How to keep people healthy when working at height

IOSH’s Research Programme Lead for Occupational Health Dr Karen Michell explores the health issues that can be faced when people work at height and how these can be managed.

For many of us, heights can be unsettling. Some can have acrophobia, an intense fear of heights that can trigger anxiety or panic attacks. For others, the issue is vertigo, a disorienting sensation of spinning or dizziness caused by various medical conditions.

Even without a diagnosed condition, some people simply feel uneasy or insecure when looking down from a great height. Fortunately, most of us can choose to avoid these triggers and steer clear of situations that provoke such fears.

The need for work at height

However, for many workers, operating at height is an essential part of their job.

Around the world, individuals in a wide range of occupations are expected to work at elevation.

This doesn’t just include those working in construction, which is the most obvious example. Other roles include firefighting, window cleaning, crane operation, and electrical work.

In some cases, the heights involved are extreme – for instance, technicians performing maintenance on wind turbines may need to ascend as high as 120 metres above the ground^{ref 1}.

Some countries have introduced explicit legislation to safeguard the health and safety of workers operating at height. Notable examples include the UK’s Work at Height Regulations 2005^ref2 and South Africa’s Construction Regulations 2014^{ref 3}.

These laws place a clear responsibility on employers to protect workers by implementing appropriate safety measures.

While much of this legislation outlines specific requirements - such as fall protection plans and fall prevention systems – the requirement to assess and ensure the medical fitness of workers is often not explicitly stated.

Although this obligation is frequently implied through broader duties of care and risk assessment, the message can easily be overlooked or misinterpreted, leading to inconsistent implementation.

"Given the inherent risks associated with working at height, it is considered best practice - and in some cases a legal requirement - to ensure workers undergo a medical assessment to confirm their fitness for such tasks."

Dr Karen Michell

Job role: Research Programme Lead; •
Company: IOSH

These assessments typically include a range of tests and examinations designed to determine an individual’s overall health and their ability to work safely at elevation.

Importantly, the accompanying risk assessment should be site- or task-specific. It should identify not only the hazards related to height but also any additional risks that may impact worker safety.

For example, working at height in confined spaces – where movement is restricted - introduces further health considerations. In such cases, the medical evaluation should also assess factors like mobility to ensure the worker is fully capable of performing the task safely.

Assessments for working at height

What can you expect from a medical assessment for working at height?

Occupational health professionals (OHPs) begin by reviewing the risk assessment or job exposure matrix to understand the specific nature of the work and the associated hazards.

This information forms the foundation of the medical evaluation, helping to identify any health conditions that may compromise a worker’s safety at height.

The following is a list of health conditions the OHPs would be assessing while conducting the assessment, and why.

Neurological conditions

Conditions such as epilepsy, vertigo, frequent migraines, or a history of fainting or blackouts pose a significant risk due to the potential for sudden incapacitation or loss of balance.
Cardiovascular conditions

Issues like uncontrolled hypertension, cardiac arrhythmias, or a recent heart attack or stroke may lead to dizziness, fatigue or sudden collapse – greatly increasing the risk of a fall.
Respiratory conditions

Tasks involving physical exertion at height require adequate oxygenation and stamina. Conditions such as severe asthma, chronic obstructive pulmonary disease (COPD) or breathlessness on exertion may impair a worker’s ability to perform safely.
Musculoskeletal disorders

Conditions affecting grip strength, mobility or limb function can hinder a worker’s ability to climb ladders or scaffolds safely. Injuries or limitations in movement are carefully assessed.
Mental health conditions

Anxiety, panic disorders, acrophobia (fear of heights), or claustrophobia (fear of confined spaces) can cause distress or disorientation, increasing the risk of an incident.
Certain medications

Examples include sedatives, antihistamines or strong painkillers. These may cause drowsiness, dizziness, impaired coordination or reduced concentration, all of which can compromise safety at height.

These medical assessments are conducted at predetermined intervals. The frequency can be influenced by several factors, including relevant legislation, the worker’s age and health status, the nature of the task, and the specific hazards involved.

The results of the assessment are treated as confidential medical information. Employers or occupational safety and health (OSH) practitioners typically receive only a professional opinion regarding the worker’s suitability for working at height – classified as fit, unfit or fit with restrictions.

The role of the OSH practitioners is to ensure these medical assessments have been conducted by competent OHPs and to follow the guidance offered by these professionals.

Given that falls remain one of the leading causes of occupational fatalities^ref4, ensuring medical fitness plays a critical role in accident prevention and in fostering a strong culture of workplace safety and health.