Hand-Arm Vibration Syndrome (HAVS)

This is simply a structured approach to health surveillance for HAVS:

– Tier 1 (Initial Assessment): A pre-employment questionnaire for new workers before they begin using vibrating tools.

– Tier 2 (Annual Screening): An annual questionnaire for all employees exposed to vibration to monitor for any new or worsening symptoms.

A HAVS Approved clinician should screen these questionnaires and those with positive responses should be further assessed by a Tier 3 or Tier 4 assessment.

– Tier 3 (Clinical Assessment): If concerns are raised at Tier 1 or 2, the employee is referred and our Occupational Health Doctor carries out a a detailed clinical assessment and examination.

– Tier 4 (Formal Diagnosis): Any employee with suspected HAVS is referred to our qualified doctors for a formal diagnosis. This involves a review of the history of exposure, examination and standardised tests to assess the vascular and sensorineural components of the syndrome.

Yes. However Carpal Tunnel Syndrome (CTS) is a condition that can be caused or aggravated by exposure to vibration. Therefore, individuals with CTS who work with vibrating tools should undergo regular HAVS health surveillance.

Some people with mild Carpal Tunnel syndrome do work occasionally with vibrating tools.

A Tier 3/4 assessment is advised if you have Carpal Tunnel syndrome. This can be performed by one of our HSE approved Occupational Health Doctors at Occupational Health Bristol.

They will take a detailed history, examine and assess you and make recommendations dependent on the severity of your CTS and the level of vibration exposure. They may recommend modifying your duties, increased rotation of tasks, improving the maintenance of tools or using alternative or low vibrations tools, they may also suggest you stop working with vibration tools if the risks are high or your symptoms are severe. Your employer is legally required to act on this advice Hand-arm vibration at work: A brief guide – HSE

Following a carpal tunnel release operation, an occupational health assessment is necessary to determine your fitness to return to work with vibrating tools. A HSE approved HAVS physician will assess your history, the success of your surgery, your residual symptoms, and an assessment of your future vibration exposure and risk. A gradual return to work or modified duties may be recommended.

Primary Raynaud’s phenomenon (Raynaud’s disease) is a condition not caused by work it can be genetic and often occurs in other family members.

Vibration White Finger (VWF) is a form of secondary Raynaud’s phenomenon, where fingers blanching / going white in the cold are specifically caused by exposure to vibration. A HAVS assessment is often required to help differentiate between the two  those primary and secondary Raynauds can overlap.

Individuals with pre-existing Primary Raynaud’s may be more susceptible to the effects of vibration. We recommend that an occupational health assessment is essential to evaluate the risks. We may advise that you avoid or limit your exposure to hand-arm vibration, following assessment and will provide information on how to help improve symptoms and advise on how to reduce the risk of worsening symptoms which can be painful or uncomfortable and can lead to significant issues if ignored.

Employees should initially have a a pre-employment (Tier 1) assessment before beginning to use vibration tools  this helps to give a baseline of what symptoms or signs of conditions the employee already has.

Employees exposed to vibration should then have a Tier 2 screening questionnaire every 12 months.

Those who have positive answers to their Tier 1 or Tier 2 questionnaires should have a further assessment. A Tier 3/4 assessment is then performed. Employees with existing conditions such as Carpal Tunnel or Raynauds may be advised to have a Tier 3/4 questionnaire straight away to help avoid additional time lost and cost. A Tier 4 report is likely to include a recommendation of when the individual should next be screened, which Tier of screening should be used and how frequently this should occur.

The Control of Vibration at Work Regulations Act 2005 sets specific limits:

– Exposure Action Value (EAV): 2.5 m/s² A(8). Above this level, employers must take action to reduce exposure.

– Exposure Limit Value (ELV): 5.0 m/s² A(8). This is the maximum daily exposure permitted, which must not be exceeded.

If a HAVS assessment indicates that you are no longer fit to work with vibrating tools, your employer has a legal duty under the Equality Act 2010 to make reasonable adjustments. This could involve re-deployment to a different role that does not involve vibration exposure.