University of Guelph Medical Surveillance - Diving Operations
Version 1.0 - December 2015
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MEDICAL SURVEILLANCE DIVING OPERATIONS
INTRODUCTION
Underwater diving undertaken for occupational reasons is highly regulated, and it can be an
important activity within research programs in a wide range of fields such as aquaculture and
marine biology. Underwater diving is also known to put particular physical stress on the body.
As such and in order to maintain compliance with applicable regulations, a sufficiently
comprehensive medical surveillance regimen in the form of dive medical examinations and
emergency/incident response has been established. This module will outline the medical
surveillance requirements for underwater diving activities at the University of Guelph
SCOPE
This module applies to personnel involved in underwater diving activities as part of University of
Guelph research and teaching programs including but not limited to employees (staff, faculty,
post-doctoral scholars) and graduate students. This program does not pertain to participants
within recreational diving courses that may be offered through the University of Guelph.
LEGISLATION AND STANDARDS
Ont. Reg. 629/94 Diving Operations
CSA Standard Z275.2-11 Occupational safety code for diving operations
CSA Standard Z275.4-12 Competency Standard for diving, hyperbaric chamber and remotely
operated vehicle operations
Code for the Medical Examination of Divers, October 2013
University of Guelph Safety Policy Occupational Diving 851.06.05
University of Guelph Underwater Diving Program
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University of Guelph Medical Surveillance -Diving Operations
Version 1.0 - December 2015
CRITERIA
Prior to engaging in any underwater diving operation (e.g. SCUBA diving) including training,
other than training for recreational diving purposes, the prospective diver must have a current
signed statement of medical fitness issued by an appropriately trained physician indicating that
the diver has received a comprehensive dive medical examination (outlined below) and is fit to
dive or fit to dive with restrictions.
Additionally a diver’s capability to function safely and effectively underwater will be assessed by
dive supervisors and divers themselves prior to each dive. Should either party determine that
the diver is unfit to dive, they will be excluded from that particular dive.
RESPONSIBILITIES
OCCUPATIONAL HEATLH PHYSICIAN
Provide medical consultation following University procedures for injury/incident
reporting and management as required
OCCUPATIONAL HEALTH AND WELLNESS (OHW)
Refer prospective divers to a physician on the Diver’s Certification Board of Canada’s list
of physicians acceptable for conducting medical examination of commercial divers.
Maintain associated clearance certificates
Maintain list of University personnel who have completed dive medical examinations and
follow up with them for subsequent examinations as required
MANAGER, RESEARCH RISK
Communicate requirement of diving medical surveillance requirements to University of
Guelph personnel who may be involved in diving activities
Identify to OHW University of Guelph personnel who may be involved in diving activities
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University of Guelph Medical Surveillance -Diving Operations
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SUPERVISORS WITH PERSONNEL INVOLVED IN DIVING ACTIVITES
Ensure all personnel whom they supervise and who are to be involved in diving activities
participate in dive medical examinations
Prior to conducting any diving related activities, ensure that personnel have obtained a
current Certificate of Medical Fitness indicating that they are fit to dive
Ensure compliance with any restrictions listed on the Certificate of Medical Fitness
Cover the costs associated with any examinations, clinical testing, etc. that must be
outsourced from the University
DIVE SUPERVISORS
Assess all dive personnel immediately prior to a dive as to their fitness to dive and
restrict or permit diving based on the results of this assessment
Ensure divers have a current Certificate of Medical Fitness indicating they are fit to dive
and/or that any listed restrictions are met as prescribed on the Certificate of Medical
Fitness
UNIVERSITY PERSONNEL INVOLVED IN DIVING ACTIVITIES
Participate in dive medical examinations as applicable
Maintain a copy of the current Certificate of Medical Fitness within the Diver’s Log
Notify Occupational Health and Wellness of any significant changes in health status
including but not limited to any surgery or illness requiring a minimum 24 hours
hospitalization, identification of serious illness that may impair the ability to dive safely,
seizure, injuries involving fractures of long bones, loss of consciousness, concussion,
diving related incident, etc.
Assess personal health status prior to any dive and disclose any health concerns/issues to
the Dive Supervisor.
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University of Guelph Medical Surveillance - Diving Operations
METHODS/PROCEDURES
DIVE MEDICAL EXAMINATIONS
OHW is to be consulted for arranging of dive medical examinations. The physician performing
the medical examination is to be recognized by the Divers Certification Board of Canada and/or
meet the requirements for Level 1 Diving and Hyperbaric Physicians as defined in CSA Z275.4-12.
Dive medical examinations are to be conducted in accordance with the requirements of the Ont.
Reg. 629/94 and CSA standards. As indicated in the Code for Medical Examination of Divers the
objective of the examination is to
1. Identify pre-existing health conditions that could be aggravated by exposure to changes
in atmospheric pressure (compression and decompression)
2. Evaluate the effect of changes in atmospheric pressure on divers
3. Enable remedial action to be taken when necessary to ensure the safety of the diver
4. Provide health education on the effects of changes in atmospheric pressure and on the
results of the medical examination
Dive medical examinations are to include:
Review of medical and occupation history
Physical examination
Clinical tests
Determination of fit
Health education (consultation during examinations)
The diver’s relevant medical history is to be assessed.
The physical examination is to focus on body systems which may be affected by changes in
atmospheric pressure and stress including cardiopulmonary, ear, nose, throat, musculoskeletal
and the central nervous system.
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University of Guelph Medical Surveillance - Diving Operations
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CLINICAL TESTS
Required tests and the corresponding frequencies are indicated in the following table:
Test
Frequency
Blood work
Complete blood count
Other blood work if clinically indicated
Upon initial examination and with each
subsequent dive medical
Urinalysis
Blood, glucose and protein (dipstick
sufficient)
Other urinalysis if clinically indicated
Upon initial examination and with each
subsequent dive medical
Chest x-rays
Full-size posteroanterior (inspiratory and
expiratory) and lateral.
Upon initial examination and periodically if
clinically indicated.
Long bone x-rays
As clinically indicated.
Electrocardiogram (ECG)
Resting ECG
Standardized exercise ECG
If less than 40 years of age, resting ECG upon initial
examination only.
At 40 years standardized exercise ECG
Over 40 resting ECG every 2 years
At or over 50 standardized exercise ECG annually
Or more frequently as clinically indicated.
Spirometry
Forced vial capacity (FVC), forced
expiratory volume (FEV1), FEV1/FVC ration
and flow volume curves
Upon initial examination and periodically if
clinically indicated.
Pure tone audiogram
250-8000 Hz inclusive at least 12 hours
after any high noise exposure
Upon initial examination and periodically every 2
years or more frequently if clinically indicated.
Psychometric testing and psychiatric examination
At the discretion of the physician
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University of Guelph Medical Surveillance - Diving Operations
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FREQUENCY
The required frequency of dive medical examinations is indicated below:
Up to age 39 - once every 2 years up to age 39
Age 40 onwards - annually
More frequently if clinically indicated and as determined by the examining physician.
The medical fitness of the diver is to be re-examined if there is a significant or relevant change in
the diver’s health and/or if the diver has been involved in a diving related incident.
DETERMINATION OF FITNESS
Guidance for determination of fitness is provided in the Code for the Medical Examination of
Divers, October 2013.
INCIDENT MANAGEMENT
The Occupational Health Physician through OHW is to be available for consultation and/or direct
follow-up for University of Guelph divers who have been involved in a diving related incident in
accordance with standard University of Guelph incident and injury management processes.
RECORDS MAINTENANCE
A written statement (diver certificate of medical fitness) issued by the physician is to be
provided to the diver and maintained in the diver’s log, and copies maintained by Occupational
Health and Wellness.
Divers certificates of medical fitness are to include:
That the diver is fit, fit with limitations or unfit to dive
That the medical examinations were conducted according to the Code for the Medical
Examinations of Divers, dated October 2013
The name of the individual
The date of the examination and the date of the next required examination
The location where the medical record is stored
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University of Guelph Medical Surveillance - Diving Operations
The qualification/disqualification of the individual
The signature of the examining physician.
Appendix A contains an example of a Diver’s certificate of medical fitness.
Diver’s logs must be maintained by the diver for at least 5 years following the last entry into the
log.
TRAINING/COMPETENCY OF PHYSICIAN
As per Ont. Reg. 629/94, the examination for medical fitness to dive must be performed by a
physician who is knowledgeable in diving and hyperbaric medicine. Specifically the physician
shall:
Be licensed to practice in Ontario
Have completed a basic training course in diving medicine
Have an effective working knowledge of the physical laws affecting diver and underwater
operation
Have an understanding of the interaction that occurs between the physical laws (above),
the diver’s physiology and of the implication for the diver
Have a sufficient awareness of the pathological conditions that can arise as a
consequence of exposure to pressure
Are familiar with the management steps to be followed in the event of an accident or
other adverse condition arising as a consequence of diving operations
Are knowledgeable with respect to the appropriate steps to be taken in the initial
investigation of any diving incidents, accidents or fatalities, including but not limited to
the appropriate autopsy protocol to be followed in the event of death.
COSTS
Costs for dive medical examinations including all associated clinical testing will be the
responsibility of the research group or department as applicable. These costs may include but
are not limited to those associated with:
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Dive medical examinations
Clinical testing required by examination such as blood work, urinalysis, respirology, x-
rays, ECG
APPENDIX A EXAMPLE OF DIVERS CERTIFICATE OF MEDICAL FITNESS
Diver’s Certificate of Medical Fitness
This certificate of medical fitness is issued as a result of the applicant having passed a comprehensive medical
evaluation meeting the requirements of the Code for the Medical Examination of Divers, dated October 2013 and
CSA Z275.2-11.
DIVER INFORMATION
Last Name (please print) First name(s)
OCCUPATIONAL DIVERS MEDICAL FITNESS EXAMINATION OUTCOME
Classification
Fit
Fit with restrictions (specify restrictions)
Unfit
Date of examination (year/month/day)
Date of medical certification (year/month/day)
Expiry date of medical fitness certificate (i.e. date of re-examination - must be renewed at least every 2 years up to age 39 and annually from
age 40 onwards, or MORE FREQUENTLY IF CLINICALLY INDICATED )
2 years from date of examination
1 year from date of examination
Other Specify expiry date (year/month/day)
Physician’s name
Mailing address
Physician’s signature
City
Province
Postal Code
Telephone number
Fax number:
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