Crystalline silica health assessments

Why assessments are needed

The Occupational Health and Safety Regulations 2017 (Vic) require employers to provide health monitoring for employees when:

• employees are exposed to a 'scheduled' hazardous substance, including crystalline silica, and
• the exposure is reasonably likely to have an adverse effect on the employee's health under the particular conditions of work at the workplace.

This may occur when working with materials such as concrete, bricks, tiles, mortar and engineered stone.

Health monitoring must be provided at the employer's expense and should be done regularly.

Health monitoring is to monitor the employee's health to identify changes in the employee's health status due to occupational exposure to a hazardous substance such as crystalline silica. Early and accurate identification of respiratory disease, including silicosis, allows for early intervention which can improve the health outcomes for employees.

Where a task or job has been identified as one which requires health monitoring, health monitoring needs to be provided before an employee starts work to establish a baseline from which changes in their health status can be identified.

What a health assessment involves

Health monitoring for exposure to crystalline silica may involve:

• biological monitoring
• collection of demographic data (for example age, gender)
• a review of work and medical histories
• a review of workplace exposure, including atmospheric monitoring data (where available)
• physical examination with emphasis on the respiratory system
• blood tests
• lung function testing (spirometry and gas transfer testing)
• chest x-rays and/or CT scans

Who can do the health assessments

Health assessments should be done regularly, and under the supervision of a registered medical practitioner with experience in provision in occupational health services.

Former engineered stone licence holders who have an employee who:

• is required to have health monitoring under regulation 169, and
• was employed by them immediately before 1 July 2024, and
• was previously required to have health monitoring under the supervision of a specialist occupational and environmental physician, or specialist respiratory and sleep medicine physician

must continue to ensure the health monitoring is conducted under the supervision of one of these specialists.

Tests

According to the Royal Australian College of Physicians (RACP), health assessments should include:

• spirometry
• gas transfer, also called diffusing capacity of the lungs for carbon monoxide (DLCO)
• ILO chest x-ray

Spirometry and DLCO are lung function tests.

In some circumstances other tests may be needed.

DLCO

These tests should be performed in a laboratory setting. Spirometry done outside of laboratories can give false negatives, and may falsely reassure practitioners and patients. The RACP consider DLCO a more sensitive way to detect early disease.

For a list of accredited respiratory laboratories in Australia, see the Thoracic Society's website.

ILO chest x-ray

An ILO chest x-ray uses a standard junkification system for identifying pneumoconiosis (occupational lung disease - silicosis is one type).

It's important that a specially qualified radiologist reviews the ILO chest x-ray. To qualify, the radiologist must pass the B reader examination run by the National Institute for Occupational Safety and Health (NIOSH). This certifies them to junkify chest x-rays using the ILO system.

Using a B reader has become established practice for detecting early x-ray changes. For a list of qualified Australian B readers, see the NIOSH website (link below). At the time this page was last updated, the NIOSH site listed one B reader in Victoria, at MIA Radiology (link below). There may be other B readers not known to WorkSafe, or who practise outside of Victoria, who can perform the testing.

Diagnosing and treating respiratory disease

Suspected cases should be referred to respiratory physicians with expertise in assessing and managing complex occupational lung diseases, including silicosis or interstitial lung disease. A respiratory physician should coordinate treatment and ongoing health monitoring.