Circular No. 28/2016/TT-BYT dated June 30, 2016 of the Ministry of Health on management of occupational diseases

THE MINISTRY OF HEALTH

Circular No.28/2016/TT-BYT dated June 30, 2016 of the Ministry of Health on management of occupational diseases

Pursuant to the Labor Code No. 10/2012/QH13 dated June 18, 2012;

Pursuant to the Law on Social insurance No. 58/2014/QH13 dated November 20, 2014;

Pursuant to the Law on Occupational hygiene and safety No. 84/2015/QH13 dated June 25, 2015;

Pursuant to the Government s Decree No. 63/2012/NĐ-CP dated August 31, 2012 defining the functions, tasks, powers and organizational structure of the Ministry of Health;

At the request of Director of Health Environment Management Agency;

The Minister of Health promulgates a Circular on management of occupational diseases,

Chapter I

GENERAL PROVISIONS

Article 1. Scopeof adjustment

This Circular provides for documents and contents of pre-employment health checkup, screening for occupational diseases, provision of periodic examination for workers having occupational diseases, occupational disease investigation and reporting.

Article 2.Subject of application

1. Workers who are exposed to harmful elements and likely to catch occupational diseases, doing arduous, toxic or dangerous works, including apprentices and interns, workers who have retired or resigned from jobs having the risk of occupational diseases, workers participating in social insurance specified in Clause 1 and Clause 4 Article 2 of the Law on Social insurance No. 58/2014/QH13 whose social insurance payment period is reserved or have resigned pending provision of pension or monthly benefits.

2. Enterprises, organizations, cooperatives, household businesses, individuals hiring workers specified in Clause 1 of this Article (hereinafter referred to as employers).

3. Health facilities capable of providing occupational disease examination in accordance with regulations of law on medical examination and treatment that provide pre-employment health checkup, screening for occupational diseases, periodic examinations for workers having occupational diseases (hereinafter referred to as examining facilities)

Chapter II

PRE-EMPLOYMENT HEALTH CHECKUP

Article 3. Subjects and time of pre-employment health checkup

1. Subjects of pre-employment health checkup are specified in Clause 3 Article 21 of the Law on Occupational hygiene and safety.

2. Health checkups shall be provided for workers before they are assigned to do harmful works.

Article 4. Pre-employment health checkup documents

1. A letter of introduction prepared by the employer according to the template in Appendix 1 enclosed herewith. If there are more than one worker have to undergo pre-employment health checkup, the employer shall enclose with the letter of introduction a list of workers which specify their jobs and harmful elements.

2. The health checkup sheet template is provided in Appendix 2 enclosed herewith.

Article 5. Health checkup contents

1. Pre-employment health checkup shall be carried out in accordance with the health checkup sheet in Appendix 2 enclosed herewith.

2. Apart from complying with provisions of Clause 1 of this Article, the chief physician shall prescribe specialist consultation suitable for the workers’ positions.

3. The physicians that directly give health checkup may prescribe subclinical testing (testing, medical imaging, function probing) suitable for the workers’ positions.

4. A worker who have undergone health checkup as prescribed in Circular No. 14/2013/TT-BYT may use the result for specialist consultation mentioned in Clause 2 of this Article.

Chapter III

EXAMINATION FOR OCCUPATIONAL DISEASES

Article 6. Subjects of screening

1. Workers specified in Clause 1 Article 2 of this Circular.

2. Workers that are not specified in Clause 1 of this Article must be reassigned to jobs posing a risk of occupational diseases.

Article 7. Screening time

1. The screening time is specified in Clause 1 Article 21 of the Law on Occupational hygiene and safety.

2. In cases of suspicion of acute occupational diseases or at the request of the employer or workers, the screening time shall be decided by the requester.

Article 8. Screening documents

1. The pre-employment health checkup sheet according to the template provided in Appendix 2 enclosed herewith; if a worker started to work before the effective date of this Circular, the latest checkup result shall be used.

2. The health checkup book according to the template provided in Appendix 3 enclosed herewith.

3. Valid copies of any of the following documents:

a) Working environment monitoring result. If the worker is exposed to microorganisms and working environment monitoring is carried out before the effective date of Decree No. 44/2016/NĐ-CP, the document shall be enclosed with a microorganism exposure assessment sheet issued by a competent authority before July 01, 2016;

b) A confirmation of exposure to acute occupational disease elements according to the template provided in Appendix 5 enclosed herewith in case of an acute occupational disease is acquired before the level of exposure to harmful elements is determined;

4. A valid copy of the discharge note or medical record summary related to the occupational disease (if any).

Article 9. Occupational disease screening procedures and contents

1. Screening examination procedures:

a) Before starting the examination, the employer or worker shall send the documents specified in Article 8 of this Circular to the examining facility;

b) After adequate documents are received, the examining facility shall inform the employer or worker of the time, location and contents of the examination;

c) First screening examinations shall be carried out in accordance with Clause 2 of this Article;

d) At the end of the examination, the examining facility shall write sufficient information on the health checkup books and aggregate result of the examination according to the template in Appendix 10 enclosed herewith;

dd) Where a worker is diagnosed with an occupational disease, the examining facility shall compile a occupational disease dossier according to the template in Appendix 7 enclosed herewith and prepare a occupational disease report according to the template in Appendix 9 enclosed herewith;

e) After the examination is done, the examining facility shall return the documents mentioned in Point d and dd Clause 1 of this Article to the employer or worker within 20 working days.

2. Screening examination contents

a) Obtain personal information, health status, medical history of the worker and his/her family, duration of exposure to harmful elements;

b) Carry out the examination in accordance with Appendix 4 enclosed herewith to discover the occupational diseases on the List of occupational diseases covered by insurance specified in Circular No. 15/2016/TT-BYT;

c) Female workers shall be provided with pelvic examination;

d) Carry out other examinations related to harmful elements of the working environment where necessary;

dd) Where workers have been provided with periodic health checkup in accordance with Circular No. 14/2013/TT-BYT, the health checkup result shall be used together with other contents specified in Point b and d Clause 2 of this Article;

e) Regarding occupational diseases that are not on the List of occupational diseases covered by insurance, full specialist consultations shall be given as prescribed by physicians;

Article 10. Consultations for occupational disease diagnosis

1. A consultation shall be held for diagnosis of asbestosis, bronchus disease, disease caused by exposure to vibration and the cases beyond the capacity of the physicians.

2. Consultation council:

The head of the examining facility shall issue a decision on establishment of a consultation council which consists of:

a) 01 representative of the examining facility as the chairperson;

b) 01 physician specialized in occupational diseases;

c) 01 physician whose specialty is related to the occupational disease that needs consulting;

d) 01 secretary appointed by the chairperson;

e) Where necessary, the chairperson shall decide whether to invite other specialists.

3. The consultation conclusion shall be written on the consultation record according to the template provided in Appendix 8 enclosed herewith.

4. Where a case is beyond the professional capacity of the examining facility, the consultation record and occupational disease dossier shall be transferred to an upper-level facility for diagnosis.

Chapter IV

PROVISION OF PERIODIC EXAMINATION FOR WORKERS HAVING OCCUPATIONAL DISEASES

Article 11. Subjects and time of periodic examinations

1. Workers diagnosed with occupational diseases.

2. Times of periodic examinations are specified in Appendix 6 enclosed herewith.

Article 12. Periodic examination documents

1. The employer shall prepare the following documents:

a) A letter of introduction according to the template in Appendix 1 enclosed herewith;

b) The occupational disease dossier.

2. A worker who has resigned or retired shall prepare the occupational disease dossier himself/herself.

Article 13. Procedures and contents of periodic examination

1. Procedures:

a) Before carrying out a periodic examination, the employer or worker shall send the documents specified in Article 12 of this Circular to the examining facility;

b) After adequate documents are received, the examining facility shall inform the employer or worker of the time, location and contents of the examination;

c) The examining facility shall examine workers having occupational diseases;

d) At the end of the examination, the examining facility shall write the result in each occupational disease dossier, aggregate the results of periodic examination according to the template in Appendix 11 enclosed herewith, and send the results to the workers within 20 working days.

2. Periodic examination contents:

a) Follow instructions in Point a, b and d Clause 2 Article 9 of this Circular and Appendix 6 enclosed herewith;

b) Addition of clinical examination and subclinical examination shall depend on the development of the disease and prescriptions of the physician.

Chapter V

OCCUPATIONAL DISEASE INVESTIGATION

Article 14. Cases of occupational disease investigation

1. First occupational disease investigation shall be carried out in the following cases:

a) The investigation is requested by a worker who has not received occupational disease benefits according to regulations of law on occupational hygiene and safety;

b) The investigation is requested by the employer;

c) There are many cases of acute occupational diseases or many people having a disease at the same time in the same workplace;

d) The working environment monitoring result exceeds the permissible limits but no workers are diagnosed with occupational diseases, or working environment monitoring and health checkup for workers are not carried out;

dd) The investigation is requested by a social insurance authority;

2. Occupational disease reinvestigation shall be carried out in the following cases:

a) The occupational disease investigation result is appealed against;

b) The reinvestigation is requested by a competent authority;

3. Final occupational disease investigation shall be carried out where the result of reinvestigation is appealed against.

Article 15. The power to establish an investigation team

1. First investigation team:

a) Director of the Provincial Department of Health, heads of regulatory bodies who establish the investigation team at the request of inspectors of Provincial Department of Health or heads of health authorities in the cases specified in Clause 1 Article 14 of this Circular;

b) Director of Health Environment Management Agency – the Ministry of Health shall establish an investigation team in the cases specified in Point c and Point d Clause 1 of this Article or the cases beyond the capacity of the investigation team mentioned in Point a of this Clause.

2. Director of Health Environment Management Agency shall establish a reinvestigation team in the cases specified in Clause 2 Article 14 of this Circular.

3. The Ministry of Health shall establish a final investigation team in the cases specified in Clause 3 Article 14 of this Circular.

Article 16. Composition of an investigation team

1. A first investigation team consists of:

a) A chief who is a senior inspector of Provincial Department of Health or head of a health authority of a Ministry;

b) 01 secretary who is a physician who has a degree in occupational diseases;

c) 01 physician whose specialty is related to the occupational disease under investigation;

d) 01 representative of the Department of Labor, War Invalids and Social Affairs;

dd) 01 representative of the Provincial Confederation of Labor;

e) 01 representative of the social insurance authority of the province or a Ministry;

g) Other members decided by the chief.

2. A first investigation team specified in Point b Clause 1 and reinvestigation team specified in Clause 2 Article 15 of this Circular consists of:

a) A chief who is a senior official of Health Environment Management Agency – the Ministry of Health;

b) 01 secretary who is a physician who has a degree in occupational diseases;

c) 01 physician whose specialty is related to the occupational disease under investigation;

d) 01 representative of the Legal Department – the Ministry of Health;

dd) 01 representative of the Department of Labor, War Invalids and Social Affairs of the province where the investigation takes place;

e) Other members decided by the chief.

3. The Minister of Health shall establish a final investigation team at the request of the chief inspector of the Ministry of Health or Director of Health Environment Management Agency. Such final investigation team consists of:

a) A chief who is a senior inspector of the Ministry of Health;

b) 01 secretary who is a physician specialized in occupational diseases of an institution which belongs to the defensive medicine system;

c) 01 physician whose specialty is related to the occupational disease under investigation;

d) 01 representative of the Ministry of Labor, War Invalids and Social Affairs;

dd) 01 representative of Social Security Administration of Vietnam;

e) Other members decided by the chief.

Article 17. Responsibilities of investigation team members

1. The chief of an investigation team has the responsibility to:

a) Organize activities of the investigation team and assign tasks to its members;

b) Hold discussions to reach consensus among the members. If such consensus cannot be reached, the chief shall make a decision and take responsibility for it;

c) Disclose the investigation record.

2. Investigation team members have the responsibility to:

a) Perform the tasks given by the chief and take responsibility for their performance;

b) Offer their dissenting opinions. Dissenting opinions shall be fully written in the investigation record.

3. Not reveal information and documents obtained during the investigation before the investigation record is disclosed.

Article 18. Time limit and procedures for investigation and disclosing investigation records

1. Time limit: 45 days from the effective date of the decision to establish an investigation team.

2. Investigation procedures:

a) Examine the workplace;

b) Collect evidence and documents about the occupational diseases (take samples of harmful elements for analysis);

c) Examine documents about occupational hygiene, workers’ health and occupational diseases at the workplace;

d) Interview workers, the employers and other persons at the workplace related to the management of occupational hygiene, workers’ health and occupational diseases;

dd) Carry out examinations and necessary tests if workers are suspected of having occupational diseases (if necessary);

e) Other contents decided by the chief of the investigation team.

3. Disclosing the investigation record:

The investigation team shall hold a meeting right after the investigation is done to disclose the investigation record. The meeting shall be attended by:

a) The chief who will chair the meeting;

b) Investigation team members;

c) The employer or a person authorized by the employer in writing;

d)The representative of the internal trade union or provisional trade union or a person selected by the workers if a trade union is not established;

dd) The requester, witnesses, and persons having relevant responsibility and interests;

e) Representative of the supervisory body of the employer (if any);

g) The minutes of the meeting shall bear signatures of the participants. The person who does not concur with the investigation record may have his/her dissenting opinion written on the record but it still has to bear his/her signature and seal (if any). Other recommendations of the investigation team shall be followed;

h) The investigation record and minutes of the meeting shall be sent to authorities whose representatives are participants in the investigation team, the social insurance authority, the workplace and patients within 05 working days from the day on which the investigation record is disclosed.

Article 19. Occupational disease investigation documents

1. Workplace examination record.

2. Relevant evidence and documents.

3. Documents about occupational hygiene, workers’ health and occupational diseases at the workplace.

4. Records of interviews with workers, the employers and other persons at the workplace related to the management of occupational hygiene, workers’ health and occupational diseases.

5. Examination and test result (if any).

6. The investigation record.

7. The minutes of the meeting for disclosing the investigation record.

8. Other documents relevant to the investigation.

9. Occupational disease investigation documents shall be retained for 15 years at the workplace and the authorities whose representatives are participants in the investigation team.

Article 20. Funding

1. The State shall cover the costs of operation of occupational disease investigation teams established by regulatory bodies.

2. The person or organization that requests the investigation shall pay for the costs of the investigation team established at their request.

Chapter V

IMPLEMENTATIONRESPONSIBILITIES

Article 21. Responsibility of workers

1. Provide truthful information about their medical history and occupational exposure during the health checkup.

2. Attend pre-employment health checkup, screening and periodic examinations (if acquired) held by the employer.

3. Follow instructions, prescriptions of physicians.

4. Retain medical records after resignation or retirement (occupational disease dossier, occupational disease reports, documents about examination and treatments at health facilities) as the basis for examination, diagnosis and assessment of occupational diseases if acquired after exposure is stopped; submit medical records to the new employer in case of change of the workplace.

Article 22. Responsibility of the employer

1. Compile, manage and retain medical records and occupational disease dossiers of workers while they are still working at the workplace; return them to workers when they move to another workplace, resign or retire.

2. Cooperate with health facilities capable of occupational disease diagnosis to provide pre-employment health checkup, screening and periodic examinations for workers.

3. Enable workers to receive treatment and recovery as prescribed by law.

4. Complete documents and have workers diagnosed with occupational diseases to undergo assessment within 20 working days after treatment or recovery (for curable occupational diseases) or after screening (for incurable diseases).

5. Improve the working conditions and prevent occupational diseases; provide personal protective equipment and perquisites for workers as prescribed.

6. Give tasks suitable for workers’ health.

7. Provide information, documents and cooperate with occupational disease investigation teams.

8. Submit periodic and ad hoc reports to local health authorities as prescribed by regulations of law on occupational hygiene and safety.

9. Where a worker is found having an occupational disease, the employer shall:

a) Report the disease in accordance with this Circular;

b) Inform other workers of the occupational disease in order to prevent it;

c) Hold a meeting to disclose the investigation record.

Article 23. Responsibilities of the examining facility

1. Cooperate with the employer in planning and carrying out pre-employment health checkup, screening and periodic examinations for workers.

2. Organize occupational disease consultations (if necessary) and take legal responsibility for results thereof.

3. Participate in medical assessment councils on request.

4. Submit biannual and annual reports on occupational disease examination to the Provincial Department of Health or the Ministry of Health before July 05 and January 10 as instructed in Appendix 9 and Appendix 12 enclosed herewith.

Article 24. Responsibility of Provincial Departments of Health

1. Instruct examining facilities to provide pre-employment health checkup, screening and periodic examinations for workers and carry out occupational disease investigations within their provinces.

2. Publish the list of licensed examining facilities on the website of the Provincial Department of Health and send it to Health Environment Management Agency within 03 working days from the day on which a facility is licensed.

3. Carry out periodic and surprise inspections at licensed examining facilities.

4. Submit biannual and annual reports on occupational disease examination to Ministry of Health (Health Environment Management Agency) before July 15 and January 15 as instructed in Appendix 9 and Appendix 12 enclosed herewith.

Article 25. Responsibility of Health Environment Management Agency – The Ministry of Health

1. Give instructions and carry out pre-employment health checkup, screening, periodic examinations for workers and occupational disease investigations nationwide.

2. Develop an occupational disease database which contains information about:

a) Infrastructure, equipment and human resources serving occupational disease examination;

b) Harmful elements at workplaces;

c) Number of workplaces where workers have occupational diseases;

d) Number of workers having occupational diseases;

dd) Developments of occupational diseases;

e) Provision of benefits for workers having occupational diseases.

3. Publish the list of licensed examining facilities on the website of the Ministry of Health.

4. Instruct defensive medicine institutes, medicine and pharmacy universities to develop and provide training courses in occupational diseases.

5. Cooperate with relevant units in providing guidelines for implementation of this Circular and carrying out inspections examining facilities.

Chapter VI

IMPLEMENTATION EFFECT

Article 26. Referenceprovisions

Where a document cited in this Circular is replaced or amended, the newest one shall apply.

Article 27. Effect

1. This Circular takes effect on August 15, 2016.

2. Circular No. 08/1998/TTLT-BYT-BLĐTBXH dated April 20, 1998 and Circular No. 12/2006/TT-BYT dated November 10, 2006 are abolished from the effective date of this Circular.

Difficulties that arise during the implementation of this Circular should be reported to the Ministry of Health (Health Environment Management Agency) for consideration./.

For the Minister

The Deputy Minister

Nguyen Thanh Long

APPENDIX 3

SPECIMEN OF THE OCCUPATIONAL DISEASE SCREENING RECORD
(Enclosed with Circular No.28/2016/TT-BYT dated June 30, 2016 of the Minister of Health)

OCCUPATIONAL DISEASE SCREENING RECORD

1. Full name(UPPER CASE): ……………………………………………………………………

2. Male □ Female □  Date of birth: ……………….……………………………………

3. ID/passport number: ……………………… date of issue ....……… by …………………

4. Permanent residence: …………………………………………………………………………

5. Current residence: ……………………………………………………………………………

6. Current job: ………………………………………………………………

7. Workplace: …………………………………………………………………….

8. Workplace address: …………………………………………………………………….

9. Date of beginning of work: ……………………….

10. Previous jobs (over the last 10 years in reverse chronological order):

(1) ……………………………………………………………………………………………………

……………………………………………………………………………………………………….

……………………………………………………………………………………………………….

Work duration: From …………………. To ………………………….

Exposed to:  ……………………………. Exposure duration …………………………………

(2) ……………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

11. Family medical history: ……………………………………………………………………

12. Personal medical history: …………………………………………………………………

I. OCCUPATIONAL DISEASE SCREENING

1. Overall examination*

*Not required if the worker has undergone periodic checkup in accordance with Circular No. 14/2013/TT-BYT.

2. Occupational disease screening contentsare specified in Appendix 4 enclosed with this Circular; any occupational disease diagnosed shall be specified in the Occupational disease dossier in Appendix 8 enclosed with this Circular).

- Clinical:

………………………………………………………………………………………………………

- Subclinical:

………………………………………………………………………………………………………

II. CONCLUSION

1. Health ranking: ...…………………………………………………………………………

2. Diseases and disabilities (if any): ……………………………………………………………

3. Occupational diseases

3.1. Preliminary diagnosis

………………………………………………………………………………………………………

3.2. Conclusion after consultation (enclosed with consultation record, if any)

………………………………………………………………………………………………………

3.3. Official diagnosis

………………………………………………………………………………………………………

4. Solution: consultation, treatment, sick leave, rehabilitation, assessment, career change (if possible): ………………………………………………………………………………

APPENDIX 4

CONTENTS OF SCREENING FOR OCCUPATIONAL DISEASES COVERED BY INSURANCE

APPENDIX 5

SPECIMEN OF THE CONFIRMATION OF EXPOSURE TO ACUTE OCCUPATIONAL DISEASE-CAUSING FACTORS
(Enclosed with Circular No. 28/2016/TT-BYT dated June 30, 2016 of the Minister of Health)

SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom – Happiness
---------------

CONFIRMATION OF EXPOSURE TO ACUTE OCCUPATIONAL DISEASE-CAUSING FACTORS

Full name: ……….…………………………………. Age : ………..Gender: …………………..

Occupation: ……………………………………………………………………………………….

Workplace: ……………………………………………………………………………………….

Circumstance of acute occupational disease: (in detail)

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Disease status:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Sources, contributing factors, exposure circumstance:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Responses:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Patient’s health status:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

APPENDIX 6

TIME AND CONTENT OF PERIODIC EXAMINATIONS FOR WORKERS HAVING OCCUPATIONAL DISEASES

* Addition of clinical examination and subclinical examination shall depend on the development of the disease and prescriptions of the physician.

APPENDIX 7

SPECIMEN OF THE OCCUPATIONAL DISEASE DOSSIER
(Attached with Circular No. 28/2016/TT-BYT dated June 30, 2016 of the Minister of Health)

OCCUPATIONAL DISEASE DOSSIER

No._____________

Patient’s full name: _____________________________________________________

Gender: _______________________________________________________

Date of birth: ____________________________________________________

ID number: ________ Issuer:_______ Date of issue:_______

Occupation: _____________________________________________________

Seniority (years): ________________________________________________________

Current residence: _______________________________________________________

Occupational disease screening record number: _____________________________

Name of workplace: _____________________________________________________

Working position: _______________________________________________

Workplace address: _______________________________________________

Phone: ______________________________ Fax: _______________________

Year ____

PART I. OCCUPATIONAL DISEASE SCREENING

(Done by occupational disease-examining facility)

I. INFORMATION ABOUT OCCUPATIONAL DISEASE-EXAMINING FACILITY

Name of examining facility: __________________________________________

Address: ________________________________________________________________

Date of dossier compilation: _______________________________________________

Phone: ______________________________ Fax: _______________________

E-mail: ___________________________Website: _____________________________

II. OCCUPATIONAL HISTORY AND CURRENT OCCUPATION

1. Previous occupations and durations thereof:_________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

2. Current works and working conditions (harmful elements, available personal protective equipment):

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

(*) This must be enclosed with a valid copy of working environment survey result or confirmation of exposure to acute occupational disease-causing factors.

III. OCCUPATIONAL DISEASE EXAMINTION RESULT

1. Medical history

- Acquired diseases (time, treating facility, treatment result): ______________________

+ Before working: _____________________________________________________

_______________________________________________________________________

_______________________________________________________________________

+ After starting to work: __________________________________________________

_______________________________________________________________________

_______________________________________________________________________

2. Disease developments:

- Current health status (primary, developments of occupational diseases):__________

______________________________________________________________________

3. Current result

3.1. Overall health:

______________________________________________________________________

______________________________________________________________________

3.2. Diagnoses relevant to occupational diseases

a) Functional symptoms

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

b) Physical examination

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

c) Subclinical examinations (tests, medical imaging, function probing)

______________________________________________________________________

______________________________________________________________________

3.3. Summary of other examination results

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

IV. CONCLUSION

1. Preliminary diagnosis

______________________________________________________________________

______________________________________________________________________

2. Conclusion after consultation(enclosed with consultation record, if any)

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

3. Official diagnosis

______________________________________________________________________

4. Solution:consultation, treatment, sick leave, rehabilitation, assessment, career change(if necessary):

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

PART II. PERIODIC OCCUPATIONAL DISEASE EXAMINATION

(Done by occupational disease- examining facility and added to occupational disease dossier)

I. INFORMATION ABOUT OCCUPATIONAL DISEASE-EXAMINING FACILITY

Name of examining facility: __________________________________________

Address: ________________________________________________________________

Date of dossier compilation: ______________________________________________

Phone: ______________________________ Fax: _______________________

E-mail: ___________________________Website: _____________________________

II. ASSESSMENT OF WORK CAPACITY REDUCTION

Diagnosed occupational disease: __________________________________________

Diagnosing facility: __________________________________________

Date of diagnosis: ____________________________________________________

Date of periodic examination ______________________ Time: _______________

Occupational disease assessment (if any):

- Medical Assessment Council:

- Medical assessment record No. ____ dated _________________________________

- Work capacity reduction rate: __________________________________________

Benefit book dated _________________________

III. OCCUPATIONAL HISTORY AND CURRENT OCCUPATION

1. Previous occupations and durations thereof:_________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

2. Current works and working conditions (harmful elements, available personal protective equipment):

_______________________________________________________________________

_______________________________________________________________________

(*) A valid copy of the latest working environment survey result must be enclosed herewith.

IV. PERIODIC OCCUPATIONAL DISEASE EXAMINATION RESULT

- Clinical:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

- Subclinical:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

III. CONCLUSION

1. Preliminary diagnosis

_______________________________________________________________________

_______________________________________________________________________

2. Conclusion after consultation(enclosed with consultation record, if any)

_______________________________________________________________________

_______________________________________________________________________

3. Official diagnosis(specify seriousness and developments of the disease compared to result of the previous examination)

_______________________________________________________________________

_______________________________________________________________________

4. Solution:consultation, treatment, sick leave, rehabilitation, assessment, career change (if necessary):

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

PART III. SUMMARY OF ANNUAL HEALTH DEVELOPMENTS

(Updated by the worker)

APPENDIX 12

SPECIMEN OF THE LIST OF WORKPLACES WHOSE WORKERS HAVE OCCUPATIONAL DISEASES
(Enclosed with Circular No. 28/2016/TT-BYT dated June 30, 2016 of the Minister of Health)

To: …………………………………………..

Biannual/annual report on periodic occupational disease screening prepared by [Name of the examining facility/Provincial Department of Health of /Supervisory health authority]:

1. List of workplaces whose workers have occupational diseases

(*) This report shall be enclosed with Appendix 10 enclosed with this Circular if occupational disease is diagnosed.

2. Difficulties and proposals

………………………………………………………………………………………………………

………………………………………………………………………………………………………

Notes:

- The examining facility shall submit biannual and annual reports to the Provincial Department of Health or supervisory health authority.

- The Provincial Department of Health or supervisory health authority shall send biannual and annual reports to the Ministry of Health (Health Environment Management Agency).