Occupational Health and Services

1. WORKPLACE ENVIRONMENT SURVEILLANCE a. Regarding changes to be made in your workplace in accordance with occupational health and safety: i. Safe design of the workplace, ii. Planning, organization, and implementation of work using appropriate materials, iii. Selection of personal protective equipment, Our occupational physician will conduct on-site observations and provide recommendations to your company to ensure these practices comply with occupational health and safety legislation and general health principles. b. To identify necessary measures in terms of ergonomics and psychosocial risks, our occupational physician will observe and report on the compatibility between the job site and the employee by taking into account employees’ physical and mental capacities and proposing ways to reduce workplace stress factors. c. The general hygiene conditions of the working area will be continuously monitored, and suggestions will be made to ensure the necessary conditions for maintaining your operations. d. Based on health surveillance results, if necessary, we will recommend environmental measurements in cooperation with the occupational safety expert, evaluate results, and provide suggestions to correct any health-compromising conditions. 2. RISK ASSESSMENT a. Participate in the risk analysis process and its implementation with the occupational safety expert regarding the evaluation of occupational health and safety risks in your workplace; provide recommendations to the employer on the necessary health precautions to be taken and monitor their execution. b. Closely monitor and inform employee groups that require special policies, and ensure they are specifically considered in the risk assessment process. 3. HEALTH SURVEILLANCE Medical Examinations "Starting with the recruitment process, each employee shall undergo a health examination suited to the position they will work in. Necessary tests will be reviewed to determine health status and suitability for the job. Preventive measures will be advised, and the occupational physician will share their assessment with your company. Where needed, follow-up and revision of periodic examinations will be performed.” Pre-Employment Medical Examination and Revisions Appropriate medical tests will be conducted before employment, based on the department and working conditions, and a report will be prepared in line with the periodic examination form to determine whether the employee is fit for the job. This report must be kept in the workplace records. Periodic Examinations and Revisions Employees with previous pre-employment reports will be checked for any changes in health status or working conditions. A periodic examination report will be issued, and the employee will be informed. Note: Based on the employee’s personal characteristics, the workplace's hazard classification, and the nature of the job, and according to the workplace risk assessment: a. In Low Hazard workplaces: at least once every 5 years, b. In Medium Hazard workplaces: at least once every 3 years, c. In High Hazard workplaces: at least once every year. These intervals may be shortened at the discretion of the occupational physician. Return-to-Work Examination When employees return to work after health-related absences, a return-to-work exam will be conducted upon request. If they are deemed unfit to return to their previous position, the physician will recommend a suitable role and submit the recommendation for employer approval. Examinations for Special Groups For employees with occupational disease diagnoses, chronic illnesses, substance abuse, or repeated workplace accidents (e.g., young workers, child laborers, pregnant or breastfeeding employees), health examinations will be carried out to ensure appropriate job placement. If occupational illness is diagnosed, other employees in the same environment will also undergo repeat health checks. 4. TRAINING AND INFORMATION a. Plan occupational health and safety training for your staff in accordance with relevant legislation, submit plans for employer approval, and implement or supervise training. b. Make recommendations regarding the organization of first aid and emergency intervention services, including related employee training. c. Provide ongoing training to your managers, employees, and, if applicable, members of the occupational health and safety board, on general health, occupational health and safety, hygiene, the harms of substance use, personal protective equipment, and collective protection methods. d. Inform employees about workplace risks, health surveillance practices, pre-employment and periodic medical examinations. e. In cooperation with the occupational safety expert, prepare an annual evaluation report summarizing the occupational health and safety efforts and health surveillance results specific to your workplace.

In addition to the health report to be issued after conducting the necessary medical tests at the recruitment stage—ensuring the suitability of your personnel for the department and working conditions they are assigned to, and evaluating their fitness for the job in terms of occupational health: An assessment will be made to determine whether there is any correlation between your personnel’s absenteeism due to health issues and potential health hazards in the workplace. If necessary, environmental measurements will be planned and submitted for employer approval, and the results will be evaluated in terms of employee health. To control infectious diseases in the workplace, efforts will be made to prevent the spread, ensure immunization, and provide necessary hygiene training. Required medical examinations and tests will also be carried out. Recommendations will be given to the employer regarding the suitability of machinery and equipment used in the workplace in terms of occupational health, including improvements to current practices and equipment. The employer will be informed about the appropriate placement and use of occupational health instructions within the workplace. Investigations will be conducted into the causes of occupational accidents and diseases occurring in the workplace, and recommendations will be made to the employer on preventive measures to avoid recurrence. In the event of incidents that do not result in death or injury but have the potential to cause harm to employees, equipment, or the workplace, analyses will be conducted to determine the causes and notifications will be made to the employer. Any necessary occupational health and safety measures will be communicated to your company in writing. To record all occupational health surveillance activities in the workplace: In cooperation with the occupational safety specialist, assessments will be carried out regarding occupational accidents and diseases, Investigations and analyses will be performed for hazardous incidents to prevent recurrence, and preventive action plans will be developed, An annual work plan including these topics will be prepared and submitted for employer approval, and the implementation of the plan will be monitored, culminating in the preparation of an annual evaluation report. An annual work plan detailing occupational health and safety activities to be conducted in the following year will be prepared together with the occupational safety specialist.

Conducting health examinations for employees in workplaces is a legal obligation. Health records of employees must be initiated at the time of employment and renewed and stored at legally specified intervals. Timely health screenings help detect potential problems early and ensure necessary preventive measures are taken. İZKA OSGB – İZKA LABORATORY, with its team of experts, provides a full range of health services including: Occupational physician services, pre-employment health reports, reports for heavy and dangerous jobs, carrier (portör) screening, health screenings, pulmonary function tests, blood and urine tests, chest X-rays, audiometry, and more. Our mobile health unit, operated within our organization or in collaboration with our solution partners, allows employees working at specific workplaces to undergo the legally required medical tests related to occupational diseases directly at their workplace. Just call us for Mobile Health Services. TESTS AND RENEWAL FREQUENCIES Test Frequency Chest X-ray At least once a year Stool Culture For Salmonella and Shigella, at least once a year Throat and Nose Culture For Staphylococcus aureus, at least once a year Microscopic Stool Examination For Entamoeba histolytica cysts, Giardia lamblia cysts, and helminth eggs – at least every 6 months Complete Blood Count (Hemogram) As needed Complete Urinalysis (CUA) As needed Liver Function Tests SGOT (AST), SGPT (ALT), Gamma-GT, LDH Kidney Function Tests Urea, Creatinine, Uric Acid Serological Tests Anti-HBs, HBsAg, Anti-HCV, HIV 1+2, and other hepatitis markers Toxicological Tests Lead in blood/urine, toluene, phenol, mandelic acid, hippuric acid in urine, etc.   CHEST X-RAY As stated by the General Directorate of Occupational Health and Safety of the Ministry of Labor and Social Security of the Republic of Turkey, chest X-rays used in “Periodic Worker Health” screenings must be at least 35×35 cm in size and meet 1st or 2nd technical quality as per ILO (International Labour Organization) standards. Our chest X-rays are taken in 35×35 cm format by our radiology technician and interpreted by our radiologist. AUDIOMETRY Hearing tests (audiometry) are conducted to evaluate potential hearing loss due to working in noisy environments. Our mobile health screening unit includes a sound-insulated audiometry cabin. Tests are conducted by our audiometrists and reported by our ENT (Ear-Nose-Throat) specialist. PULMONARY FUNCTION TEST (PFT) The Pulmonary Function Test measures lung function and capacity under appropriate conditions. It is used to assess the risk of respiratory and lung diseases caused by exposure to gases, dust, fumes, and chemicals in the workplace. CARRIER (PORTÖR) SCREENING Carrier screening includes: Chest X-ray Throat culture Stool culture Stool microscopy Clinical examination Samples are collected either in our laboratory or mobile health screening unit under proper conditions and processed in İzka Laboratory, and results are reported. VACCINATION SERVICES Vaccinations are carried out in our İzka Laboratory and Mobile Health Screening Vehicle by nurses or healthcare officers, following proper cold chain protocols. Vaccines include: Tetanus vaccine Hepatitis vaccines (administered to appropriate individuals based on test results) Influenza vaccines (administered upon request to prevent workforce loss during seasonal outbreaks) REPORT FOR HEAVY AND DANGEROUS JOBS Reports for heavy and dangerous jobs are issued by our experienced occupational physicians in accordance with the “Regulation on Heavy and Dangerous Work,” published in the Official Gazette dated June 16, 2004, issue number 25494.

At our Fixed Medical Examination Unit within İzka Joint Health and Safety Unit, we perform the following examinations and all legally required tests for pre-employment health reports, high-altitude work eligibility, heavy and dangerous work suitability, and return-to-work examinations. All reports are approved by a Specialist Physician: PA Chest X-ray Pulmonary Function Test (PFT) Audiometry (Hearing Test) Hemogram Electrocardiogram (ECG) HbA1c Fasting and Postprandial Blood Glucose ALT, AST, GGT Urea, Creatinine Complete Urinalysis Blood Type HBsAg, Anti-HBs, Anti-HIV 4-in-1 Carrier Test Eye Examination Tetanus Vaccine Anti-HCV HAV IgM / HAV IgG Blood Lead Level Sedimentation BUN Triglycerides MEDICAL EXAMINATIONS UNDER HEALTH SURVEILLANCE “From the moment an employee is hired, a health check must be performed based on their job role. Tests must be reviewed, health status determined, and job compatibility assessed from an occupational health perspective. The occupational physician shall provide feedback, recommend preventive measures, and revise periodic check-ups as needed.” Pre-Employment Examination & Revisions Medical tests appropriate to the position and work environment will be conducted, and a health suitability report will be prepared and stored in line with the periodic examination form. Periodic Examinations & Revisions Employees previously cleared during pre-employment will undergo periodic examinations to detect any changes in working conditions or personal health. Reports will be issued and communicated. NOTE: Based on the workplace's risk classification and the nature of the work, and as per workplace risk assessment results: Low-risk workplaces: at least once every 5 years Medium-risk workplaces: at least once every 3 years High-risk workplaces: at least once per year (These periods may be shortened by the occupational physician if deemed necessary – Regulation No. 28713, Article 9/C3) Return-to-Work Examination If an employee returns to work following a medical leave, a return-to-work exam can be conducted. If the employee is found unfit for their former role, a suitable alternative may be recommended with the employer's approval. Special Group Examinations For employees with occupational disease diagnoses, chronic conditions, substance addiction, repeated workplace injuries, or those in special categories (young workers, child laborers, pregnant or nursing women), appropriate health exams will be conducted and documented. Other employees in the same work environment may also be re-evaluated when an occupational illness is confirmed. HEALTH SCREENINGS We perform all legally required medical tests and screenings for issuing pre-employment health reports in accordance with International Labour Organization (ILO) standards through our specialist physicians. CARRIER (PORTÖR) SCREENING INCLUDES: Chest X-ray Throat culture Stool culture Stool microscopy Clinical examination Samples collected either in our Fixed Medical Examination Unit or Mobile Health Screening Vehicle are preserved under appropriate conditions and analyzed in our facility. Results are reported accordingly. CARRIER TESTS Stool parasite examination Stool culture & antibiogram Nasal culture & antibiogram Throat culture & antibiogram Chest X-ray ADDITIONAL TESTS Hepatitis screening Blood lead level Heavy metals and toxic substances in blood or urine Routine biochemical monitoring panel Blood, culture, and microscopy samples are collected in groups from your employees. The organization and test list are coordinated with your company. AVAILABLE TESTS AT İZKA OSGB FIXED MEDICAL LABORATORY INCLUDE: AFP (ELECSYS) Albumin ALP, ALT, Amylase Anti-HBC IgG / IgM Anti-HCV, Anti-HIV Anti-M, Anti-T, Anti-TPO Anti-HAV IgG / IgM Anti-HBs (including ELISA) APTT, ASO, AST Brucella Tube Agglutination BUN, CA15-3, CA19-9 CEA, CRP, Vitamin D Iron, TIBC, Direct Bilirubin Drug Test, Estradiol Ferritin, Folic Acid FSH, FT3, FT4 GGT, Glucose, HbA1c HBsAg (including ELISA) HDL Cholesterol, Hemogram HIV (ELISA), IgE Indirect Bilirubin Insulin, Insulin Resistance Calcium, Blood Type Measles IgG / IgM Chloride, Cholesterol Creatinine, LDH, LDL LH, Magnesium Peripheral Smear Coagulation Time Pneumoconiosis A-B Carrier (Portör) Potassium, Progesterone Prolactin, Prothrombin Time RF, Sedimentation Free PSA, Sodium, CUA Total Bilirubin Total Iron Binding Capacity Total Lipid, Total PSA Total Testosterone Transferrin, Triglyceride TSH, Urea, Uric Acid VDRL, Vitamin B12 RADIOLOGY & FUNCTIONAL TEST REPORTING Chest X-ray Interpretation ECG Reporting Audiometry Reporting Pulmonary Function Test Reporting HEAVY METAL & TOXICOLOGICAL PANEL Lead, Zinc, Aluminum Solvent, Manganese Hippuric Acid, Phenol TCA, Chromium, Nickel Copper, Hydroxypyrene Cadmium, Cobalt o-Cresol, Trans-Muconic Acid Mandelic Acid