Evaluation of Results in Pre-Employment Health Examinations and Tests in Terms of Diseases

Pre-employment medical examinations are not limited to issuing a “fitness for work” certificate. This process is a critical preventive medicine practice in terms of assessing the employee's current health status, analyzing their compatibility with occupational risks, and fulfilling the employer's legal responsibilities.

From the perspective of the Joint Health and Safety Unit (OSGB), the accurate interpretation of test results obtained during pre-employment medical examinations correct interpretation of test results in terms of diseases is a fundamental step in both protecting employee health and preventing work accidents and occupational diseases.

1. The Primary Purpose of Pre-Employment Medical Examinations

Pre-employment medical examinations conducted under the Occupational Health and Safety Law No. 6331 have the following objectives:

• Identify the employee's existing chronic or acute illnesses
• Match occupational risks with health status
• Base the decision on job suitability on scientific data
• Prevent diseases that could progress through early diagnosis
• Ensure that the employer fulfills their legal obligations

At this point, the assessment is not merely labeling laboratory results as “normal/abnormal,” but rather interpreting them based on risk according to the nature of the job.

2. Frequently Performed Tests and Evaluation in Terms of Disease
3. A) Hemogram (Complete Blood Count)

Purpose: Screening for anemia, infection, hematological diseases

What is a Hemogram (Complete Blood Count)?

A hemogram is a test that counts the different types of cells in the blood and examines the size, shape, and other characteristics of these cells. This test determines the number and ratio of blood cells, especially red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. A hemogram is used in the diagnosis of many health problems such as anemia, infections, immune system disorders, and cancer.

The Importance of Hemogram Testing in Occupational Health

Within the scope of occupational health, the hemogram test is an important tool for monitoring the general health status of employees and detecting occupational diseases at an early stage. This test is particularly important in the following areas.

Assessment of Anemia and Fatigue Complaints

Employees' complaints of constant fatigue and weakness can often stem from blood-related problems such as anemia. A hemogram test helps detect the presence of anemia by measuring the number of red blood cells and hemoglobin levels. Anemia can negatively affect work performance and therefore early diagnosis is important.

Evaluation of Infection and Immune System

The number of white blood cells indicates how the body fights infections. A hemogram test measures the number and ratio of white blood cells, assessing employees' resistance to infections and the overall state of their immune system.

Function of Platelets and Assessment of Bleeding Risk

Platelets play a role in blood clotting. A low platelet count can increase the risk of bleeding. The hemogram test helps identify potential bleeding risks by evaluating the number and function of platelets.

Monitoring Occupational Diseases

In various occupations, especially among workers exposed to chemicals, radiation, or other harmful agents, these exposures may have adverse effects on blood cells. A hemogram test can be used to detect such exposures at an early stage and take the necessary precautions.

Evaluation Criteria:

• Low hemoglobin (Hb):
• Iron deficiency anemia
• Chronic disease anemia
• Hidden blood loss
• May pose a risk in heavy physical work
• High white blood cell (WBC) count:
• Active infection
• Inflammation
• Smoking
• Platelet abnormalities:
• Risk of bleeding or clotting

The occupational health physician makes the “fitness for work” decision based on the physical requirements of the job, especially in the presence of anemia in heavy and hazardous work.

1. B) Chest X-ray

Purpose: Screening for tuberculosis, chronic lung diseases, and occupational lung pathologies

What is a Chest X-ray?

A chest X-ray is a medical test that uses X-rays to produce images of the chest area. This test allows for detailed examination of the structure of the lungs, bronchi, heart, and other organs in the chest cavity. In the context of occupational health and safety, chest X-rays are used for the early detection of possible abnormalities in the respiratory system of employees.

The Importance of Chest X-rays in Occupational Health and Safety

Early Diagnosis of Occupational Diseases: Chest X-rays are of vital importance, especially for workers in industries such as mining, construction, textiles, and chemicals, where there is a high risk of exposure to dust or chemicals. Harmful substances accumulated in the lungs can lead to serious respiratory diseases in the long term. These X-rays are used to detect these risks to which workers are exposed at an early stage and to take the necessary precautions.

Detection of Tuberculosis and Other Respiratory Diseases

Chest X-rays also play a critical role in the early diagnosis of infectious diseases such as tuberculosis. Early detection of these types of diseases is important both to prevent the spread of the disease and to protect the health of employees.

Periodic Health Checks

In accordance with occupational health and safety regulations, it is mandatory for individuals working in certain sectors to have regular chest X-rays. These periodic checks are important for monitoring the impact of risk factors in the workplace on employees and intervening when necessary.

Reporting Chest X-rays

After the chest X-ray is taken, these images must be evaluated and reported by a specialist radiologist. The reporting process is important to determine whether there are any abnormalities in the lungs and, if so, to identify the severity of the condition and its possible causes.

Normal Findings

If the radiologist does not detect any pathological findings on the chest X-ray, the report is considered “normal.” This means there is no health risk for the employee.

Abnormal Findings

If an abnormality is detected in the X-ray, this is detailed in the report. For example, conditions such as pulmonary fibrosis, pneumoconiosis, tuberculosis, or pneumonia may be identified. The presence of abnormal findings may indicate that potential risks in the workplace need to be re-evaluated.

Recommendations for Further Examination

During the reporting process, further examinations or referral to a specialist may be recommended based on the findings detected in the X-ray. This is the next step to be taken to protect the employee's health.

Lung X-Ray Applications in Occupational Health and Safety

Chest X-rays are an integral part of occupational health and safety programs. Regular testing is critical to protecting the health of employees in the workplace and preventing occupational diseases. By providing this service to their employees, employers fulfill their legal obligations and ensure a healthy and safe working environment in the workplace.

Possible Findings:

• Tuberculosis sequelae
• COPD findings
• Early signs of silicosis
• Fibrotic changes

Chest X-ray findings are of great importance for personnel who will work in dusty environments. If there are any risky radiological findings, further examination may be requested or a change of duties may be recommended.

1. C) Respiratory Function Test (RFT)

Purpose: To assess respiratory capacity

What is a Respiratory Function Test?

A Respiratory Function Test measures how much air the lungs can take in, how quickly they can expel this air, and how efficiently the lungs exchange oxygen and carbon dioxide. PFT is used in the diagnosis and monitoring of respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and fibrosis.

The Importance of Pulmonary Function Testing in Occupational Health and Safety

SFT is a critical test for monitoring the health status of employees exposed to harmful substances that may affect the respiratory tract in the workplace. This test is of great importance in terms of occupational health and safety for the following reasons:

Early Diagnosis of Occupational Diseases

Workers who are exposed to dust, fumes, chemicals, or other harmful particles in the workplace for long periods of time may be at risk of decreased respiratory function over time. SFT helps prevent occupational diseases by detecting the effects of such exposure on the lungs at an early stage.

Monitoring Workers' Respiratory Health

SFT ensures that workers who are susceptible to respiratory diseases or at risk for such diseases are regularly monitored. This allows for early diagnosis and the necessary treatment or preventive measures to be taken.

Assessment of Risk Factors in the Workplace

SFT results can be used to assess the effects of potential hazards in the workplace on employees. If a decrease in respiratory function is observed in more than one employee, workplace conditions may need to be reviewed and improved.

Interpretation in Terms of Disease:

• Obstructive pattern → Asthma, COPD
• Restrictive pattern → Fibrotic diseases
• Mild impairment → Close monitoring is recommended

SFT results are critically important for individuals who will be working in chemical, dusty, or gaseous environments. 

1. D) Audiometry (Hearing Test)

Purpose: To determine the baseline hearing level in personnel who will work in noisy environments

What are Audiometers and Hearing Tests?

An audiometer is a device used to measure hearing ability. This device produces sounds at different frequencies and intensities to test a person's ability to hear these sounds. A hearing test evaluates the overall health of the hearing sense by determining at what level and frequency a person can hear sounds.

The Importance of Audiometry Testing in Occupational Health

Hearing loss is a common problem, especially in industrial and manufacturing sectors. Prolonged exposure to noise can cause irreversible damage to hearing ability. Audiometry testing plays a critical role in protecting workers' hearing health by detecting early signs of such exposure.

Prevention of Occupational Hearing Loss

Hearing loss is common among employees exposed to high noise levels in the workplace. Audiometry tests enable the early diagnosis of such losses and help employers prevent the progression of hearing loss by taking the necessary precautions.

Monitoring Noise Exposure

Audiometry is used to monitor the effects of noise levels in the workplace on workers' hearing health. These tests enable the determination of necessary noise control measures and the evaluation of the effectiveness of workplace noise control programs.

Compliance with Occupational Health and Safety Regulations

Occupational health and safety regulations in many countries require regular audiometry tests to prevent hearing loss. These tests help employers fulfill their legal obligations and offer a proactive approach to protecting employee health.

Assessment:

• 4000 Hz threshold → Onset of noise-induced hearing loss
• Unilateral loss → Further evaluation required

From an OSGB perspective, it is important to record the baseline value. These data play a critical role in occupational disease claims in subsequent years.

1. E) Biochemical Tests (Liver, Kidney, Blood Sugar)

Biochemistry Tests are important laboratory tests used to assess the general health status of employees in the field of occupational health and safety, monitor the effects of potential risks in the workplace, and diagnose occupational diseases early. These tests are performed by measuring specific biochemical parameters in blood, urine, or other body fluids and provide critical data for protecting the health of workers in the workplace.

The Importance of Biochemical Tests in Occupational Health and Safety

Biochemical tests are used to monitor the effects of environmental factors to which employees are exposed at work on their health and to assess their general health status. These tests are of great importance in occupational health and safety for the following reasons:

Early Diagnosis of Occupational Diseases

Chemicals or other harmful agents that employees are exposed to in the workplace can lead to various occupational diseases in the long term. Biochemical tests are used to detect early signs of such exposure. For example, parameters such as liver enzymes, kidney function, blood sugar levels, and electrolyte balance can indicate potential health problems.

Monitoring the General Health Status of Employees

Biochemical tests are part of regular health screenings conducted at regular intervals to monitor the general health status of employees. These tests are particularly important for monitoring the condition of employees who are prone to chronic diseases and for early intervention when necessary.

Risk Assessment and Preventive Measures

Biochemical tests can be used to assess the effects of chemical, biological, and physical risks in the workplace on employees. These tests can identify the adverse effects of hazardous work environments on employees and enable the necessary preventive measures to be taken.

Areas of Assessment:

• High ALT/AST → Liver dysfunction
• High creatinine → Kidney function problem
• High fasting blood sugar → Suspected diabetes

Liver function tests are particularly important for personnel working with chemicals. For employees with diabetes, tasks such as working at heights or shift work should be reevaluated.

3. Chronic Diseases and Fitness for Work Decision

The OSGB workplace physician additionally evaluates the following chronic diseases:

• Hypertension
• Diabetes
• Epilepsy
• Coronary artery disease
• Psychiatric disorders

The basic principle here is as follows:

The presence of a disease alone does not prevent employment; the relationship between risk and disease is decisive.

For example:

• Working at heights may not be suitable for patients with epilepsy.
• Individuals with uncontrolled hypertension may be at risk in strenuous jobs.

4. Medical Responsibility for the “Fit for Work” Decision

The fit-for-work decision can be given in three categories:

1. Fit for work
2. Fit for work with restrictions
3. Not fit for work

This decision is based on:

• Medical findings
• Risk analysis of the job
• The employee's medical history
• Regulatory provisions

is formed by evaluating these factors together.

5. Legal and Ethical Dimension

Pre-employment examination results:

• It is personal health data
• It must be protected under the KVKK (Personal Data Protection Law)
• Only the “suitability result” is shared with the employer
• Diagnostic information is confidential

The OSGB has both medical and legal responsibilities here.

6. Risk-Based Assessment Model in OSGBs

The modern OSGB approach does not rely solely on test results. The following parameters are evaluated together:

• Hazard class of the job
• Type of exposure (dust, chemicals, noise, vibration, etc.)
• Working hours
• Shift system
• Personal protective equipment status

This comprehensive approach protects employee health and minimizes the legal risks that employers may face in the future.

Pre-employment medical examinations are not a mere formality

Pre-employment health examinations form the basis for early diagnosis, prevention of occupational diseases, and a safe working environment.

Thanks to a scientific and careful outcome assessment conducted by the Occupational Health and Safety Services Organization (OSGB):

• Workplace accidents decrease
• Occupational diseases are prevented
• Employee productivity increases
• Employers are protected from legal risks

Healthy employees mean a safe workplace.