(MTP Ordinance No. 567, of March 10, 2022)
SUMMARY
7.1 Objective
7.2 Scope
7.3 Guidelines
7.4 Responsbilities
7.5 Planning
7.6 Documentation
7.7 Individual Microentrepreneur, Microenterprise, and Small Business – EPP
Annex I Monitoring of Occupational Exposure to Chemical Agents
Annex II Control of Exposure to Elevated Sound Pressure Levels
Annex III Radiological and Spirometric Control of Exposure to Chemical Agents
Annex IV Control of Exposure to Hyperbaric Conditions
Annex V Control of Exposure to Carcinogenic Chemical Substances and Ionizing Radiation
Glossary
7.1 Objective
7.1.1 This regulatory standard (NR) establishes the guidelines and requirements for developing the Occupational Health Medical Control Program (PCMSO) in organizations, with the goal of protecting and preserving the health of their employees concerning occupational risks, as evaluated by the organization’s Risk Management Program (PGR).
7.2 Scope
7.2.1 This standard applies to organizations and public administration bodies, both direct and indirect, as well as legislative and judicial branches and the Public Prosecutor’s Office, 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 in the field of employee health and must be harmonized with the provisions of other regulatory standards (NR).
7.3.2 The guidelines of the PCMSO are:
a) To screen and early detect health issues related to work;
b) To detect possible excessive exposures to harmful occupational agents;
c) To determine each employee’s fitness to perform their specific functions or tasks;
d) To support the implementation and monitoring of the effectiveness of preventive measures adopted in the organization;
e) To support epidemiological and statistical analyses on health issues and their relationship with occupational risks;
f) To support decisions on the removal of employees from work situations that may compromise their health;
g) To support the issuance of notifications of work-related health issues, according to pertinent regulations;
h) To support the referral of employees to Social Security;
i) To monitor employees whose health may be especially affected by occupational risks;
j) To support Social Security in professional rehabilitation actions;
k) To support professional readaptation actions;
l) To control active immunization of employees related to occupational risks, whenever recommended by the Ministry of Health.
7.3.2.1 The PCMSO must include actions of:
a) Passive monitoring, based on information about the spontaneous demand of employees seeking medical services;
b) Active monitoring, through directed medical exams that include, besides the exams provided in this NR, the collection of data on signs and symptoms of health issues related to occupational risks.
7.3.2.2 The PCMSO should not serve as a personnel selection tool.
7.4 Responsbilities
7.4.1 It is the employer’s responsibility to:
a) Ensure the development and effective implementation of the PCMSO;
b) Cover all costs related to the PCMSO procedures without charging employees;
c) Appoint a responsible occupational health physician for the PCMSO.
7.5 Planning
7.5.1 The PCMSO should be developed considering the occupational risks identified and classified by the PGR.
7.5.2 If there is no occupational health physician in the locality, the organization may hire a physician of another specialty to be responsible for the PCMSO.
7.5.3 The PCMSO should include the evaluation of the health status 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 execution of such activities.
7.5.4 The organization must ensure that the PCMSO:
a) Describes the possible health issues related to the occupational risks identified and classified in the PGR;
b) Contains a plan for the necessary clinical and complementary medical exams, according to the identified occupational risks, complying with the requirements of this NR;
c) Includes criteria for interpreting and planning actions related to the findings of medical exams;
d) Is known and adhered to by all physicians conducting occupational medical exams for employees;
e) Includes an analytical report on the program’s development, as per subitem 7.6.2 of this NR.
7.5.5 The physician responsible for the PCMSO, upon observing inconsistencies in the organization’s risk inventory, must reassess them together with the PGR responsible parties.
7.5.6 The PCMSO must include the mandatory performance of the following medical exams:
a) Pre-employment;
b) Periodic;
c) Return-to-work;
d) Change of occupational risk;
e) Termination.
7.5.7 The medical exams referred to in subitem 7.5.6 comprise a clinical examination and complementary exams, conducted according to the specifications of this and other NRs.
7.5.8 The clinical examination must adhere to the following deadlines and periodicities:
I. In the pre-employment examination: before the employee assumes their duties;
II. In the periodic examination: according to the following intervals:
a) For employees exposed to occupational risks identified and classified in the PGR and for those with chronic diseases that increase susceptibility to such risks:
1. Every year or at shorter intervals, at the discretion of the responsible physician;
2. According to the periodicity specified in Annex IV of this standard, for employees exposed to hyperbaric conditions;
b) For other employees, the clinical examination should be conducted every two years.
7.5.9 In the return-to-work examination, the clinical examination must be performed before the employee resumes their duties if absent for 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 evaluation should determine the need for a gradual return to work.
7.5.10 The change of occupational risk examination must be performed before the date of the change, adjusting medical control to the new risks.
7.5.11 In the termination examination, the clinical examination must be performed within 10 days from the termination of the contract, and it may be waived if the most recent occupational clinical examination was conducted less than 135 days ago for risk level 1 and 2 organizations, and less than 90 days ago for risk level 3 and 4 organizations.
7.5.12 The complementary laboratory exams provided in this NR must be conducted by a laboratory that complies with RDC/Anvisa No. 302/2005, concerning procedures for sample collection, handling, transportation, and analysis, and interpreted based on the criteria in the Annexes of this standard. These exams are mandatory when:
a) The preliminary survey of the PGR indicates the need for immediate preventive measures;
b) Occupational exposures exceed the action levels determined in NR-09 or if the PGR risk classification indicates.
7.5.12.1 The timing of biological sample collection must follow the requirements in Tables 1 and 2 of Annex I of this NR.
7.5.12.2 When the organization handles the storage and transportation of samples, the procedures recommended by the contracted laboratory must be followed.
7.5.13 The exams listed in Tables 1 and 2 of Annex I of this NR must be conducted every six months, which may be anticipated or delayed by up to 45 days, at the discretion of the responsible physician, with a technical justification, to ensure the exams are conducted in conditions more representative of the employee’s exposure to the agent.
7.5.14 For seasonal activities, the periodicity of the exams listed in Tables 1 and 2 of Annex I of this NR may be annual, provided they are conducted concurrently with the activity period.
7.5.15 The exams listed in Table 1 of Annex I of this NR are not mandatory in pre-employment, return-to-work, change of occupational risk, and termination exams.
7.5.16 Employees must be informed during the clinical examination of the reasons for conducting the complementary exams provided in this NR and the meaning of the results of such exams.
7.5.17 In the pre-employment examination, complementary exams conducted in the 90 days prior may be accepted at the discretion of the responsible physician, except when different deadlines are specified in the Annexes of this NR.
7.5.18 Other complementary exams may be conducted 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 conducted, the physician must issue an Occupational Health Certificate (ASO), which must be made available to the employee, and provided in physical form when requested.
7.5.19.1 The ASO must contain at least:
a) The organization’s corporate name and CNPJ or CAEPF;
b) The employee’s full name, CPF number, and function;
c) A description of the hazards or risk factors identified and classified in the PGR that require medical control provided in the PCMSO, or their absence;
d) The indication and date of the occupational clinical and complementary exams to which the employee was subjected;
e) The definition of fitness or unfitness for the employee’s function;
f) The name and professional registration number of the physician responsible for the PCMSO, if any;
g) The date, professional registration number, and signature of the physician who conducted 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 exams are conducted without a clinical examination, the organization must issue a receipt of delivery of the exam results, and the receipt must be provided to the employee in physical form when requested.
7.5.19.4 If excessive exposure to agents listed in Table 1 of Annex I of this NR is detected, the occupational health physician responsible for the PCMSO must inform the PGR responsible parties for reassessment of occupational risks and preventive measures.
7.5.19.5 If a work-related illness or an alteration indicating organic dysfunction is detected through complementary exams in Table 2 of Annex I, other Annexes of this NR, or complementary exams included based on subitem 7.5.18 of this NR, the organization, upon being informed by the physician responsible for the PCMSO, must:
a) Issue a Work Accident Communication (CAT);
b) Remove the employee from the situation or work when necessary;
c) Refer the employee to Social Security if the work absence exceeds 15 days for disability evaluation and determination of social security conduct;
d) Reassess occupational risks and pertinent preventive measures in the PGR.
7.5.19.6 The employee in one of the situations specified in subitems 7.5.19.4 or 7.5.19.5 must undergo a clinical examination and be informed of the significance of altered exams and necessary actions.
7.5.19.6.1 The physician responsible for the PCMSO must evaluate the need for medical examinations in other employees subject to the same work situations.
7.6 Documentation
7.6.1 The data from clinical and complementary exams must be recorded in an individual medical file under the responsibility of the physician responsible for the PCMSO or the physician responsible for the exam if the organization is exempt from the PCMSO.
7.6.1.1 The employee’s medical file must be kept by the organization for at least 20 years after the employee’s termination, except as otherwise provided in the Annexes of this NR.
7.6.1.2 In case of replacement of the physician responsible for the PCMSO, the organization must ensure that the medical files are formally transferred to the successor.
7.6.1.3 Electronic medical records may be used provided they meet the requirements of the Federal Council of Medicine.
7.6.2 The physician responsible for the PCMSO must prepare an annual analytical report of the Program, considering the date of the last report, containing at least:
a) The number of clinical examinations conducted;
b) The number and types of complementary exams conducted;
c) Statistics of abnormal results of complementary exams, categorized by type of exam and operational unit, sector, or function;
d) Incidence and prevalence of work-related diseases, categorized by operational unit, sector, or function;
e) Information on the number, type of events, and diseases reported in CATs issued by the organization for its employees;
f) Comparative analysis with the previous report and discussion on the variations in results.
7.6.3 The organization must ensure that the physician responsible for the PCMSO considers the data from medical records transferred to him/her when preparing the analytical report, if applicable.
7.6.4 If the physician responsible for the PCMSO has not received the medical records or considers the information insufficient, he/she must report this in the analytical report.
7.6.5 The analytical report must be presented and discussed with the organization’s safety and health at work responsible parties, including the CIPA, if any, to adopt necessary preventive measures in the organization.
7.6.6 Organizations with risk levels 1 and 2 with up to 25 employees and risk levels 3 and 4 with up to 10 employees may prepare an analytical report only with the information requested in subitems “a” and “b” of subitem 7.6.2.
7.7 Individual Microentrepreneur (MEI), Microenterprise (ME), and Small Business (EPP)
7.7.1 MEI, ME, and EPP exempt from preparing the PCMSO, as per subitem 1.8.6 of NR-01, must conduct and bear the costs of pre-employment, termination, and periodic occupational medical exams every two years for their employees.
7.7.1.1 Employees must be referred by the organization for occupational medical exams to:
a) An occupational health physician; or
b) A specialized occupational health service, duly registered, in accordance with legislation.
7.7.2 The organization must inform the occupational health physician or specialized occupational health service that it is exempt from preparing the PCMSO, according to NR-01, and that the employee’s function or intended function does not present occupational risks.
7.7.3 For each occupational clinical examination, the physician who conducted the examination must issue an ASO, which must be made available to the employee upon receipt, in physical form when requested, and comply with subitem 7.5.19.1 of this NR.
7.7.4 The analytical report is not required for:
a) Individual Microentrepreneurs (MEI);
b) ME and EPP exempt from preparing the PCMSO.
Annex I Monitoring of Occupational Exposure to Chemical Agents
Annex II Control of Exposure to Elevated Sound Pressure Levels
Annex III Radiological and Spirometric Control of Exposure to Chemical Agents
Annex IV Control of Exposure to Hyperbaric Conditions
Annex V Control of Exposure to Carcinogenic Chemical Substances and Ionizing Radiation
Glossary