In Australia, road and rail drivers account for approximately 80% of all machine operator fatalities. 

Each year, for the past 5 years, an average of 50 road and rail drivers experience some form of fatal injury. With the number of Australians relying on goods and public transport increasing, maintaining rail worker safety is more important than ever. 

The National Standard for Health Assessment of Rail Safety Workers, provides rail operators and health professionals with guidance on how to manage rail worker health conditions which may affect their ability to perform their job safely. 

Since its conception in 2004, the Standard is reviewed regularly by an experienced and diverse team of health practitioners, government transport departments, rail operators, rail safety regulators and unions to ensure all health assessments and recommendations are current and in-line with emerging scientific evidence. 

Below, we summarise the key changes made to the 2024 Standard.

Revision 1: Cardiac risk assessments

Authorised Health Professionals (AHPs) must utilise the newly updated Australian Cardiovascular Risk Calculator  to determine the risk of any Category 1 rail worker (e.g. train drivers and shunters) experiencing a cardiac event within the next 5 years.

The new calculator is based on Australian and New Zealand data, and therefore, more accurately identifies individuals in the Australian population who are at risk of developing heart disease or experiencing a stroke. Additionally, the calculator accounts for:

• the presence of atrial fibrillation (irregular heartbeat)
• the presence of diabetes and insulin use.

Q: What if an individual is identified as high-risk?

A: The 2024 revisions aim to minimise unnecessary visits to health specialists, if an individual is already being appropriately managed by a general health practitioner.

• Individuals identified as high-risk, must be referred to a cardiologist of their choosing.

REVISED: Individuals with existing heart conditions, will no longer be required to complete an exercise stress test (unless it is recommended by a cardiologist).

Revision 2: Sleep disorder screening

To adopt more standardised testing for the assessment of obstructive sleep apnoea, the Standard now requires all category 1 and 2 workers (e.g. rail safety workers) to be screened using the STOP-Bang questionnaire in addition to the Epworth Sleepiness Scale. 

Q: What is the STOP-Bang questionnaire?

A: The STOP-Bang questionnaire consists of 8 'yes/no' questions which can allow AHPs to assess how many risk factors are relevant to a worker. The questionnaire tests a range of factors which can broadly categorised as:

• self-perception factors (e.g. intensity of snoring and daytime tiredness)
• physical factors (e.g. blood pressure, neck circumference, body mass index, age and gender).

Revision 3: Inclusion of neurodevelopmental disorders

The Standard has been revised significantly to more specifically address health assessments of neurodevelopmental disorders, e.g. autism spectrum disorder and attention deficit hyperactivity disorder (ADHD).

Q: How does the health assessment differ?

A: Category 1 and 2 rail workers must declare any neurodevelopmental disorders. Fitness for Duty is ONLY assessed based on the impacts of the disorder on performance/functional ability. The individual is NOT assessed based on the diagnosis alone.

Revision 4: Health assessment notifications

To support increased transparency between rail operators and rail workers, the Standard now requires all operators to notify workers of upcoming assessments in writing  atleast 10 working days  prior to the scheduled health assessment.

Specifically, operators should advise employees:

• the reason(s) for which the assessment has been scheduled
• details of which health assessment is scheduled
• appointment details (e.g. date, time and place).

Operators and employees may mutually agree to a shorter notice period.

Revision 5: Authorised Health Professionals

To ensure that every rail medical performed nationwide is assessed against the same criteria and is conducted in a consistent fashion, all operators must utilise AHPs to conduct their assessments.

An AHP has undergone standardised training and passed competency assessments to the satisfaction of an experienced Chief Medical Officer.

Only AHPs can perform and assess an individual's Fitness for Duty or fitness for return to work, even if an individual is managed by a separate general health practitioner.

Q: Where do you find an AHP?

A: As of 11 November 2024, only AHPs who have been briefed on Standard changes are eligible to conduct rail assessments. To search for an eligible AHP, head to the official AHP Program website.

Revision 6: Revised 'Fitness for Duty' categories

In line with the improvements to medical assessments and the management of pre-existing health conditions, the Standard has revised its Fitness for Duty categories.

The 2024 Standard no longer includes a 'Fit for Duty (conditional)' category.

The four categories are now:

• Fit for Duty (Unconditional)
• Fit for Duty (Subject to Review)
• Temporarily Unfit for Duty
• Permanently Unfit for Duty.

There is also space to record any appropriate aids that the worker wears/or must wear when undertaking rail safety work and job modifications that have been put in place/will be required for the worker, irrespective of the outcome.

This revision ensures that all rail workers benefit from improved health monitoring. Please note, that while this revision allows for improved monitoring, this does not equate to more individuals being found Unfit for Duty.

Revision 7: Updated privacy measures

The privacy guidelines included in the 2024 Standard have undergone significant revisions to better manage rail workers' private health information. 

Operators should:

• only receive the outcome of a worker's Fitness for Duty rather than the entire medical 
• ensure they have internal processes in place (e.g. Privacy Policy) that detail how the organisation prevents unauthorised access to workers' medical information
• develop processes for notifying, supporting and managing data breaches (if they occur).

Revision 8: Form requirements

To facilitate increased transparency and higher quality assessments, operators must now provide the following information:

• Worker Notification and Questionnaire – the reason for initiating a health assessment and who it was requested by. Includes additional prompts for neurodevelopmental disorders and illicit drug use.
• Request and Report Form– information about the specific physical requirements of a worker's role.

The full 2024 Standard and additional resources can be found HERE.