Examination according to order 302. How to draw up an order to undergo a periodic medical examination. List of documents from the medical institution
An order for medical examinations is a document that determines the procedure for medical examinations. They help identify problems in the health of employees and prevent occupational diseases in a timely manner. We sorted out what periodic medical examinations are, order 302n and compiled a sample order for undergoing a periodic medical examination.
Periodic medical examinations in 2019 (Order 302n of the Ministry of Health dated April 12, 2011, Articles 212, 213 of the Labor Code of the Russian Federation) are carried out, as before, to monitor the health status of workers and reduce the number of injuries at the enterprise. Periodic medical examination (order 302n establishes the rules of the process) is carried out when exposed to certain harmful factors for specific species labor activity.
Download Order of the Ministry of Health 302n dated 04/12/2011
When and why are periodic medical examinations performed?
The order of the Ministry of Health on conducting periodic medical examinations establishes specific terms for the procedure, which depend on what harmful factor affects the employee and the degree of its danger.
The timing of a medical examination in a medical institution is determined at least once every two years, for some influencing factors and types of activities - at least once a year. Workers under 21 years of age must be tested every year. The Occupational Pathology Center carries out procedures at least once every 5 years.
The order to conduct periodic medical examinations of employees provides for checking for the following risks:
- Chemical (those whose content in the air of the employee’s place of work and on his skin can be measured, including elements of a biological nature derived through chemical synthesis - antibiotics, vitamins).
- Biological (pathogens, spores, microorganisms with pathogenic properties).
- Physical (ionizing and non-ionizing radiation, vibration, noise, high or low ambient temperature).
- The severity of the work process (static and dynamic load, posture during work, weight of loads).
- Intensity of the work process (degree of load on the senses, voice, degree of density of sound and light signals).
Periodic medical examinations 2019 (order 302n) are required for:
Measures to ensure the safety of employee health are carried out on a planned basis and, accordingly, are approved by a local act of the employer.
There is no template for an administrative document defined at the legislative level; it can be generated arbitrarily.
The order for periodic medical examinations must:
- approve the date or schedule for the implementation of procedures;
- identify the person responsible for the process;
- provide information about the medical institution;
- explain responsibility for failure to pass;
- oblige heads of departments to ensure attendance in accordance with the lists;
- familiarize the participants in the process against signature;
- inform about the employee responsible for execution;
- Attach a list of employees who need to be examined.
The document is signed by the head of the institution.
Sample order for periodic medical examinations
Who should undergo treatment and which doctors?
To conduct periodic medical examinations, the employer determines a list of employees (depending on the harmful factors affecting them and the type of work in which they are employed).
The list for medical examination should include the following employees:
- those who are affected by harmful production factors from the list approved by the administrative document of the Ministry of Health;
- those whose work activities are related to the list of types of work and professions provided for in the same document;
- related to transport (Article 213 of the Labor Code of the Russian Federation);
- workers in the food industry, catering and trade, medical and child care institutions, and water supply facilities (Article 213 of the Labor Code of the Russian Federation);
- athletes (Article 348.3 of the Labor Code of the Russian Federation);
- under 18 years of age (Article 266 of the Labor Code of the Russian Federation).
The list of medical specialists and tests that an employee needs to undergo during a periodic medical examination is established depending on the type of work included in the list by the Ministry of Health and the influencing factors.
The medical institution forms a medical commission chaired by an occupational pathologist who has a valid certificate and approves the composition of the commission.
The list of doctors who must examine the employee during a periodic medical examination is given in the table.
| Type of impact | Doctors |
|---|---|
| Chemical |
|
| Biological |
|
| Physical |
|
| Labor |
|
The procedure is carried out by medical institutions of any form of ownership that have the appropriate right.
Who sends for periodic medical examination and how?
The procedure for referral for medical examination is strictly defined. It consists of the following actions by the employer:
- compiles a list of employees, including the name of the type of work and the influencing factor;
- approves the list of the contingent subject to examination (a sample order for undergoing a periodic medical examination - below) and sends it to the territorial agency of Rospotrebnadzor in the region of location;
- sends a list of the contingent and a list of employees by name to the medical institution that will conduct the procedure 2 months before its start;
- introduces employees to the calendar plan at least 10 days before their start;
- provides a referral indicating the name of the employer, form of ownership and type of activity according to OKVED, name of the medical institution, type of examination, full name, position, type of work of the employee and influencing factors;
- Based on the results, draw up a joint final act and receive one copy of it.
Guarantees for employees when undergoing a medical examination
The Labor Code of the Russian Federation in Article 185 provides certain guarantees for employees participating in the medical examination procedure. During the period of examination, the employee must retain his place of work and the average salary.
If markers of an occupational disease are detected, the employee is sent to an occupational pathology center and for the duration of the examination in this center, the employee retains the average salary.
Consequences of failure to undergo a medical examination
The Labor Code of the Russian Federation has made it the employer's responsibility to conduct inspections, and for a number of categories of employees to undergo them. Violation of these provisions will result in sanctions for both parties.
Punishment for the employee
Labor Code of the Russian Federation in Art. 214 directly states the employee's duty. If he is given notice of the procedure, but he refuses, the employer removes the employee from performing functions until the examination is completed. No wages are paid for this period. Disciplinary liability in the form of a reprimand, reprimand or dismissal is also provided.
Punishment for the employer
If control authorities identify employees at an enterprise who have not passed a medical examination, the employer faces a fine in accordance with Part 3 of Art. 5.27.1 Code of Administrative Offenses of the Russian Federation:
To prevent occupational diseases, the occurrence and spread of infectious diseases, and to determine the suitability of employees to perform assigned work, preliminary (before starting work) and periodic (during the work) medical examinations are carried out.
According to what order of the Russian Federation are mandatory medical examinations carried out?
To ensure safe conditions and labor protection, the employer conducts medical examinations of employees, the costs of which are paid by the employer.
Mandatory medical examinations are carried out in accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n (hereinafter referred to as the Order).
Who undergoes a medical examination under order 302n?
Periodic medical examinations are carried out in mandatory only some categories (parts 1, 2 of Article 213 of the Labor Code of the Russian Federation), in particular:
- workers who perform work in harmful and dangerous conditions;
- workers performing work related to traffic, including subway workers;
- workers employed in the food industry;
- employees of trade organizations and Catering;
- water workers;
- workers medical organizations;
- workers in child care institutions;
- workers involved in the production and distribution of food products;
- workers providing hairdressing and cosmetic services in public utility organizations;
- medical workers, rescuers, and other water park personnel located in the water area.
Frequency of medical examination
The frequency with which periodic medical examinations are carried out is determined by the factors of the working environment that affect the employee, or by the type of work.
Periodic medical examinations are carried out within the time limits established by the Order.
Employees under 21 years of age undergo medical examinations annually; other employees are subject to medical examinations every 1-2 years.
Medical examination by order 302n: which doctors to undergo
Medical examinations are carried out by state and private organizations that have licenses to conduct medical examinations. To conduct periodic medical examinations, the organization creates a commission of doctors operating on an ongoing basis.
Depending on the conditions of work, as well as taking into account the recommendations of medical specialists, other doctors are involved in conducting a medical examination, in particular an otolaryngologist, a dermatovenerologist, a neurologist, an ophthalmologist, and an allergist.
Medical diagnostics
All employees subject to periodic medical examinations undergo laboratory and functional tests in the form of:
- clinical urine and blood tests;
- fluorography or radiography of the chest organs;
- biochemical screening.
Working women are examined annually by an obstetrician-gynecologist with mandatory examinations: bacteriological and cytological.
For women, breast examination is also provided through mammography or ultrasound once every 2 years. This requirement applies to women over 40 years of age.
Depending on the conditions of work, ultrasound, spirometry, blood tests, including hormonal tests, and other specific medical studies may be additionally performed.
Guarantees for employees when undergoing a medical examination
An employee who is required to undergo a medical examination retains his place of work, position and wage(Article 185 of the Labor Code of the Russian Federation).
Consequences of failure to undergo a medical examination
Since undergoing a medical examination is the employee’s responsibility, if this obligation is not fulfilled or contraindications for performing work are identified based on the results of the medical examination, the employee is not allowed to work (paragraph 4, part 1, article 76 of the Labor Code of the Russian Federation). During the entire period of non-admission to work, the employee is not entitled to wages. But if the employee does not undergo a medical examination through no fault of his own, the period during which the work is not performed is paid to him as idle time.
In accordance with Art. 212 of the Labor Code of the Russian Federation, the employer is obliged to provide his subordinates with safe working conditions. He is also obliged to comply with all labor safety standards - this is a vast and rather complex area in Russian legislation. Occupational safety measures include, among other things, medical examinations of workers. It is regulated by the Order of the Ministry of Health and Social Development on compulsory medical examinations, in force since January 1, 2012.
At the time of entry into force, this act caused a lot of controversy and discussion, and it must be said that they still do not stop. The provisions of the document cover a huge list of professions and jobs, so not only occupational safety inspectors need to study them. We will tell you what the main provisions are contained in order 302n dated April 12, 2011 of the Ministry of Health and Social Development (as amended in 2018-2019). Its full text is in current edition can be downloaded at the end of the article.
Order 302n - general information
Article 213 of the Labor Code of the Russian Federation requires regular medical examinations of workers employed in hazardous industries. The purpose of the measures is to establish suitability for the profession, early detection of health problems among employees and prevention of the spread of infectious diseases.
In fact, the circle of workers who must undergo a medical examination (not only during work, but also at the time of employment) is much wider. The fact is that the harmfulness of working conditions is determined by the SOUTH ( special assessment working conditions). And if it is not carried out or its validity period has expired, then all jobs in an organization that has not passed the SOUT are considered “harmful”.
Expenses for medical services– tests, diagnostics and other procedures are borne by the employer. The duty of employees is to undergo examination. Those who refused the federal law No. 52-FZ “On the sanitary and epidemiological welfare of the population” dated March 30, 1999 prohibits permission to work (clause 4 of Article 34).
The factors determining the need for medical examinations are called by the order of the Ministry of Health and Social Development 302n dated April 12, 2011 “On approval of lists of harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting mandatory preliminary and periodic medical inspections (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions.”
It consists of three applications:
- the first lists potentially dangerous factors;
- the contents of the second are types of work that can only be performed with the permission of medical specialists;
- the third dictates the procedure for organizing medical examinations, presents samples of directions, medical reports and explains how to fill them out.
This order came into force shortly before the dissolution of the Ministry of Health and Social Development. Since then, it has been adjusted several times - already by orders of the Ministry of Health, which was separated from the reorganized ministry.
The current version contains amendments to the first two sections (order No. 801n dated December 5, 2014 amended the lists of harmful factors and contraindications), as well as changes made to clause 20 of Appendix No. 2 “Name of work and professions” by orders of the Ministry of Labor No. 62n, Ministry of Health 49n dated 02/06/2018 and entered into force on 03/16/2018.
Appendix 1. Harmful and dangerous factors
The first appendix, compiled in the form of a table, indicates the circumstances and grounds for carrying out mandatory medical examinations. Unfavorable factors are divided into four groups:
- chemicals – substances and mixtures, allergens, carcinogens, etc.;
- biological – hepatitis B and C viruses, poisons of animals, plants, etc.;
- physical - radiation, radioactive substances, noise from technological equipment (included in 2015 by order of the Ministry of Health No. 801n), etc.;
- labor process factors – physical and sensory stress, etc.
For most factors, the degree of threat to human health is determined by a special assessment of working conditions (SAW).
Other columns of the table contain information:
- how often medical examinations are carried out;
- Which doctors of narrow specialties need to be examined;
- about the tests and procedures required for taking and passing;
- about medical contraindications for work requiring contact with these factors.
For example, an employee of an enterprise working with inorganic nitrogen compounds (clause 1.2.1) needs to be examined by an otolaryngologist and dermatovenerologist once every two years. Mandatory procedures include a study of pulmonary function and an analysis of reticulocytes and methemoglobin levels. Applicants with chronic diseases of the bronchi and lungs cannot apply for a position involving contact with ammonia - order 302n (as amended in 2018-2019) on medical examinations prohibits them from employing them.
Appendix 2. Harmful and dangerous working conditions
The following appendix lists the types of work for which medical examinations are prescribed:
- carried out in the Far North and other territories with a harsh climate, in uninhabited, remote places located far from populated areas with medical facilities - on oil rigs, drilling rigs, geological exploration and hydrometeorological stations, etc.;
- related to natural and man-made hazards - prevention and elimination of accidents, emergencies, gas and oil blowouts in fields;
- involving risk and requiring special physical training - at heights, under water, underground; in the collection service, paramilitary security, etc.;
- involving direct contact with a large number of people - in medical and educational institutions, including preschools, schools and others, in the areas of trade and public catering, consumer and transport services;
- involving contact with food products (food processing, food warehouses, distribution points, as well as transportation of such products);
- on industrial production(related to welding, machine tools, pressure vessels, etc.);
- related to driving vehicles (from crane operator to driver and even elevator operator).
The second appendix of the document, numbered 302n (order of the Ministry of Health on medical examinations as amended for 2018-2019), explains in as much detail as the first how often an employee should visit specific medical specialists. Thus, paramilitary security personnel must undergo a medical examination once a year to confirm their suitability for further service. The medical report must be signed by a neurologist, ophthalmologist, otolaryngologist, dermatovenerologist and surgeon. If problems with hearing, vision and diseases are identified, which are listed by order 302n dated April 12, 2011, Appendix 2 in paragraph 7, the security guard will not be able to continue working.
In addition, there is a list of general tests that every person undergoing a medical examination must undergo. This is a general blood and urine test, ECG, fluorography, blood test for glucose, cholesterol. Mandatory visits to a therapist, psychiatrist and narcologist have been established.
For women, an additional appointment with a gynecologist is required (with bacteriological and cytological analysis, and for women over 40 - also mammography (or ultrasound) once every 2 years).
Appendix 3. Procedure for conducting medical examinations
Order No. 302n regulates the procedure for organizing two types of medical examinations:
- preliminary (at the stage of employment of future employees);
- periodic (regularly among existing employees).
For a preliminary medical examination, the employer must issue a referral to the applicant for vacant position. To the periodic HR services you need to prepare in advance:
- make a list of employees indicating their names, positions, and the nature of the work they perform;
- provide it to the medical institution with which the contract is concluded. Order 302n (as amended in 2018-2019) on medical examinations requires that the list be submitted no later than two months before the start of the procedures;
- after approval of the list, send it to the sanitary and epidemiological inspection within 10 days;
- familiarize employees with the medical examination calendar at least 10 days before the event;
- give them directions.
A conclusion on the examination completed is issued by a commission headed by an occupational pathologist. Based on medical recommendations, extraordinary examinations may be scheduled.
Responsibility
Failure to comply with the requirements of Article 213 of the Labor Code of the Russian Federation and the order of the Ministry of Health on examinations for professional suitability will result in a fine (Part 3 of Article 5.27.1 of the Code of Administrative Offenses of the Russian Federation):
- from 15,000 to 25,000 rubles – for officials and individual entrepreneurs;
- from 110,000 to 130,000 rubles – for legal entities.
At the same time, liability can arise even for untimely medical examinations of office workers, which is confirmed by the Supreme Court decision No. 34-AD17-5 dated December 6, 2017, which considered a fine of 120,000 rubles imposed on a Murmansk company selling cars and spare parts justified. The highest judicial body of Russia considered the argument that employees who did not undergo a medical examination - specialists performing analytical work - to be untenable: after studying the case materials, the Supreme Court of the Russian Federation came to the conclusion that all employees of trade organizations must regularly undergo medical tests and be examined by doctors.
Order of the Ministry of Health and Social Development of Russia No. 302n dated April 12, 2011
On approval of lists of harmful and (or) dangerous production factors and work, during the performance of which preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with hazardous and (or) hazardous working conditions.
In accordance with Article 213 Labor Code Russian Federation(Collected Legislation of the Russian Federation, 2002, No. 1 (Part 1), Art. 3; 2004, No. 35, Art. 3607; 2006, No. 27, Art. 2878; 2008, No. 30 (Part 2), Art. 3616) and clause 5.2.100.55 of the Regulations on the Ministry of Health and social development of the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 2004 No. 321 (Collected Legislation of the Russian Federation, 2004, No. 28, Art. 2898; 2009, No. 3; Art. 378),
order:
1. Approve:
1. list of harmful and (or) dangerous production factors, in the presence of which mandatory preliminary and periodic medical examinations (examinations) are carried out, according to Appendix No. 1;
2. a list of works during the performance of which mandatory preliminary and periodic medical examinations (examinations) of workers are carried out, in accordance with Appendix No. 2;
3. The procedure for conducting mandatory preliminary (upon entry to work) and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions, in accordance with Appendix No. 3.
2. Enact lists of harmful and (or) dangerous production factors and work, during which preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting preliminary and periodic medical examinations (examinations) of workers engaged in heavy work and work with harmful and (or) dangerous working conditions, from January 1, 2012.
3. Recognize as invalid from January 1, 2012:
0. Order of the Ministry of Health and Medical Industry of the Russian Federation dated March 14, 1996 No. 90 “On the procedure for conducting preliminary and periodic medical examinations of workers and medical regulations for admission to the profession” (according to the conclusion of the Ministry of Justice of Russia, document in state registration does not need, letter dated December 30, 1996 No. 07-02-1376-96);
1. Order of the Ministry of Health and Social Development of the Russian Federation dated August 16, 2004 No. 83 “On approval of lists of harmful and (or) hazardous production factors and work, during the performance of which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these inspections (examinations)" (registered by the Ministry of Justice of the Russian Federation on September 10, 2004 No. 6015);
2. Order of the Ministry of Health and Social Development of the Russian Federation dated May 16, 2005 No. 338 “On amendments to Appendix No. 2 to the order of the Ministry of Health and Social Development of Russia dated August 16, 2004 No. 83 “On approval of lists of harmful and (or) hazardous production factors and work during which preliminary and periodic medical examinations (examinations) are carried out, and the procedure for conducting these examinations (examinations)” (registered by the Ministry of Justice of the Russian Federation on June 3, 2005 No. 6677).
4. Establish that from January 1, 2012, subparagraphs 11, 12 (with the exception of subparagraphs 12.2, 12.11, 12.12), 13 of Appendix No. 2 to the order of the USSR Ministry of Health dated September 29, 1989 No. 555 “On improving the system of medical examinations of workers and individual drivers Vehicle».
Minister
T.A. Golikova
