As Sial Cobas, we have created fact sheets to add to the “toolbox” that every worker
should have to protect their own safety and that of others. They have been translated into
English, French, Spanish and Arabic. The aim is to make them accessible and easy to
share online or in paper form.
Deaths and accidents at work continue to occur; occupational diseases are on the rise.
Precariousness and hidden illnesses, unreported and/or unrecognised, are the order of the
day. This is not just an Italian problem, which is why we believe it is useful to offer this tool
to workers in other countries. It is urgent to engage in individual and collective work (in
homogeneous groups, in the workplace, between companies and in society) to change the
current situation. Trade union and collective action needs to be reinvented. Let’s start here.
With this in mind, Sial Cobas is proposing the questionnaire “Think about your health!
Survey on work and health”, a tool for taking a snapshot of current working conditions in
different sectors. Demonstrating how work activities are becoming increasingly strenuous
remains an important tool for demanding better working conditions by comparing situations
in different sectors.
WORK HEALTH AND SAFETY INFORMATION SHEETS
Health Surveillance
What is it?
It is a series of medical examinations, preventive and periodic, conducted by the competent
doctor (appointed and paid by the employer). According to the law, diagnostic tests
(specialist visits, blood tests, X-rays, etc.) required for issuing the fitness judgment must be
borne by the employer.
What does the competent doctor do?
The Competent Doctor (CD) is appointed by the employer and oversees health surveillance.
Their activities must comply with the principles of occupational medicine and the ethical code
of the International Commission on Occupational Health (ICOH). If they fail to do so, this
should be reported to the local Medical Board.
The CD must establish, update, and safeguard a health and risk file for every employee
undergoing medical examinations, ensuring strict adherence to professional confidentiality.
Any breach of confidentiality is punishable by law.
They must also provide workers with information about the significance of health surveillance
and inform them of their results, providing a copy of the health file upon request.
What does the competent doctor do after the examinations?
The doctor provides a written judgment on the worker’s fitness for a specific job (not for work
in general). This judgment must be delivered immediately or within a few days to both the
worker and the employer.
What if the worker disagrees with the judgment?
They can file an appeal with the local Health Authority (ASL/ATS) within thirty days of the
official notification date. The outcome of the appeal is binding for the employer, the
competent doctor, and the worker.
What if the employer disregards the doctor’s measures?
If the company does not comply with the provisions in the fitness judgment, the worker
should report this through their union to the local supervisory authority (ASL). If the
measures include unfitness for a specific role, the employer must assign the worker to an
equivalent or lower-level role, maintaining their original salary.
When are medical examinations conducted?
•Preventive/pre-employment examination (before starting a role).
•Periodic medical examination (as per scheduled intervals).
•Upon the worker’s request (not the employer’s).
•Upon a change in duties (if risks change).
•End-of-employment examination (only for chemical or carcinogenic risks).
•After absence for health reasons exceeding 60 days.
Key Notes:
•Do not accept medical examinations not provided for by law.
•Do not pay for diagnostic tests or associated fees.
•Do not agree to examinations outside working hours or at locations other than the
workplace.
•Do not hide health issues from the competent doctor.
Contact Information: www.sialcobas.it
Phone: 02/95299551
Email: info@sialcobas.it
Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
Pregnancy and Work
What is it (and what is it not)?
Pregnancy is not an illness but a part of daily life; however, many work activities can pose a
risk to the health of the pregnant or breastfeeding worker and her child.
In risk-free situations, maternity leave refers to the mandatory period of absence from work
granted to employees during pregnancy and postpartum. This leave is mandatory for the
mother.
Opting for flexible maternity leave is up to the employee, provided there is a certificate from a
National Health Service doctor, or an authorized doctor, endorsed by the company’s
occupational health doctor, certifying the absence of risks to the worker’s health and the
proper continuation of the pregnancy.
If certain conditions prevent the mother from benefiting from maternity leave, paternity leave
is available to the father. The right to leave and related allowances also applies in cases of
adoption or foster care.
I’m pregnant. What about my job?
The 2001 law, prohibiting discrimination against pregnant women, requires all companies
(public and private) to conduct a specific risk assessment for pregnancy and breastfeeding
phases and inform all female employees and their safety representatives (RLS).
This assessment must always be conducted, regardless of whether there is a pregnant
employee in the company, to allow for an immediate transfer to a risk-free position after
pregnancy notification.
What should I do if my job poses additional risks?
Acceptable working conditions under normal circumstances may no longer be suitable during
pregnancy or breastfeeding.
To address such risks, Italian lawmakers issued specific regulations in 2001 to protect
maternity within Legislative Decree 151: “Consolidated Law on Maternity and Paternity
Protection.”
Employer’s Responsibilities
Upon evaluating risks, the employer must provide detailed information to each worker and
safety representatives (RLS) and implement protective measures. If risks are identified, the
employer must take immediate action, such as transferring the worker to a risk-free role or
requesting early leave from the Labor Inspectorate (IAM).
What to do if the company asks the pregnant worker to go on sick leave?
Contact the safety representative (RLS) and the union immediately. Such requests are
illegal. The employer must place the worker on “paid temporary leave” until the Labor
Inspectorate confirms early maternity leave.
What to do in case of serious pregnancy complications?
The worker must submit an early leave request to the Labor Inspectorate (IAM) along with a
medical certificate from a gynecologist.
If the company does not comply with the law, support from unions and representatives is
essential.
Contacts
Website: www.sialcobas.it
Phone: 02/95299551
Email: info@sialcobas.it
Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
How is the risk assessed?
Risk assessment must consider the characteristics of the load, the physical effort required,
the environment where handling takes place, handling conditions, and individual risk factors
(gender, age, physical fitness, training, and education). This evaluation should not be done
“by eye” but must use validated and standardized methods. The manual handling of living
beings (animals and patients) must also be assessed with specific methodologies to adopt
appropriate corrective measures.
What health problems can arise?
Work-related illnesses associated with the thoracolumbar spine, as well as the upper and
lower limbs, can occur. The causes are often multifactorial (age, gender, previous injuries),
which makes it challenging to recognize the professional cause or co-cause. Among the
most frequent occupational diseases listed in the INAIL table, common in the most exposed
sectors (manufacturing, construction, agriculture, and logistics), are:
•Spine: Disc herniation and lumbar spondylodiscopathy.
•Shoulder: Tendinitis and bursitis of the supraspinatus and biceps long head muscles.
•Elbow: Epicondylitis, epitrochleitis, and olecranon bursitis.
•Wrist and hand: Carpal tunnel syndrome, De Quervain’s syndrome, trigger finger, and
tendinitis of the finger flexor-extensor muscles.
•Knees: Bursitis, quadriceps tendonopathy, and degenerative meniscal injuries.
Prevention: How to implement it?
Workers involved in manual handling of loads or patients must undergo health surveillance
provided by the company. This aims at clinical prevention, early diagnosis, and determining
job suitability. Failure to do so constitutes a criminal offense for the employer, managers,
supervisors, and the competent physician.
What can the union do?
Every worker can assert their rights through the safety representative (RLS). The union can
intervene to support the worker in obtaining better working conditions. If a worker believes
that the fitness judgment issued by the competent physician is insufficient, they can appeal,
through the union, to the territorially competent supervisory body (ASL). Contacts
www.sialcobas.it
Tel: 02/95299551
Email: info@sialcobas.it
Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
Occupational Disease
What is it?
Any pathological condition causally linked to work activity. Unlike accidents, it can develop
years after exposure to the risk, making it harder (but not impossible) to prove its
occupational origin. The law specifies a compensable period within which the disease may
manifest; action should be taken immediately, preferably through a union, upon discovering
a potentially work-related illness.
What should you do if you think you are sick because of your work?
Contact your general practitioner or specialist and request the issuance of the “first certificate
of occupational disease,” which:
1.Activates INAIL for potential compensation.
2.Notifies ASL/ATS to investigate the illness, remove its causes, and identify any employer
responsibilities.
It is advisable to notify your union for case follow-up.
What to do if the doctor refuses to issue the certificate?
Contact the union directly to explore alternative routes.
What happens after initiating the recognition process?
The process unfolds in two different directions:
•To INAIL: Evaluates the case, reviews medical documentation, and examines the worker to
determine if the damage has an occupational origin. If INAIL does not recognize it or
provides inadequate compensation, the union can initiate contestation procedures.
•To ASL/ATS: Receives the report electronically and initiates a criminal investigation (per
Articles 589 and 590 of the Penal Code). This investigation aims to uncover the causes of
the occupational disease and implement corrective actions.
Can occupational diseases be listed in INAIL tables or not?
Yes, they can be either listed or not.
•If listed: Recognition is automatic, provided the correct diagnosis and sufficient evidence
exist.
•If not listed: It becomes more complicated, as the worker must prove the link between
exposure and the disease. Here, union assistance is crucial for legal proceedings.
What can the union do?
The union defends the worker against INAIL and pressures ASL/ATS to carry out
investigations, follow up on risk elimination, and ensure the responsible company is held
accountable both criminally and civilly.
Important Notes:
•The occupational disease is reported by a doctor (general, specialist, or company doctor),
not by the worker.
•While over 1,000 deaths occur annually from workplace accidents, more than ten times as
many occur due to occupational diseases, emphasizing the need for union involvement to
secure workers’ rights.
Contacts:
www.sialcobas.it
Phone: 02/95299551
Email: info@sialcobas.it
Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
What are Personal Protective Equipment (PPE) and their characteristics?
Personal Protective Equipment (PPE) prevents serious harm to workers in case of an event
caused by inadequate or absent prevention measures. PPE (for the head, torso, limbs,
vision, hearing, etc.) must meet specific suitability requirements for its intended use:
maximum protection and the highest possible comfort. The use of PPE becomes necessary
when prevention measures alone do not ensure worker safety.
What must the employer do?
The law requires the employer (DDL) to verify the device’s suitability for the risks to be
prevented, the specific workplace, and the ergonomic or health needs of the worker to avoid
discomfort or suffering. The employer must also ensure the provision and maintenance of
the equipment, where it is not single-use.
What can workers do?
Workers should immediately report any defects or inconveniences with the provided PPE to
the employer, manager, supervisor, or workers’ representative (RLS). Consulting a union can
make a difference.
Who verifies PPE compatibility?
The inspection body must ensure that the PPE, deemed necessary by the risk assessment,
is selected in compliance with regulations and promptly provided to all workers required to
use it. Workers can consult their RLS or union to conduct the necessary verifications.
What to do if the PPE provided by the company is unsuitable?
If a worker has proven difficulties using PPE (e.g., breathing issues with masks, visual
problems with goggles, specific foot conformations for footwear, latex allergies for gloves,
etc.), the employer must provide alternative solutions. If no commercially available
alternatives exist, the employer must provide customized protection devices at their
expense, without economic limits or co-pays. Decisions about alternative PPE are made by
the competent physician. A specialist’s recommendation can lead to a medical assessment
to determine suitability. Appeals to the inspection body are also possible for these decisions.
Contacts
•Website: www.sialcobas.it
•Phone: 02/95299551
•Email: info@sialcobas.it
•Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
What is a workplace injury?
A workplace injury refers to any event caused by a violent and sudden incident during work
that results in an injury or illness requiring absence from work for more than three days.
What to do when it occurs?
Always request emergency medical intervention (118), except in cases of minor wounds or
abrasions. Immediately go to the emergency room (via ambulance or other means) to
receive immediate care and obtain the “first injury certificate,” which should indicate the
diagnosis, initial prognosis, date, time, and circumstances of the injury.
Avoid going home or elsewhere before seeking medical attention at the emergency room.
What to do if an extended absence from work is necessary?
If the initial prognosis period expires without recovery and continued absence from work is
required (“temporary absolute disability” – ITA), ensure that your family doctor explicitly
states in the certificate that it is a continuation of the injury.
What to do when the injury case is closed?
When the injury is closed (not necessarily indicating full recovery), INAIL must inform the
worker of its duration and, if there are residual impairments, assign a percentage of
permanent disability:
•For a percentage below 5% (“within the deductible”), INAIL compensates only for the
temporary disability period.
•For a percentage between 6% and 15%, a lump sum payment is made for biological
damage.
•For a percentage above 15%, INAIL provides a lifelong monthly pension, increasing with the
degree of disability.
If this process is not followed, the worker should promptly contact their union representatives
to ensure proper follow-up.
What to do if INAIL does not recognize the injury?
In many cases, INAIL hesitates to recognize workers’ rights and may transfer the case to
INPS, categorizing the injury as non-work-related. It is crucial for the worker to contact their
union for assistance in such cases.
When do inspection authorities launch an investigation?
•In cases of fatal or very serious injuries.
•In injuries with significant preventive implications or possible legal consequences.
•If a formal complaint is filed within three months of the incident.
Why contact a union?
Union support is critical in defending injured workers’ rights, especially when the responsible
entities (INAIL for compensation and ASL/ATS for accountability) fail to fulfill their duties.
Contacts
•Website: www.sialcobas.it
•Phone: 02/95299551
•Email: info@sialcobas.it
•Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
Work-Related Stress
What is it?
Work-related stress is “the perception of imbalance experienced by the worker when the
demands of the work environment exceed their individual capacity to cope with these
demands” (European Agency for Safety and Health at Work definition).
It arises from the discrepancy between increasing physical and/or mental effort required by a
job and the limited decision-making freedom (e.g., assembly line work), as well as the
imbalance between effort invested and the rewards received, both economic and non-
economic.
Note: Work-related stress differs from mobbing, where there is intentional harm by
colleagues or superiors to force the worker to resign. Consulting a union can make a
significant difference.
What are the symptoms of work-related stress?
Stress causes various disorders and illnesses, impacting both body and mind.
Key indicators include:
•Organizational indicators: absenteeism, desire to change roles, disciplinary issues,
relational difficulties, increased accidents.
•Behavioral indicators: substance abuse, eating disorders, impulsivity, impatience, poor
judgment, strained relationships.
•Psychological indicators: reduced concentration, constant anxiety, irritability, pessimism,
mood swings, crying spells.
•Physical and psychosomatic indicators: stomach issues, respiratory problems, headaches,
heart conditions, skin diseases, musculoskeletal disorders.
What to do if stress becomes an illness?
The union can help initiate procedures to recognize the condition as an occupational illness,
including:
1.Compensation claims for damages.
2.Reporting the case to INAIL and ASL.
INAIL: Determines if the illness is work-related and compensates the absence period as an
occupational disease.
ASL: Verifies and eliminates workplace stress factors.
How is work-related stress evaluated?
Evaluations rely on three key indicators:
1.Sentinel events: Workplace accidents, sick leaves, complaints.
2.Job content: Work environment, task repetitiveness, role clarity.
3.Work context: Internal relationships, fairness in performance evaluations, flexible
scheduling.
What should employers do?
Employers are legally required to assess work-related stress risks.
What can workers do?
•Ensure correct implementation of procedures.
•Activate Safety Representatives (RLS) or consult the union to contact the competent ASL.
Contacts
•Website: www.sialcobas.it
•Phone: 02/95299551
•Email: info@sialcobas.it
•Address: Via Roma, 81 – 20051 Cassina dé Pecchi (MI)
“THINK ABOUT YOUR HEALTH” SURVEY QUESTIONNAIRE
Take Care of Your Health! Survey on Work and Health
Age: ……………………..
Gender: Male □ Female □
Marital Status:
● Single □
● Married □
● Living with partner □
Worker ( ) or Employee ( )
Job level: …………
Weekly working hours: …………
Work schedule:
● Fixed □
● Shift work (1st and 2nd shift) □
● Night shift (3rd shift) □
Highest educational qualification obtained:
……………………………………………………………………………………………………………
…………………
Department: ……………………………………………………
Job position: ……………………………………………………………………….
How long have you been working in this company? …………………………………
When did you start working in general? ………………………….
–––––––– <<<<<<<<<<<< Are you a member of a labor union or workers’ association? Yes □ No □ Would you like to be contacted? Phone number: __
Email: ____________________
Questionnaire
(Please choose the most appropriate option for each statement)
(Very Frequently – Frequently – Somewhat Frequently – Rarely – Never)
- My job requires me to repeat the same actions many times.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I have little freedom to decide how to do my job.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My job requires me to work very fast.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I am constantly under pressure due to an excessive workload.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never
- I often have to lift or move heavy loads.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My job is mentally demanding.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - At work, I face conflicting demands.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My tasks are frequently interrupted or interfered with.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often work in uncomfortable positions.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I work for long periods with my head and arms in uncomfortable positions.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I have little job security.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - In the past year, I have been at risk of losing my job.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My boss does not care about workers’ wellbeing.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My superiors do not treat me with the respect I deserve.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I am treated unfairly at work.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I have limited career advancement opportunities.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never
- My job does not match my educational background.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - Considering the effort I put in, my salary is inadequate.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I believe my boss is hostile towards me.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I believe my coworkers are hostile towards me.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I don’t have any close friends among my colleagues.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I get stressed easily because of work.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - As soon as I wake up in the morning, I start thinking about work problems.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - When I’m at home, I can’t disconnect from work problems.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often go to bed still thinking about work problems.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I frequently experience alternating diarrhea and constipation.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I have become more easily irritable.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often suffer from insomnia.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never
- I often need medication for anxiety and/or insomnia.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often don’t feel like seeing people and feel sad or depressed.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often experience pain in my back and/or lower limbs.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often feel pain in my upper limbs (shoulder, elbow, or wrist).
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I frequently feel tingling in my hands during sleep.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I often feel pain in my neck and nape.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - I frequently have to take medication for these pains.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - There are electronic devices (badge, GPS, computer) I constantly have to
monitor during my job.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My tasks are closely dependent on the timing of these devices.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never - My superiors evaluate my work based on the activities monitored by these
devices.
□ Very Frequently □ Frequently □ Somewhat Frequently □ Rarely □ Never
Other:
● I experience other symptoms that I believe are work-related:
…………………………………………………………………………………………………
………………………
● There are other aspects of my work experience not covered in this
questionnaire:
…………………………………………………………………………………………………
………………………
Would you like to be contacted for specific issues?
Please leave a phone number or email:
……………………………………………………………………………………………………………
……………
Do you have any illnesses that you haven’t reported to the company doctor?
(Please contact us first for a consultation before doing so)
Yes ( ) No ( )
