Frequently asked questions

The Cardiovascular Health Standard has been developed to help approved medical practitioners make consistent, evidence-based clinical decisions related to cardiovascular health. It outlines the investigations required to assess a coal mine worker’s cardiovascular health and cardiovascular risk; and specifies when they should be referred to their GP and/or a cardiologist for further assessment.   

It details follow-up requirements for any existing conditions, the frequency of health assessment reviews, and outlines the actions and considerations required when certifying fitness for work. 

The Cardiovascular Health Standard has several purposes:  

• to assess if a coal mine worker’s cardiovascular health is adequate for their position and risk category  
• to identify, monitor and manage coal mine workers with known cardiovascular conditions  
• to identify coal mine workers at risk of future events like heart attacks or cardiac arrest  
• safely return to work after a cardiac event or intervention, and ensure they receive appropriate monitoring and management.

Cardiovascular conditions, such as heart attacks, strokes or arrhythmias, can cause sudden incapacity, affecting a coal mine worker’s health and safety.  

Even before symptoms appear, many coal mine workers may have underlying cardiovascular issues, such as high blood pressure or high cholesterol, putting them at increased risk.

That’s why it’s essential to regularly assess cardiovascular health.  By identifying and addressing cardiovascular issues early, the Cardiovascular Health Standard helps to ensure coal mine workers can continue working safely without putting themselves, and/or others, at risk.

The Cardiovascular Health Standard is the first NSW Coal Industry health standard that has incorporated the use of risk categories to help approved medical practitioners determine what further medical investigations are required when assessing a coal mine worker’s fitness for work, particularly when a cardiovascular condition has been identified.   

This targeted approach helps to reduce unnecessary follow-ups and testing and supports approved medical practitioners to make consistent health certifications based on a coal mine worker’s risk category.

This is expected to reduce impact to industry by reducing the number of health assessment reviews required. Changes and reasons for this include:  

• Coal mine workers who weigh ≥120 kg will not be required to return for an earlier review based on their weight alone. This requirement will now be based on their BMI. A comment will remain on the health assessment certificate for coal mine workers who weigh ≥120 kg due to equipment weight rating requirements. 
• Coal mine workers who have a BMI of 30 kg/m2 to <50 kg/m2 will be referred to their general practitioner (GP) for weight management, but an early review will not be required. This will be known as a duty of care referral. 
• All coal mine workers who have low and intermediate CVD risk scores (<10%) and Category C workers with a high CVD risk score (≥10%) will be referred to their GP, if required, to manage any CVD risk factors, but an early review will not be required. Only Categories A and B coal mine workers with a high CVD risk score (≥10%) will require an early review.  
• Coal mine workers with a blood pressure of ≥140 to <170 mmHg systolic OR ≥90 to <100 mmHg diastolic will be referred to their GP if their hypertension is untreated. However, they won’t require an early review.  
• Only coal mine workers in higher risk categories will require annual review for managed cardiovascular conditions. 

Risk categories are used to determine the level of risk for a coal mine worker’s position, based on the tasks they perform. In the NSW coal industry, positions range from office-based duties to operating equipment in open cut, underground and industrial environments often in dynamic workplace conditions.   

Each position has different levels of risk and coal mine workers must be physically and psychologically able to perform their tasks safely and respond effectively to changes and hazards using sound perception and judgment. 

Medical conditions, disabilities, and/or treatments may affect these capabilities, potentially leading to serious incidents that may impact the coal mine worker and/or others in the workplace. 

There are 3 risk categories:  

• Category A: Safety critical       
  A coal mine worker or prospective coal mine worker whose immediate action or inaction from an unavoidable and/or sudden medical incapacity may lead directly to a serious incident affecting others in the workplace.   
• Category B: Safety sensitive  
  A coal mine worker or prospective coal mine worker whose immediate action or inaction from an unavoidable and/or sudden medical incapacity may lead directly to a serious incident affecting themselves and is not likely to affect others in the workplace.   
• Category C: Non-safety sensitive  
  A coal mine worker or prospective coal mine worker whose immediate action or inaction from an unavoidable and/or sudden medical incapacity will not lead to a serious incident affecting others in the workplace and their work environment will not contribute adversely to the outcome.

Employers are responsible for assessing coal mine workers’ positions and determining their corresponding risk category.  

Employers must notify the approved medical practitioner of the risk category for a coal mine worker’s position whenever the coal mine worker attends a health assessment or health assessment review. 

Coal Services has developed Risk Category Guidelines to assist employers in assessing the risk category of coal mine workers. These guidelines, and other information about risk categories, can be found here.

The Cardiovascular Health Standard is drafted to reflect the risk categorisation of coal mine workers by employers as defined in the proposed replacement for Order 43. Until the replacement Order comes into effect, the PCBU is not required to nominate risk categories for the coal mine workers; however, can begin to do so after the Cardiovascular Health Standard is released. Where an employer has not nominated a risk category for a coal mine worker having an Order 43 health assessment, the approved medical practitioner will manage workers with office-based duties as Category C: Non-safety sensitive. All other coal mine workers will be managed as Category A: Safety critical. 

Additionally, the Cardiovascular Health Standard does not include recommendations for sleep studies related to obesity and the risk of sleep apnoea.  

Until the NSW Coal Industry Sleep Health Standard is developed (due for release in 2026), approved medical practitioners will continue to use recommendations for sleep studies contained within the CS Health Cardiovascular Risk Management Guidelines for the NSW Coal Industry. Within these guidelines, a BMI of ≥40 kg/m2 triggers the need to request a sleep study for all coal mine workers, except Category C: Non-safety sensitive (office-based workers), who should be referred to their GP for management.   

All NSW coal mine workers undergo the same routine cardiovascular health examinations as part of the NSW coal industry health surveillance scheme, regardless of their position or risk category.  

These include a cardiovascular assessment, checking the coal mine worker’s medical history of cardiovascular disease (CVD) and assessing blood pressure, cholesterol levels and cardiovascular risk score.  

If any of these routine investigations highlight a history of CVD or abnormal results, the approved medical practitioner will refer the coal mine worker to their GP and/or cardiologist for further cardiology assessment and investigations in accordance with the recommendations in the Cardiovascular Health Standard.  

CS Health is responsible for monitoring the health of NSW coal mine workers for any health effects due to occupational exposures. Coal mine worker health assessments also screen for any health and lifestyle related conditions that may impact a coal mine worker’s ability to work safely and effectively. This includes the presence of any existing cardiovascular conditions and identification of coal mine workers at increased risk of cardiovascular disease and having a cardiovascular event.   

Coal mine workers may not have any symptoms prior to a cardiovascular event, so it is essential that overall cardiac risk is assessed and investigated.   

Assessment of cardiovascular disease risk involves calculating a coal mine worker’s cardiovascular disease (CVD) risk score. This score estimates the probability of a cardiovascular event (such as a heart attack or stroke) occurring within the next 5-year period.   

The CVD risk score is calculated using the Australian cardiovascular disease risk calculator, which has been developed by medical experts and is used throughout Australia. The calculator incorporates age, sex, family and medical history, smoking status, blood pressure and cholesterol levels and use of cardiovascular medications to give an individual CVD risk score. 

The CVD risk score corresponds to 3 different risk categories: 

Risk category    CVD risk score
Low                         <5%
Intermediate        ≥5% to <10%
High                      ≥10%  

Although obesity (BMI ≥30 kg/m2) isn’t a cardiovascular condition, it increases the risk of developing cardiovascular disease, including hypertension, high cholesterol, heart disease and stroke. Even if coal mine workers with a BMI ≥30 kg/m2 do not currently have any cardiovascular disease, it is still important they are supported to manage their weight to decrease their future risk of developing cardiovascular disease and other health problems. Having a BMI of 30 kg/m2 to 50 kg/m2 won’t affect a coal mine worker’s fitness for work, but they will be referred to their GP by the approved medical practitioner as a duty of care.  These coal mine workers will not need to come back for an early review.    

Coal mine workers who are in Categories A or B and have a BMI ≥50 kg/m2 will be certified temporarily unfit for work and referred to their GP and/or cardiologist for further assessment of cardiac risk and confirmation their CVD risk is being managed.

BMI is still an internationally recognised standard for classifying overweight and obesity. It is a simple screening tool that helps to indicate potential health risks and guide when further assessment and investigation is required. However, it does have some limitations. BMI can’t show how much fat versus muscle someone has and doesn’t factor in age, gender or ethnicity which can decrease its accuracy in certain populations. For example, this includes men or women with a high muscle mass, who may be classified as overweight according to their BMI (i.e. BMI 25 kg/m2 to 30 kg/m2). For this reason, BMI should be considered in conjunction with other assessments, including waist circumference. Waist circumference measurements are a routine component of Order 43 health assessments and help to show whether someone is carrying excess body fat around their middle (abdominal region). A high waist circumference is shown to be a strong predictor of cardiovascular disease, type 2 diabetes and other chronic health problems. Coal mine workers with a BMI ≥30 kg/m2 will be considered for referral to their GP for weight management in conjunction with waist circumference and other health risks.

If a coal mine worker has a history of cardiovascular disease, or the results of their cardiovascular health assessment are abnormal, they may be referred to their GP and/or cardiologist for further investigation and management. The cardiologist may recommend additional specialist tests to help diagnose any cardiac conditions, make recommendations for treatment and prevention of cardiovascular issues, and provide advice on follow up requirements.  

In many cases coal mine workers may be able to continue working whilst further investigations occur. However, if the worker’s cardiovascular risk is high they may need to temporarily stop working until they’ve seen the GP or cardiologist.

It is the responsibility of both the coal mine worker and employer to ensure that coal mine workers complete any required further cardiovascular investigations. We recommend that employers have systems and processes in place to ensure that the required information from the coal mine worker’s GP or cardiologist is provided back to the approved medical practitioner within the requested timeframes. If no medical information is provided to the approved medical practitioner, then the coal mine worker’s health assessment certificate will expire.   

CS Health does not routinely provide health certificate extensions. It is important that both employers and coal mine workers ensure further investigations and health assessment reviews are completed in a timely manner.  

In order to complete the health assessment, the approved medical practitioner needs to ensure the coal mine worker’s cardiovascular health is adequate to undertake their position and risk category. If the coal mine worker already has an existing condition, this may require further investigations and/or confirmation from the coal mine worker’s GP or treating specialist that their condition is adequately managed.

There has been a change in evidenced-based medicine regarding the use of exercise stress tests. Coal mine workers are only allowed to return to work based on the advice of their treating specialist. The need for an exercise stress test will be determined by the specialist and not approved medical practitioners.  

Where a coal mine worker weighs ≥120 kg, their weight will be recorded on the health assessment certificate due to equipment weight rating requirements. However, they will not be required to return for an early review based on their weight alone—this requirement is now based on their BMI. Workers with a BMI ≥30kg/m2 may be provided with a duty of care referral to their GP for weight management but there is no medical evidence to support that repeated reviews under Order 43 provide any significant benefit. 

A duty of care referral to a GP typically means that the approved medical practitioner has identified a health condition and the coal mine worker needs a further medical review to ensure that appropriate follow-up care is provided. The GP is not required to provide information back to the approved medical practitioner. For example: A coal mine worker undergoes a health assessment and is found to have moderately high blood pressure. The approved medical practitioner will issue a duty of care referral to the coal mine worker’s GP for ongoing blood pressure management, but they will not need any information back from the GP and the coal mine worker will not need an early Order 43 review.

Order 43 approved medical practitioners are responsible for determining fitness for work. Coal mine workers will be referred to their GP and/or cardiologist if their cardiovascular health assessment results are abnormal and warrant further investigation and management. The approved medical practitioner will use the information provided by the GP and/or cardiologist to complete the coal mine worker’s health certification.

The Cardiovascular Health Standard guides approved medical practitioners on the required actions and management if the coal mine worker is diagnosed with a cardiovascular condition. This includes whether a coal mine worker will be fit for work or has to temporarily stop working until the condition is adequately stabilised and managed. Minimum non-working periods following a cardiovascular event or procedure are also outlined in the Standard. Management will vary depending on the coal mine worker’s type of cardiovascular condition, event, position, and risk.

While there is no cost for appointments with CS Health, coal mine workers will need to pay for any GP and/or cardiologist appointments and any associated testing relating to cardiovascular health.  

Assessments such as a cardiologist or GP appointment are at coal mine worker’s expense. If repeat testing (clinical findings) is required at a CS Health office, there will be no cost associated with these appointments.  

Privacy is important to us. CS Health needs a coal mine worker’s written consent to share any health information, including whether a coal mine worker has been referred for further investigations. If the coal mine worker is fit to work whilst undergoing further investigations, the employer will not be notified of the nature of the medical condition – only that an early health assessment review is required.    

If the coal mine worker is made temporarily unfit, the approved medical practitioner will discuss with both the coal mine worker and the employer to advise them of the health certification, however no medical information will be shared with the employer. The approved medical practitioner will assess whether the coal mine worker is suitable for other tasks in consultation with the employer.