Guest blog by Tracy Turner
The construction industry is seeing a significant rise in workers undergoing Safety‑Critical Medicals (SCMs), driven by an ageing workforce, increasing numbers of workers managing long‑term health conditions, and stricter site entry requirements by contractors*. These workers often bring extensive skills, experience, and site knowledge, making it essential that workplaces support them to remain safely and effectively employed. SCM standards exist to protect the health and safety of workers and to ensure that those performing high‑risk tasks can do so safely. They are defined through standards such as SEQOHS standards, DVLA Group 2 medical criteria, with advice from SOM construction guidance.
Recently, a worker was refused access to site after reasonable adjustments were recommended following his SCM. He later asked for these adjustments to be removed so he could return without restrictions; however, this was not permissible. Adjustments cannot be withdrawn simply for convenience or to bypass safety measures - they must always reflect clinical needs, functional impact, and legal requirements. Their purpose is to protect both the workers and the wider site workforce. With large contractors requiring valid SCM certification for any site entry, even short‑duration visits, the demand for assessments has risen sharply.
Construction is physically demanding, fast‑paced, and regulated, meaning employers must understand their duties under the Equality Act 2010. This requires employers to take steps so that disabled workers are not placed at a substantial disadvantage and to provide reasonable adjustments that enable them to carry out their role safely and effectively. With construction facing ongoing labour shortages, thoughtful adjustments also help retain skilled staff at a time when experience is more valuable than ever. Reasonable adjustments are not optional, they are:
- a legal duty;
- a core safety measure;
- a means of ensuring fair access to work.
Under the Equality Act, a disability is a physical or mental impairment that has a substantial and long‑term effect on a person’s ability to perform normal daily activities. Many construction workers meet this definition, often without realising it. Conditions such as chronic musculoskeletal disorders, repetitive strain injuries, hearing loss, diabetes, epilepsy, depression, anxiety, and other long‑term health issues are common across the sector. In addition, conditions like cancer, HIV, and multiple sclerosis are automatically recognised as disabilities from the point of diagnosis.
For employers, the key consideration is not the diagnosis itself, but how the condition affects mobility, stamina, coordination, concentration, or the safe performance of safety‑critical tasks. Reasonable adjustments are practical steps to reduce or remove disadvantages linked to disability. Examples on construction sites include:
- reallocating ground‑level tasks for workers unable to work at height;
- providing audio‑visual alarms for those with hearing impairments;
- using lifting aids to reduce manual strain;
- modifying shift patterns or break schedules;
- supplying adapted or ergonomic tools.
Most adjustments are low‑cost and straightforward, yet they significantly improve safety, inclusion, and operational performance.
Employers must make adjustments when they know - or could reasonably be expected to know - that a worker has a disability. This applies during recruitment, induction, training, day‑to‑day job allocation, and return‑to‑work processes. Awareness may arise through direct disclosure, recurrent sickness patterns, or observations that an employee is struggling with particular tasks.
Failure to implement reasonable adjustments can amount to disability discrimination, carrying both legal and operational risks. Whether an adjustment is reasonable depends on:
- the effectiveness of the change;
- how practical it is on a live construction site;
- cost and available resources;
- its impact on the safety of the wider workforce.
Employers are not expected to remove the fundamental nature of a job - for example, eliminating essential heavy lifting from a labouring role - but they are expected to explore supportive measures or consider alternative duties. Proportionate adjustments allow risks to be managed without compromising productivity.
Occupational health (OH) is essential in advising construction employers on clinical risk, functional impact, and safe deployment. OH recommendations focus on what a worker can do, outlining any limitations relating to strength, stamina, coordination, concentration, or the ability to carry out safety‑critical tasks. OH input supports early intervention, informed management decisions, phased returns, and mental health considerations, ensuring that workplace decisions remain safe, fair, and legally compliant.
Implemented well, they reduce sickness absence, improve retention, and help maintain high safety standards.
Where does responsibility lie in a sector where contractors, subcontractors, and self‑employed workers work side by side? Under the Equality Act, the organisation that controls the workplace environment (the “principal contractor” or site controller) shares responsibility for ensuring reasonable adjustments are considered and implemented. Employers of subcontracted or self‑employed workers also retain duties toward their own personnel.
Clear communication between OH providers, employers, site controllers, and workers is essential so that everyone understands why adjustments are recommended, who is responsible for implementing them, and how they protect individuals and the wider site.
Many workers in construction operate on a self‑employed or sub-contracted basis, but this does not remove the duty to consider reasonable adjustments where a health condition may place them at a disadvantage. Under the Equality Act 2010, employers, contractors, and self‑employed people hired to personally carry out the work are all covered, meaning both the individual’s engaging business (if applicable) and the site controller/principal have responsibilities to consider reasonable adjustments.
The organisation controlling the site must not discriminate against contract workers, including by denying access without first exploring safe and reasonable alternatives. The Principal Contractor also has CDM 2015 duties to plan, manage and monitor work so that it is carried out without risk to health and safety.
Where OH recommends adjustments, these should be reviewed collaboratively. Site access should only be restricted if no safe or reasonably practicable adjustments can be implemented after proper review. Failure to consider adjustments may amount to a breach of the Equality Act.
Tracy Turner is a nurse with over 40 years of experience in a variety of settings, including theatres, A&E, and ITU. She is a specialist OH nurse with a particular interest in OH Law, a menopause expert champion, and the founder of Turners OH. Read a blog about her career journey here.
*Health and Safety Statistics: Key figures for Great Britain 2024 to 2025 (Published 20 Nov 2025) - work-related ill health at an all-time high - estimated 1.9 million workers reported suffering from work-related ill health in 2024/25, an 11.8% increase year-on-year. 79,000 construction workers reported work-related ill health. Musculoskeletal disorders and respiratory issues remain higher than the national average.