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Risk Assessment : a case study

By Phina Amahoro

Published 12 September 2023


One of the primary goals of public health is to establish conditions that allow people to live healthy lives for as long as feasible. People are believed to spend around one-third of their lives at work. As a result, protecting the health of the working population through occupational health services has been recognised as an important component of public health strategy (WHO, 2001).

Occupational Health Nurses (OHN’s) deploy a variety of evidence-based clinical and risk management interventions to ensure that an employee’s work tasks do not have a negative impact on their health (WHO, 2001).

This case study will outline the health and safety recommendations provided to a local authority in accordance with evidence-based clinical and risk management guidance.



The author was contracted by a maintenance team manager regarding occupational health advice. Management provided information about the employees’ occupational health history which included stress (work-related) and epilepsy.

The Health and Safety Executive (2009) advises employers on how to keep their employees physically and psychologically safe at work. According to the HSE, all workers have the right to work in environments where risks to their health and safety are effectively managed (Health and Safety and Executive, 2009).

Work Stress

The Health and Safety Executive (HSE) has identified six fundamental features that can contribute to work-related stress in the workplace (Health and Safety Executive, 2019). These features will be addressed in the section below and linked to the employee-reported workplace issues. According to HSE (2022), the estimated number of workers in the United Kingdom suffering from a work-related illness is 1.8 million, with stress, depression, and anxiety accounting for over half of all instances.

Epilepsy and work

It is estimated that 50 million worldwide suffer from epilepsy, Epilepsy is defined as recurrent, unpredictable, and usually unprovoked seizure activity. Individuals with epilepsy are among the most vulnerable members of society because epilepsy is a hidden disability that remains a highly stigmatized condition to this day (Mula and Kaufman, 2020).

Evidence suggests that individuals with epilepsy face several challenges when it comes to finding and obtaining employment (De Boer, 2005). There are a variety of external factors that contribute to the disadvantages that individuals with epilepsy encounter when it comes to finding and retaining work. Researchers observed that employers were often unfamiliar with the different types of epilepsy, the varying ways in which epilepsy can affect different people, and the fact that anti-epileptic drugs can control the condition in some people (Francis, Byford and Wilson, 2019). The aforementioned factors were considered when developing a robust OH intervention plan for the employee in question.

Occupational Health interventions

The management team informed the author that the employee had recently had frequent sickness absences, all of which were attributed to work stress. The maintenance worker was initially hired as a Slater. However, in the last 18 months, the individual has been redeployed to another position – working in a canteen. The employee is currently absent from his workplace due to reported work-related stress.

An initial fitness for work assessment was conducted as soon as operationally feasible as evidence suggests that intervention-based case management in OH can result in people returning to work sooner, which is cost-effective for the organization (Parsons et al., 2021).

Following a recent absence, the author assessed the employee’s fitness for work and discovered that the source of the perceived work stress was twofold. The author discovered that the employee had a known epilepsy diagnosis and had a single seizure 18 months ago. This appeared to be the first seizure in a decade. The employee stated that he experienced multiple absences due to work-related stress during the 18-month period of redeployment. The employee felt unsupported by the management team and desired to return to his substantive work as a slater. The author wished to gain clarity on the employees’ health history. To do so, further medical evidence was sought from the employees’ GP and neurologist. The employee’s treating specialists provided evidence about the employee’s medical diagnosis, how his condition presents, and what treatment pathways have been recommended.

HRA findings

The first level of risk management in the workplace is risk assessment. It is the process of considering all of the aspects in a given circumstance, including recognising the dangers, the potential degree and nature of any risk, and those who may be affected (Williams, Dotson and Maier, 2012).

Risk assessment’s findings serve as the foundation for ongoing planned management. Risk management is a plan, strategy, or programme that tries to manage an incident, event, or danger by removing or lowering factors that may cause harm and allowing any chance for beneficial outcomes to be taken as safely as possible (Aven, 2016).

Stress risk Assessment

  1. Demands – The employee reported working in a deployed role where tasks allocated did not match his skill set and where he felt that his specialist skills were not being utilized.
  2. Control – The employee stated that he felt that he had little control over his current work environment and whether he would be able to return to his substantive post.
  3. Support – The employee stated that he had not had much interaction with management since changes in management structure, and his health/work situation had not been reviewed as previously recommended.
  4. Relationships at work – The employee reported that he was having difficulty blending in with the catering staff because they had been working together for many years and had a fixed ‘culture’. He added that he missed his colleagues in his substantive role, with whom he had worked for many years.
  5. Role – The employee was unclear as to why, after several months in his redeployed function and with his condition having stabilized, he had not yet been reviewed or spoken with management about the possibility of returning to his previous role.
  6. Change – The employee felt that the combination of changes in management structure, his job role, and the changes to his typically good attendance record were all too much and that he was unable to envision staying in the workplace if things remained the same.

Epilepsy Risk Assessment

The author was able to provide management with advice on health, safety, and risk management for this individual employee after reviewing and observing the employee’s medical history and specialist reports. According to the employee’s specialist, the individual had focal (partial) seizures without loss of consciousness. It was established that the diagnosis was given to him as a child, and he had been seizure free for ten years. It was noted that the disease was adequately managed with prescription anti-epileptic drugs, and that the seizure 18 months prior was caused by unforeseeable circumstances. It was noted that the employee had gone on holiday without taking his prescribed medication for ten days.

Regarding risk management and the employee’s role, the author’s OH opinion was that the employee was fit for his substantive role which includes working from heights with a few recommendations. The employee should always be harnessed and wear protective headgear when working at heights, he should never be the first ascender and these recommendations should be kept in place for a minimum of 2 years. The author carried out an individual risk assessment with guidance from the specialist report and Epilepsy Action.  The risk assessment was to be reviewed and updated every 6 months.


Risk management in the workplace is determined by four pillars. These include the employees’ current capacity to perform their work tasks and whether they have any physical or psychological issues that may interfere with their performance. The other three pillars entail the employees’ work tasks, work means / equipment, and the working environment. Collaboration between management and employees is required for occupational health to provide effective health and safety advice. Employers must follow good safety practices established by legal frameworks from apt governing authorities and legislation. (Jardine et al., 2003). Occupational Health Services (OHS) play an essential role in protecting all workers’ health and wellbeing. Our primary engagement with employers as OH practitioners is through management referrals. Ensuring that all Bio-Psycho-social components and workplace contributors are addressed in a consultation allows OHN’s to provide fitness-for-work(Nicholson, 2017) advice as well as education and support for those managing the employees.


Headshot Phina Amahoro
Phina Amahoro |Baba Yangu Foundation

Phina is a Specialised Occupational Health Nurse (SCHPN) currently working for PAM Group. She is particularly passionate about community health and is a trustee of a charity focusing on tackling mental ill-health within the African / Caribbean communities – Baba Yangu foundation



OH Today Spring 2023
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