preliminary and periodic medical examinations.

2. Get up to December 1 preceding periodic medical examination of the year binding lists contingents subject to periodic medical examinations. The lists must be certified in the center of the state-poidnadzor and contain information on the number of workshops surveyed by professions, harmful substances and production factor (in accordance with Annexes No. 1.2 of the Order of the Ministry of Health of the Russian Federation No. 90), work experience, the frequency of medical examinations and the date of the last medical examination.

3. Take an order to conduct preliminary and periodic medical examinations of employees of supervised enterprises. To appoint a person responsible for conducting preliminary and periodic medical examinations on the LPU, to indicate the composition of a medical brigade, carrying out medical examinations, determine the work of the medical brigade. The person responsible for conducting preliminary and periodic medical examinations in the LPU must have a certificate with a degree in Profitology.

4. Create a schedule of the work of the doctor's brigade.

5. Make a schedule of work of laboratory doctors.

6. Create a schedule of work of doctors-functionalists.

7. In the absence of a specialist doctor in the LPU, to conclude an agreement with another LPU to attract a specialist of this profile to conduct preliminary and periodic medical examinations. The deadlines for the inspection of workers should coincide with the work schedule of the main medical brigade.

8. Ensure the presence of a specialist person who participates in periodic medical examinations of contingents to be periodic medical examinations in the current year. In the lists it is necessary to provide 3 additional graphs: the diagnosis, conclusion (suitable, not suitable), medical and health events.

9. Create a schedule of work of the Clinical Expert Commission (KEK) to make the conclusion of contraindications to continue working in harmful conditions Breast and solving conflict situations.

Conducting preliminary medical examinations.

Under the contract with the employer (head of the organization), the LPU is obliged to ensure a preliminary medical examination of the employee.

The scheme for conducting a preliminary medical examination in the LPU:

Registration of the employee's appearance in the LPU length of the preliminary medical examination.

Registration of an employee in the LPU for the passage of pre-medical examination is made in a special journal. The form of registration should include the date of appeal, passport data, the name of the enterprise, sent by the employee, harmful production factors in the future place of work and the conclusion about the compliance of the health of the alleged work.

During the registration of the employee, a check of documents required for the passage of preliminary medical examination is carried out:

The direction from the personnel department of the enterprise (organization), which indicates a list of harmful substances and production factors in the future place of work in accordance with Annexes No. 1.2 of the Order of the Ministry of Health of the Russian Federation No. 90,

Passports or other document certifying the person, military ticket,

An outpatient medical card from the place of permanent medical care. In the absence or incomplete compliance of documents, the requirements (for example, there is no outpatient map, there are no harmful substances and production factors in the direction). Medical examination is not carried out.

Filling a sheet of professional employee's route in an outpatient map.

In a sheet of professional route, the employee indicates the name of the enterprise, shop, site, profession, work experience in this place of work,

harmful substances and production factors at this place of work, the final conclusion on the compliance of the health of the assigned work. In arbitrary form on a professional route list, data on the composition of the medical team carrying out a medical examination according to the Order of the Ministry of Health of the Russian Federation No. 90, and the scope of the necessary laboratory and functional studies are made.

Inspection by medical professionals. Each doctor lies an objective inspection data into an employee's outpatient card and gives its conclusion about the compliance of the state of health of the assigned work. In a sheet of direction to a preliminary medical examination, the main professional specialist is made by the final, conclusion about the compliance of the health of the intended work. The conclusion, signed by the main professional specialist, is bonded by the seal of the LPU. In a professional route sheet, the main doctor of the specialist duplicates the final conclusion about the compliance of the health of the intended work.

The main face conducted by a preliminary medical examination is the therapist, indicated in the first place as part of a medical team, according to column 5 ("participation of specialist doctors") applications No. 1.2 of the order of the Ministry of Health of the Russian Federation No. 90. During the medical examination, the reception must complete a medical examination. The doctor makes its conclusion, taking into account the data of laboratory and functional methods of an employee survey, which are pasted into the outpatient map. In the direction of the direction to a preliminary medical examination, the conclusion signed by the doctor is bonded by the seal of the LPU.

We remind you that regardless of the place of work, the blood test (hemoglobin, leukocytes, EE) is carried out in a mandatory basis, the radiograph of the chest organs in direct projection, women are examined by an obstetrician-gynecologist with a bacteriological (on flora) and cytological (for atypical cells) .

In the event of a non-compliance of the state of the health of the challenged work, the employee is sent to the meeting of the LPU Clinical and Expert Commission. The Clinical Expert Commission on the basis of the results of the survey of the employee makes a conclusion about the unsuitability of it to work in harmful labor conditions. The first instance of the conclusion is issued to the employee's hands, a copy of the conclusion within a three-day period is sent to the employer who issued the direction.

Registration of preliminary medical examination results

The result of the conclusion of a preliminary medical examination is made in the journal of accounting for preliminary medical examinations.

When transferring an employee to another place of work with similar working conditions and production factors, documents are issued by the attending physician on the basis of the data of the previous preliminary or periodic medical examination. The direction indicates the period of re-medical examination.

When transferring an employee 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 job location

Periodic medical examinations.

Periodic medical examinations are conducted in accordance with the schedule plan approved by the head physician of the LPU and agreed with the employer.

Registration of employee turnouts on a periodic medical examination.

The workers' turnout on periodic medical examinations is provided by the employer according to the approved plan. Registration is carried out to verify necessary documents For a periodic medical examination: directions from the employer to pass a periodic medical examination, passport or other document certifying the identity, military ticket, an outpatient medical card from the place of permanent medical care. In the absence or incomplete compliance of documents, the requirements of the medical examination is not conducted.

During registration, the priority of inspection by specialist doctors and the time of delivery of the tests, the passage of functional methods of examination, x-ray study is determined. Note! In the order of the Ministry of Health of the Russian Federation No. 90, X-ray of the chest organs is indicated as a compulsory method of examination, and not a fluorographic study.

Filling a sheet of professional route.

Insertion of the date of inspection, work experience, and in the event of a change in the place of work - information about the name of the enterprise, the workshop, the site, professions, the work experience in the new place of work, harmful substances and production factors at the new job site. Correct data on the composition of the medical team carrying out a medical examination according to the order of the Ministry of Health of the Russian Federation No. 90, and the amount of necessary laboratory and functional studies.

Inspection by medical professionals.

Each doctor lies an objective inspection data into an employee's outpatient card and gives its conclusion about the state of health. In the event of a detection of a disease, an obstacle to the continuation of work in harmful conditions, a decision is made to send a patient to the meeting of the Clinical and Expert Commission of the LPU. The list of general medical contraindications to the work associated with harmful substances and production factors is indicated in Appendix 4 of the order of the Ministry of Health of the Russian Federation No. 90. The list of additional medical contraindications, depending on the particular harmful factor, is given in column 7 of Appendix No. 1.2 of the order of the Ministry of Health of the Russian Federation No. 90.

If the employee is found from the employee of the general disease that prevents the continuation of contact with harmful substances and production factors, a complex of medical and preventive measures is being developed. (In the event that the medical examinations are not conducted in the LPU of continuous monitoring, notifications of all cases for the first time identified common diseases are transmitted to the LPU at the place of permanent medical care of the employee. Forms of notifications are manufactured at the employer's means).

In case of identifying an employee of deviations from individual bodies and systems of the body, a complex of additional diagnostic measures is appointed. The survey plan is entered into an outpatient map of the patient for further in-depth examination of the employee at the place of permanent medical care (the employer does not pay the range of additional medical services not included in Appendix No. 1.2 of the Order of the Ministry of Health of the Russian Federation No. 90). The final diagnosis is established by specialists of the LPU of permanent medical care and is carried out in a sheet of updated. Diagnosis.

The main face conducted by a periodic medical examination. The doctor specified in the first place as part of the medical team, according to column 5 ("participation of specialist doctors") 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 a medical examination. The doctor makes its conclusion, taking into account the data of the laboratory and functional methods of the employee survey, which are pasted into the outpatient card.

When identifying an employee of the occupational disease, he is sent to a meeting of the Clinical and Expert Commission of the Medical and Preventive Institution, conducting a periodic medical examination in order to solve the issue of further examination in the profession center. Further actions of doctors are regulated by the Decree of the Government of the Russian Federation of 15.12.2000 No. 967 "On approval of the Regulation on the Investigation and Accounting of Professional Diseases."

In relation to each person with disabilities in health, a doctor conducting a medical examination, appoints medical and recreation activities: diet, direction on outpatient treatment, inpatient treatment, spa treatment, in sanatorium-pretentia, holiday homes.

Work of the Clinical Expert Commission.

The Clinical Expert Commission on the basis of the results of the employee's survey makes a conclusion about its suitability for work in harmful working conditions. All conclusions of the Commission are recorded in the journal of the KEK meetings. The first instance of the conclusion is issued to the employee's hands, a copy of the conclusion in a three-day period is sent to the employer who issued the direction. The deadlines for the survey of the employee at a meeting of the Clinical and Expert Commission should not exceed 3 days relative to the schedule plan for the periodic medical examination of the employee.

By the decision of the KEK, the employee can be eliminated from continuing to work in harmful conditions of labor (the presence of general and additional medical contraindications), transferred to work in lightweight working conditions, is aimed at MCEC due to the common disease.

If an employee has signs of a professional disease, the decision of the KEK is heading to the regional center of occupational diseases. A doctor who is responsible for conducting preliminary and periodic medical examinations in the LPU is sent an emergency notice to the Center for GosanaPidadzor to drafting the sanitary and hygienic characteristics of the worker's working conditions.

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

A leaf of the direction to the periodic medical examination (forms of directions to the periodic medical examination is made to the means of the employer) the main physician of the specialist is made the final conclusion about the compliance of the health of the intended work. The conclusion, signed by the main doctor-specialist bonded the seal of the LPU.

Registration of the Final Act

The results of periodic medical examinations of workers are summarized in the form of concluding acts. The final act is drawn up within 2 weeks from the date of the end of the periodic medical examination. At the end of the periodic inspection, the information for its conduct is transferred to the compilation of the final act. The official form of the final act specified in the notes to applications No. 1.2 of the order of the Ministry of Health of the USSR No. 555 is canceled legally, although not developed.

The final act must contain the following data;

The composition of the Commission on the compilation of the final act;

The composition of the medical team conducted by the inspection of workers. For each specialist doctor, the term of the latest improvement on vottatology is indicated;

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

The number of viewed (percentage of inspection coverage), including women;

The number of unsystemated (indicating the reason);

The number of persons with the firstly identified common disease;

The number of persons included in the dispensary monitoring groups due to chronic common diseases (according to inspection data and data of outpatient cards);

- (the number of disabilities in the state of health in need of access to the place of residence;

Number of persons sent to the KEK LPU

The number of persons in need of temporary translation to another work on the state of health (common diseases, occupational diseases);

The number of persons in need permanent translation to another work on the state of health (common diseases, occupational diseases);

Number of persons aimed at MCEC (common diseases);

The number of identified persons with suspicion of the professional disease (including women), the lost list;

Number of persons sent to the regional trade-founding center, the lost list;

The number of persons to be treated on outpatient treatment.

The number of persons to be treated for inpatient treatment;

The number of persons to be treated on sanatorium-resort treatment;

The number of persons to be sent to the sanatorium-pre-selection;

The number of persons in need of diet and specialization;

The final act is drawn up in 4 copies and is transmitted to the CGSAN, ADM. Enterprises, Farmer, LPU.

LPU is fully legal responsibility for the quality of the medical examination, as extrabudgetary activities, on the basis of existing legislation.

Control over the quality of preliminary and periodic medical examinations is entrusted to the GSEN bodies and the trade center.

Order No. 90.

Unfortunately, in the order No. 90 there are a number of defects that significantly complicate the work.

In order No. 90 there are no requirements for the preparation of medical certificates and the final act.

Compared to 555 orders, there is no third graph: earlier - the nature of the work carried out, which makes it difficult to choose contingents for the PMO. Example - Work in contact with ultrasound - In order 555, work with medical equipment was indicated, in order No. 90, there are no instructions, as a result of which jobs in the LPU are not submitted to the GSEN bodies and are not subject to preliminary and PMM in the amount of order .

The term "participation of doctors - specialists" appears: "According to the testimony". Indications may be either a long experience, or the presence of clinical signs of the disease. The testimony must define the doctor therapist. It is known that chronic nephocals in the early stages have a low-speed flow and cannot Being identified by complaints. Consequently, in the order itself, the possibility of diagnosing these nebrables only in the later stages. Example: Impact high temperatures Cataract is indicated in the contraindications. And the participation of an ophthalmologist according to the testimony. But the first 3 stages of thermal cataract are not accompanied by a decrease in visual acuity and, therefore, complaints of patients.

In addition to the optional participation of some medical professionals in PMOs (according to indications) in column 7 exist references to medical contraindications In addition to the shared honey. Contraindications. In particular, in column number 7, in contact with fluoroplasts (pages .30), it is indicated on chronic diseases of the nervous system as contraindications to work, but the participation of a neurologist in the commission is not provided. Such a situation is observed at contact with cyanoys (p.22): as contraindications indicated the disease of the forefish, and there is no oculist in the commission. Contraindications to work with acrylnitril (p.22) are allergic skin diseases, dystrophic changes V.D.P., Diseases of peripheral N.S., but the ENT doctor does not participate in the Commission. Dermatologist and neurologist. With vibratory disease, high and complicated myopia are indicated as contraindications, but there is no oculist in the commission (in the order No. 555, the Okulist was a mandatory specialist physician).

With a number of harmful factors in the same column No. 7 of the Order No. 90 there are no contraindications previously approved by Order No. 555. Such inconsistencies make it difficult for specialist doctors and lead to the development of injuries and proceedings in production under the fact of high-quality medical examinations.

Count number 6 indicates laboratory and functional studies carried out during the PMO. But inaccuracies are admitted here. Mandatory is the analysis of blood analysis with the number of red blood cells, leukocytes, ESO. In terms of tables, reference is given to a general blood test (p. 22, chromium), and in the part - on the leukocyte formula (p. 22, acrylnitrile). If in the first case there was a study on the number of reticulocytes and platelets, it is not clear to the indication of these studies during contact with aromatic hydrocarbons (p. 16). with lead (p. 12). Another indication of the study on the study on the leukocyte formula according to the testimony (p. 9, copper), for a general analysis of blood according to the testimony (p. 10, lithium). In order No. 555, contact with the welding aerosol containing Mn, Mg. Ti, Zn, SI, meant the study of the leukocyte formula, in order No. 90, this study is not indicated.

When contacting with abrasive dust, the lungs RG-graphics are not specified (p. 36) with more than 15 years, although in the future there is a reference to this paragraph repeatedly.

Separately, it should be stopped at periodic medical examinations of workers in the conditions of the Centers of Votpatology. 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 affecting harmful and hazardous substances and industrial factors, but are almost universally conducted. Medical examinations should be carried out in the Consultative Polyclinic or Hospital of the Center of Profitology.

Previously, there were standard objections from employers in carrying out these medical examinations. As a rule, they relied on p. 2.9. Order "No. 405:" "... inspections maybe Conducted in the conditions of PC ... ", implying the option of fulfilling the requirements of Count No. 4 of the Order of the Ministry of Health of the Russian Federation No. 90. However, from the moment of adoption of the order No. 83, the situation has changed radically. Employees with more than 5 years will be inspected in the trade center 1 time in 5 years .

Conducting medical examinations in enterprises of the exitbrigades.

This approach significantly reduces enterprises' costs, avoids workflow and related to the beneficial benefits of enterprises, while maintaining the quality of surveys.

One exit brigade per year is able to spend more than 5000 surveys. At the same time, the benefits are obvious not only for enterprises, but also for the profession.

Complete set of brigades:

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

2. Car for medical brigade

3. UAZ car equipped with the following equipment:

1. Spirosalizer (CHEST, Microspiro, etc.)

2. Apparatus ECG

3. Vibration

4. Tamper,

5. Laboratory set: hemoglobinometer, microscope binocular, ka-lillaries, tubes, glass, e-meters, tripods, scarifiers, hot chambers, reagents, automatic micropipettes, bixes, suitcase laying

6. Set of ophthalmologist: ophthalmoscope straight, bean-Sivzian table, test glass set, set of test glasses, perimeter arc, maclakova tonometers, or indicator WGD, Rabkin table;

7. Set of otorhinolaryngologist: Audiometer, ear funnels, nose mirrors, spatulas, intricultural mirrors, nasopharynk mirrors, pine-shaped trays, ear tweezers, syringe Jean (reusable),

8. Tonometers, steltofondoscopes, thermometers.

The average daily load of the medical team, staffed by doctors and middle medical personnel, is at least 50-60 people with a guarantee of preserving the quality of work. The detectability of signs of occupational diseases compared to medical examinations carried out by the LPU at the place of residence increases 10-12 times, and reaches 1.1% of the number of surveys (when conducting highrsmiths by the LPU forces at the place of residence, only 0.1% and less) . At the same time significantly reduces the primary output for disability about the caregings due to the fact that they are detected in functional-reversible stage and can be effectively treated with the use of a labor hospital sheet.

Attention should be paid to the fact that with this approach, actually paying the identification of general general diseases is an employer, which reduces the costs of health budgets.

In case of detection of signs of deviation in a state of health, employees are sent to the Center for Professional Pathology for Pass medical examination According to the column "4" of the order No. 90 of the Ministry of Health of the Russian Federation (inpatient examination).

The given system of organizing medical care workers of harmful industries allows to carry out on an outpatient polyclinic stage:

* Qualitative periodic medical examinations,

* identification of occupational diseases in functionally reversible phase

* Early detection of general general diseases from workers of harmful processes

* Selecting persons with individual signs of impact of harmful production factors (control groups) and dynamic observation of them in the facilities of the profession center

* Development for each patient individual scheme of medical rehabilitation measures aimed at preserving health in harmful working conditions,

* If necessary, timely removal from the impact of harmful factors.

In this way, modern concept L.

In the state of the enterprise there are car drivers, truck drivers and personal car drivers. Car drivers, incl. Cargo, cargo delivery (raw materials and materials) and separation of products (bakery products). Drivers of service vehicles are delivered by employees on official need. Also in the staff of the enterprise there is a boiler operator (hazardous production facility). Is it necessary in the relations of the above categories of workers to conduct psychiatric examination? What amount is the psychiatric examination of the above categories of workers? What administrative responsibility can be applied to the enterprise in the event that these categories of employees have not passed a psychiatric examination?

Answer

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

Psychiatric examination passes, as a rule, in a psychoneurological dispensary. But it may not be any psychiatrist, but only a medical commission. Usually it consists of three psychiatrists.

For the passage of psychiatric examination, the employer issues an employee to the direction 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 appeal. If necessary, it can request additional information About the health of the employee in other medical institutions.

The purpose of the examination:

• determine whether an employee has a mental disorder;
• to establish the relationship between the nature of the disorder and the possibility of successfully and safely performing the activity specified in the direction of the employer.

The decision of the Commission takes a simple majority of votes and gives it to writing An employee is under the painting within three days after adoption. In the same period, the employer is sent to the employment date of the decision by the Commission and the date of issuing his employee.

The date of the next re-examination is indicated in the conclusion of the Commission. If necessary, it can be carried out ahead of schedule on the initiative of an employee or an employer. The conclusion about unsuitability of work related to the source of increased danger is issued for a period of no more than five years. *

Is the employee have the right to abandon psychiatric examination.

Psychiatric examination is carried out voluntarily, except for cases directly indicated in the legislation. For example, when a person is direct danger to himself and others. In other cases, the psychiatrist will ask the employee to sign a signature on agreement on conducting a survey. "

"There are situations where the employee does not bother the absence wagesHe is not in a hurry to undergo a survey and continues to be listed in the organization. Such behavior of the employer may regard as a disciplinary violation and declare a remark to the employee. In the case of repeated failures - to declare reprimand and dismiss for repeated non-fulfillment by the employee without valid causes of labor duties, if it has a disciplinary penalty ().

To avoid a lawsuit, it is necessary to comply with the procedure for applying disciplinary penalties ():

1. Conditions by commitable passage psychiatric examination should be spelled out in labor agreement employee or in a collective agreement, the rules of the internal labor regulation or other local regulatory act An employer with whom the employee is familiar with the painting. If there is no such condition in the documents, it is impossible to prove that the employee does not fulfill the requirements of the employer.
2. It is necessary to request a written explanation from the employee. If it is not provided in two days, make an act of this.
3. Need to publish an order to use disciplinary penalty And to declare his employee under the painting within three working days from the date of his publication, not counting the time of the absence of an employee at work (a detached employee is obliged to work, despite the fact that it is not allowed to work). If the employee refuses to get acquainted with the order, then the act is also drawn up.

Answers to your questions.

Do you need to send students to psychiatric examination?

Does it be necessary to direct on the psychiatric examination of students who undergo production practices? Anna Nemtsova, personnel specialist (Kirovsk)

Yes, it is necessary if they will perform work for which the corresponding contraindications are installed. You can find them in the list of medical psychiatric contraindications for implementation separate species Professional activities and activities related to the source of increased danger 3.

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