Don't expect a quick fix when employees report health problems that have no clear connection to the workplace. But you can expect to hear more about these problems. These reports originally seemed to come mostly from occupants in new office buildings; they have now expanded to include any employee at any work location. New processes and new job activities appear to initiate or stimulate the condition.

Malaise, headaches, fatigue, dizziness, irritability, chest pain, forgetfulness, and heightened annoyance to certain odors are the health complaints most often cited. Complaints have been noted to arise more among young women than men or older women.

Numerous theories have been proposed to explain the causes of these symptoms, but most, if not all, lack scientific and clinical evidence. Complaints are not clearly occupationally related, but since health symptoms usually improve when the employee is away from work, the work environment is considered to be at least a contributing factor.

Placing a fan near the employee to dilute whatever may be in the air is management's most common response. Moving the employee to another job is also an initial consideration. When simple fixes fail to resolve the problem, some managers begin to label the employee as a complainer and assume the problem is mostly "in the employee's head."

This is usually when health and safety professionals come into the picture. By this time the employee is apprehensive and defensive. What should you do? Each case is different, but here are 15 general steps you can take:

Sequence of events

1. Review the situation with management. Is the employee regarded as a "good worker?" If the answer is "no" assume some job stress is possible. Determine if the employee is facing any abnormal stress factors at work and in their private life.

2. Take care of recordkeeping. Inform management that the employee's report of symptoms of illness needs to be entered into the OSHA 200 records. Later, if no job connection is discovered, the item can be lined out.

3. Review the situation alone with the employee. Ask for their opinion of what is happening. Does the employee have any suggestions to resolve the problem? If any changes were made, did the employee feel better? Without being judgmental, ask if anything could relate to stress factors on or off-the-job. Ask if any new diet, medications, or similar factors could contribute. Determine if the employee is sensitive to any chemicals away from work, including perfumes, colognes, deodorants, or household cleaning products. Also ask about smoking and sensitivity to smoke, and allergies, seasonal or otherwise.

4. Check MSDSs. Review with the employee all material safety data sheets relevant to the employee's work. Describe acceptable limits for healthy working.

5. Analyze the job. Have the employee demonstrate in the work area how the job is done. Determine if any activity of the job is a concern to the employee.

6. Verify chemical exposure limits. Verify that temperature, humidity and oxygen levels are acceptable. Check for carbon monoxide sources. Determine if carbon dioxide levels build up during the employee's work shift. Ensure that no microbial sources are present from evaporators, air conditioning systems, or other such equipment or conditions.

7. Meet with co-workers. Ask other employees who work with or near the employee experiencing health problems for their opinion of what is happening and what, if anything, can or should be done to help resolve the problem.

8. Educate medical providers. If the employee meets with a doctor, ensure that the doctor is familiar with the work process, understands the chemicals involved in the process, and is aware of verified chemical exposure concentrations and the general air quality conditions at the location where the employee works. The doctor should only be provided with the MSDSs that the employee is exposed to.

9. Any recommendations from the doctor must be specific. "Keep employee away from offending chemicals" is not specific. Any limits prescribed by the doctor should be compared with exposure limits from recognized agencies such as OSHA or the American Conference of Governmental Industrial Hygienists. For example, "Limit the employee's exposure to chemicals to one-tenth of the OSHA permissible exposure limit" would be a workable recommendation from a doctor.

10. Consider respiratory protection. Ask the doctor if respiratory protection can be tried to resolve health complaints. Specify the respirator that would be suitable to filter or capture chemicals used at the process.

11. Qualify the employee to wear a respirator. Explain that the respirator is being tried to see if it helps eliminate health problems. Tell other employees that they are not at risk. Explain the situation to co-workers.

12. Get feedback. Monitor, over several days, the employee's subjective opinion of whether the respirator eliminates health problems. If it does, chemical sensitivities are likely to exist. Substitution of chemicals at the process or more effective exhaust ventilation can be considered. The long-term use of a respirator may or may not be a suitable alternative.

13. Consider alternatives. If respiratory protection fails to resolve the problem, or the employee is reluctant to wear the respirator, they may not be qualified to work at the job.

14. Document the case. If the employee is not qualified to do the job, provide records of the condition to human resources and legal counsel to determine company and employee rights and responsibilities. For example, does the condition trigger any Americans with Disabilities Act (ADA) requirements?

15. A final thought: If all reasonable accommodations have been made to help the employee and problems still exist, and the employee is not qualified to perform any other work, termination of employee is possible.

By Dan Markiewicz, CIH, CSP, CHMM, senior industrial hygienist with Aeroquip-Vickers, Inc., Maumee, Ohio.