UKOM Sp.Ok cheat sheet

Legal basis: UU No. 1/1970 on Occupational Safety covers all workplaces; UU No. 13/2003 (Ketenagakerjaan) mandates employer protection of worker safety, health, and morals; PP No. 50/2012 governs SMK3 implementation.

SMK3 (Sistem Manajemen Keselamatan dan Kerja) is mandatory for workplaces with ≥100 workers or high hazard potential; audited by an accredited body with certificate valid 3 years.

Permenaker No. 3/1982 requires occupational health services (Pelayanan Kesehatan Kerja) in workplaces meeting worker/hazard thresholds; Permenaker No. 8/2020 on K3 in the workplace.

Doctor and paramedic roles in company health services are regulated by Permenaker No. 3/1982 and Kepmenaker No. 333/1989 on occupational health service personnel; occupational physicians require Surat Izin Praktik (SIP) plus occupational health certification.

Ethical pillars: informed consent for medical surveillance, confidentiality of worker health records (medical secret), non-discrimination in fitness decisions, and reporting occupational diseases without breaching privacy.

Occupational disease reporting: Permenaker No. 10/2015 lists 31 occupational diseases (penyakit akibat kerja); employers must report to the labour office and BPJS Ketenagakerjaan for benefit claims.

BPJS Ketenagakerjaan covers work injury (JKK) and death benefits; BPJS Kesehatan covers general health - workers cannot be denied JKK benefits for work-related injury regardless of fault, except self-inflicted injury.

Regulatory hierarchy: UU (law) > PP (government regulation) > Permenaker (ministerial regulation) > Kepmenaker (ministerial decree) > circulars; when conflict arises, the higher instrument prevails.

Dose-response principle: toxic effect is a function of dose; Paracelsus - 'the dose makes the poison'; distinguish acute (high dose, short) versus chronic (low dose, long latency) effects.

Exposure routes: inhalation (most common in industry), dermal absorption, ingestion, and injection; route determines target organ and biological monitoring matrix.

Threshold Limit Values (TLV-TWA, TLV-STEL, TLV-C) are 8-hour time-weighted averages, 15-minute short-term limits, and ceiling limits respectively; TLVs are not legal standards but professional guidance.

Formula: TWA = Σ(Ci × Ti) / 8 hours, where Ci is concentration and Ti is hours exposed; compare to TLV-TWA to determine compliance.

Biological Exposure Indices (BEI) are reference values for biological monitoring (blood, urine, exhaled air) that indicate exposure comparable to TLV exposure.

Hazard identification tools: MSDS/SDS review, workplace walkthrough, process inventory, and job-exposure matrix (JEM); hazard = intrinsic property, risk = probability × severity.

Risk assessment formula: risk = probability of occurrence × severity of consequence; risk matrix classifies low/medium/high/extreme for control prioritization.

Occupational exposure limits in Indonesia: Permenaker No. 13/2011 sets NAB (Nilai Ambang Batas) for chemical and physical hazards in workplace air.

Ergonomic risk factors: awkward posture, repetition, force, vibration, contact stress, and duration; assess with RULA/REBA for postural load and NIOSH lifting equation for manual handling.

NIOSH lifting equation: RWL = LC × HM × VM × DM × AM × FM × CM; LI = Load / RWL; LI > 1 indicates increased injury risk.

Circadian rhythm: core body temperature and alertness peak in late afternoon, trough at 03:00–05:00; night shift workers face increased error rates during trough.

Shift work effects: circadian disruption, sleep debt, gastrointestinal disorders, cardiovascular risk, and increased cancer risk (IARC Group 2A for long-term night shift work).

Recommended shift design: forward-rotating shifts (morning → afternoon → night), avoid >8-hour night shifts, minimum 11 hours rest between shifts, and adequate recovery after night blocks.

Heat stress: WBGT (Wet Bulb Globe Temperature) index; acclimatization takes 7–14 days; workers should drink 1 cup every 15–20 minutes during heat exposure.

Workload assessment: heart rate monitoring, VO2max estimation, and perceived exertion (Borg scale); physical work capacity declines with age and deconditioning.

Vibration exposure: hand-arm vibration syndrome (HAVS) from prolonged tool use; whole-body vibration from driving; Permenaker 13/2011 sets exposure limits for both.

Biological hazard categories: bacteria, viruses, fungi, parasites, prions; transmission routes are airborne, droplet, contact, vector-borne, and percutaneous (needlestick).

Needlestick injury protocol: wash with soap and water, do not squeeze, report immediately, assess source status (HIV, HBV, HCV), and initiate PEP within 2 hours for HIV (max 72 hours).

Hepatitis B: vaccination is the primary prevention for healthcare workers; post-exposure prophylaxis includes HBIG plus vaccine for non-immune workers.

Tuberculosis in healthcare workers: airborne precaution with N95 respirator, negative-pressure room, and annual screening; IGRA or Mantoux for latent TB.

Brucellosis: zoonotic risk for farmers, veterinarians, and abattoir workers; transmitted by contact with infected animal products; presents as undulant fever.

Leptospirosis: risk for rice farmers, sewer workers, and miners; transmitted by rat urine in water; prevention via boots, gloves, and doxycycline prophylaxis in high-risk settings.

COVID-19 and respiratory viruses: risk assessment by exposure proximity and duration; PPE hierarchy includes engineering controls (ventilation), administrative controls, and respirators.

Biological waste management: color-coded segregation (yellow for infectious, red for sharps, black for general); autoclave or incineration per Permenkes standards.

Pneumoconiosis: silicosis (silica dust, mining/construction), asbestosis (asbestos, latency 15–30 years), coal worker's pneumoconiosis; diagnosed by chest X-ray (ILO classification) and exposure history.

Occupational asthma: variable airflow obstruction caused by workplace sensitizers (isocyanates, flour dust, latex); diagnosis by peak flow monitoring at and away from work, and specific IgE.

Byssinosis: cotton dust exposure in textile workers; Monday morning chest tightness; prevention by dust control and cotton dust standards.

Occupational dermatitis: irritant (direct damage) versus allergic (type IV hypersensitivity); common agents are detergents, solvents, epoxy resins, and nickel; patch testing identifies allergens.

Contact dermatitis management: remove from exposure, barrier creams, gloves, and topical corticosteroids; document with occupational dermatitis reporting.

Musculoskeletal disorders (MSDs): cumulative trauma from repetition, force, posture, and vibration; common sites are lower back, neck, shoulder, and wrist (CTS).

Carpal tunnel syndrome: median nerve compression from repetitive wrist flexion; symptoms are nocturnal numbness and thenar atrophy; diagnosed by nerve conduction study.

Occupational hearing loss is sensorineural and irreversible; noise-induced hearing loss shows a 4 kHz notch on audiogram; prevention by noise control and hearing protection.

IARC classification: Group 1 (carcinogenic to humans), 2A (probably), 2B (possibly), 3 (not classifiable), 4 (probably not); occupational agents in Group 1 include asbestos, benzene, silica, and ionizing radiation.

Occupational cancers: mesothelioma (asbestos), bladder cancer (aromatic amines, rubber industry), leukemia (benzene), lung cancer (silica, arsenic, diesel exhaust), and sinonasal cancer (wood dust).

Latency period for occupational cancer is typically 10–40 years; surveillance must account for latency and former exposures.

Neurotoxic agents: lead (peripheral neuropathy, encephalopathy), mercury (erethism, tremor), organophosphates (cholinergic crisis), and solvents (central nervous system depression).

Lead exposure: blood lead level is the biomarker; effects include anemia, hypertension, and neurotoxicity; Permenaker 13/2011 sets a biological limit.

Reproductive hazards: teratogens (ionizing radiation, organic solvents, lead, mercury), mutagens, and endocrine disruptors; risk assessment must cover both male and female workers.

Pregnancy protection: job reassignment away from teratogens without loss of pay; UU No. 13/2003 protects pregnant workers from hazardous work.

Occupational health surveillance for carcinogens: pre-employment, periodic, and exit medical exams; record retention for at least 30 years after exposure ends.

Fitness-for-work categories: fit, fit with restrictions, temporarily unfit, and permanently unfit; the decision must be based on job demands versus worker capacity.

Pre-employment medical examination assesses baseline health and suitability; periodic examination monitors health changes from exposure; exit examination documents final health status.

Medical surveillance is required for workers exposed to specific hazards (noise, dust, chemicals, radiation) per Permenaker 13/2011 and 3/1982.

Return-to-work (RTW): staged rehabilitation, modified duties, and workplace accommodation; the occupational physician coordinates with employer and treating clinician.

Workplace accommodation principles: job modification, assistive devices, flexible scheduling, and ergonomic adjustments to enable return without re-injury.

Disability assessment: use standardized impairment scales and consider functional capacity, not just diagnosis; document with the worker's consent.

Confidentiality in fitness decisions: the employer receives only fitness status and restrictions, not the diagnosis; the medical record remains with the occupational health service.

Sickness absence management: early contact with absent workers, referral to occupational health, and return-to-work plans reduce long-term disability.

Hierarchy of controls: elimination, substitution, engineering controls, administrative controls, and PPE (least effective, last resort).

Local exhaust ventilation (LEV): capture velocity, duct velocity, and hood design determine effectiveness; test with smoke tubes and monitor airflow regularly.

Respiratory protection: N95 filtering facepiece for particulates; half/full-face respirators with cartridges for gases; fit testing is required before use and annually.

PPE selection: gloves (nitrile for chemicals, cut-resistant for sharps), eye protection (goggles for splash), hearing protection (earplugs NRR), and protective clothing.

Hearing conservation: noise >85 dB(A) requires hearing protection and audiometric testing; >80 dB(A) requires hearing protection availability and training.

Ventilation standards: general dilution ventilation for low-toxicity contaminants; local exhaust for high-toxicity; measure with anemometer and compare to design specifications.

Substitution example: replace benzene-based solvents with less toxic alternatives; replace silica-containing abrasives with non-silica media.

Administrative controls: job rotation to reduce exposure duration, work-rest schedules, training, and housekeeping; these do not eliminate the hazard but reduce dose.

Emergency response plan components: hazard identification, emergency organization, communication, evacuation routes, assembly points, and drills.

First aid priorities: scene safety, ABC (airway, breathing, circulation), and call for help; in chemical exposure, decontaminate before treatment.

Chemical splash to eye: irrigate with water for at least 15 minutes, remove contact lenses, and seek medical evaluation; do not neutralize chemicals.

Cardiopulmonary resuscitation (CPR): 30 compressions to 2 breaths for adults; compression rate 100–120/min, depth 5–6 cm; use AED as soon as available.

Fire emergency: RACE (Rescue, Alarm, Contain, Evacuate/Extinguish); use fire extinguisher with PASS (Pull, Aim, Squeeze, Sweep).

Disaster preparedness at workplace: risk assessment for natural and technological disasters, emergency supplies, trained first-aid team, and regular drills at least annually.

Occupational first aid kit requirements: Permenaker No. 15/2008 regulates first aid in the workplace; kit contents scale with workforce size and hazard type.

Mass casualty triage: START (Simple Triage and Rapid Treatment) - assess respiration, perfusion, and mental status; tag immediate, delayed, minor, and deceased.

Occupational health service functions: health surveillance, workplace assessment, first aid, health promotion, and rehabilitation; managed by a physician-led team per Permenaker 3/1982.

Health promotion programs: smoking cessation, physical activity, nutrition, mental health, and vaccination; evaluated by participation rates and health outcome indicators.

Epidemiological measures: incidence (new cases / population at risk / time), prevalence (all cases / population), relative risk, attributable risk, and standardized mortality ratio (SMR).

SMR = observed deaths / expected deaths × 100; SMR >100 indicates excess mortality in the workforce compared to the reference population.

Study designs: cross-sectional (prevalence), cohort (incidence, relative risk), case-control (odds ratio), and intervention trials; selection and information bias must be considered.

Health surveillance data should be analyzed by work unit and exposure group to detect clusters and evaluate control effectiveness.

Occupational health records: kept confidential, retained per regulation (e.g., 30 years for carcinogen exposure), and used for program evaluation without identifying individuals.

Program evaluation: use structure, process, and outcome indicators; benchmark against national occupational health standards and worker health outcomes.