Medical follow-up and medical surveillance respond to two distinct logics in French labor law, but their confusion remains common, even among HR professionals. The individual health monitoring (SIR) concerns the majority of employees, while the enhanced individual surveillance (SIR) targets positions at risk defined by the Labor Code. Understanding this distinction is crucial for employer compliance and the quality of prevention.
Regulatory framework for individual health monitoring at work
Since the 2017 reform, the Labor Code distinguishes between two circuits. Individual health monitoring applies to employees who do not occupy positions with specific risks. The information and prevention visit (VIP), conducted by an occupational physician, a collaborating doctor, or an occupational health nurse, replaces the old fitness visit for these workers. Its maximum frequency is set by decree, adjustable according to health status, age, and working conditions.
You may also like : Discover the best tips to boost your fitness and well-being
To delve deeper into the criteria that separate these two regimes, we recommend consulting medical surveillance on Santé Boost, which details the respective obligations of the employer and the prevention service.
Enhanced individual surveillance, on the other hand, concerns employees exposed to identified risks: asbestos, lead, carcinogenic, mutagenic, or reprotoxic agents (CMR), work in hyperbaric environments, risk of falling from heights, electrical authorizations. These employees undergo a fitness medical examination before being assigned to the position, and then at intervals defined by the occupational physician, without exceeding the regulatory ceiling.
Read also : The best solutions to easily secure and customize your home
Enhanced surveillance: eligibility criteria and employer obligations
The employer is responsible for identifying positions subject to enhanced surveillance. This evaluation of professional risks, formalized in the Unique Document, determines the applicable monitoring circuit for each employee. Failing to identify a position at risk exposes the company to gross negligence in the event of an accident or occupational disease.
We observe that the most common errors relate to three points:
- Underestimating exposure to CMR agents, especially when exposure is intermittent or indirect (maintenance of contaminated equipment, for example).
- Forgetting to re-evaluate the Unique Document after a change in process, tooling, or chemical product, which leaves employees in an unsuitable monitoring circuit.
- Confusing the return-to-work visit (mandatory after a prolonged absence) with the periodic surveillance visit, which have different triggers and purposes.
The occupational physician remains the only one authorized to issue a fitness or unfitness opinion within the framework of enhanced surveillance. An occupational health nurse can provide guidance but cannot decide on fitness for a position at risk.
Telemonitoring and digital follow-up: what changes for employees
Since 2023, telemonitoring of certain chronic pathologies (heart failure, kidney failure, diabetes, respiratory failure, cancers) is included in common law. The High Authority of Health has published guidelines that frame the digital solutions eligible for reimbursement. This evolution formalizes continuous remote monitoring, with eligibility criteria, data transmission frequency, and annual re-evaluation.
For an employee with a chronic illness, telemonitoring does not replace health monitoring at work. It complements the curative follow-up provided by the attending physician or specialist. The occupational physician does not have access to telemonitoring data unless the employee explicitly consents to their transmission, in accordance with CNIL recommendations on digital health tools.
This point raises an operational question: an employee under telemonitoring for insulin-dependent diabetes and occupying a machinery operation position falls under both enhanced surveillance (at-risk position) and a curative telemonitoring system. The two circuits coexist without substituting for one another, and the employer does not need to know the details of the curative follow-up.
Health data at work: traceability and employee rights
The Medical File in Occupational Health (DMST) is distinct from the Shared Medical File (Mon Espace Santé). The occupational physician records visits, exposures, and recommendations there. The employee has a right to access their DMST, but the employer never has access to it. They only receive the visit report mentioning fitness or restrictions.
Automated monitoring algorithms do not apply to health monitoring at work. The current framework concerns curative telemonitoring (alerts generated by connected devices for identified pathologies). In occupational health, prevention relies on clinical evaluation and job analysis, not on an automated data stream.
CNIL reminds us that any collection of health data via connected objects or platforms requires specific information for the patient and informed consent. This framework protects the employee against an unauthorized extension of monitoring to data that pertains to their private life.
Prevention in the workplace: articulating follow-up and surveillance without confusing roles
The occupational physician leads the prevention strategy. The employer finances the occupational health and prevention service (SPST), updates the Unique Document, and implements recommendations. The employee, for their part, cannot refuse mandatory visits without risking disciplinary action.
We recommend that employers formalize a dashboard cross-referencing each position with the applicable type of monitoring (VIP or fitness examination), frequency, and date of the last visit. This dashboard serves as a simple compliance tool, verifiable during an inspection by the labor authorities.
An employee changing positions must have their monitoring circuit re-evaluated. Transitioning from an administrative position to a position exposed to chemical risks triggers enhanced surveillance, with a fitness examination before taking up the role. The reverse is also true: leaving a position at risk can return the employee to standard monitoring, but the occupational physician retains traceability of previous exposures in the DMST.