Harmful factors 302. List of harmful and dangerous production factors by profession - order on medical examinations

Order No. 302n on medical examinations establishes not only the categories of employees who must undergo them, but also the procedure for conducting them. In March 2018, changes were made to this regulatory act. We'll tell you which ones.

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Order of the Ministry of Health 302n with amendments and additions of 2018

The order approved the rules for passing medical examinations. The list of professions and jobs for which an employee undergoes an examination upon entry is determined based on working conditions. It must be compiled by the employer.

If an employee performs work included in the list, he will be required to first undergo this procedure. Appendix 2 is a table that is used not only by the employer, but also by the medical institution. Columns 3 to 5 contain:

• lists of specialists who will need to be visited;
• list of studies, how laboratory tests, and functional measurements;
• additional health contraindications.

It is worth noting that if several types of work are performed during production, it is necessary to take into account the need to conduct medical examinations for these types of work simultaneously. Example: maintenance and repair of existing electrical installations.

Changes to Order 302n in 2018 were made in March. They affected Appendix 2. The list of workers who were sent for medical examinations was expanded. Instead of employees of social shelters and nursing homes, employees of organizations should be sent for medical examination social services providing social services:

• in stationary form of social services;
• semi-stationary form of social services;
• in the form of social services at home.

Harmful factors for medical examination by profession in Appendix 1

During the work process, an employee is constantly or periodically exposed to various production factors.

They can be:

• optimal;
• acceptable;
• harmful;
• dangerous.

This gradation of production environment factors has been established. The presence of a production factor of a particular group is determined in the process special assessment working conditions.

The application concerns only groups 3 and 4 - harmful and dangerous factors.

Harmful working conditions are understood as those in which the impact of harmful and (or) dangerous factors exceeds hygienic standards and can lead to varying degrees of health damage.

The 3rd group is divided into 3 subgroups depending on the intended.

Dangerous factors are considered to be those that during a working day or shift can lead to a threat to the life of a citizen, and their prolonged exposure inevitably leads to acute occupational diseases.

Order 302n on medical examinations does not contain a gradation according to the “harmfulness” of a particular exposure. It provides a gradation depending on the operating factor (chemical, biological, physical, labor process). This classification allows you to quickly navigate the list.

Procedure for medical examinations 302n

Occupational medical examinations can be carried out both during employment and during work. Their main purpose is to identify health problems that prevent an employee from performing work. The procedure is set out in Appendix 3.

Preliminary medical examinations must be carried out before the candidate goes to work. In the HR department of the organization, the future employee is given a referral for a medical examination, and it is possible to undergo the medical examination at the place of residence or in any medical institution convenient for him.

The cost of the applicant undergoing a medical examination must be reimbursed by the employer.

The direction is drawn up on the organization's letterhead. It must contain the name of the company, as well as its details. The text of the document itself contains the candidate's full name, date of birth, position and department, production factors and types of work in accordance with Appendices 2 and 1. The direction is signed by an authorized person and the company seal is affixed.

At the clinic, the employee must present a referral, a passport, a psychiatrist’s report and a health passport, if available. Health workers make a list of necessary specialists and tests that need to be completed. After completing all procedures, the employee is given a certificate of completion of a medical examination. He must provide this conclusion to the employer.

Final act on medical examinations 302n (sample)

The final act is issued to the employer upon completion of the medical examination as a whole, as established by paragraph 42. It is a summary table for the entire staff of the enterprise or part of it.

Download the final act form>>>

The final act contains information about the employer and the number of personnel. Based on the results of the inspections, summary tables 1 and 2 are filled out by name. The employer is given suggestions for health-improving activities and... The act is filled out in 4 copies.

The completed final report on medical examinations must be kept for 50 years in the medical organization that conducted the examinations.

Corrected visual acuity is below 0.6 in the best eye, below 0.2 in the worst. Acceptable correction for myopia and farsightedness 8.0DDDD.

Lack of vision in one eye with visual acuity below 0.8 (uncorrected) in the other.

Central scotoma is absolute or relative (in case of scotoma and the presence of changes in visual function not lower than the values ​​​​specified in clause 1 of this column of the subclause - admission without restrictions).

Condition after refractive operations on the cornea (keratotomy, keratomileusis, keratocoagulation, refractive keratoplasty). Persons are allowed to drive 3 months after surgery with corrected visual acuity of no less than 0.6 in the best eye, and no less than 0.2 in the worst.

Acceptable correction for myopia and farsightedness 8.0D, including contact lenses, astigmatism - 3.0D(the sum of the sphere and the cylinder should not exceed 8.0D). The difference in lens power between the two eyes should not exceed 3.0D, in the absence of complications and initial (before surgery) refraction - from +8.0 to -8.0D. If it is impossible to establish preoperative refraction, questions professional suitability are resolved positively when the eye axis length is from 21.5 to 27.0 mm.

Artificial lens, at least in one eye. Experienced drivers with corrected visual acuity of at least 0.6 on the best eye, not less than 0.2 on the worst. Acceptable correction for myopia and farsightedness 8.0D, including contact lenses, astigmatism -
3,0 D(the sum of the sphere and the cylinder should not exceed 8.0D). The difference in lens power between the two eyes should not exceed 3.0D, normal visual field and no complications for six months after surgery.

Chronic diseases of the membranes of the eye, accompanied by significant impairment of visual function, persistent changes in the eyelids, including their mucous membranes, paresis of the muscles of the eyelids, interfering with vision or limiting the movement of the eyeball (after surgical treatment with a positive result, admission is carried out individually).

Chronic inflammation of the lacrimal sac that cannot be treated conservatively, as well as persistent lacrimation that cannot be treated.

Paralytic strabismus and other disorders of concomitant eye movement.

Persistent diplopia due to strabismus of any etiology.

Spontaneous nystagmus when the pupils deviate 70° from the average position.

Limitation of field of view to more than 20 0 in any of the meridians.

Color vision impairment.

Diseases of the retina and optic nerve (retinitis pigmentosa, optic nerve atrophy, retinal detachment, etc.).

Glaucoma

The absence of one upper or lower limb, hand or foot, as well as deformation of the hand or foot, significantly complicating their movement. As an exception, persons with one leg amputation may be admitted if the amputation stump is at least 1/3 of the leg and mobility in the knee joint of the amputated limb is fully preserved.

Absence of fingers or phalanges, as well as immobility in the interphalangeal joints:

absence of two phalanges thumb on the right or left hand;

absence or immobility of two or more fingers on the right hand or complete abduction of at least one finger;

the absence or immobility of three or more fingers on the left hand or the complete abduction of at least one finger (while maintaining the grasping function and strength of the hand, the issue of admission to control is decided individually).

Shortening of the lower limb by more than 6 cm - the examinees can be considered fit if the limb has no defects in bones, soft tissues and joints, the range of motion is preserved, the length of the limb is more than 75 cm (from the heel bone to the middle of the greater trochanter of the femur).

Absence of the upper limb or hand, absence of the lower limb at any level of the thigh or lower leg with impaired mobility in the knee joint.

Traumatic deformities and defects of the skull bones with the presence of severe neurological symptoms that impede control vehicles. In the presence of minor neurological symptoms, admission is carried out individually with re-examination after one year.

Complete deafness in one ear with the perception of spoken speech in the other at a distance of less than 3 m, whispered speech - at a distance of 1 m, or the perception of spoken speech in each ear is less than 2 m (in case of complete deafness, deaf-muteness, admission is carried out individually with re-examination at least after 2 years).

Chronic unilateral or bilateral purulent inflammation of the middle ear, complicated by cholesteatoma, granulations or polyp (epitimpanitis). The presence of a fistula symptom (after surgical treatment with good result the issue is resolved individually).

Chronic purulent mastoiditis, complications due to mastoidectomy (cyst, fistula).

Diseases of any etiology that cause dysfunction of the vestibular analyzer, dizziness syndromes, nystagmus (Meniere's disease, labyrinthitis, vestibular crises of any etiology, etc.).

Diseases of the endocrine system of a progressive course with persistent severe dysfunction of other organs and systems (admission to driving is decided individually, subject to annual re-examination after examination and treatment by an endocrinologist).

Coronary heart disease: unstable angina, exertional angina, FCIIIArt., high grade heart rhythm disturbances, or a combination of these conditions (admission to driving is decided individually, subject to annual re-examination after examination and treatment by a cardiologist).

Hypertension IIIstage, 3 degrees, risk 1V(admission to driving is decided individually, subject to annual re-examination based on the results of treatment and recommendations of a cardiologist)

Diseases of the bronchopulmonary system with symptoms of respiratory failure or pulmonary-heart failure, grade 2-3. (admission to driving is decided individually after examination and treatment by a pulmonologist).

Prolapse of the uterus and vagina, retrovaginal and vesicovaginal fistulas, perineal ruptures with disruption of the integrity of the rectal sphincters, hydrocele of the testicle or spermatic cord, hernias and other diseases that cause restrictions and pain in movements that interfere with driving.

The organization of medical examinations at some enterprises is mandatory. And allowing employees to work without passing it entails serious legal consequences for the employer. We decided to look into it in detail and tell you in which cases employees are required to undergo a medical examination, what the employer faces for being allowed to work without an examination, and how to issue a referral.

According to Article 46 Federal Law of November 21, 2011 No. 323-FZ, a medical examination is a set of medical interventions aimed at identifying pathological conditions in workers. Thus, this is not only a useful event for workers, allowing for the early detection of dangerous diseases, but also good opportunity for employers to avoid accidents at work with all the ensuing legal consequences.

Types of medical examinations

Article 46 of the Federal Law of November 21, 2011 No. 323-FZ highlights the following types medical examinations:

• preventive – aimed at early detection of dangerous diseases and conditions;
• preliminary - carried out upon hiring;
• periodic - carried out at enterprises during the periods established by regulations in order to identify and prevent occupational and other diseases;
• pre-shift or pre-trip - carried out immediately before the employee goes on shift;
• post-shift or post-trip - carried out at the end of the working day.

All listed types of medical examinations, according to articles and 213 Labor Code, must be carried out at the expense of the employer. And during its passage, the employee must maintain an average wage and position. This is stated in the articles, and 219 Labor Code of the Russian Federation. The costs of such medical examinations can be taken into account in the expenses of profit, in accordance with subparagraph. 7 p. 1 Art. 264 Tax Code of the Russian Federation. The Ministry of Finance recalled this in Letter No. 03-03-06/1/85069 dated November 26, 2018.

Order No. 302n on passing medical examinations

Order No. 302n dated 04/12/2011, adopted by the Ministry of Health and Social Development, establishes mandatory preliminary and periodic medical examinations for workers involved in hazardous types of production and in contact with factors harmful to health. Order No. 302n contains Appendix 1, which contains a list of harmful and dangerous production factors, in the presence of which are carried out mandatory medical examinations. Their approval became one of the main innovations in the field of monitoring the health of workers. Information in this normative act is presented in the form of a table, which, in addition to the names of harmful phenomena at work, indicates the frequency of examinations, as well as a list of doctors who should be visited by workers. For example, workers who come into contact with nitrogen compounds should visit an otolaryngologist and dermatovenerologist once every two years.

As for the list of jobs that require medical examinations, Order No. 302n in Appendix 2 contains the relevant information. The table directly shows the list of types of activities, the frequency of visits to doctors, their list, as well as the types of necessary tests and contraindications for continuing labor activity. For example, drivers ground transport should visit a neurologist, ophthalmologist, otolaryngologist, surgeon and dermatovenerologist once every two years.

In 2018, by Order No. 49n dated 02/06/2018, changes were made to the Procedure - the list of employees was expanded and clarified social sphere who must undergo an annual examination by a dermatovenerologist, otorhinolaryngologist, dentist and infectious disease specialist, as well as a number of examinations: now the requirements apply to those workers who provide social services in stationary and semi-stationary forms of social services, as well as at home.

We especially note that employees under the age of 18 are subject to mandatory medical examination, and employees under the age of 21 are required to undergo a medical examination annually.

Procedure for conducting a medical examination

The procedure for conducting medical examinations of workers is regulated by Chapters 1 and 3 of Order 302 of the Ministry of Health. This document contains a detailed algorithm for organizing the event. The procedures for conducting preliminary and periodic inspections are somewhat different from each other. Let's look at both algorithms in more detail.

Preliminary medical examination

This type of inspection is carried out when an employee is hired on the basis of a referral. This document is filled out based on the list of groups for which a medical examination is mandatory. Existing legislation does not provide for a unified form of referral. However, Order 302 on Medical Examinations contains a list of information that must be provided. Thus, each enterprise can independently develop the form of this document. However, in practice, employers try to use the forms used in medical institutions, since this avoids controversial issues.

The referral for a medical examination must contain the following information:

• employer's name;
• form of ownership and type economic activity;
• name of the medical institution, its address and OGRN code;
• type of inspection;
• FULL NAME. employee;
• Date of Birth;
• Name structural unit and positions;
• hazardous factors and types of work that the employee will encounter;
• FULL NAME. and the signature of the person responsible for issuing the referral;
• employee signature;
• FULL NAME. employee responsible for recording issued referrals.

A sample referral is provided below.

After receiving this document, the candidate for the vacancy is sent to a medical institution, where he provides a referral, passport, health passport (if available) and, if necessary, a psychiatric report. Then a medical card and a health passport are created for the employee, where the conclusions of specialists are entered.

As a result of the medical examination, the employee is given a report indicating the result of the examination. Namely, whether any contraindications for carrying out a specific type of activity have been identified. This document is drawn up in two copies. One of them is attached to the outpatient card, and the second is issued to the employee.

Periodic medical examination

This type of inspection is carried out on the basis of lists of names. They include all employees engaged in hazardous or harmful work, indicating their position and harmful factor. The list must be prepared no later than two months before the start of the medical examination.

An important innovation is that immediately before undergoing a medical examination, the employer must give the employee a referral, which is drawn up in the same way as during a preliminary examination.

The medical organization with which the employer must enter into an agreement prepares calendar plan inspections, which must be provided to the employer no later than 14 days before the inspection. Next, the medical examination process takes place in the same order as the preliminary one, and ends with the issuance of conclusions to employees. Then the medical organization summarizes the results obtained and reflects them in the final act. This document states:

• number of employees who underwent inspection;
• number of employees with contraindications;
• how many employees need treatment and additional examination, and so on.

The act is drawn up in four copies, which are certified by the head of the commission. One copy is sent to the enterprise, the second remains in the medical institution, the third - to the occupational pathology center, the fourth - to the territorial executive authority responsible for the sanitary and epidemiological situation.

Responsibility of the employer and employee for permission to work without a medical examination

Existing legislation provides for liability for employers who allow employees to work without undergoing a mandatory medical examination. The punishment for such an offense is provided for in Part 3 Article 5.27.1 of the Code of Administrative Offenses of the Russian Federation. According to this norm, officials face a fine of 15,000 to 25,000 rubles. Persons carrying out entrepreneurial activity without forming a legal entity - from 15,000 to 25,000 rubles. Legal entities promises a fine of 110,000 to 130,000 rubles. It should be taken into account that the size of the fine depends on the number of illegally admitted workers. If, due to evasion of a medical examination, the employee’s health is harmed or his death occurs, the employer’s actions will be qualified in accordance with the provisions of the Criminal Code.

As for employees who refuse for any reason to undergo a medical examination, they must be suspended from work until they have a conclusion confirming their suitability for work. Such responsibility is provided for. We emphasize that during the suspension the employee’s salary is not retained, and he must be made aware of this fact.

Since the date of its original publication, Order 302n itself on undergoing medical examinations has never been changed or supplemented, but in 2013 and 2015 changes were made to its annexes.

Compared to the original edition, the following changes have been made to the applications:

• The list of hazardous and harmful production factors has been expanded, for example:
  • welding aerosols with manganese- and silicon-containing compounds have been added to the chemical factors;
  • in biological ones, the number of allergens and infected material has been significantly expanded and hepatitis B, C and AIDS viruses have been added, etc.;
  • in physics, a new section has been added on ionizing radiation and increased gravitational overloads, etc.;
• the number of medical specialists performing medical examinations has increased (dentists, allergists, and endocrinologists have been added to sections where they were not originally present);
• the number of additional contraindications for work has increased certain conditions(for example, in electromagnetic fields) and certain types of work (for example, for work in remote geographical areas and for work with machine tools);
• a completely new section has been added for substances and compounds united by a chemical structure that cause various types of diseases (section 1.2 chemical factors), and the list of pesticides has also been significantly expanded (section 1.3.2).

List of contingents by order 302n

The contingent of employees who, in accordance with the order of the Ministry of Health and Social Development dated April 12, 2011 No. 302n, must be sent for a medical examination, is formed from the list of positions and professions for which employees are subject to being sent for a medical examination upon employment.

Everyone who is employed is sent for inspection:

• in harmful and dangerous working conditions ( chemical production, ionizing radiation, etc., a complete list of factors is indicated in Appendix No. 1);
• on certain type work (at height, under water, underground, etc., the full list is given in Appendix No. 2).

The contingent list is mandatory document and should contain:

• names of positions and professions, during employment for which mandatory and periodic medical examinations are carried out in accordance with current legislation(Appendix No. 2);
• harmful and dangerous working conditions (Appendix No. 1). Necessary clarification: all working conditions are determined based on the results of a special assessment of working conditions.

Due to the fact that the form of the document is not approved by law, it can be made in the form of a list; Order 302n with the amendment of 2019 on medical examination allows this.

Harmful production factors by profession

Each profession has its own harmful working conditions, but Order 302 of the Ministry of Health does not provide for referral for a medical examination by profession. But it provides for the presence or absence of harmful and dangerous production factors, such as, for example, an increased level of electromagnetic radiation and decreased physical activity of the computer operator.

According to Order 302n, harmful production factors by profession are:

• chemical;
• biological;
• physical;
• conditions of the labor process associated with performing work in certain conditions and with certain substances that can cause harm to health or cause death.

The presence or absence of specific harmful conditions labor is determined based on the results of a special assessment of working conditions carried out in accordance with Federal law dated December 28, 2013 No. 426-FZ. Comprehensive lists of harmful factors are set out in Appendix No. 1 to Order 302n on medical examinations.

Name list of employees according to order 302n

A list of employees by name according to Order 302 is compiled every time employees are sent for periodic medical examinations.

This document is drawn up on the basis of the “Contingent...” (302n dated 04/12/11 of the Ministry of Health and Social Development, referral for a medical examination) and includes:

1. FULL NAME. employee, his profession or position.
2. Name of the harmful or dangerous production factor.
3. Name of the structural unit.

How to get a referral for a medical examination using Form 302n

According to the norm, which was approved by Order 302n dated April 12, 2011 of the Ministry of Health and Social Development, a referral for a medical examination is issued during an employment interview, and the candidate must sign for receipt of the referral in a special journal. The referral is issued by the employee carrying out documenting hiring and dismissal of employees.

In the direction according to order 302n the following must be indicated:

1. Name of the organization that issued the referral.
2. Form of ownership and eight-digit code of economic activity according to OKVED.
3. Name of the medical organization, actual address of its location and OGRN code.
4. Type of medical examination (preliminary or periodic).
5. FULL NAME. a person entering or working as an employee.
6. Date of birth of the person entering the job (employee).
7. The name of the structural unit (if any) in which the job candidate (or current employee) will be employed.
8. Name of position (profession) or type of activity.
9. Harmful and dangerous production factors, as well as the type of work in accordance with the approved “Staff of Workers”.

The referral is signed by the employee who issued the referral, indicating his position, surname, and initials.

Final medical examination report

In accordance with Order 302n, the medical organization, upon completion of the periodic medical examination by employees, together with representatives of the employer and Rospotrebnadzor, draws up a final act according to Order 302n, which indicates:

• Date of preparation;
• employer's name;
• name of the medical organization;
• percentage of employees covered by periodic medical examinations;
• a list of newly diagnosed chronic somatic diseases indicating the class of diseases;
• results of implementation of recommendations of the previous final act;
• recommendations for the implementation of a set of health-improving measures;
• lists of workers who have not completed or undergone periodic medical examinations, as well as those who have been diagnosed with a persistent degree of disability and other indicators ( full list is in paragraph 43 of the procedure for conducting preliminary medical examinations under order 302n).

The final act under Order 302 is approved by the chairman of the commission, who certifies it with the seal of the medical organization.

Order of the Ministry of Health and social development RF dated April 12, 2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) workers employed at hard work and at work with hazardous and (or) dangerous conditions labor" (with amendments and additions)

Order of the Ministry of Health and Social Development of the Russian Federation of April 12, 2011 N 302n
"On approval of lists of harmful and (or) dangerous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions"

With changes and additions from:

list of works during the performance of which mandatory preliminary and periodic medical examinations (examinations) of workers are carried out, in accordance with Appendix No. 2;

The procedure for conducting mandatory preliminary (upon entry to work) and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions, in accordance with Appendix No. 3.

2. Enact lists of harmful and (or) dangerous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions, from January 1, 2012.

order of the Ministry of Health and Medical Industry Russian Federation dated March 14, 1996 N 90 “On the procedure for conducting preliminary and periodic medical examinations of workers and medical regulations for admission to the profession” (according to the conclusion of the Ministry of Justice of Russia, a document in state registration does not need, letter dated December 30, 1996 N 07-02-1376-96);

Order of the Ministry of Health and Social Development of the Russian Federation dated August 16, 2004 N 83 “On approval of lists of harmful and (or) hazardous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these examinations ( surveys)" (registered by the Ministry of Justice of the Russian Federation on September 10, 2004 N 6015);

Order of the Ministry of Health and Social Development of the Russian Federation dated May 16, 2005 N 338 "On amendments to Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated August 16, 2004 N 83 "On approval of lists of harmful and (or) hazardous production factors and work , during which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these examinations (examinations)" (registered by the Ministry of Justice of the Russian Federation on June 3, 2005 N 6677).

4. Establish that from January 1, 2012, subparagraphs 11 (with the exception of subparagraphs 12.2, 12.11, 12.12) of Appendix No. 2 to the order of the USSR Ministry of Health of September 29, 1989 No. 555 “On improving the system” are not applied on the territory of the Russian Federation medical examinations of workers and drivers of individual vehicles."

New lists of harmful and (or) hazardous production factors and work have been approved, during which preliminary and periodic medical examinations(examinations). The procedure for conducting such inspections has been revised.

The lists establish the frequency of examinations and the composition of the medical specialists participating in them. The laboratory and functional studies carried out are listed, medical contraindications to perform the work.

The examination can be carried out by any medical organization that has such a right, as well as carrying out an examination of professional suitability. The medical commission includes an occupational pathologist and medical specialists who have undergone advanced training in the specialty “occupational pathology” or have a valid certificate in it.

The employer issues a referral for inspection. The requirements for filling it out are given. The employee presents a passport and a referral to the medical organization. A medical card and health passport are issued for him (if he does not have one). The latter is given to the employee after inspection.

For periodic examinations, the employer sends name lists employees, on the basis of which an inspection schedule is drawn up. At the end of the examination, a medical report is drawn up in 2 copies (the first is given to the employee, the second is attached to the medical record). The employee is assigned to one of the dispensary groups and given recommendations on disease prevention and, if there are medical indications, on further observation, treatment and rehabilitation. If an occupational disease is suspected, a referral to the occupational pathology center is issued.

Accident participants, persons with lasting consequences of industrial accidents and a number of other workers undergo periodic inspections in occupational pathology centers.

Based on the results of the examinations, the medical organization draws up a final report and sends it to the employer, to the occupational pathology center, and also territorial body Rospotrebnadzor.

Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 N 302n “On approval of lists of harmful and (or) hazardous production factors and work, during which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions"