1. 1
Neurobehavioral Performances Among Lead Exposed Workers In
Malaysia: An Early Detection Of Lead Toxicity
Mazrura Sahania,1 and Noor Hassim Ismailb
a
Institute for Medical Research, Kuala Lumpur
b
Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia.
Abstract
The objectives of this study is to evaluate subjective symptoms and neurobehavioral performances among
workers exposed to lead and its relation with blood lead levels. The methodology of this study was restricted to
141 Malaysian battery manufacturing factories male workers with mean (SD) age of 35.2 (9.6) years, years of
employment 9.1 (7.1), current blood lead concentration 40.5 (16.8) µg/dl were given WHO neurobehavioral core
test battery. Results showed that highly exposed group blood lead level (high ≥ 40 µg/dl) performed less well in
4 of 13 responses reported higher subjective symptoms of weakness of lower limbs and anorexia. Significant
correlation was found between blood lead and Digit Symbol, Digit Forward, Digit Backward, Aiming Pursuit
Test and Trail B. Regression analysis showed reduction in cognitive, memory and concentration functions at ≤
30 µg/dl blood lead levels with maximum lead effect at Digit symbol’s score at 40 µg/dl. In conclusion, this
study is consistent with the larger body of neurobehavioral tests in lead exposure and has proven the ability of
these tests in detecting low level of lead toxicity.
Keywords: Blood lead, low level, neurobehavioral test, workers, Malaysia.
Introduction toxicity, whereas subclinical evidence of
lead poisoning has been reported in
The ever increasing interest of neurophysiological and neurobehavioral
neurobehavioral test is probably due to its studies (Landrigan 1989; Campara et al.
sensitivity shown by psychological 1984; Arnvig et al. 1980). Most of the
measurement techniques to unveil changes neurobehavioral studies undertaken have
which otherwise would not detected in come from the industrialised countries
human. The evidence that this changes are (Seppalainen et al. 1975; Hanninen et al.
among the earliest indicators of the 1979; Baker et al. 1984), only few have been
occurrence of health effects has by now, reported in developing countries
become unequivocal. As a consequence this (Jeyaratnam et al. 1985; Maizlish et al.
test has come to be regarded as a major 1995; Mohamed 1986).
device of major importance for monitoring
of potential health hazards (Iregen & The purpose of the present study was to
Gamberle 1990). assess the neurobehavioral performances
among workers exposed to inorganic lead in
Clinical manifestation of lead poisoning battery manufacturing factories in Malaysia.
such as anaemia, wrist drop, and renal
failure lie at the upper end of the range of
1
Correspondence author: Dr. Mazrura Sahani, email: mazrura@imr.gov.my

2. 2
Materials and methods Surrey, United Kingdom. This blood lead
measurement was assumed to reflect average
Study Design and Population Studied exposure.
The study design was cross-sectional Neurobehavioral Core Test Battery
and subjects were drawn from two battery
manufacturing factories in the state of To correct the lack of standardisation in
Selangor, Malaysia. On average 360 neurobehavioral assessment, the World
employees were employed, with local citizen Health Organisation (WHO) Neuro-
to foreign workers from Bangladesh ratio behavioral Core Test Battery (NCTB) has
1:1. Because of high turn-over of the foreign been advocated as a validated, standardised
workers and the foreseen difficulties psychological test battery that has been
(language problems) in conducting the reported as transcultural (WHO 1986). This
neurobehavioral test, they were excluded study used 5 tests of NCTB and 1 test from
from the study. Eligibility to our study was California University (Trail Making Test).
restricted to 141 male workers from 3 major This neurobehavioral is a simple pencil and
ethnic groups; Malays, Chinese and Indian paper test and test conducted by trained
who have given consent. Walk-through examiners. All test has been translated from
surveys were conducted together with an English to Bahasa Malaysia which is the
industrial hygienist to exclude other national language which also has been pre-
neurotoxicants in the factories. tested. But the tests were conducted in either
Bahasa Malaysia, Chinese or English
Procedure according to participants choice.
The participants were given Table 1 summarises neurobehavioral tests
questionnaire which covers personal data, used in this study and their domain functions
medical and occupational history, hobbies,
smoking, alcohol consumption and Digit Symbol
subjective symptoms complaints. They were The subject is presented with a key at the top
interviewed and examined physically by one of the page with the numbers 1 to 9
of the researchers. Trained examiners blind displayed with their respective matching
to participants’ exposure history conducted symbols. Below are blanks with digits
test in quiet rooms during the beginning of above. The subject must copy the
the shift to avoid effect of fatigue. The appropriate matching symbols for each digit
procedure took nearly one hour per person. based on the key at the top of the page. The
number of correct symbols in the 9 seconds
Blood Lead Measurement test period is the score.
All participants were requested to Digit Span
provide 10 mls samples of venous blood by Digit span, from Weschler adult intelligence
venepuncture from a forearm for blood lead scale measures short term memory and
analysis by atomic absorption spectrometry attention. In the digit forward the tester
in Institute for Medical Research recites group of 3, 4, 5, 6, progressively up
(Fairulnizal 1996). Quality control of the to 8 numbers and the subject is requested to
measurement had been taken care by using repeat each exactly as he hears them. The
commercial controls from Bio-Rad, USA digit backwards sequence runs from two to
and by participating in ‘Trace Elements eight digits and the subject is requested to
External Quality Assessment Scheme’ repeat them in exactly reversed order. The
organised by Robens Institute, University of

3. 3
score is the total number of correct sequence drawing. The number correct in 10 trials is
individually. the score.
Santa Ana Manual Dexterity Test Trail Making Test
The subject must rotate pegs through 1800. This test has two parts, each consisting of 25
The pegs are arranged in 4 rows of 12 pegs circles distributed over a sheet of paper. In
on rectangular board. The number of pegs Trail A the circles contain numbers 1 to 25.
rotated in 30 seconds is the score. The test The subject is required to draw a line
was repeated for the preferred, non-preferred connecting the circles in numerical sequence
and both hands. as quickly as possible. Trail B differs from
Trail A in that the circles contain numbers 1
Table 1. Neurobehavioral tests and the to 13 and letters A to L. In connecting the
functional domain tested circles the subjects is required to alternate
Test Function Domain between the numbers and letters as he
proceeds in ascending sequence. The test is
Digit Symbol Motor Speed, Visual
scored as the number of seconds needed to
Scanning, Working
finish each part.
Memory
Digit Span Short term memory and Questionnaire for Subjective Symptoms
attention
This questionnaire was adapted from
Santa Ana Motor Speed, co-
WHO for assessing subjective symptoms. It
Dexterity ordination
consist of 20 items grouped systematically
Benton Visual Visual Perception, into the following subscales; central nervous
Retention Memory system, peripheral nervous system,
gastrointestinal system and other symptoms.
Pursuit Aiming Fine motor control and
motor steadiness Statistical Methods
Trail Making Attention, Visual
Scanning, Processing All data were entered in dBase IV and
Speed analysis was done with SAS. To test the
relation of blood lead with its influencing
Pursuit Aiming Test factors, t-test or chi-square were used. To
With a pencil, the subject is instructed to dot control the effect of confounding variables
the centre of circles as quickly and (age, education level, alcohol, tobacco
accurately as possible. The circle is 2 mm in smoking, exposure to other chemical, usage
diameter are arrayed on a paper sheet in 30 of personal protective equipment and
columns by 40 rows. Excluding outliers, the hobbies) general linear model analysis was
number of dotted circles in two 30 s trials is used. Correlation analysis is used to see the
the score. significant of the relations between blood
lead, haemoglobin levels and
Benton Visual Retention Test neurobehavioral performances. To test the
The subject is shown a drawing for 10 hypothesis of the sensitivity of
seconds composed of geometric figures. neurobehavioral test in comparison with
After the drawing is removed, the subject is clinical findings and anaemia, t-test, chi-
shown four similar looking drawings, only square and multiple regression analysis were
one of which is a true replica of the original. used that incorporate age, education level
The subject must identify the correct and years of employment.

4. 4
Results Significant difference in score was found
between the highly exposed group with the
Table 2 shows the summary of the low exposed group (Table 4) in Digit
demographic characteristic of the symbol, Digit forward, Santa Ana Preferred
participants. The response rate from factory hand, Santa Ana both hands, Benton,
A was 78.8% and 81.9% from factory B. Pursuit Aiming and Trail B tests.
Blood lead analysis was not performed for 3
workers (**) because of the unsuitability of
the specimens.
Table 2. Demographic characteristic of the
participants
Demographic N Mean Range
Characteristics (SD)
Age (years) 141 35.2 20-69
(9.6)
Years employed 141 9.01 0.33-32
(7.1)
Education 141 9.0 2-16
(*)
Blood lead 138** 40.5 4.9-76.5
(µg/dl ) (16.8)
Duration of 84*** 11.2 1-30
smoking (years) (6.7)
*= not available, ***= smokers only
The ethnicity of the participants is shown in
Table 3 . Participants came from different
job categories with the majority of them
from production, maintenance and quality
control sections (71.6%) whereas the others
came from the technical and packaging
sections (10.6%), raw material (4.9%),
administrative and marketing (6.3 %) and
production supervisors (6.4%).
Table 3. Ethnic distribution of the participants
Ethnic group Numbers Percentages
Malay 71 50.4
Chinese 35 24.8
Indian 35 24.8
Total 141 100
Neurobehavioral Test Performances
The participants were divided into 2
groups of highly exposed group with blood
lead levels (PbB) ≥ 40 µg/dl and low
exposed group of PbB < 40 µg/dl according
to WHO’s biological exposure index.

5. 5
Table 4 . Mean score of neurobehavioral test analysis which revealed the similar results
with blood lead level (Table 5).
PbB < 40 PbB ≥ 40
µg/ dl µg/ dl p- Table 5. Correlation coefficients between
Tests Mean Mean value
blood lead and neurobehavioral
Score Score
performances
Digit Symbol* 49.6 37.4 0.02 Tests N Correlation p-
coefficients value
Digit Forward 9.4 8.5 0.19
Digit Symbol* 135 -0.4348 0.00
Digit 7.3 5.4 0.01
Digit Forward* 135 -0.2107 0.02
Backward*
Digit Backward* 134 -0.3040 0.00
Santa Ana 25.1 23.5 0.04
Preferred Santa Ana 135 -0.0469 0.14
Hand* Preferred Hand
Santa Ana 22.6 22.4 0.05 Santa Ana Non- 134 -0.0529 0.91
Non-preferred Preferred Hand
hand Santa Ana Both 132 -0.0141 0.17
Hands
Santa Ana 30 26.5 0.02
Both Hands* Benton 135 -0.1520 0.18
Benton* 8.7 7.8 0.02 ‘Aiming’ * 135 -0.2476 0.00
‘Aiming’ * 213 182 0.00 Trail A 133 0.1221 0.16
Trail B* 132 0.3040 0.00
Trail A 45.3 55.5 0.05
seconds seconds (Correlation analysis,* = p < 0.05)
Trail B* 88 121 0.00 Prevalence of Subjective Symptoms
seconds seconds
(t-test, * =p<0.05) Workers were complaining high
prevalence of subjective symptoms of
Several factors were found influencing fatigue and insomnia (13.5%) , tremor of
blood lead levels in this study significantly; both hands (8.5%) and sleepiness during
years of employment (p=0.02), previous working and forget-minded (6.4%). Higher
exposure to lead (p=0.01), usage of personal exposed group were also complaining
protective equipment (p=0.04), and exposure significant symptoms of weakness of both
to non-neurotoxic chemicals (p=0.04). lower limbs and loss of appetite.
However, age, smoking habits, alcohol
consumption and hobbies had no significant
effects to blood lead levels. After controlling
for cofounders, poorer score on the Digit
symbol, Digit backwards, Aiming Pursuit
and Trail B Tests were consistently
associated with lead exposure.
Correlation between the blood lead
levels and the neurobehavioral performances
indicate higher blood lead level tended to
have poorer neurobehavioral performances
(Table 4) in Digit Symbol, Digit span,
Aiming and Tail B tests. This correlation is
also supported with the linear regression

6. 6
Testing of Hypothesis levels up to 30 µg/ dl (p<0.05)*, thereafter
there were no significant correlation between
Hypothesis of this study is this two parameters (p=0.66). Lead also has
neurobehavioral test as a diagnostic test to shown it maximum effect at digit symbol
detect lead toxicity at low levels in score of 40**. Therefore this analysis can
comparison with overt clinical findings. Few confirm that the hypothesis of this study is
clinical problems were identified such as not rejected.
hypertension, skin diseases, muscu-
losceletal, respiratory, tremor and eye Multiple regression analyses
problems among workers. However, no revealed the significant contribution of years
significant findings were found in relation to of employment (YE) together with the
blood lead levels (Table 6). blood lead levels to Digit Symbol score (R2=
0.2385, p<0.05). This is consistent with the
Further regression analysis were concept of blood lead levels (PbB) reflecting
used to assessed the contributions of blood recent exposure and years of employment
lead levels to neurobehavioral tests in reflecting chronic (cumulative) exposure
particular Digit Symbol because of the (Balbus et al. 1995; Rappaport 1991). This
strongest correlation’s (r= -0.4348, p<0.05) is shown by the formula;
in this study (Figure 1). This analysis has
proven that the digit score symbol were
negatively correlated with the blood lead Digit Symbol = 60.28 - 0.307 PbB - 0.818 YE

7. 7
Table 6. Clinical findings in relation to blood lead levels
Clinical Problems % Positive Mean (sd) PbB (µg/dl) p-value
cases Positive cases Normal cases
1. Hypertension 8.4 40.2 (16.0) 40.6 (17.0) 0.94
2. Skin 10.9 38.9 (11.7) 40.7 (17.4) 0.59
3. Musculoskeletal 13.0 42.5 (14.8) 40.2 (17.1) 0.50
4. Respiratory 6.5 43.4 (15.9) 40.3 (16.9) 0.58
5. Eye 2.9 48.8 (7.3) 40.3 (17.0) 0.09
6. Tremor 8.0 40.2 (16.1) 44.6 (24.4) 0.56
7. Anaemia 141 44.4 (21.4) 40.0 (16.0) 0.39
Digit Symbol Score
100 + .
| .
| . .. .
| ...... . . . . .
| .. .. . .. . . . .
50 + .. . . *.. .. ...... ...... .. . . .
| . . . . .......... ...... . .. ***. .
**| . . .. .. ....... ...... .. . .. ..
| . . . . . .. . .. .
| . .. . . .
+ .. .
---+-------------+--------------+--------------+--------------+-------
0 20 40 60 80
Blood lead levels ( µg/dl )
2
*y= 67.09 - 1.0634 PbB, p<0.05, R = 0.1891
** Limit value in Digit symbol’s score of 40
*** p= 0.6557
Figure 1. Relationship of Digit Symbol’s Score And Blood Lead Levels
Discussion given higher subjective complaints of
weakness of lower limbs and loss of
Results from this study has shown appetite in the highly exposed group.
that lead can cause dysfunction’s of central This findings of lead toxicity to
nervous system in terms of processing speed, neurobehavioral performances and the
attention, concentration, memory functions subjective symptom were consistent with
and motor steadiness. This is shown in the many other studies (Campara et al. 1984;
significant associations between blood lead Seppalainen 1975; Hanninen 1979;
levels with Digit Symbol, Digit Span, Trail Grandjean etal 1978; Hogstedt et al 1983,
B and Pursuit Aiming Test. Lead also has Schwartz 1993; Valciukas et al. 1978;

8. 8
Williamson & Teo 1986). This study also behavioural electrophysiological
confirmed the ability of the neurobehavioral evaluation. Study design and one year
test in comparison with the overt clinical results. Br J Ind Med. 1984; 41: 352-
findings whereby the toxic effect of lead to 361
the cognitive functions can be seen at blood
lead levels lower than 30 µg/ dl. Baker E. L. , White R.F. , Pothier L.J. ,
Due to maximum effect of lead at Berkey C.S. , Dinse G.E. , Travers
digit symbol score of 40, This score can be P.H. , Harley J.P. , & Feldman RG.
taken as a limit value between normal and 1985. Occupational lead neuro-
abnormal score. Score less than 40 can be toxicity: improvement in behavioural
considered as an abnormal score. This effects after reduction of exposure. Br
findings highlight the importance of the J Ind Med: 42: 507-516.
neurobehavioral tests which can be
incorporated in the medical surveillance Balbus JMK , Stewart W & Bolla KI
programme of Lead Regulations Malaysia. Cumulative exposure to inorganic
Facilities for blood lead measurements are lead and neurobehaviour test
not widely available throughout Malaysia performance in adult: an
and the resistance of the workers to this epidemiological review. Occup
invasive procedure which need to be Environ Med 1995; 52: 2-12.
routinely conducted, hinder the success of
the surveillance program. On the other hand Campara P , Andrea FD & Micciliolo R l.
the applications of the neurobehavioral tests Psychological performance of workers
can also detect the early toxic effect of lead, with blood-lead concentration below
which enhances the prevention strategies the current threshold limit value. Int.
before leading to any irreversible damage Arch. Occup. Environ. Health. 1984;
(Baker 1985). 53 : 233-246.
Acknowledgements Fairulnizal M.N.. Determination of blood
lead levels with Graphite Furnace
This study was supported by a grant from Atomic Absorption Spectrometry. Drug
National University of Malaysia. We would and toxicology laboratory,
like to thank the staff and management of Biochemistry division, Institute for
both factories for participating and Medical Research. 1996. (Unpublished
supporting this study. We are grateful to script).
Institute for Medical Research, Department
of Occupational Safety and Health and Iregen A & Gamberale F. Human
Associate Professor Dr Abdul Aziz Jemain. behavioural toxicology. Central
nervous effects of low-dose exposure
References to neurotoxic substances in the work
environment. Scand J Work Environ
Health. 1990; 16 (suppl. 1): 17-25.
Arnvig E. , Grandjean P. & Beckmann J.
1980. Neurotoxic Effects of heavy lead
Grandjean P , Arnvig E & Beckmann J.
exposure determined with
Psychological dysfunction in lead
psychological tests. Toxicol Lett. 5:
exposed workers: relation to
399-404.
biological parameters of exposure.
Scand J Work Environ Health. 1978;
Baker EL , Feldman RG & White RA
4 : 295-303.
Occupational lead neurotoxicity: a

9. 9
Hanninen H , Hernberg S & Mantere P.. Seppalainen AM, Hernberg S & Kock R,
Psychological performance of subjects Subclinical neuropathy at ‘safe’ levels
with low exposure to lead. J Occup of lead exposure. Arch Environ
Med. 1979; 20: 683-68. Health. 1975; 30: 180-183.
Hogstedt C , Hane M , Agrell A et al. Schwartz BS, Bolla KI, Stewart W et al.
Neuropsychological tests result and Decrements in neurobehavioral
symptoms among workers with well- performance associated with mixed
defined long-term exposure to lead. exposure to organic and inorganic
Br J Ind Med. 1983; 40 : 99-105. lead. Am J Epidemiol. 1993; 137 :
1006-1021.
Jeyaratnam J. , Boey K.W. , Ong C.N. ,
et al. Neuropsychological studies on Rappaport S.M. Assessment of long-term
lead exposed workers. Br J Ind exposures in air. Ann Occup Hyg.
Med. 1985; 42: 173-177. 1991; 35: 61-121.
Landrigan PJ. Toxicity at low dose. Br Valciukas JA, Lilis R, Fischbein A et
J Ind Med. 1989; 46 : 593-596. al. Central nervous system dysfunction
due to lead exposure. Science. 1978;
Maizlish N.A , Parra G, Feo O. 201: 465-467.
Neurobehavioural evaluation of
Venezuelan workers exposed to World Health Organisation. Operational
inorganic lead. Occup Environ Med . guide for the WHO Neurobehavioral
1995; 52: 408-414. Core Test battery. 1986. Geneva.
WHO.
Malaysia. 1994. Factories and machinery
(lead) Regulations, Factories and Williamson AM, Teo RKC.
Machinery Act, 1967 (Act 139). Neurobehavioural effects of
Regulations and Rules. 1984; 267- occupational exposure to lead. Br J
284. Kuala Lumpur. International Law Ind Med. 1986; 43: 374-380.
Book Services.
Mohamed AAEL , Alla SH & Yousif
AAE. Effects of exposure to lead
among lead-acid battery factory
workers in Sudan. Arch Environ
Health. 1986; 41: (4) 261-265.

10. 10
The Validity-Reliability Study of the Malay Version of
Copenhagen Psychosocial Questionnaire (COPSOQ) in
Assessing Psychosocial Status in Relation to
Nature of Work among Workers
Fauziah Nordina2, Quek Kia Fattb, Agus Salim M Banonc
a
Occupational & Environmental Health Unit,
b
Medical Statistic Unit,
Social and Preventive Medicine Department,Faculty of Medicine, University of Malaya
c
National Institute of Occupational Safety and Health (NIOSH) Malaysia
Abstract
This study aimed to validate the Malay Version of Copenhagen Psychosocial Questionnaire for
Malaysian use and application for assessing psychosocial work environment factors. Validity and Reliability
were studied in 50 staff nurses of Hospital Selayang. The validity of the questionnaire was evaluated by
calculating the percentage of sensitivity and specificity at the different score level. Both percentage of
sensitivity against specificity were plotted to produce a ROC (Receiver Operating Characteristics) curve, and
score 52 has the highest both sensitivity and specificity was used as an overall index that expresses the
probability that measure the psychosocial problems. For reliability purposes, a descriptive of Test-Retest
Mean Scores and Paired Sample T-Test and the coefficient-correlation test were calculated. The Test-Retest
Mean Scores and Paired Sample T-Test for all 26 scales were calculated and showed statistically not
significant. The reliability of the questionnaire and its 26 scales was assessed by using Pearson (r) (overall
questionnaire r within a range of 0.00 to 1.00). The COPSOQ appears to be a reliable and responsive
measure of workers for Malaysian use and can be applied for assessing psychosocial work environment
factors.
Keywords: Malay version of COPSOQ, sensitivity and specificity validity, test-retest reliability, Pearson r,
Malaysia.
Introduction The psychosocial demands of the
modern workplace are often at variance with
According to an important International the workers’ needs and capabilities, leading
Labour Organizations (ILO) (1975) to stress and ill-health. The most important
resolution, work should not only respect situational factors that give rise to
workers’ lives and health and leave them psychosocial stressors at work are
free time for rest and leisure, but also allow quantitative overload, qualitative underload,
them to serve society and achieve self- role conflicts, lack of control over one’s own
fulfillment by developing their personal situation, lack of social support, physical
capabilities (Steven et al, 1998). stressors, mass production technology,
2
Correspondence author: Dr. Fauziah Nordin, email: pauafiq@pd.jaring.my

11. 11
highly automated work process and
shiftwork (Lennart, 1998). Tage S.K., et al (2000) have done a
project on the reliability and validity of the
Social support increases coping ability assessments among 1858 adult Danish
and facilities adaptation. There are five employees, 20 to 60 years of age, 49 per
possible elements of social support, which cent women and the response rate of 62 per
are emotional support (example, care and cent. The medium size questionnaire for
love), encouragement (example, praise and work environment professionals has been
compliments), advice (example, useful developed in which all dimensions have a
information to solve problems), national average of 50. Results deviated
companionship (example, time spent with from the average were in a job group of
supporter) and tangible aid (example, technicians, shop assistants, secretaries,
money) (Freda, 1998). domestic helpers, accountants, metal
workers, shop assistants, cleaners, drivers,
Psychosocial factors which lead to office clerks and food industry workers.
stress at work and associated health and When the questionnaire is used for assessing
safety problems, include aspects of the job the psychosocial work environment of a
and work environment such as workplace it is possible to compare each
organizational climate or culture, work roles, department as well as the whole workplace
interpersonal relationships at work, and the with the national average on all 26
design and content of tasks (example; dimensions.
variety, scope, repetitiveness). The concept
of psychosocial factors extends also to the Since the study population in each
extra-organizational environment (example; country differed culturally and
domestic demands) and aspects of the sociodemographically from one to another,
individual (example; personality, attitudes) therefore a translation version of the
which may influence the development of questionnaire is require for the assessment of
stress at work (Lennart, 1998). the local population study. Beside the main
study, a pilot-study on reliability-validity of
The need for valid and reliable the Copenhagen Psychosocial Questionnaire
instruments for assessment of exposures in Malaysian population hopefully may
applies to the psychosocial field as well as to provide a valid new tool for assessing
other fields of work environment research psychosocial factors at work for Malaysian
and practice. The Copenhagen Psychosocial use.
Questionnaire (COPSOQ), a questionnaire
for assessing psychosocial work Study Material
environment factors, has been developed by
the Psychosocial Department, National The validity of the study depends on the
Institute of Occupational Health (NIOH) in sampling methodology used, instrument
Copenhagen, Denmark. They have done the reliability and validity, and the design of the
reliability and validity of the assessments, study (Steve, 2003). It is important to have a
among adult Danish employees in Danish reliable and valid study instrument before
version in a year 2000. The questions of the conducting a study (Abramson et al, 1999).
COPSOQ have been translated into English, For this research, since the study instrument,
and some of the questions also into the Copenhagen Psychosocial Questionnaire
Japanese. Spanish, German, and Flemish has been developed in other countries; and
versions are under development (Tage et al, since each country differed socio-culturally,
2000). therefore there is a need for validation of this

12. 12
instrument and to look how acceptable the considered having psychosocial problems
instruments to Malaysian population. (positive psychosocial status), whereas
values below average are considered not
Reliability refers to the stability or having psychosocial problems (negative
consistency of information, which means the psychosocial status). The scales of the
extent to which similar information is COPSOQ are formed by adding the points of
obtained when a measurement is performed the individual questions of the scales by
more than once. There are various indices giving equal weights to each question. The
for reliability measurement. For this scale value is calculated as the simple
research, after considering the most practical average. Respondent who answer less than
measurement to be used for an interval or half of the questions in a scale is regarded as
ratio-scale measure questionnaire, the test- missing. If a person has answered at least
retest method will be conducted during the half of the question, the scale value is
pretesting period. calculated as the average of the questions
answered (Steve, 2003).
The Copenhagen Psychosocial
Questionnaire (COPSOQ) is a new tool for
assessing psychosocial factors at work and
has been prepared by the National Institute
of Occupational Health (NIOH) of
Copenhagen, Denmark in year 2000. It has
been developed in three versions: a long
version for researchers, a medium size
version to be used by work environment
professionals, and a short version for the
workplaces. The whole concept has been
labelled “the three-level concept”.
The permission to use the questionnaire
has been obtained from the author. In order
to make sure the objective to assess the
work-related psychosocial status using the
medium size version of the questionnaire is
met, the author has emphasized that the
researcher must use either long version or
medium size version of the questionnaire.
The short version can only be used by the
workplaces employer, not for research
purposes. The 95-item medium version of
COPSOQ has been used in this study. The
questionnaire has been validated
internationally and it is a reliable instrument
for assessment of exposure applies to the
psychosocial field (Steve, 2003).
The questionnaire / instruments have
been developed in the form of Likert Scale.
The values above or at average are

13. 13
Study Methods
The initial preparation was in English
version. The whole set of the questionnaire
has been translated to Bahasa Malaysia by a
qualified and an expert person in both
language, and the other person translated
back to English version without referring to
the original questions. It is purposely done to
make sure the original content and meanings
of the questionnaire will be the same.
The self-administered question-naire
was distributed to 50 subjects consists of 25
staffnurses who are shiftworkers and another
25 staffnurses who are not doing
shiftworkers and were chosen randomly.
Data was collected 2 times (Test-Retest
Method) 2 weeks apart. Each respondent
was given a set of complete self-
administrated questionnaire in an envelope
that has been distributed by the matron of
Hospital Selayang. The complete
questionnaire was returned back to the
matron after 2 weeks.
Raw data obtained was coded and
entered into Statistical Package for Social
Sciences (SPSS) Version 11.5. The data was
edited and cleaned for double entry and
outliers before analysis could be done.

14. 14
Results Table 1. Validity Test – Percentage
Sensitivity and Specificity at Different Score
It is highly probable that language is a Level
factor confounding the validity-reliability of Psychosocial Sensitivity Specificity
the study and it is important to look into it. Scores (%) (%) (%)
The initial preparation of COPSOQ 44 100 36
questionnaire was in English version. The 46 100 44
whole set of the questionnaire has been 48 92 56
translated to Bahasa Malaysia by a qualified 50 84 64
and an expert person in both language, and 52 76 76
the other person translated back to English 54 60 84
version without referring to the original 56 48 92
questions. It is purposely done to make sure
the original content and meanings of the Both percentage of sensitivity against
questionnaire will be the same and to ensure specificity for those different score levels
better reliability for the main study. were plotted to produce a ROC (Receiver
Operating Characteristics) curve (Figure 1)
Sensitivity and specificity of the and the highest both sensitivity and
instrument had been evaluated by comparing specificity (score 52 percent) are used as an
the scores in exposed group and un-exposed overall index that expresses the probability
group for the psychosocial factors. The that measure the psychosocial problems.
validity was established by calculating the
percentage of sensitivity and specificity at The differences between the paired
the different score level around the average (paired test-retest means) samples,
score. However from the result, score 52 calculated using paired sample t-test (Table
percent is taken as an overall index that 2), shows that mean scores of test and the
expresses the probability that measure the retest were not significant for all scales. This
psychosocial problems (Table 1). means the variations between scores from
the two administrations were insignificant
and are thus, reliable and consistent (Loh,
2002).
Stres s Sco re
100% 80% 60% 40% 20% 0%
120%
100%
44
46
80% 48
50
60% 52
54
40%
56
20%
0%
Figure 1. ROC (Receiver Operating Characteristics) curve for psychosocial status score.

15. 15
Table 2. Descriptive of Test-Retest Mean Scores and Paired Sample T-Test
Test Retest Mean Differences
COPSOQ 26 mean-scores mean-scores Mean Diff. 95% CI t Sig.
Scales (+SD) (+SD) + SD (Lower-upper (2-tailed)
n=50 n=50 Diff.)
L U
Quantitative 39.00(12.91) 40.50 (10.51) -1.50 (13.81) -5.42 2.42 -0.77 0.446
demands
Cognitive 37.13 (4.95) 36.87 (4.59) 0.25 (5.20) -1.22 1.72 0.34 0.735
demands
Emotional 32.67 (11.88) 33.83 (12.42) -1.17 (14.48) -5.28 2.95 -0.57 0.571
demands
Demands for 42.75 (13.14) 42.25 (13.81) 0.50 (14.28) -3.55 4.55 0.25 0.805
hiding emotions
Sensorial demands 38.63 (11.62) 42.75 (11.32) -4.13 (12.35) -7.64 0.62 -2.36 0.220
Influence at work 53.37 (13.78) 54.50 (13.48) -1.13 (12.67) -4.72 2.47 -0.63 0.533
Possibilities for 65.75 (11.79) 65.75 (14.41) 0.00 (13.77) -3.91 3.91 0.00 1.000
development
Degree of freedom 24.87 (7.19) 27.25 (7.44) -2.37 (8.17) -4.70 0.05 -2.06 0.045
at work
Meaning of work 79.16 (10.27) 77.99 (9.33) 1.17 (10.92) -1.94 4.27 0.76 0.454
Commitment to 54.87 (24.07) 55.13 (23.17) -0.25 (22.30) -6.58 6.08 -0.80 0.937
workplace
Predictability 74.00 (11.80) 73.75 (12.44) 0.25 (13.24) -3.51 4.01 0.13 0.894
Role-clarity 71.75 (11.24) 72.00 (10.12) -0.25 (12.56) -3.82 3.32 -0.14 0.889
Role-conflicts 26.13 (11.27) 27.87 (11.65) -1.75 (11.85) -5.12 1.62 -1.04 0.301
Quality of 79.50 (14.40) 82.13 (14.45) -2.63 (13.66) -6.51 1.26 -1.36 0.181
leadership
Social support 72.13 (3.62) 72.37 (3.81) -0.25 (3.78) -1.33 0.82 -0.47 0.642
Feedback at work 61.00 (9.99) 61.25 (9.86) -0.25 (10.26) -3.16 2.66 -0.17 0.864
Social relations 31.12 (12.27) 29.08 (12.34) 2.04 (14.06) -1.99 6.08 1.02 0.315
Sense of 78.57 (15.96) 75.17 (14.78) 3.40 (15.21) -0.97 7.77 1.57 0.124
community
Insecurity at work 65.31 (34.16) 64.80 (33.82) 0.51 (36.97) -10.11 11.13 0.10 0.923
Job satisfaction 76.66 (9.44) 76.66 (9.86) 0.00 (11.05) -3.17 3.17 0.00 1.000
General Health 48.67 (5.75) 49.18 (4.93) -0.51 (6.39) -2.35 1.33 -0.56 0.579
Mental Health 34.56 (10.77) 33.76 (11.72) 0.80 (12.47) -2.74 4.34 0.45 0.652
Vitality 44.70 (12.22) 43.60 (12.26) 1.10 (13.49) -2.73 4.93 0.58 0.567
Behavioural stress 14.25 (8.19) 15.75 (8.68) -1.50(7.63) -3.67 0.67 -1.39 0.171
Somatic stress 29.87 (14.07) 28.87 (13.99) 1.00 (14.25) -3.05 5.05 0.50 0.622
Cognitive stress 27.00 (14.75) 28.37 (14.52) -1.38 (15.74) -5.85 3.09 -0.62 0.540
* All scales show the mean-difference are not significant at p<0.05

16. 16
The reliability of the questionnaire and were clearly showed that correlation for each
its 26 scales was assessed by calculating the scale showed statistically significant at the
coefficient-correlation test using Pearson (r) 0.05 level. The strength of the correlation of
which showed that overall questionnaire has test-retest is presented in Table 3.
value r within a range of 0.00 to 1.00. They
Table 3. Reliability of COPSOQ Scales on Malaysian Sample
COPSOQ 26 Scales No. of Questions Pearson, r Significant
n=50 (2-tailed)
Quantitative demands 4 0.319* 0.024
Cognitive demands 4 0.409* 0.003
Emotional demands 3 0.290* 0.041
Demands for hiding emotions 2 0.440* 0.001
Sensorial demands 4 0.421* 0.002
Influence at work 4 0.568* 0.000
Possibilities for development 4 0.462* 0.001
Degree of freedom at work 4 0.377* 0.007
Meaning of work 3 0.383* 0.006
Commitment to workplace 4 0.555* 0.000
Predictability 2 0.404* 0.004
Role-clarity 4 0.312* 0.027
Role-conflicts 4 0.466* 0.001
Quality of leadership 4 0.551* 0.000
Social support 4 0.483* 0.000
Feedback at work 2 0.466* 0.001
Social relations 2 0.348* 0.014
Sense of community 3 0.513* 0.000
Insecurity at work 4 0.408* 0.004
Job satisfaction 4 0.346* 0.015
General Health 5 0.291* 0.042
Mental Health 5 0.388* 0.005
Vitality 4 0.395* 0.005
Behavioural stress 4 0.592* 0.000
Somatic stress 4 0.485* 0.000
Cognitive stress 4 0.422* 0.002
*Correlation is significant at the 0.05 level (2-tailed). All correlation is significant for 26 scales.

17. 17
Discussion Research and Development Management
Unit for providing the research grant (VotF
The validity-reliability of the Malay F0143/2004B) for this study. Special thanks
Version of COPSOQ for 50 staffnurses was for Dr.Noor Akma Md.Yusof, Deputy
tested. Score 52 percent has the highest both Director of Hospital Selayang and Puan
sensitivity and specificity is used as an Rokiah Shaari, Matron of Hospital Selayang
overall index that expresses the probability for their great assistance. Especially for Mr.
that measure the psychosocial problems. Tage S. Kristensen from National Institute of
There were no variations between scores Occupational Health, Copenhagen, Denmark
from the two administrations of the for permission and invaluable assistance
questionnaire and are thus, reliable and with the copyright COPSOQ questionnaire.
consistent. Based on the reliability methods Also, we would like to extend our
in the Survey Methods in Community appreciation to Puan Noor Aizan Mahmud
Medicine (Abramson et al, 1999) stated that and Puan Nurul Khalbee Abdul Kadir for
for value r below 0.5 suggested poor to their assistance and guidance on English
moderate reliability, 0.5 to 0.75 suggested language for this report.
moderate to good reliability and above 0.75
suggested good reliability. From the findings
above showed that the questionnaire has
poor to moderate reliability. This could be References
attributed to some changes in the scores
during the test and retest. Since each Steven L.S., Joseph J.H.Jr., Lawrence R.M.,
domains comprised from 2 to 5 questions, Lennart L. Psychosocial and
therefore, there is likelihood changes in the organizational factors. Encyclopedia of
total scores although majority of individual Occupational Health and Safety. ILO
items or questions may not changed much (International Labour Office), Geneva,
during test retest. Volume II, 5th Impression 1998; 34.2-
34.3
The validity showed high sensitivity
and specificity in the Malay version Lennart L. Psychosocial factors, stress and
COPSOQ. Therefore, it is sensitive and health. Encyclopedia of Occupational
specific at assessing the psychosocial impact Health and Safety. ILO (International
of the workers. The cut off point were 76 for Labour Office), Geneva, Volume II, 5th
both sensitivity and specificity. These cut off Impression 1998; 34.3-34.6
points were chosen based on the need that
the questionnaire to be highly sensitive and Freda L.P. Work and workers. Shifting
specific. The purpose of having high Paradigms and policies. Women
specificity is to overcome Type I error workers. Encyclopedia of Occupational
(False positive). Health and Safety. ILO (International
Labour Office), Geneva, Volume II, 5th
Overall, the COPSOQ questionnaire as Impression 1998; 24.2-24.5
a whole is a reliable tool to measure
psychosocial work environment factors in a Tage S.K., Vilhelm B. A new tool for
Malaysian population. assessing psychosocial factors at work:
The Copenhagen Psychosocial
Acknowledgement Questionnaire, 2000. Available at:
www.ami.dk/apss
The authors would like to express their
gratitude to the University Malaya’s

18. 18
Steve R.T. The validity of a study is our Journal of Community and Applied
most important concern. Research Social Psychology, 1993; 3: 235-242
Methodology instructor notes, 2003.
Available at: Loudoun R.J., Bohle P.L. Work/Non-work
http://www.scis.nova.edu/~terrel/doctor Conflict and Health in Shiftwork:
al/2000/resd700/gaybook.PDF Relationships with Family Status and
Social Support. Int Journal
Abramson J.H., Abramson Z.H., Survey Occupational and Environmental
Methods in Community Medicine, Health, 1997; 3(2): 71-77
Epidemiological Research, Programme
Evaluation, Clinical Trials. Churchill World Health Organization; Regional Office
Livingstone, Fifth Edition1999; 1-14, for the Western Pacific, Manila, 2001.
43-54, 69-78, 89-104, 161-170, 185- Health Research Methodology, A Guide
204 For Training In Research Methods.
2001, Second Edition; 11-41, 71-84,
Loh S.Y. Occupational Pressure of Female 147-168, 169-186.
Allied Health Professionals.
Dissertation for the degree of Master of Kirkwood B. R., Essentials of Medical
Counselling, 2002. University Malaya. Statistics. Blackwell Science 1988 ; 76-
84, 87-93, 109-110, 167-170, 191-193.
Yawen C., Ichiro K., Eugenie H.C., et al.
Association between psychosocial work Martin B., An Introduction to Medical
characteristics and health functioning in Statistics. Oxford University Press
American women: prospective study. 1995, Second Edition; 27-32, 225-252,
British Medical Journal, 2000; 254-264, 331-341.
320(7247): 1432-1436
Jeanne A., Rudolf H.M. Work stressors in
Health Care: context and outcomes.

19. 19
Hepatitis B Sero-Conversion Following Immunisation among a
Cohort of Rural Australian Health Care Workers
Derek R. Smitha,b,3, Julie Portera,c, Peter A. Leggata, Rui-Sheng Wangb
a
School of Public Health and Tropical Medicine, James Cook University, Townsville, Australia
b
Department of Hazard Assessment, National Institute of Industrial Health, Kawasaki, Japan
c
Charters Towers Rehabilitation Unit, Charters Towers, Australia
Abstract
Although vaccination against Hepatitis B Virus (HBV) is highly effective in preventing
occupational transmission among health care workers, not all people develop protective immunity.
Furthermore, little is known about sero-conversion in rural areas. We investigated the serology of Anti HBV
Surface Antigens (Anti-HBs) among staff at a regional health facility in Queensland, Australia between 1998
and 2000. Anti-HBs concentrations were divided into four categories (<10, 10 to 499, 500 to 999, ≥ 1000
mIUmL), with <10 mIUmL considered unprotected. Statistical analysis was conducted by intention to treat.
At baseline, 91.8% of staff were found to be unprotected against HBV. After the first vaccination, this level
had dropped to 44.3% and further to 9.8% by the second schedule. However, after 3 vaccinations, 1.6% of
the original group still had Anti-HBs levels below 10 mIUmL and thus, remained unprotected. Overall, this
study has shown that Anti-HBs levels among rural cohorts can be increased by multiple booster vaccinations.
Nevertheless, HBV vaccine was not 100% effective, even after 3 doses. Vaccination against HBV is an
important occupational consideration in many areas of health care. Nevertheless, as a certain percentage of
individuals in rural areas do not successfully sero-convert, alternative vaccination strategies may need to be
considered.
Keywords: Hepatitis B Virus, Regional, Vaccination, Occupational, Australia
Introduction (Anti-HBs) following vaccination (Playford
et al, 2002). As this group is clearly at risk,
Vaccination against Hepatitis B Virus occupational screening for Anti-HBs is
(HBV) has been shown to be highly highly recommended (Public Health
effective in preventing horizontal Association of Australia, 2004). Despite this
transmission (Brotherton et al, 2003). HBV fact, little is known about occupational sero-
vaccine is now almost universally offered to conversion following HBV immunization
hospital staff (Queensland Department of and the epidemiology of Anti-HBs levels in
Health, 2004). HBV immunization has been regional health facilities.
a condition of employment with Queensland
Health since 1997 (Murray et al, 2002). Subjects and Methods
Despite a high coverage rate, up to 12% of
health care workers may not develop We investigated the nature of Anti-HBs
protective Anti HBV Surface Antigens sero-conversion among staff at a rural,
3
Correspondence author: Dr. Derek R Smith, email: smith@niih.go.jp

20. 20
mental health facility in Charters Towers, employed as registered nurses, enrolled
Queensland, Australia between 1998 and nurses or nursing assistants. Their mean age
2000. Anti-HBs levels were established was 51.5 years (SD: 10.5 years). At baseline,
using ELISA at Queensland Pathology 91.8% were considered to be unprotected
Health Services. Concentrations were against HBV. After the first vaccination, this
divided into the following categories: <10, level had dropped to 44.3% and further to
10 to 499, 500 to 999 and ≥ 1000 mIUmL. 9.8% by the second schedule. However,
Staff with Anti-HBs levels below 10 mIUmL after 3 vaccinations, 1.6% of the original
were considered to be unprotected against group still had Anti-HBs levels below 10
HBV. Those with a low level (<10) were mIUmL. The serology of Anti-HBs in the
automatically offered a booster vaccination, other concentration ranges was not linear,
while those with Anti-HBs levels between although all showed an improvement. The
10 and 499 were also offered a booster percentage of staff in the range 10 to 499
vaccine to increase their potential level of mIUmL rose continuously throughout the
immunity. Staff were re-tested three months vaccination schedule. A similar effect was
after the booster vaccination. Three also seen for the concentration range ≥ 1,000
vaccination schedules were offered and mIUmL. Interestingly, for 500 to 999
statistical calculations were performed by mIUmL, the number levelled off after 2
intention to treat (as a percentage of all vaccinations, with no improvement seen
staff). after 3 courses (Refer to Table 1). Over the
duration of our study, 8 staff dropped out or
Results were lost to follow-up due to resignation,
relocation or retirement.
A total of 61 individuals were studied.
Most (78.7%) were health care workers,
Table 1. Anti HBV Surface Antigen Concentrations among Rural Health Care Workers
Number and Percentage of Staff at Each Vaccination a
Concentration Baseline First Second Third
<10 mIUmL 56 (91.8) 27 (44.3) 6 (9.8) 1 (1.6)
10 – 499 mIUmL 0 (0.0) 22 (36.0) 27 (44.3) 28 (45.9)
500 – 999 mIUmL 0 (0.0) 2 (3.3) 3 (4.9) 3 (4.9)
≥ 1000 mIUmL 0 (0.0) 10 (16.4) 19 (31.1) 21 (34.4)
b
Unknown 5 (8.2) 0 (0.0) 6 (9.9) 8 (13.2)
TOTAL 61 (100) 61 (100) 61 (100) 61 (100)
a
Calculated as a percentage of all staff, with intention to treat (n = 61)
b
Staff member was either not tested at baseline or lost to follow-up
Discussion HBs levels below the recommended figure.
As such, this study has demonstrated that
This investigation showed that the Anti-HBs levels among rural health care
majority of rural health staff who were workers can certainly be improved by HBV
vulnerable to HBV at baseline had reached vaccination. However, there are a few
adequate immunity by the third vaccination reasons why rural staff may be difficult to
schedule. Nevertheless, after three doses vaccinate and follow-up. Firstly, there may
some of our original group still had Anti- be problems accessing appropriate health

21. 21
care facilities. Secondly, HBV vaccination
may not attract a high priority in regional References
areas, where community levels of the disease
are probably lower than for urban centres. Brotherton JML, Bartlett MJ, Muscatello
Thirdly, it may also be difficult to follow-up DJ, Campbell-Loyd S, Stewart K,
staff after vaccinations, simply due to the McAnulty JM. Do we practice what we
dispersed geographical nature of many rural preach? Health care workers screening
communities. Nevertheless, HBV and vaccination. American Journal of
vaccination is highly recommended for all Infection Control 2003; 31: 144-150.
health care workers and those at risk of
occupational exposure to HBV. Health care Queensland Department of Health. QLD
workers whose occupation poses a potential Health Policy for Hepatitis B
risk of exposure to blood or body fluids must Immunisation.
be immunised against HBV according to www.health.qld.gov.au/sexhealth/docu
Queensland Health Infection Control ments/hepb_policy.PDF (accessed June
Guidelines (Queensland Department of 2004)
Health, 2004). HBV immunisation is a
condition of employment for Queensland Murray SB, Skull SA. Poor health care
Health workers who have direct patient worker vaccination coverage and
contact, as well as those staff who may be knowledge of vaccination
occupationally exposed to blood or body recommendations in a tertiary
fluids. By the end of our study, a small but Australian hospital. Australian and New
significant proportion of the original group Zealand Journal of Public Health 2002;
remained unprotected against HBV. It has 26: 65-68.
been previously suggested that as many as
12% of vaccinated health care workers may Playford EG, Hogan PG, Bansal AS,
not develop protective antibodies in this Harrison K, Drummond D, Looke
regard (Playford et al, 2002). Where DFM, Whitby M. Intradermal
adequate Anti-HBs levels are not reached recombinant Hepatitis B vaccine for
following three vaccinations, the possibility healthcare workers who fail to respond
of HBsAg carriage should be investigated to intramuscular vaccine. Infection
(Public Health Association of Australia, Control and Hospital Epidemiology
2004). Those who are HBsAg negative and 2002; 23: 87-90.
do not respond should be offered further
doses of vaccine. Persistent non-responders Public Health Association of Australia.
should be informed about the need for Hepatitis B Vaccination Policy.
Hepatitis B Immunoglobulin (HBIG) within www.phaa.net.au/policy/HepBF.htm
48 hours of parenteral exposure to HBV (accessed June 2004)
(Public Health Association of Australia,
2004). Intradermal administration of HBV
vaccine has also been trialled for those
failing to sero-convert, and may hold some
promise in various health care situations
(Playford et al, 2002). Controlled trials of
intradermal HBV vaccine should now be
undertaken among rural cohorts where
immunisation-related sero-conversion does
not reach 100%.

22. 22

23. 23
Off -Site Emergency Planning
Hj Mohamad bin Jamil4
Major Hazard Division
Department of Occupational Safety and Health (DOSH) Malaysia
Abstract
Emergency in a major hazard installation may cause extensive damage to property and serious
disruption both inside and outside the installation. The overall objectives of an emergency plan are: to
localise the emergency and, if possible, eliminate it; and to minimise the effects of the accident on people and
property. The off-site emergency plan is an integral part of any major hazard control system. In many
countries the duty to prepare the off-site plan lies with the local authorities, including Malaysia. Thus, the
preparations of written off-site emergency response planning is required to minimize the impact of major
accident to the people , property and environment.
Keyword: emergency, plan, off-site, Malaysia
Introduction and an essential part of major hazard
control is concerned with mitigating the
A major emergency in a major hazard effects of a major accident.
installation is one, which has the potential to An important element of mitigation is
cause serious injury, loss of life, and damage emergency planning, i.e recognising that
to environment. It may cause extensive accidents are possible, assessing the
damage to property and serious disruption consequences of such accidents and deciding
both inside and outside the major hazard on the emergency procedures, both on site
installation. It would normally require the and off-side, that would need to be
extensive assistance of outside emergency implemented in the event of an emergency.
services to handle it effectively. Although Emergency plans are likely to be
the emergency may be caused by a number separate for on-site and off-site matters, but
or different factors, e.g plant failure, human they must be consistent with other, i.e. they
errors, earthquake, vehicle crash or must be related to the same assessed
sabotage, it will normally manifest itself in emergency conditions. While an on-site plan
three basic forms: fire, explosion or toxic will always be the responsibility of the
release. manufacturer, different legislations may
Other major hazard controls are place the responsibility for the off- site plan
concerned with preventing accidents through elsewhere: for example, the Control of
good design, operation, maintenance and Industrial Major Accidents Regulations
inspection. Achieving all this will reduce the (CIMAH), 1996 requires the authority to
risk of an accident, but it will not eliminate it prepare the off-site plan but not mandatory.
altogether - absolute safety is not achievable,
4
Correspondence author: Hj.Mohamad bin Jamil, email: mohd_j@mohr.gov.my

24. 24
Objective of Emergency Planning manufacturer and local authority. Either
way, the plan must identify an emergency
The overall objectives of an emergency coordinating officer who would take overall
plan are: to localise the emergency and, if command of the off-site activities. As with
possible, eliminate it; and to minimise the the on-site plan, an emergency control centre
effects of the accident on people and will be required within which the emergency
property. coordinating officer can operate.
Elimination will require prompt action An early decision will be required in
by operators and installation emergency staff many cases on the advice to be given to
using, for example fire-fighting equipments people living "within range" of the accident -
emergency shut-off valves and water sprays. in particular whether they should be
Minimising the effects may include evacuated or told to go indoors. In the later
rescue, first aid, evacuation, rehabilitation case, the decision can regularly be reviewed
and living information promptly to people in the event of an escalation of the incident.
living nearby. Consideration of evacuation may include the
following factors:
Off-Site Emergency Planning (a) in the case of a major fire but
without explosion risk (e.g. an oil
The off-site emergency plan is an storage tank), only houses close to
integral part of any major hazard control the fire are likely to need
system. It should be based on those evacuation, although severe smoke
accidents identified by the manufacturer, hazard may require this to be
which could affect people, property and the reviewed periodically;
environment outside the installation. Thus,
the off-site plan follows logically from the (b) if a fire is escalating and in turn
analysis that took place to provide the basis threatening a store of hazardous
for the on-site plan and the two plans should material, it might be necessary to
therefore complement each other. The off- evacuate people nearby, but only if
site plan in detail should be based on - those there is time; if insufficient time
events, which are most likely to occur, but exists, people should be advised to
other less likely events, which would have stay indoors and shield themselves
severe consequences should also be from the fire. This latter case
considered. Incidents which would have very particularly applies if the
severe consequences yet have a small installation at risk could produce a
probability of occurrence will be in this fireball with very severe thermal
category, although there will be certain radiation effects (e.g. Liquidfied
events which are so improbable that it would Petroleum Gas storage);
not be sensible to consider them in detail in
the plan. These events might include aircraft (c) for releases or potential releases of
crashes on to the installation. However, the toxic materials, limited evacuation
key feature of a good off-site emergency may be appropriate down wind if
plan is flexibility in its application to there is time. The decision would
emergencies other than those specifically depend partly on the type of
included in the formation of the plan. housing 'at risk". Conventional
The roles of the various parties who housing of solid construction with
may be involved in the implementation of an windows closed offers substantial
off-site plan are described below. For protection from the effects of a
CIMAH regulation, the responsibility for the toxic cloud - while shanty houses
off-site plan will be likely to rest with the

25. 25
which can exist close to factories, 1976); hazards from potential lost
particularly in developing of containment.
countries, offer little or no (c) rapid release of limited duration,
protection. due to plant failure. e.g fracture of
pipe: hazards from toxic cloud,
The major difference between releases limited in size, which may quickly
of toxic and flammable materials is that disperse.
toxic clouds are generally hazardous down (d) massive release of toxic substance,
to much lower concentrations, and therefore due to failure of large storage or
hazardous over greater distances. Also, a process vessel or uncontrollable
toxic cloud drifting at, say, 300 meters per chemical reaction and failure of
minute cover a large area of land very safety systems; the exposure hazard
quickly. Any consideration of evacuation would affect a wide area.
must take this into account.
Although a plan should have sufficient The assessment of possible incidents
flexibility built into cover the consequences should produce a report indicating -
of the range of accidents identified for the (a) the worse events considered.
on-site plan, it is suggested that it should (b) the route to those worst events.
cover in some detail the handling of the (c) the time-scale to lesser events along
emergency to particular distance from each the way.
major hazard installation. This distance may (d) the size of lesser events if their
be judge form the result of worst case development is halted.
consequence analysis. (e) the relative likelihood of events.
(f) the consequences of each event.
Identification and Assessment of Hazards
Incidents should be assessed in terms of
Most major hazard accidents come the quantity of hazardous materials which
within the following categories: could be released, the rate of release and the
(1) Events involving flammable materials effects of that release – i.e. as thermal
(a) major fires with no danger of radiation from a fire or fireball or as a toxic
explosion: hazards from prolonged gas cloud - as a function of distance from the
high levels of thermal radiation and plant.
smoke. Guidance on the dangers of uncommon
(b) fire threatening items of plant hazardous substances should be obtained
containing hazardous substances; from the suppliers of those substances.
hazards from spread of fire, The overall assessment of the major
explosion or release of toxic hazard provides the framework for both
substances. emergency plans to be drawn up.
(c) explosion with little or no warning;
hazards from blast wave, flying Aspects to be Included in an Off-Site
debris and high levels of thermal Emergency Plan
radiation.
(2) Events involving toxic materials The CIMAH Regulation has not given
(a) slow or intermittent release of toxic the aspects to be included in off-site
substances, e.g. from a leaking emergency plans but ideal plan develop at
valve. least having the following:
(b) items of plant threatened by fire
(Chemical Industrials Association,

26. 26
Organisation Assessment
Details of command structure, warning Arrangement for:
systems, implementation procedures, (a) collecting information on the
emergency control centers names and causes of the emergency.
appointments of incident controller, site (b) reviewing the efficiency and
main controller, their deputies and other key effectiveness of all aspects of the
personnel. emergency plan.
Communications Role of the Emergency Coordinating
Identification of personnel involved, Officer
communication centre, call sign, network,
lists of telephone numbers. The various emergency services
will be coordinated by an emergency
Specialised Emergency Equipment coordinating officer (ECO) who is likely to
Details of availability and location of be a senior police officer but, depending on
heavy lifting gear, bulldozers, specified fire- the circumstances, could be a senior fire
fighting equipment fire boats. officer. The ECO will liase closely with the
site main controller.
Specialised Knowledge
Details of specialist bodies, firms and Role of Major Hazard Installation
people upon whom it my be necessary to Managements
call, e.g. those with specialised chemical
knowledge, laboratories. The role of major hazard installation
managements in off-site emergency planning
Voluntary Organisations will be to establish liaison with those
Detail of organisers, telephone numbers, preparing the plants and to provide
resources, etc. information appropriate to such plans. This
will include a description of possible on-site
Chemicals Information accidents with potential for off-site harm,
Detail of the hazardous substances together with their consequences and an
stores or processed on each site and a indication of the relative likelihood of the
summary of the risks associated with them. accidents.
Advice should be provided by major
Meteorological Information hazard installation managements to all the
Arrangements for obtaining details of outside organisations which may become
weather conditionals prevailing at the time involved in handling the emergency off site
and weather forecasts. and which will need previously to have
familiarised themselves with some of the
Humanitarian Arrangements technical aspects of the major hazards
Transport, evacuation centres, installation activities, e.g. emergency
emergency feeding, treatment of injured, services, medical departments and also water
first aid, ambulances, temporary mortuaries. authorities (if water contamination could be
a consequence of an accident).
Public Information
Arrangements for: Role of the Local Authority
(a) dealing with the media-press office.
(b) informing relatives. In many countries the duty to prepare
the off-site plan lies with the local
authorities, including Malaysia. They may

27. 27
have appointed an emergency planning
officer (EFO) to carry out this duty as part of
the EPO's role in preparing for a whole
range of different emergencies within the
local authority area. The EPO will need to
liaise with the major hazard installation to
obtain the information to provide the basic
for the plan. This liaison will need to be
maintained to ensure that the plan is
continually kept up to date.
It will be the responsibility of the EPO
to ensure that all those organisations which
will be involved off site in handling the
emergency know of their role and are able to
accept it by having, for example, sufficient
staff and appropriate equipment to cover
their particular responsibilities.
Role of the Police
The overall control of an emergency is
normally assumed by the police, with a
senior officer designated as emergency
coordinating officer. Formal duties of the
police during the emergency include
protecting life and property and controlling
traffic movements. Their function including
controlling bystanders, evacuating the
public, identifying the dead and dealing with
casualties, and informing relatives of death
injury.
Role of the Fire Authorities
The control of a fire is normally the
responsibility of the senior fire brigade
officer who would take over the handling of
the fire from the site incident controller on
arrival at the site. The senior fire brigade
officer may also have a similar responsibility
for the other events, such as explosions and
toxic releases. Fire authorities should be
familiar with the location on site of all stores
of flammable materials, water and foam
supply points, and fire-fighting equipment.
They may well have been involved in on-site
emergency rehearsals both as participants
and, on occasion, as observers of exercises
involving only site personnel.

28. 28
Rehearsals and Exercises in Off-Site installation, this advice would be
Emergency Planning inappropriate because, for example, of the
low protection from gas cloud that such
Extensive experience in the chemical housing offers, and large-scale evacuation
industry with on-site emergency planning might, be necessary. In these cases, film
has proved the need and value of rehearsals shows are considered a useful medium for
of emergency procedures. passing advise to local people, particularly
The organization responsible for where a proportion of them may be unable to
producing the off-site plan should test its read.
arrangements in conjunction with on-site
exercises. Table-top rehearsals have proved Conclusion
extremely useful in such cases, although
needing close control to maintain a sufficient Although identification, prevention and
element of realism in the exercises. mitigation of major accident in place at
An essential component of any trial is major hazard installation but risk of
that of testing fully the various occurrence such accident cannot be
communication links necessary to gather the eliminate. Thus, the preparations of written
information needed for overall coordination, off-site emergency response planning is
e.g. between major hazard installation and required to minimize the impact of major
emergency control centre and the incident. accident to the people, property and
Management of major hazard environment. The most important is to keep
installation are well placed to advise on the up to date of the establish plan and conduct
setting up of rehearsals, and particularly to drill to ensure the plan is working.
advise on the scope for an escalation in the
degree of emergency.
Information to the Public
Experience of major accidents,
particularly those involving toxic gas
releases, has shown the importance of the
public nearby having prior warning of: (a)
how to recognize that an emergency is
occurring; (b) what action they should take;
(c) what remedial medical treatment would
be appropriate for anyone being affected by
the gas. CIMAH regulation requires those
living near to the major hazard installation to
be given information, particularly covering
their action in the event of an emergency.
For inhabitants of conventional housing of
solid construction, the advice in the event of
an emergency is to go indoors and close all
doors and windows, switch off all
ventilation air conditioning, and switch on
the local radio for further instructions.
Where the large numbers of shanty-
dwellers like close to a major hazard

29. 29
References on the 3rd International Conference On
Disaster Management. Sarawak,
Occupational Safety and Health (Control of Malaysia, 2002.
Industrial Major Accident Hazard)
Regulations 1996. Elizabeth Girardi Schoen. Emergency
Planning and Response.
Major Hazard Control, A Practical Manual,
ILO, 1988. Ronald H. Mountain, A System for Local
Authority Management in a Major
Sa'ari Mustapha and Izani Mohd Zain, Emergency. Disaster Prevention and
Prevention, Control and Mitigation Management, Vol 2 No. 1, 1993
Measures of Major Industrial Accidents

30. 30
Safety in the Construction Industry:
Are we Barking at the Wrong Tree?
Khairuddin Sulaiman5, Norhayati Mahyuddin
Faculty of Built Environment, University of Malaya.
Abstract
The construction industry is an important industry in the Malaysian’s economy. Much has been said
about the quality of the product as well as the image of the industry due to the small percentage of local
workers on site. The industry’s welfare and safety record is not at all encouraging. To stop the rot, the
government has taken important and significant steps by the establishment of the Malaysian Construction
Industry Development Board (CIDB) and the National Institute of Occupational Safety and Health (NIOSH).
These efforts have shown some significant positive improvement in the perception and action of those
involved in the industry but we are still far from the standard shown in other developed countries in terms of
site safety. This paper is to discuss the roles and responsibilities of the key players in the industry be it the
clients, consultants or contractors. The focus is on the ‘upstream’ activities i.e. the pre-construction stage,
rather than the ‘downstream’ i.e. the construction phase of a project:
Keyword: safety, responsibilities, upstream activities, Malaysia.
Introduction who is in charge of maintenance, who design
the drivers schedule-the answer is the
The building and construction industry management. Therefore, in many ways they
is a dynamic and hazardous industry, making are also responsible for the accident. This
it both unique and challenging to study. This example is taken as to compare what is
is due to diverse and complex nature of work happening on construction sites. In the event
tasks, trades and environments, as well as of an accident, all fingers will be pointing to
the temporary and transitory nature of the contractor. There are many contributory
construction workplaces in the construction factors to any accident that happens. This
workforce. Have you come across an will be discussed further later, but the point
incident involving an express bus causing here is that in any accident on construction
catastrophic death? In usual case scenario, site, the root cause of an accident must be
the driver is always found guilty of reckless looked into and the contractor or builder is
driving and will be given a few years prison not the only one to be blamed for any injury
sentence. On the other hand, what about the or fatality on construction site.
company? No charge was taken and of
course they are covered by insurance and in The theory of accident causation
no time they can buy a new bus and hire There are many theories about accident
another driver. In other words they got off causation but one of the most simple and
scotts free! Now let us think, who is in easy to accept theory is the Domino Theory.
charge of the company, who hires the driver, This theory has been developed in the
5
Correspondence author: Assoc. Prof. Khairuddin Sulaiman, email: khairsulaiman@um.edu.my

31. 31
Management Operational Unsafe condition Accident Injury
structure Area and unsafe action (Loss)
Figure 1: Adam’s Dominoes Sequence ( Adapted from: Karim & Lee,1993 )
1930’s by a man called Heinrich and has will result in accidents to happen and
been modified by several others including workers will suffer.
Bird (1974) and Adam (1976). Another famous theory is The Failure
The above Figure 1 shows the dominoes Initiation Theory by Whittington et al
in Adam’s theory which represents the (1992). This theory addresses deficient
elements that contribute to the injury policy in the top of organizational level,
resulting from an accident. Basically, the suggesting that it stimulates failures in the
source of an accident is at the management lower levels of organization, including in the
level, example lack of clear safety policy for site and operational levels. The model of this
the project, and this might triggers choosing theory is as shown in Figure 2 below.
in competent contractor who do not care Figure 2 suggests that there four levels
about safety resulting in dangerous at which failures can occur. In this theory,
operation. The unsafe action or operation the failures at higher level will increase the
probability of failures at lower
Policy Project Site Invidual Accident
Failures management management failure event
failure failure
Figure 2: Adam’s Dominoes Sequence ( Adapted from: Karim & Lee,1993 )
level. Failure at top level can be the failure construction starts. This is where the roles of
of the company’s policy which will increase other players in the production process
the probability of failures at the project namely the client and consultants or
level. Examples of failures at this level are, designers in the upstream activities can be
in adequate in training policy or poor related to what is happening on site.
methods of procurement. At the project level
the failures are, lack of planning, poor work Who is responsible?
schedule, or choice of inappropriate It is common in the construction
construction methods. At the site industry that design and construction be
management level, failures can be poor undertaken separately by different
communication, lack of supervision or professional organisations. Design of the
failure to adequately segregate work. At constructed facility is normally the
individual level failures can be wrong responsibility of an architect and engineer,
equipment or failure to comply with an whereas design of the construction process,
agreed method of work. including safety, is conventionally
considered to be the contractors’
Therefore causes of accident in responsibility. It is now generally
construction site can be linked to many understood in Europe, enshrined in
factors that can be traced along the European legislation and, more specifically,
production process i.e. even before the since the introduction in 1994 of the