The Fitness for Work Judgement 
We do not intend to discuss the merits of the complex questions pertaining the criteria used to express the above-mentioned judgement (fitness with or without conditions, temporary or permanent unfitness) that probably represents the most delicate and exacting task for the competent doctor within a strictly technical context, also due to the parties' possibility of resorting to the supervisory authorities responsible for the specific area within thirty days after the communication date (article 17, section 4); the importance that the involved decree gives to the dangers linked with a potentially noxious working activity must nevertheless be underlined.  
Article 3, section 1, letter m), in fact, also provides for the “workers' removal from the exposure to risk due to health reasons involving them”.  
The general applicability of such provision, although it cannot easily be interpreted as far as permanent or temporary fitness judgements are concerned, might create some problems in case workers who previously left their work due to serious health issues resume their jobs.  
It could thus create serious problems from medical and legal standpoints in case they resume the specific job which had previously been recognised as being pathogenic (a professional disease indemnified by the National Insurance Institute for Industrial Accidents), considering article 590 of the penal code as changed by the law 689/91 (“... The crime (of negligent personal injuries - editor's note) can be prosecuted... only for accidents at work and pertaining industrial hygiene or that caused a professional disease”) and article 136 of the Presidential Decree 1124/65 (“... if the unfitness can be reduced by permanently or temporarily leaving the job that caused the disease, and the hired person does not intend to cease his/her work, the revenue will be adjusted according to the lowest degree of presumable unfitness...”).  
Such provision, that the National Insurance Institute for Industrial Accidents does not apply, seems however to be surpassed by the provision of article 4, sections 5 and 17, section 1, letter a) that lays down the employer's obligation, along with the competent doctor, to take all the measures necessary to “protect the workers' safety and health”, which clearly include the general measures reported in the mentioned article 3 that ultimately represents the involved provisions' mainstay.  

Special health controls requested  
by the worker  

The involved decree later introduced an important novelty pertaining sanitary surveillance with article 17, section 1, letter i) that concerns the worker's possibility of undergoing health controls upon his/her request “in case such request is linked to professional risks”.  

Advice to the employer  

Article 17, section 1, in agreement with what is set down in other parts of the decree, also lays down several other exacting tasks for the competent doctor, most of which are included by the Legislative Decree 277/91 and thus now pertains almost all workplaces.  
Within this context, an advice activity for the employer is not a novelty also because it is consistent with the principles that inspired the community provisions. Such advice activity includes:  
- the proper measures to be taken in order to protect the workers' health (article 17, section 1, letter a);  
- the planning of the workers' exposure to specific corporate risks following a control of the workplaces at least twice a year (article 17, section 1, letter a) and h));  
- the setting up of a first-aid service (articles 15 and 17, section 1, letter l);  
- workers' training and information services (article 17, section 1, letter m), 21 1 22).  
As far as the workers and their representatives are concerned, on the other hand, the competent doctor must perform general and specific sanitary information tasks:  
- explaining the meaning of sanitary controls and, in case of exposure to long-term agents (carcinogenic and biological agents according to the provision of articles 69, section 6, 70, section 3, 71, 86, section 2-quater, 87, section 4 and 88), need of further controls also after the termination of the work (article 17, section 1, letter g));  
- communicating to the involved workers the results of the sanitary controls and possible issuing, upon request, of the relative sanitary documents (article 17, section 1, letter f)).  
As far as the provisions specifically laid down by the decree concerning the sanitary surveillance of the workers professionally exposed to specific chemicals, physical and biological agents, the following remarks can be set down.  

Sanitary surveillance  
for people working  
with hand-operated machines  

For people who manually move things, it is important first of all to underline how the provisions concerning the sanitary surveillance of the workers involved is connected with the existence of “risks of dorsal and lumbar injuries” that the law defines as “injuries to osteomiotendinous and nervovascular apparatus at a dorsal and lumbar level”.  
As far as the methods to be adopted in order to concretely carry out the tasks connected with the surveillance of the workers of the above-mentioned field, unfortunately the competent doctor does not even have general normative instructions pertaining the standards to grant fitness in the preventive examination and especially the recurrence of the medical examinations.  
Because of the impossibility of referring by analogy to any of the points included in the table of the Presidential Decree 303/56 and awaiting the setting up of a proper scientific panel able to give valid information, it would be important to generally propose recurrent medical controls pertaining dorsal and lumbar risks (the only risks specified in the previously mentioned legislative decree) in order to avoid the possible constant resort to only special examination requested by the single worker (article 17, section 1, letter i)).  

Sanitary surveillance  
of people working  
with computers  

As far as the sanitary surveillance of people working with computers is concerned, the involved decree gives a whole series of information pertaining:  
- the type and the nature of the specific working risks (sight and eyes, position, ergonomics, environmental factors and psychophysical stress);  
- the minimal requirements of the equipment used (screen, keyboard, work table, work chairs), of the work environment (space, lightning, noise, temperature, radiation and humidity) and of the man-machine interface (software);  
- the sanitary controls to be performed by the competent doctor.  
During the preventive examination, the competent doctor will have to pay special attention to any “possible structural malformations” and to examine “eyes and sight” also in case proper further specialised controls have to be carried out, in order to give a correct fitness judgement.  
Within such a context, it is however important to underline the interpretative problems of the last point that is certainly a little unclear if not even technically incorrect: broad interpretations, in fact, that refer to the typical problems pertaining correction with lenses and that envisage the supply of “normal” glasses too, oppose restrictive interpretations that, on the other hand, would limit such supply to just “special” glasses that, however, are used (exceptionally) by people suffering from sight alterations that are so serious as to prevent them from using screen computers.  

Sanitary surveillance  
of workers exposed  
to carcinogenic agents  

As far as workers exposed to carcinogenic agents are concerned, the novelties introduced by the decree involving the doctor essentially concern the field of application, the definition of carcinogenic agent and some epidomiological aspects (exposure register and noise registration).  
Article 70 lays down the introduction of an “exposure register” that contains the names of the exposed workers, of the carcinogenic agent used and, if known, its exposure value.  
Although such information should also be included in the health and risk record, on the one hand it is important to underline the importance of the competent doctor's role in keeping such a register, and on the other, the complexity of the various bureaucratic passages (with postponement to a subsequent interministerial decree) pertaining the institution, the update and the transmission among the various bodies involved (employer, the Institute for Prevention and Safety of the Workplace, the Local Health Care Unit) of the documents mentioned above to be kept by the employer until termination of employment and at the Institute for Prevention and Safety of the Workplace until 40 years from the termination of the work exposing workers to carcinogenic agents.  
The contents of article 71 (recently also included in the Legislative Decree 230/95 in the field of protection against radiation) are also very interesting. It forces all doctors who spotted neoplastic pathologies due to working exposure to carcinogenic agents to send the Institute for Prevention and Safety of the Workplace a copy of the clinical and work records pertaining the single case observed in order to set up an archive of names of case of work-related tumours. Even in this case the decree refers to a subsequent interministerial decree for the characteristics of information systems regarding this aspect.  

Keeping the registers  
of the exposed people  
and of accidental events  

Article 87 sets down complex provisions pertaining the compilation, the keeping and the storing (by the employer helped by the competent doctor) of a register of the exposed people and of the accidental events for workers professionally exposed to biological agents classified in groups 3 and 4.  
Even when doubts about the scarce organic unit of the provisions pertaining the gathering and the management of information are overcome, especially when comparing the information flows involving the Institute for Prevention and Safety of the Workplace, the Health Institute and the supervisory authority responsible for a specific area (even though the decree refers again to the issuing of a proper inetrministerial decree), it is important to underline the obligation to keep such register at the Institute for Prevention and Safety of the Workplace alongside the health and risk records (article 87, section 4) for a 10-year or even 40-year period (as with the provisions pertaining carcinogenic agents) in case it is known that biological agents can cause persistent or latent infections or diseases having a long-period recrudescence  or serious long-term consequences.  
Finally, article 88 lays down the creation of a register of cases of diseases or of deaths due to professional exposure to biological agents according to the relating clinical registration given by doctors and public and private health care facilities at the Institute for Prevention and Safety of the Workplace.  
The methods of keeping will have, however, to be established with the umpteenth interministerial decree.  

Conclusions  

To sum up this short comment of the provisions included in the Legislative Decree 626/94 pertaining the workers' health protection, it has to be underlined how the lawmaker failed to exhaustively harmonise the various and complex current provisions in the field of industrial medicine and hygiene in Italy.  
Presently, in fact, despite the strong lawmaker's efforts in the last decrees, the lack of a uniform and consistent legislative picture does not envisage an easy and homogeneous application of the provisions included in the Legislative Decree 626/94, especially in working fields currently regulated with previous provisions.  
Finally, awaiting the involved Ministers to issue the decrees laid down by the Legislative Decree 626/94, it is important to underline the need for a technical comparison of the professionals working in the various fields of corporate safety (physicians, engineers, environmental technicians and so on) and for the National Insurance Institute for Industrial Accidents to participate in an increasingly active way in carrying out prevention programmes across the nation in the light of its recognised and deep experience in the field of work-related risks.  

 
Daria Pesce 
Avvocato Penalista