Evidence-based pre-employment medical examination in the Dutch construction industry

Introduction
Construction workers are highly exposed to many high work demands. Among preventive measures, pre-employment medical examinations (PE-ME) are aimed to protect employees from work-related diseases and secure their ability to work during their employment. The Dutch legislation requires that PE-ME focuses only on specific job demands, demands being not preventable with state of the art ergonomics knowledge and that may overburden the bodily capacities, safety or health of workers. The purpose of this study was to develop an evidence-based PE-ME for the construction industry.

Methods
Job demands in the construction industry were identified through a systematic literature review (PubMed, Embase, PsychINFO en Picarta) and an expert meeting (21 experts of the Dutch construction industry). In order to acknowledge theses job demands as specific job demands, existing standards (legislation, guidelines), health and safety risks (literature) and ergonomic measures were sought. Then, instruments (self-report questions, valid questionnaires and/or performance-based tests) were selected and/or developed in order to assess the job requirements related to the specific job demands.

Results
Forty-two job demands were identified through the systematic literature review and expert meeting. After studying existing standards, health and safety risks (literature) and potentially ergonomic measures, 23 specific job demands were identified such as “Alertness and judgment capacity”, “Working under time pressure“ and “Lifting or carrying”. Job requirements related to these 23 specific job demands were defined. Then, for each of the 103 jobs within the Dutch construction industry, a battery of several questions and/or tests was gathered in order to assess the specific job requirements.

Discussion
The PE-ME is a first step in the development of evidence-based medical examinations for the Dutch construction industry to assess ability to work. The procedure applied for this PE-ME could be applied to other occupational sectors in order to develop evidence-based PE-ME that fits the recent Dutch legislation.