Medical Surveillance: The Non-Negotiable

The Legal Foundation

Several pieces of South African legislation directly require medical surveillance for workers exposed to occupational hazards.

The Occupational Health and Safety Act, 85 of 1993 (Section 8(1)–(2))

The OHS Act places a general duty on employers to provide and maintain a work environment that is safe and without risk to health.

Section 8(2)(b)–(e) specifically requires employers to identify health risks and take steps to eliminate, control, or monitor exposure to them.

In practice: if you identify hazards such as silica dust, noise, welding fumes, or chemical exposure, you must have a system of medical monitoring to ensure workers’ health is not deteriorating due to those exposures.

These regulations make it clear that any employee exposed to health hazards — including noise, hazardous chemicals, radiation, or confined spaces — must undergo:

• Baseline medicals before placement;
• Periodic medicals during employment; and
• Exit medicals upon termination or reassignment.

The employer must also keep a record of all results and ensure confidentiality, as these are medical documents protected by law.

Hazardous Chemical Agents Regulations, 2021

Under Regulation 8, employers must:

• Conduct an exposure assessment;
• Ensure affected workers are placed under medical surveillance; and
• Maintain individual health records for at least 40 years.

This applies to any worker exposed to harmful substances such as solvents, paints, fuels, welding fumes, or cleaning chemicals.

Failing to implement surveillance where exposure exists is a breach of Regulation 8 and a prosecutable offence under the OHS Act.

Hazardous Biological Agents Regulations, 2022

For workers exposed to biological risks, including sewage, medical waste, laboratory samples, or animal by-products, Regulation 9 requires a formal medical surveillance programme.
This must include pre-employment screening, ongoing medical checks, and health education for all employees exposed to HBAs.

What a Proper Medical Surveillance Programme Includes

A compliant programme does more than tick boxes. It provides a full health-management cycle for every employee:

1. Baseline medical examination – Conducted before a worker starts exposure duties, establishing a health benchmark.
2. Periodic medicals – Conducted annually (or as determined by risk level) to identify early signs of occupational disease or hearing loss.
3. Exit medicals – Conducted when an employee leaves or changes roles, providing a final health record.
4. Confidential health records – Stored securely for 40 years, available only to authorised persons or inspectors.
5. Medical fitness certificates – Issued by an Occupational Health Practitioner (OHP) confirming the employee’s fitness for duty.

The Consequences of Non-Compliance

Failing to implement medical surveillance isn’t a paperwork issue, it’s a legal breach that could cost you your business.

If the Department of Employment and Labour inspects your site and you cannot produce valid medical records for exposed workers, you could face:

• Contravention notices or an instruction to remove unfit workers;
• Fines or prosecution under the OHS Act;
• Compensation claims or civil liability if a worker develops an occupational disease;
• Work stoppages until proof of compliance is submitted.

Medical surveillance is not about ticking a box; it’s about protecting the people who keep your business running. It’s the first sign of a responsible, compliant employer — and the last line of defence against costly health claims, shutdowns, or prosecutions.

For more information on how Zenith Safety Consultants can help your business, please contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or call 021 010 0209.