Circular No. 09/2000/TT-BYT on guiding the care of workers' health in small and medium-sized enterprises

CIRCULAR

NUMBER 09/2000/TT-BYT OF APRIL 28, 2000 OF THE MINISTRY OF HEALTH GUIDING THE CARE OF WORKERS' HEALTH IN SMALL AND MEDIUM ENTERPRISES

- BASED ON THE POPULATION HEALTH PROTECTION LAW OF JULY 11, 1989.

- BASED ON CHAPTER IX OF THE LABOR CODE OF JUNE 23, 1994.

- BASED ON DECREE 06/CP OF THE GOVERNMENT OF JANUARY 20, 1995 PROVIDING DETAILS ON CERTAIN PROVISIONS OF THE LABOR CODE REGARDING WORK SAFETY AND SANITATION.

- BASED ON DECREE 68/CP OF THE GOVERNMENT OF OCTOBER 11, 1993 DEFINING THE FUNCTIONS, TASKS, RIGHTS, AND ORGANIZATIONAL STRUCTURE OF THE MINISTRY OF HEALTH.

AFTER CONSIDERING THE OPINION OF THE MINISTRY OF LABOR, INVALIDS, AND SOCIAL AFFAIRS AT DOCUMENT NUMBER 946/LDTBXH-BHLĐ OF APRIL 3, 2000.

The Ministry of Health guides the implementation of health care for workers in production and service enterprises.

I. OBJECTS AND SCOPE OF APPLICATION

1. EVERY ORGANIZATION, INDIVIDUAL, AND UNITS ENGAGED IN PRODUCTION, BUSINESS, AND SERVICE ACTIVITIES (COLLECTIVELY REFERRED TO AS ENTERPRISES):

State-owned enterprises, enterprises of various economic sectors, companies, foreign-invested enterprises, limited liability companies, joint-stock companies, cooperatives, production units under administrative and public service agencies, social organizations, mass organizations, military forces, and people's police.

2. HEALTH UNITS ARE RESPONSIBLE FOR IMPLEMENTING HEALTH CARE FOR WORKERS.

II. REGULATIONS FOR SMALL AND MEDIUM ENTERPRISES

Small and medium enterprises are temporarily defined according to Government Circular Number 68/CP-KTN of June 20, 1998 as follows:

- A medium enterprise is an enterprise with 51 to 200 workers.

- A small enterprise is an enterprise with up to 50 workers.

III. CONTENT OF HEALTH CARE FOR WORKERS
IN SMALL AND MEDIUM ENTERPRISES

1. COMPLY WITH THE REQUIREMENTS FOR WORK ENVIRONMENT SANITATION: WORKPLACES WITH HARMFUL FACTORS MUST HAVE CLEAR WRITTEN REGULATIONS PLACED IN EASY-TO-SEE LOCATIONS. WORKPLACES WITH OCCUPATIONAL DISEASE-CAUSING FACTORS MUST INFORM WORKERS ABOUT PREVENTIVE MEASURES SO THAT THEY CAN SELF-PREVENT.

2. TRAINING ON SAFETY AND SANITATION: ANNUALLY, THE LABOR MANAGER MUST ORGANIZE TRAINING FOR WORKERS ON THE IMPACT OF FACTORS GENERATED IN THE WORK ENVIRONMENT ON HEALTH SO THAT THEY CAN SELF-PROTECT AND AVOID OCCUPATIONAL HAZARDS AND DISEASES. THE TRAINING CONTENT IS HANDLED BY THE PREVENTIVE MEDICAL TEAM UNDER THE DISTRICT HEALTH CENTER, CITY HEALTH CENTER, PROVINCE HEALTH CENTER, OR CENTRAL HEALTH CENTER (HEREINAFTER COLLECTIVELY REFERRED TO AS PROVINCE), AND THE INDUSTRY HEALTH CENTER ACCORDING TO THE PROVISIONS OF THIS CIRCULAR (APPENDIX 1).

3. EMERGENCY RESPONSE ORGANIZATION: EMPLOYERS MUST EFFECTIVELY ORGANIZE EMERGENCY RESPONSE AT THE ENTERPRISE. EMERGENCY PERSONNEL MUST BE TRAINED AND OBTAIN A CERTIFICATE FROM THE PROVINCE HEALTH CENTER, CENTRAL HEALTH CENTER, INDUSTRY HEALTH CENTER, OR DISTRICT HEALTH CENTER (HEREINAFTER COLLECTIVELY REFERGED TO AS DISTRICT). EACH WORKSHOP MUST HAVE AN INITIAL FIRST-AID KIT ACCORDING TO THE LIST PROVIDED IN THIS CIRCULAR (APPENDIX 2). EMERGENCY RESPONSE PROCEDURES MUST BE POSTED AT WORKPLACES FOR WORKERS TO KNOW HOW TO HANDLE THEM.

4. ESTABLISH HEALTH AND SAFETY RECORDS: EACH ENTERPRISE MUST HAVE A LABOR HEALTH RECORD ACCORDING TO THE MODEL PROVIDED IN CIRCULAR NUMBER 13/TT-BYT OF OCTOBER 21, 1996. ANNUAL TESTING AND INSPECTION RESULTS OF THE WORK ENVIRONMENT AND REGULAR HEALTH CHECKS MUST BE UPDATED INTO THE HEALTH AND SAFETY RECORD.

5. TESTING AND INSPECTION OF THE WORK ENVIRONMENT: ANNUALLY, THE ENTERPRISE MUST ORGANIZE TESTING AND INSPECTION OF THE WORK ENVIRONMENT TO EVALUATE THE HARMFULNESS OF THE ENVIRONMENT AND TAKE MEASURES TO IMPROVE WORKING CONDITIONS. TESTING AND INSPECTION RESULTS MUST BE PERFORMED ACCORDING TO THE PROVISIONS OF CIRCULAR NUMBER 13/BYT-TT OF OCTOBER 21, 1996 AND CLASSIFIED AS FOLLOWS:

- FOR ENTERPRISES WITH HIGH RISKS OF OCCUPATIONAL DISEASES, THE PROVINCE HEALTH CENTER SHALL CARRY OUT THE TESTING.

- FOR OTHER ENTERPRISES, THE PREVENTIVE MEDICAL TEAM UNDER THE DISTRICT HEALTH CENTER SHALL CARRY OUT THE TESTING.

THE PREVENTIVE MEDICAL TEAM SHALL STATISTICALLY LIST THE TYPES OF ENTERPRISES AND REQUEST COOPERATION FROM THE PROVINCE HEALTH CENTER.

6. HEALTH SCREENING FOR EMPLOYMENT: BEFORE STARTING WORK, WORKERS (INCLUDING APPRENTICES) MUST UNDERGO HEALTH SCREENING; EMPLOYERS MUST BASE THE ASSIGNMENT OF JOBS ON THE HEALTH STATUS OF THE WORKERS. THE HEALTH SCREENING RECORD MUST BE KEPT IN THE HEALTH FILE.

7. REGULAR HEALTH CHECKS: EMPLOYERS MUST ORGANIZE REGULAR HEALTH CHECKS FOR WORKERS AT LEAST ONCE A YEAR. THE PURPOSE OF REGULAR HEALTH CHECKS:

a. TO DETECT SYMPTOMS AND SIGNS OF OCCUPATIONAL DISEASES TO EARLY IDENTIFY OCCUPATIONAL DISEASES AND TIMELY TREATMENT AND PREVENT OCCUPATIONAL DISEASES.

b. TO MONITOR PEOPLE WITH CHRONIC DISEASES AND WEAK HEALTH TO PLAN FOR RECOVERY AND FUNCTIONAL REHABILITATION.

THE HEALTH CHECKS MUST BE SIMPLE AND NOT NECESSARILY COMPLETELY SPECIALIZED BUT MUST INCLUDE NECESSARY SPECIALTIES TO DIAGNOSE OCCUPATIONAL DISEASES. THE REGULAR HEALTH CHECK RECORD MUST FOLLOW THE MODEL PROVIDED IN THIS CIRCULAR (APPENDIX 3).

COMPREHENSIVE HEALTH CHECKS: ARE COMPREHENSIVE SPECIALTY CHECKS TO EVALUATE AND CLASSIFY THE HEALTH OF ALL WORKERS IN THE ENTERPRISE. COMPREHENSIVE HEALTH CHECKS MUST BE CONDUCTED AT LEAST ONCE EVERY THREE YEARS. IF POSSIBLE, REGULAR HEALTH CHECKS AND COMPREHENSIVE HEALTH CHECKS CAN BE COMBINED ANNUALLY.

8. EARLY DETECTION OF OCCUPATIONAL DISEASES: EMPLOYERS MUST ORGANIZE EARLY DETECTION OF OCCUPATIONAL DISEASES FOR WORKERS IN HARMFUL ENVIRONMENTS. EARLY DETECTION OF OCCUPATIONAL DISEASES MUST BE COMBINED WITH REGULAR HEALTH CHECKS IN ENVIRONMENTS WITH OCCUPATIONAL DISEASE RISKS. OCCUPATIONAL DISEASE CHECKS MUST BE HANDLED BY OCCUPATIONAL DISEASE CLINICS AND COMPLETE THE RECORDS ACCORDING TO CURRENT REGULATIONS.

9. Medical examination due to occupational accidents and occupational diseases: All workers who suffer from occupational accidents or occupational diseases shall be entitled to undergo occupational health examinations at the Medical Examination Council. Workers suffering from occupational diseases must be regularly re-examined every six months, receive treatment, and recover their functions at healthcare facilities. The regulations on occupational diseases shall be implemented in accordance with Circular No. 08/1998/TTLT-BYT-BLDTBXH dated April 20, 1998 issued jointly by the Ministry of Health and the Ministry of Labor, Invalids and Social Affairs.

10. Compensation in kind: If, after improving working conditions, harmful factors still do not meet permissible hygiene standards, the employer shall be responsible for compensating workers in kind who work in such environments (applying Circular No. 10/1999/TTLT-BLDTBXH-BYT dated March 17, 1999). Healthcare staff at the grassroots level must advise business owners about the items needed to compensate workers based on the specific nature of their jobs (such as sugar, milk, fruits...).

11. Facilities serving workers: Workplaces must have sufficient sanitary facilities including: bathrooms with clean water supply, washing areas, rest areas, and clean dining rooms. Each enterprise should establish a health corner where workers can read books, pamphlets, posters promoting disease prevention, and use first aid kits. If conditions permit, enterprises may arrange separate rooms.

IV. RESPONSIBILITIES FOR MANAGEMENT AND CARE OF WORKERS' HEALTH
WORKERS AT SMALL AND MEDIUM-SIZED ENTERPRISES

A. RESPONSIBILITIES OF THE BUSINESS OWNER

1. According to Circular Joint No. 14/1998/TTLT dated October 13, 1998 issued by the Ministry of Labor - Invalids and Social Affairs, the Ministry of Health, and the General Confederation of Labor Vietnam, the deployment of healthcare personnel to care for workers' health at small and medium-sized enterprises is as follows:

- Enterprises that already have doctors, medical assistants, or company clinics shall maintain them to provide services.

- For medium-sized enterprises without healthcare personnel, one healthcare worker must be deployed.

- For small enterprises that cannot afford to employ one healthcare worker to care for workers' health, they may contract with healthcare personnel from health stations, retired healthcare workers, etc., to work according to specified days and hours, but must register with the County Health Center to be subject to overall direction. Healthcare personnel may concurrently perform other tasks to fit within the labor management of the enterprise.

- Organize a safety and hygiene network at the enterprise to provide immediate first aid in case of accidents.

2. Healthcare personnel caring for workers' health at enterprises must be trained in the occupational safety and hygiene program by the Preventive Health Team of the County Health Center, Provincial Preventive Health Center, Industry Health Center, or training institutions.

3. Healthcare personnel serving in small and medium-sized enterprises are directly supervised by the clinic of the commune, ward, town, and the County Health Center (Preventive Health Team) regarding occupational health matters.

4. Enterprises must properly carry out initial health care, timely emergency care, and general medical treatment for workers, and educate workers on disease prevention.

B. RESPONSIBILITIES OF COMMUNE, WARD, AND TOWN HEALTH SERVICES

Commune, ward, and town health services are responsible for directing and coordinating with small and medium-sized enterprises located within their jurisdiction to implement the following tasks:

1. Strengthening education and propaganda, regularly inspecting and urging occupational safety and hygiene work. Actively prevent diseases. When an epidemic occurs, participate and organize prompt control measures.

2. Understanding the number of enterprises and hazardous factors to guide health care for workers.

3. Managing health records of workers in small and medium-sized enterprises within their jurisdiction.

4. Providing initial emergency care for patients, occupational accidents, chemical poisoning, and other incidents.

5. Propaganda on hygiene and disease prevention, occupational disease prevention for workers.

C. RESPONSIBILITIES OF COUNTY HEALTH CENTER (PREVENTIVE HEALTH TEAM) AND CITY HEALTH CENTER UNDER PROVINCE

According to Decision No. 2468/1999/QD-BYT dated August 17, 1999 of the Minister of Health, the responsibilities of the Preventive Health Team are specifically defined as follows:

1. Promoting and urging enterprises within their jurisdiction to implement measures to handle feces, wastewater, garbage, and production waste... according to technical guidance from higher levels.

2. Guiding enterprises to establish occupational hygiene files, manage hazardous factors in the workplace environment, and manage workers' health. Occupational hygiene files should be duplicated into two copies, one managed by the enterprise and one managed by the Preventive Health Team.

3. Conducting inspections and urging enterprises to implement measures to control and eliminate newly generated hazardous factors during production to ensure occupational safety and hygiene requirements. Guiding and inspecting compliance with current laws on occupational safety and hygiene to prevent occupational diseases among workers.

4. Organizing regular health check-ups for workers: The Preventive Health Team will plan with enterprises regarding the time, quantity, and specialties required for the check-ups. The structure of the regular health check-up team should be streamlined but must meet the requirements of diagnosis, treatment recommendations, and preventive measures against diseases related to harmful factors in the workplace and those causing occupational diseases. The regular health check-up team must issue recommendations for employers to address treatment and rehabilitation programs for workers showing signs of illness and feasible measures to improve the workplace environment according to hygiene and safety standards.

5. Cooperating with local functional agencies to organize inspections on the implementation of state policies and benefits concerning workers' health protection.

6. Organize propaganda, education, and training on occupational health safety for workers operating within the managed area, with emphasis on preventing poisoning from plant protection chemicals and other harmful factors arising during production.

7. Compile the labor health plan of communes, towns, and wards to report to the Provincial Department of Health and the Provincial Preventive Health Center.

D. RESPONSIBILITIES OF THE PROVINCE'S PREVENTIVE HEALTH CENTER, CENTRAL CITY AFFILIATES
CITY UNDER CENTRAL ADMINISTRATION

1. Direct the annual planning for health care of workers in small and medium-sized enterprises.

2. Organize professional training for lower levels regarding occupational safety and health work.

3. Guide testing and environmental monitoring at workplaces and complete relevant files according to regulations.

4. Manage and guide regular health check-ups and early detection of occupational diseases for workers at risk of occupational diseases.

5. Guide the content of propaganda, education, and training on occupational health safety for districts, counties, and healthcare facilities. Emphasis should be placed on preventing poisoning from plant protection chemicals.

6. Supervise and urge the implementation of reporting systems by all levels and compile reports to send upwards.

7. Annually summarize experiences regarding the organization of health care for workers in small and medium-sized enterprises.

E. RESPONSIBILITIES OF THE LABOR HEALTH CENTERS OF MINISTRIES/SECTORS
OF MINISTRIES/SECTORS

1. Closely cooperate with local health services to jointly carry out common tasks in the field of occupational safety and health and occupational disease prevention.

2. Guide the development of annual plans to ensure occupational safety, hygiene, and occupational disease prevention for small and medium-sized enterprises.

3. Guide the implementation of environmental testing, regular health examinations, and early detection of occupational diseases.

4. Organize rehabilitation and treatment for those injured at work and suffering from occupational diseases.

5. Propagate, train, and educate workers about occupational safety, hygiene, and occupational disease prevention.

6. Inspect, summarize, and draw lessons from health care work for workers.

F. RESPONSIBILITIES OF THE DEPARTMENT OF HEALTH OF PROVINCES AND CENTRAL CITY AFFILIATES
PROVINCE DIRECTLY UNDER CENTRAL ADMINISTRATION

1. Organize, manage, and comprehensively direct the health care work for workers in small and medium-sized enterprises within their jurisdiction.

2. Disseminate and guide state documents on occupational safety and hygiene to healthcare facilities and enterprises.

3. Build and strengthen the organizational network of enterprise healthcare, frontline health services for occupational hygiene and occupational disease work.

4. Upgrade technical equipment serving workers.

5. Allocate personnel and create conditions to improve the qualifications of healthcare staff to effectively perform health care work for workers.

6. Inspect the implementation of state regulations concerning health care for workers in enterprises.

V. REPORTING REGIME

Reporting procedures shall be carried out according to Circular No. 13/BYT-TT dated October 21, 1996, and are stipulated as follows:

Quarterly Report: Each quarter, enterprises must complete their reports and submit them to the District, County, City, Town Health Centers (Preventive Medicine Teams) and commune health stations by March 20, June 20, September 20, and December 20.

Semi-annual and Annual Reports:

- District, County, City, Town Health Centers report to the Provincial Department of Health and the Provincial Preventive Health Center on June 20 and December 20.

- The Provincial Department of Health (Provincial Preventive Health Center), Labor Health Centers of Ministries/sectors report to the Ministry of Health (Department of Preventive Health) as prescribed.

VI. IMPLEMENTATION

1. The Departments of Health of provinces and centrally-administered cities are responsible for developing implementation plans for this Circular, submitting them to the People's Committees of provinces and centrally-administered cities for approval to organize dissemination and guidance at all levels to implement this Circular in small and medium-sized enterprises located in their areas.

2. Ministries, sectors, and labor-using agencies instruct and urge subordinate units to strictly comply with regulations concerning health care for workers in small and medium-sized enterprises.

3. Employers in small and medium-sized enterprises are responsible for fully implementing the health care provisions for workers stipulated in this Circular.

This Circular takes effect fifteen days after its issuance date. During implementation, if there are any difficulties, units and localities are requested to reflect them to the Ministry of Health (Department of Preventive Health) for research and timely resolution.

Ministry of Health

Nguyen Van Thuong

ANNEX 1

CONTENTS OF TRAINING ON OCCUPATIONAL HYGIENE AND FIRST AID FOR WORKERS

(Annexed to Circular No. 09/2000/TT-BYT dated April 28, 2000)

CONTENTS HOURS OF STUDY

I. Occupational Hygiene and Occupational Disease Prevention + Review and examination of Section II:

1. Hazards of workplace temperature and microclimate and preventive measures

2. Hazards of thermal radiation and preventive measures.

3. Hazards of various types of dust and preventive measures against diseases

4. Hazards of noise and vibration and preventive measures

5. Hazards of chemicals and preventive measures

6. Introduction to occupational diseases covered by social insurance

II. On-site First Aid + Review and examination of Section II:

1. Electric shock first aid

2. Burn first aid

3. Suffocation first aid

4. Cardiac arrest first aid

5. Stopping bleeding and bandaging wounds

6. Transporting patients

7. Chemical accident first aid

ANNEX NO. 2

REGULATIONS ON FIRST AID KITS

(Annexed to Circular No. 09/2000/TT-BYT dated April 28, 2000)

1. Location of placement of first aid kits/bags:

- At the workplace of workers.

- In the most visible place, easily accessible, marked with a distinctive sign (usually a cross).

- Inform workers of the location and specify usage rules.

2. Equipment, tools, and medicines for first aid kits

- All first aid kits must contain sufficient quantities of necessary equipment and tools for first aid. No other items should be included.

- Regularly inspect first aid kits to ensure that they have the full complement of equipment.

3. Number of emergency bags

The number of emergency bags or first aid kits required depends on the arrangement at the facility and the number of workers. There should be at least one box or container for first aid supplies on each floor. The total number of different types of bags is presented below according to the number of workers.

Number of workers Number of and type of emergency bags

Less than 25 people At least 01 Type A bag

From 26 to 50 people At least 01 Type B bag

For every 51 to 150 people At least 01 Type C bag

Note: One Type B bag is equivalent to two Type A bags, and one Type C bag is equivalent to two Type B bags.

ANNEX 3

(Annexed to Circular No. 09/2000/TT-BYT dated April 28, 2000)

RECORD

REGULAR HEALTH CHECK-UP

RECORD NUMBER...

Name:

Workplace:

Name of unit:

Province/City:

Year …

REGULAR HEALTH CHECK-UP RECORD

Name of unit:

Province/City:

I. GENERAL INFORMATION SECTION: (this section is self-reported by the unit)

1. Full name: 2. Year of birth: 3. Male

Female

4. Place of origin:

5. Permanent address:

5. Year started working:

5. Current job title: 6. Occupational category

7. Year started current job:

8. Mark factors of exposure related to current work:

Too hot Too cold Noise

Vibration Dust Smoke, toxic gas

Solvent Other chemical Stress

Light Too strong Insufficient

Other factors:

9. Mark protective equipment provided:

Gloves Regular mask Half-mask

Gas mask Earplugs Glasses

Protective clothing Shoes/boots Other:

10. Health classification before starting work at the unit:

11. Smoking: Yes No

12. If yes, how many years have you been smoking:

13. Current chronic illnesses:

Head of the unit

(Signature, stamp)

II. HEALTH CHECK-UP SECTION