Contents
7.1 Objective
7.2 Scope of Application
7.3 Guidelines
7.4 Responsibilities
7.5 Planning
7.6 Documentation
7.7 Individual Microentrepreneur – MEI, Microenterprise – ME and Small Sized Enterprise – EPP
Annex I – Monitoring of occupational exposure to chemical agents
Annex II – Occupational medical control of exposure to high sound pressure levels
Annex III – Radiological and spirometric control of exposure to chemical agents
Annex IV – Occupational medical control of exposure to hyperbaric conditions
Annex V – Occupational medical control of exposure to carcinogenic chemical substances and ionizing radiations
Glossary
7.1 Objective
7.1.1 This Regulatory Standard (NR) establishes guidelines and requirements for the development of the Occupational Health Medical Control Program (PCMSO) in organizations, aiming to protect and preserve the health of its employees against occupational risks, in accordance with the risk assessment of the organization's Risk Management Program (PGR).
7.2 Scope of Application
7.2.1 This Standard applies to organizations and public bodies of direct and indirect administration, as well as to the bodies of the legislative and judiciary powers and the Public Ministry that have employees governed by the Consolidation of Labor Laws - CLT.
7.3 Guidelines
7.3.1 The PCMSO is an integral part of the broader set of initiatives adopted by the organization in the field of employee health, and shall be aligned with the provisions of other Regulatory Standards.
7.3.2 The guidelines of the PCMSO are as follows:
a) Screen and detect work-related health injuries at an early stage;
b) Identify possible excessive exposure to occupational harmful agents;
c) Define the fitness of each employee to perform their assigned functions and tasks;
d) Support the implementation and effectiveness monitoring of prevention measures adopted by the organization;
e) Support epidemiological and statistical analyses of health injuries and their correlation with occupational risks;
f) Support decisions on removing employees from work situations that may impair their health;
g) Support the issuance of notifications of work-related health injuries in accordance with applicable regulations;
h) Support the referral of employees to the Social Security system;
i) Provide differentiated follow-up for employees whose health status may be specially affected by occupational risks;
j) Support the Social Security system in professional rehabilitation actions;
k) Support professional readaptation measures;
l) Control active immunization of employees related to occupational risks whenever recommended by the Ministry of Health.
7.3.2.1 The PCMSO shall include actions of:
a) Passive occupational health surveillance, based on information regarding the spontaneous demand of employees seeking medical services;
b) Active occupational health surveillance, through targeted medical examinations which, in addition to the tests provided for in this Regulatory Standard, include data collection on signs and symptoms of health injuries related to occupational risks.
7.3.2.2 The PCMSO shall not be used for personnel selection purposes.
7.4 Responsibilities
7.4.1 The employer shall be responsible for:
a) Ensuring the preparation and effective implementation of the PCMSO;
b) Bearing all costs related to the PCMSO at no expense to the employee;
c) Appointing an occupational physician responsible for the PCMSO.
7.5 Planning
7.5.1 The PCMSO shall be prepared considering the occupational risks identified and classified by the PGR.
7.5.2 If there is no occupational physician in the locality, the organization may hire a physician of another specialty to be responsible for the PCMSO.
7.5.3 The PCMSO shall include the health status assessment of employees in critical activities as defined in this Standard, considering the risks involved in each situation and the investigation of pathologies that may prevent the safe performance of such activities.
7.5.4 The organization shall ensure that the PCMSO:
a) Describes possible health injuries related to occupational risks identified and classified in the PGR;
b) Contains the planning of necessary clinical and complementary medical examinations, according to the identified occupational risks, complying with the provisions of the Annexes of this NR;
c) Contains the interpretation criteria and procedural planning related to medical examination findings;
d) Is known and followed by all physicians who perform occupational medical examinations of employees;
e) Includes an analytical report on the program development, in accordance with subitem 7.6.2 of this NR.
7.5.5 The physician responsible for the PCMSO, if observing inconsistencies in the organization's risk inventory, shall re-evaluate them together with those responsible for the PGR.
7.5.6 The PCMSO shall include the mandatory performance of the following medical examinations:
a) Pre-employment examination;
b) Periodic examination;
c) Return-to-work examination.
d) Occupational risk change examination;
e) Dismissal examination.
7.5.7 The medical examinations referred to in subitem 7.5.6 include clinical examination and complementary tests, carried out in accordance with the specifications of this and other Regulatory Standards.
7.5.8 The clinical examination shall comply with the deadlines and the following periodicity:
I – Pre-employment examination: to be performed before the employee assumes their activities;
II – Periodic examination: to be performed according to the following intervals:
a) For employees exposed to occupational risks identified and classified in the PGR and for holders of chronic diseases that increase susceptibility to such risks:
1. Annually or at shorter intervals, at the discretion of the responsible physician;
2. In accordance with the periodicity specified in Annex IV of this Standard, for employees exposed to hyperbaric conditions;
b) For other employees, the clinical examination shall be performed every two years.
7.5.9 In the return-to-work examination, the clinical examination shall be performed before the employee resumes duties, when absent for a period of 30 days or more due to illness or accident, whether occupational or not.
7.5.9.1 In the return-to-work examination, the medical assessment shall define the need for gradual return to work.
7.5.10 The occupational risk change examination must be performed before the change date, adapting medical control to the new risks.
7.5.11 In the dismissal examination, the clinical examination shall be performed within up to 10 days from the end of the employment contract; it may be waived if the most recent occupational clinical examination was performed less than 135 days prior for risk grade 1 and 2 organizations, and less than 90 days prior for risk grade 3 and 4 organizations.
7.5.12 The complementary laboratory examinations provided for in this NR must be performed by a laboratory compliant with RDC/Anvisa No. 302/2005 regarding collection, packaging, transportation and analysis procedures, and interpreted based on the criteria set forth in the Annexes of this Standard. They are mandatory when:
a) The preliminary survey of the PGR indicates the need for immediate prevention measures;
b) Occupational exposures exceed the action levels set in NR-09 or as indicated by the PGR risk classification.
7.5.12.1 The timing of biological sample collection shall follow the provisions set out in Tables 1 and 2 of Annex I of this NR.
7.5.12.2 When the organization carries out the storage and transportation of samples, the procedures recommended by the contracted laboratory shall be followed.
7.5.13 The examinations set forth in Tables 1 and 2 of Annex I of this NR shall be performed every six months, and may be advanced or postponed by up to 45 days, at the discretion of the responsible physician with technical justification, so that the examinations are carried out under conditions more representative of the employee's exposure to the agent.
7.5.14 For activities performed on a seasonal basis, the periodicity of the examinations set forth in Tables 1 and 2 of Annex I of this NR may be annual, provided they are performed during the activity period.
7.5.15 The examinations set forth in Table 1 of Annex I of this NR shall not be mandatory for pre-employment, return-to-work, occupational risk change and dismissal examinations.
7.5.16 Employees shall be informed during the clinical examination of the reasons for performing the complementary examinations provided for in this NR and the meaning of the results of such examinations.
7.5.17 For pre-employment examinations, complementary examinations performed within the previous 90 days may be accepted at the discretion of the responsible physician, unless different time limits are specified in the Annexes of this NR.
7.5.18 Other complementary examinations may be performed at the discretion of the responsible physician, provided they are related to the occupational risks classified in the PGR and technically justified in the PCMSO.
7.5.19 For each occupational clinical examination performed, the physician shall issue an Occupational Health Certificate – ASO, which must be provenly made available to the employee, and provided in physical form upon request.
7.5.19.1 The ASO shall contain at minimum:
a) The company name and CNPJ or CAEPF of the organization;
b) The employee's full name, CPF number and position;
c) Description of hazards or risk factors identified and classified in the PGR that require medical control under the PCMSO, or statement of their absence;
d) Specification and date of the occupational clinical and complementary examinations undergone by the employee;
e) Determination of fit or unfit for the employee's position;
f) Name and professional registration number of the physician responsible for the PCMSO, if any;
g) Date, professional registration number and signature of the physician who performed the clinical examination.
7.5.19.2 Fitness for work in specific activities, when defined in Regulatory Standards and their Annexes, must be recorded in the ASO.
7.5.19.3 When complementary examinations are performed without a clinical examination, the organization shall issue a receipt for delivery of the exam result, which shall be provided to the employee in physical format upon request.
7.5.19.4 Whenever the possibility of excessive exposure to agents listed in Table 1 of Annex I of this NR is verified, the occupational physician responsible for the PCMSO shall inform those in charge of the PGR for reassessment of occupational risks and prevention measures.
7.5.19.5 If the occurrence or worsening of work-related illness or organic dysfunction alteration is detected through complementary examinations in Table 2 of Annex I, other Annexes of this NR, or complementary examinations included under subitem 7.5.18 of this NR, the organization, after being informed by the physician responsible for the PCMSO, shall:
a) Issue the Work Accident Communication – CAT;
b) Remove the employee from the work situation or activity when necessary;
c) Refer the employee to the Social Security system when work leave exceeds 15 days, for disability assessment and social security proceeding definition;
d) Reassess occupational risks and corresponding prevention measures within the PGR.
7.5.19.6 An employee falling under the situations set forth in subitems 7.5.19.4 or 7.5.19.5 shall undergo a clinical examination and be informed of the meaning of altered exam results and required procedures.
7.5.19.6.1 The physician responsible for the PCMSO shall evaluate the need for performing medical examinations on other employees exposed to the same work conditions.
NR-7 - Occupational Medical Control and Occupational Health Program - PCMSO
