Occupational Heath By Dr. Sujatha Sathananthan

1. Occupational Health
Dr.S.Sujatha MD., DPH.,
Assistant Professor
Department Of Community Medicine
Chengalpattu Medical College

2. LEGISLATIONS
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3. Legislations for Health, Welfare and
Safety of Workers
 The Factories Act,1948
 The Mines Act,1952
 The Employees State Insurance (ESI) Act,1948
 The Workmen’s Compensation Act,1923
 The Trade Union Act,1926
 The Minimum Wages Act,1948
 The Dangerous Machine (Regulation)Act,1983
 The Plantation labor Act,1951
 The Bonded Labor System(Abolition)Act,1970
 The Contract Labor Act,1970
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4. The Employees State Insurance
Act, 1948
An Act to provide for certain benefits to employees in case of
sickness, maternity and injury during employment and to make
provision for certain other matters in relation thereto.
 Originally called as “Workmen’s State Insurance Bill” 1946
 Came into force on 19th April 1948
 Amended in 1975, 1984, 1987 , 2010 and 2016-17
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5. Applicability
 The ESI Act of 1948 – covered all non-seasonal factories employing 10
or more persons ( excluding mines, railways & defence establishments )
 The provisions of the ESI (Amendment ) Act of 1975 were extended to;
 small factories employing 10 or more persons irrespective of power
usage
 Shops, hotels, restaurants
 Cinemas, theatres
 Road-motor transport undertakings, and
 Newspaper establishment
The scheme has been extended to private medical &
educational institutions employing 20 or more persons in
some states
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6. Coverage of employees:
 an ‘employee’ means any person employed for wages in
or in connection with the work of a factory or
establishment to which this act applies.
All employees – manual, clerical, supervisory and
technical getting up to Rs.21000 / month
 the monthly wage ceiling of Rs.21000
Employees State Insurance Act,
2016 updates
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7. ESI - Administration
Autonomous body – ESI Corporation
 Chairman - Union Minister for Labour
 Vice-Chairman - The Secretary to Govt. of India,
Ministry of Labour
 Consists of members representing Central & State Govts,
employers & employees organisations, medical
profession & parliament
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8. ESI- Administration
Standing Committee :
 Constituted from the members of the corporation,
 Acts as an executive body for administration of the
scheme
Chief Executive
Officer (Director
General)
Insurance
Commissisoner
Medical
Commissioner
Financial
Commissioner
Actuary
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9. Medical Benefit Council
Medical Benefit Council :
• Headed by Director General of Health Services, GOI
• Assisted by the Medical Commissioner in all matters
relating to medical relief
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10.  Finance: ESI Fund
* State Government share 1/8th of expenditure on
medical treatment & attendance
* 7/8th of the expenditure borne by ESIC
 Employers: 4.75% of the total wage bill
 Employees: 1.75% of the wages
 Employees with a daily average wage upto Rs. 137 are
exempted from payment of contribution. Employers will
however contribute their share
Employees State Insurance Act,
2016 updates
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11. 2017 Updates In ESI
1. Wage Limit for Coverage:
– Upto Dec-2016 : Rs 15000/- pm
– From 01-01-2017 : Rs. 21000/-pm
2. Rate of Contribution:
– Employee Share : 1.75 %
– Employer Share : 4.75 %
– Total Payable 6.5 %
– In newly Implemented areas for the Initial 2
years rate of contribution will be :
– Employee Share : 1 %
– Employer Share : 3 %
– Total Payable 4%
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12. Benefits:
 Medical Benefit
 Sickness Benefit
 Maternity Benefit
 Disablement Benefit
 Dependant Benefit
 Funeral Expenses
 Rehabilitation
 Unemployment Benefit
Employees State Insurance Act,
1948
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13. Medical Benefits
1. MEDICAL BENEFIT :
• Consists of full & reasonable medical care including
hospitalization
• Free of cost to the insured person & his family members
from the day he enters insurable employment
• There is no ceiling on expenditure on treatment
Old Age Medical Care :
• Retired & disabled insured persons & their spouses
• Annual premium of Rs. 120
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14. Services
 Out-patient care
 Supply of drugs
 Specialist services
 Pathological & Radiological investigations
 Antenatal, Natal & Postnatal services
 Family Planning services
 Emergency services
 In-patient treatment
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15. Provision Of Medical Care
Medical care services to beneficiaries are provided by two
ways:-
Direct Provision through ESI schemes own network of
dispensaries, diagnostic centres and hospitals.
By service dispensaries ,part time dispensaries and mobile
dispensaries
 Indirect Provision through tie-up with private clinics (panel
system), diagnostic centres and hospitals
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16. The various systems prevalent are:-
 Allopathy
 AYUSH
ESI Scheme provides all three different levels of care i.e. Primary care,
Secondary care and Tertiary care (Super Speciality care).
 Primary care is provided through dispensaries & panel clinics.
 Secondary care is provided through diagnostic centres and hospitals.
 Tertiary care is provided by entering into tie up arrangement with
specialized private and government diagnostic facilities and hospitals
System & Level
of Medical Care Services
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17. Sickness Benefit
BENEFIT CONTRIBUTORY
CONDITION
DURATION RATE
SICKNESS
BENEFIT
Payment of contribution for
78 days in corresponding
contribution period
Upto 91 days
in 2
consecutive
benefit periods
70% of
the average
daily wages
ENHANCED
SICKNESS
BENEFIT
Payment of contribution for
78 days in corresponding
contribution period
Tubectomy –
14 days
Vasectomy –
7 days
100% of
the average
daily wages
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18. Extended Sickness Benefit
CONTRIBUTORY
CONDITION
DURATION RATE
EXTENDED
SICKNESS
BENEFIT
For 34 specified long term
diseases continuous
insurable employment for 2
years with minimum 156 days
contribution in 4 consecutive
contribution periods
Extended upto
2 years on
medical advice
80% of
the average
daily wages
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19. L
List of 34 Diseases
1. TB
2. Leprosy
3. Chronic empyema
4. AIDS
5. Malignant diseases
6. DM with proliferative retinopathy/ Diabetic
foot/Nephropathy
7. Monplegia
8. Hemiplegia
9. Paraplegia
10. Hemiparesis
11. Intra cranaial space occupying lesion
12.Spinal cord compression
13. Parkinson’s disease
14. MG/ Neuromuscular dystrophy
15. Immature cataract with vision 6/60 or less
16. Detachment of retina
17.Glaucoma
18.Coronary artery Disease
a. Unstable angina
b. MI with EF <45%
19. Congestive Heart Failure- Left, Right
20.Cardiac valvular diseases with failure /
complications
21. Cardiomyopathies
22.Heart disease with surgical interventions
along with complications
23. Bronchiectasis
24. Interstitial Lung Disease
25. COPD with congestive heart failure
26. Cirrhosis of liver with ascitis / chronic active
hepatitis
27. Dislocation of vertebra / prolapse of
intervertebral disc
28. Non union or delayed union of fracture
29. Post Traumatic surgical amputation of lower
extremity
30. Compound fracture with chronic
osteomyelitis
31. Psychosis
a. Schizophrenia
b. Endogenous depression
c. Manic Depressive Psychosis
d. Dementia
32.Morethan 20% burns with
infection/complication
33. CRF
34. Reynaud’s disease/ Burger’s disease
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20. Maternity Benefit
CONTRIBUTORY
CONDITION DURATION RATE
Payment of
contribution of
70 days in 2
preceding
contribution periods
Confinement – 26 weeks
Miscarriage – 6 weeks
Extendable upto 1 month on medical
advice incase of sickness arising out
of
pregnancy/confinement/miscarriage
100% of
the
average
daily
wages
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21. 2017 Amendments on
Maternity Leave
 Maternity Leave -26 Weeks
 Can avail 8 weeks before delivery.
Eligibility:
 A Commissioning Mother – biological mother wishes to
have a child and prefer to get embryo implanted in any
other women
 A women legally adopts a child upto 3 months of age
 An insured mother with 2 or more than 2 surviving
children can avail 12 weeks of leave with 6 weeks before
delivery
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22. Disablement Benefit
CONTRIBUTORY
CONDITION DURATION RATE
TEMPORARY
DISABLEMENT
BENEFIT
From day 1 of
insurable
employment for
disablement due
to employment
injury
As long as
temporary
disablement
lasts
90% of the average
daily wages
PERMANENT
DISABLEMENT
BENEFIT
From day 1 of
insurable
employment for
disablement due
to employment
injury
For whole
life
Total - 90% of the
average daily wages
Partial –
proportionate to the
loss of earning
capacity
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23. Dependent Benefit
CONTRIBUTORY
CONDITION
DURATION RATE
From day 1 of
insurable
employment in case
of death due to
employment injury
Wife – lifelong
Dependent children –
till 25 yrs
(daughter – till her marriage)
90% of the
average daily
wages sharable
in fixed
proportion
among all
dependents
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24.  Funeral expenses on death of an I.P. subject to a maximum of a
Rs10,000/- payable at the Branch Office. The claim of such
payment should be made within three month of the death of IP.
 Vocational Rehabilitation in case of physical disablement due to
employment injury under 45 years of age with 40 percent or more
disablement. Payable as long as vocational training lasts - actual
fee charged or Rs.123/- a day whichever is higher
Other Benefits Offered
by ESI
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25.  Free supply of physical aids and appliances such as crutches,
wheelchairs, dentures, spectacles and other such physical aids.
 Preventive health care services such as immunization, family
welfare service, HIV/AIDS detection, treatment etc.
 Confinement Expenses Rs.5000/- is paid to an insured woman or
insured person in respect of his wife in case confinement occurs at a
place where necessary medical facilities under ESI Scheme are not
available. This is paid for two confinements only
Other Benefits Offered
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26. Unemployment Allowance
2016 update
RAJIV GANDHI SHRAMIK KALYAN YOJANA (RGSKY)
In case of involuntary loss of employment due to closure of factory or
permanent invalidity due to non employment injury
CONTRIBUTORY
CONDITION
DURATION RATE
Should have
contributed under
the scheme for
minimum 2 yrs.
prior to loss of
employment
Maximum 24 months 1. 0-12 Months:
50 % of Last
Average
Wages
2. 13-24 Months:
25 % of Last
Average
Wages.
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27.  The insured persons and their family members are entitled to
Super Speciality medical care and /or reimbursement along with
the cost of supply of medicines .
 If the I.P completes 3 months service and contribution for
39 days w.r.t self and
 6 month service and 78 days contribution in case of family
members.
Super Speciality Treatment
(SST)
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28. Persons with disabilities employed on or after
01.04.2008 and drawing monthly wages upto Rs.25000/-
are covered under the Scheme and Employers’ share of
contribution is paid by Government for three years.
Incentives To Employers
In The Pvt. Sector Providing
Employment To
The Persons With Disablities
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29.  Exemption from applicability of Workmen’s compensation
act,1923
 Exemption from Maternity Benefit Act,1961
 Exemption from payment of medical allowance to
employees & their dependants or arranging for their
medical care
 Rebate under the Income Tax Act on contribution
deposited in the ESI account
 Healthy work force
Benefits to Employers
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30. Panchdeep Project
IT enabled
PEHCHAN cards for IP and family which will enable
availment of benefits anywhere anytime.
Insurance number & Card to remain same even if job changes.
 Online registration of factory/estt., employees
Online submission of challan and contribution payment
IP can access eligibility, status of claims
Registration of patients in hospitals/dispensaries &
Medical history of patient.
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31. Pehchan Cards
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32.  Modernisation/upgradation/expansion of all ESI
Hospitals to bring them at par with best Corporate
hospitals.
 Hospital Development Committees constituted in all
ESI Hospitals with executive/financial powers and
representation of stakeholders.
Recent Initiatives
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33.  Medical Colleges, Para-medical and nursing training
institutions will be set up to improve quality of medical
care and to overcome shortage of medical/para-medical
personnel.
 Tie-up arrangements
Recent Initiatives
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34. Our Motto:
Efficient
Services to
Insured-persons
ESIC
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36. The Factories Act,1948
It is one of the noble & comprehensive labour legislation
which is in force in our country
Secures - Safety, health & welfare
Regulates - Working hours
Ensures - Annual leave with wages
Provides - Protection from hazardous processes
Protection to women workforce
Prohibition of employment of children
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37. Factories Act
 The original Act was passed in 1881
 The Act has been revised & amended several times; latest –
2005
 Major amendment was in 1987 – following the Bhopal Gas
Tragedy in Dec. 1984
 The Act has;
 11 Chapters
 120 Sections
 3 Schedules
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38. CHAPTER I : SCOPE & DEFINITIONS
• SCOPE : The Act extends to the whole of India except
Jammu & Kashmir
• DEFINITIONS :
• Not completed 15th yearCHILD
• Completed 15th year but not 18th yearADOLESCENT
• An individual who has completed 18th yearADULT
• Means an energy transmitted mechanically
& is not generated by human agencyPOWER
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39. CHAPTER I : SCOPE & DEFINITIONS
• An establishment employing 10 or more
persons where power is used &, 20 or more
persons where is not used
• Includes both seasonal & perennial factories
FACTORY
• A person employed directly or through any
agency, whether for wages or not, in any
manufacturing process, or in any kind of
work incidental to or connected with the
manufacturing process
WORKER
• Introduced in 1987 Amendment Act
• The person who has control over the affairs
of the factory
OCCUPIER
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40. CHAPTER II : THE INSPECTING STAFF
INSPECTORS :
• The State Govt. may appoint Chief Inspector & Additional
Inspectors of factories
• District Magistrate – Inspector for his district
POWERS :
• An Inspector can enter any factory, within his local limits &
make an examination of premises, machineries or records
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41. CHAPTER II : THE INSPECTING STAFF
CERTIFYING SURGEONS :
• The State Govt. may appoint qualified medical practitioners to be
certifying surgeons, for;
 The examination & certification of young persons under this
Act
 The examination of persons engaged in factories in
dangerous occupations or processes
 Supervising the factories where cases of illness or injury to
workers have occurred due to manufacturing process
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42. CHAPTER III : HEALTH
• Section 11 : Cleanliness
• Section 12: Disposal of refuse
• Section 13: Ventilation and Temperature
• Section 14: Dust and Fumes
• Section 15: Artificial humidification
• Section 16: Over-crowding
• Section 17: Lighting
• Section 18: Drinking water
• Section 19: Latrines and urinals
• Section 20: Spittoons
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43. CHAPTER IV : SAFETY
• Casing / fencing of the machinery
• The Act provides that no worker shall be
required to lift or carry loads which are likely
to cause him injury
• The 1976 Amendment provides for the
appointment of “Safety Officers” in every
factory wherein 1000 or more workers are
employed
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44. CHAPTER V : WELFARE MEASURES
• Facilities for washing, drying & storing the
cloths
• Facilities for rest & recreation
• Canteen - > 250 workers
• Creches - > 30 women workers
• First aid appliances – 1 box for every 150
workers
• Welfare Officer – 500 or more workers are
employed
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45. CHAPTER VI : WORKING HOURS
• Weekly hours – Not more than 48 hrs in a week
Not more than 60 hrs including over-time
• Weekly holiday – 1 day / week; preferably Sunday
• Daily hours – Not more than 9 hrs, with half hr rest after 5
hrs of continuous work (adolescents- after
4 and ½ hours per day)
• Women – No women shall be allowed to work
between 7pm to 6am
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46. CHAPTER VII : EMPLOYMENT &
YOUNG PERSONS
• No child, who has not completed his 14th yr, shall be allowed
to work in any factory
• Adolescents – duly certified by the “Certifying Surgeons”
regarding their physical fitness
• Adolescent employee – work only between 6 am to 7 pm
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47. CHAPTER VIII: ANNUAL LEAVE
WITH WAGES
• Every worker is entitled to leave with wages, after 12
months of continuous service
• At the rate of 1 day for every 20 days of work ( for young –
1 day for every 15 days of work)
• Leave can be accumulated upto 30 days and in young
persons - can accumulate leave for 40 days.
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48. CHAPTER IX: SPECIAL PROVISIONS
Section 88 :
• Certain accidents, including death or serious injuries , should be
notified by the manager to District Magistrate & Police
Section 89 :
• Acts gives a schedule of notifiable diseases
• Notified to Chief Inspector & Certifying Surgeon by the manager
• The 1976 Amendment Act includes Byssinosis, Asbestosis,
Occupational Dermatitis & Noise Induced Hearing Loss to the list of
other notifiable diseases
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49. CHAPTER X: PENALTIES & PROCEDURES
In case of violation of any rules or order, the Occupier &
Manager of the factory - is punishable with 2 yrs
imprisonment / fine upto 1 lakh or both
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50. CHAPTER XI: SUPPLEMENTAL
Display of notices :
• Abstracts of this Act & rules, name & address of the Inspector
& Certifying Surgeon
• In English & local language understood by majority of
workers
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51. CHAPTER XI: SUPPLEMENTAL
Right of workers :
• Right to obtain from the occupier,
information relating to workers’ health &
safety at work
• Represent to the Inspector directly or
through his representative in the matter of
inadequate provision for protection of his
health or safety in the factory
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52. FIRST SCHEDULE
List of factories involving hazardous
processes
• Coal industries
• Fertiliser Industries
• Cement Industries
• Petroleum Industries
• Drugs and Pharmaceutical Industries
• Rubber (Synthetic) Industries
• Glass and Ceramics
• Manufacture, handling and processing of asbestos and its
products
• Dyes and Dyestuff including their intermediates
• Highly flammable liquids and gases
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53. SECOND SCHEDULE
Permissible levels of certain chemical substances
in work environment
• Chlorine – 1ppm
• Ammonia- 25ppm
• Carbon disulphide -Skin- 10ppm
• Carbon Monoxide- 50 ppm
• Carbon Tetrachloride Skin – 5ppm
• Chlorine- 1ppm
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54. THIRD SCHEDULE
List of notifiable diseases
• Lead poisoning
• Mercury poisoning
• Arsenic poisoning
• Phosphorous poisoning
• Silicosis
• Byssinosis
• Asbestosis
• Noise induced hearing loss
• Carbon monoxide
• Coal miners' pneumoconiosis
• Occupational cancer
• Radio or radioactive substances4/3/2018 54Community Medicine , CH.M.C

55. CHILDREN AND WORK
Article 45 : Right to Education
Free & compulsory education to all children
up to the age of 14 yrs
Article 24 : Prohibition of
employment of children
No child below the age of 14 yrs shall be
employed in work in any factory or mine or
engaged in any other hazardous employment
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56. References
 Park K. Textbook of Preventive And Social Medicine. 23rd Edition.
Bhanot Publication;2015: pgs.803-819
 Suryakantha AH. Community Medicine with Recent Advances. 3rd ed.
Jaypee Brothers Medical Publishers; 2014: pgs.213-238
 Rajvir Bhalwar. Text book of Public Health & community Medicine. 1st
edition. AFMC Pune & WHO Publications, 2009, 1291-1293
 Wallace/Maxcy- Rosenau- last, Public Health & Preventive Medicine,
15th edition, TMH Publication, 2008, 763-778
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57. References
 Roger Detels. Oxford Textbook of Public Health,
4thEdition, OkDokey Publications, 2002, 2163-2197
 http://www.ilo.org/global/lang--en/index.htm
 http://www.dgfasli.nic.in/statutes5.htm
 http://labour.nic.in/industrial-safety-health
 http://www.nioh.org/
 http://www.esic.nic.in/
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