The Washtenaw ID Project: A Government-Issued ID Coalition Working Toward Social, Economic, and Racial Justice and Health Equity.

Introduction. The policing of identities through policies that restrict access to IDs issued by U.S. governmental entities disparately affects communities of color; communities who identify as low-income, immigrant, older, and/or transgender; and community members who experience chronic mental illness, housing instability, or incarceration. Yet government-issued IDs are increasingly needed to access health-promoting resources such as housing, banking, social services, and health care, and in interactions with law enforcement. Methods. Since 2012, the Washtenaw ID Project's coalition-building process has involved communities affected by restrictive ID policies, advocates, and institutional stakeholders to enact community and systems change regarding inequities in government-issued IDs. We discuss the coalition-building process that culminated in the implementation of a photo ID issued by Washtenaw County government as a policy change strategy. We also highlight the community-academic research partnership evaluating the effectiveness of the Washtenaw ID in order to ensure equity in Washtenaw ID access and acceptance. Results. In 2015, 77% of Washtenaw ID holders reported having no other locally accepted ID. At follow-up, Washtenaw ID holders reported favorable Washtenaw ID acceptance rates in several domains (e.g., health care, school), but not when accessing banking services and housing. Additionally, community discussions suggested racial inequities in carding and ID acceptance. We discuss next steps for policy improvement to ensure equitable impact of the ID. Conclusions. Without national policy reform instating access to government-issued IDs for all, the social movement to establish local IDs may improve access to health-related resources contingent on having an ID. Careful attention must be paid to community organizing processes, policy implementation, and evaluation to ensure equity.

Work injuries in internal migrants to Alberta, Canada. Do workers' compensation records provide an unbiased estimate of risk?

INTRODUCTION: It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury. METHODS: Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta. RESULTS: Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40). CONCLUSION: Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days.

Development and validation of a search filter to identify equity-focused studies: reducing the number needed to screen.

BACKGROUND: Health inequalities, worse health associated with social and economic disadvantage, are reported by a minority of research articles. Locating these studies when conducting an equity-focused systematic review is challenging due to a deficit in standardised terminology, indexing, and lack of validated search filters. Current reporting guidelines recommend not applying filters, meaning that increased resources are needed at the screening stage. METHODS: We aimed to design and test search filters to locate studies that reported outcomes by a social determinant of health. We developed and expanded a 'specific terms strategy' using keywords and subject headings compiled from recent systematic reviews that applied an equity filter. A 'non-specific strategy' was compiled from phrases used to describe equity analyses that were reported in titles and abstracts, and related subject headings. Gold standard evaluation and validation sets were compiled. The filters were developed in MEDLINE, adapted for Embase and tested in both. We set a target of 0.90 sensitivity (95% CI; 0.84, 0.94) in retrieving 150 gold standard validation papers. We noted the reduction in the number needed to screen in a proposed equity-focused systematic review and the proportion of equity-focused reviews we assessed in the project that applied an equity filter to their search strategy. RESULTS: The specific terms strategy filtered out 93-95% of all records, and retrieved a validation set of articles with a sensitivity of 0.84 in MEDLINE (0.77, 0.89), and 0.87 (0.81, 0.92) in Embase. When combined (Boolean 'OR') with the non-specific strategy sensitivity was 0.92 (0.86, 0.96) in MEDLINE (Embase 0.94; 0.89, 0.97). The number needed to screen was reduced by 77% by applying the specific terms strategy, and by 59.7% (MEDLINE) and 63.5% (Embase) by applying the combined strategy. Eighty-one per cent of systematic reviews filtered studies by equity. CONCLUSIONS: A combined approach of using specific and non-specific terms is recommended if systematic reviewers wish to filter studies for reporting outcomes by social determinants. Future research should concentrate on the indexing standardisation for equity studies and further development and testing of both specific and non-specific terms for accurate study retrieval.

[Validity and reproducibility of two direct observation assessment forms for evaluation of internal medicine residents' clinical skills]. / Validité et reproductibilité de deux grilles d'observation des compétences cliniques des internes en DES de médecine interne.

INTRODUCTION: The revision of the French medical studies' third cycle ought to be competency-based. In internal medicine, theoretical and practical knowledge will be assessed online with e-learning and e-portfolio. In parallel, a reflection about clinical skills assessment forms is currently ongoing. In this context, our aim was to assess the reproducibility and validity of two assessment forms based on direct clinical observation. METHOD: A prospective and multicentric study has been conducted from November 2015 to October 2016 aiming at evaluating the French translations of the MINI-Clinical Examination Exercice (MINI-CEX) and the Standardized Patient Satisfaction Questionnaire (SPSQ). Included residents have been assessed 2 times over a period of 6 months by the same binoma of judges. RESULTS: Nineteen residents have been included. The inter-judge reproducibility was satisfactory for the MINI-CEX: intraclass coefficients (ICC) between 0.4 and 0.8 and moderate for the SPSQ: ICC between 0.2 and 0.7 with a good internal coherence for both questionnaires (Cronbach between 0.92 and 0.94). Significant differences between the distributions of the scores given by the judges and a significant inter-center variability have been found. CONCLUSION: If the absolute value of the scores should not be taken into account in the evaluation process given its high variability, it could be of interest for the follow-up of the progression in the competencies. These forms could support the residents' debriefing based on the general trends given by the scores.

Adoption and Foster Care Analysis and Reporting System. Final rule.

The Social Security Act (the Act) requires that ACF regulate a national data collection system that provides comprehensive demographic and case-specific information on children who are in foster care and adopted. This final rule replaces existing Adoption and Foster Care Analysis and Reporting System (AFCARS) regulations and the appendices to require title IV-E agencies to collect and report data to ACF on children in out-of-home care, and who exit out-of-home care to adoption or legal guardianship, children in out-of-home care who are covered by the Indian Child Welfare Act, and children who are covered by a title IV-E adoption or guardianship assistance agreement.

Quality expectations and tolerance limits of trial master files (TMF) - Developing a risk-based approach for quality assessments of TMFs.

This article addresses the question of when a trial master file (TMF) can be considered sufficiently accurate and complete: What attributes does the TMF need to have so that a clinical trial can be adequately reconstructed from documented data and procedures? Clinical trial sponsors face significant challenges in assembling the TMF, especially when dealing with large, international, multicenter studies; despite all newly introduced archiving techniques it is becoming more and more difficult to ensure that the TMF is complete. This is directly reflected in the number of inspection findings reported and published by the EMA in 2014. Based on quality risk management principles in clinical trials the authors defined the quality expectations for the different document types in a TMF and furthermore defined tolerance limits for missing documents. This publication provides guidance on what type of documents and processes are most important, and in consequence, indicates on which documents and processes trial team staff should focus in order to achieve a high-quality TMF. The members of this working group belong to the CQAG Group (Clinical Quality Assurance Germany) and are QA (quality assurance) experts (auditors or compliance functions) with long-term experience in the practical handling of TMFs.

[Measurements of PSA and of vitamin D: a period of 3-months of use of special forms based on the guidelines of the Haute autorité de santé shows a clear improvement of prescription behaviors]. / Dosages de PSA et de vitamine D : nette amélioration des pratiques professionnelles après 3 mois d'utilisation de formulaires spéciaux fondés sur les recommandations de la HAS.

In France practice guidelines of the Haute Autorité de santé (HAS) are not implemented as often as they should. As a consequence resources are wasted that could be useful elsewhere. In Avril 2014 prescription-forms were introduced in our hospital for PSA and for vitamin-D. If those forms were not filled-in by the physicians, then PSA and vitamin-D were not measured any more by our laboratory. PSA was measured in only two circumstances: therapeutic follow-up of, or screening for, prostate cancer. Patients had to give their formal consent for being screened with PSA. Vitamin-D was measured in the only six circumstances recommended by the HAS. After a few months of use of these two forms we observe a sharp decrease in PSA, and even more so in vitamin D, measurements. Our prescription-forms' legitimacy is high because they are based on governmental guidelines. All the more since the values that are promoted in these guidelines clearly cover the four core principles of bioethics, that is beneficence, non-malevolence, respect for the patient's autonomy (particularly for PSA) and equity. Our results need to be confirmed over a longer period of time, and to be analysed in more detail, particularly regarding the way consent forms are filled-in by the patients.

Standardized referral form: Restricting client-centered practice?

BACKGROUND: To increase homecare efficiency, the Ministry of Health and Social Services in Québec, Canada, encourages standardization of practices, including those of community occupational therapists (COTs). The impact of standardization is not known and might reduce client-centeredness. Aim/objectives. To explore the content and use of a referral form to standardize COTs' practice. MATERIAL/METHODS: An institutional ethnography inquiry was conducted through observations of work and interviews with 10 COTs working in three homecare programs. Secondary informants were also interviewed and documents collected. Data were analyzed using institutional ethnography procedures. FINDINGS: The referral form, completed by the COTs' colleagues, includes categories primarily related to safety or autonomy in personal care and mobility. The form organizes COTs' work, including information collection and interactions with clients and caregivers. Seen as consultants, COTs assess needs and make recommendations to keep clients at home safely for as long as possible, an important element of the homecare discourse. CONCLUSION/SIGNIFICANCE: The impact on COTs' potential to be truly client-centered revealed by these findings merits serious consideration by other health professionals. Concerted efforts by professionals to question and act upon contextual barriers to client-centeredness are needed.

Quality of referrals for elective surgery at a tertiary care hospital in a developing country: an opportunity for improving timely access to and cost-effectiveness of surgical care.

INTRODUCTION: A disproportionate number of surgeries in low- and middle-income countries (LMICs) are performed in tertiary facilities. The referral process may be an under-recognized barrier to timely and cost-effective surgical care. This study aimed to assess the quality of referrals for surgery to a tertiary hospital in Ghana and identify ways to improve access to timely care. METHODS: All elective surgical referrals to Komfo Anokye Teaching Hospital for two consecutive months were assessed. Seven essential items in a referral were recorded as present or absent. The proportion of missing information was described and evaluated between facility, referring clinician type and whether or not a structured form was used. RESULTS: Of the 643 referrals assessed, none recorded all essential items. The median number of missing items was 4 (range 1-7). Clinicians that did not use a form missed 5 or more essential items 50% of the time, compared with 8% when a structured form was used (p = 0.001). However, even with the use of a structured form, 1 or 2 items were not recorded for 10% of referrals and up to 3 items for 45% of referrals. CONCLUSION: Structured forms reduce missing essential information on referrals for surgery. However, proposing that a structured form be used is not enough to ensure consistent communication of essential items. Referred patients may benefit from referrer feedback mechanisms or electronic referral systems. Though often not considered among interventions to improve surgical capacity in LMICs, referral process improvements may improve access to timely surgical care.

[Development of a claim form for the initiation of post-treatment rehabilitation for nationwide use by all reimbursement agencies: a report and plea for reducing administrative barriers]. / Entwicklung eines bundeseinheitlichen und kostenträger- übergreifenden Antragsformulars für die Einleitung der Anschlussrehabilitation: Projektbericht und Plädoyer zum Abbau administrativer Hürden.

We describe the results of a survey of claim forms that are used when starting rehabilitation following inpatient treatment and of an evaluation of a claim form developed on the basis of the results. The survey of different existing forms shows a high overlapping in content, suggesting the possibility of unification to one claim form that can be accepted by all insurers. In analogy to the Delphi method criteria for evaluation were consented and applied by the author group to assess the relevance of the claim forms content items for the process of initiating rehabilitation. A group of further experts added their evaluations. We prioritised the results and extracted the essential contents to conceive a unified claim form eligible for all types of rehabilitation. The claim form was discussed in 3 focus groups, revised accordingly and tested in the Hannover Medical School. Test results show that all relevant information is asked for and that the form is well manageable. The users' request for an IT-based solution and further ideas for improvement were integrated into the revised and validated version of the claim form. It is now available for all stake holders, in particular for insurers, as a means to improve quality of care and efficiency by standardisation of rehabilitation claim forms.

[Assessment of the completeness of medical imaging request forms in a sub-Saharan African setting]. / Évaluation de la conformité des demandes d'examens d'imagerie médicale : une expérience en Afrique subsaharienne.

UNLABELLED: The technical quality, interpretation, and clinical utility of diagnostic imaging examinations can increase considerably when the request forms are correctly filled out. This study sought to evaluate the completeness of these request forms at the Women and Children's Hospital in Yaoundé, Cameroon, to the 8 criteria established by the French High Health Authority (HAS, France). METHODS: This cross-sectional study evaluated 118 request forms for ultrasounds, 110 for conventional radiography, and 34 for computed tomography (CT scans), all completed by physicians at our university-affiliated hospital. They were sampled consecutively three days a week for several weeks, on days randomly selected at the beginning of each week, to minimize bias and ensure that as many different physicians as possible were assessed. We doubled the sample size recommended by the HAS. Conformity was defined by the presence of the required data on the request forms (data classified as either administrative or clinical). RESULTS: Overall, 52 request forms (19.8%) had all 5 administrative items, but only 9.2% had all 3 clinical components. Only 3 forms (1.1%) were 100% complete, including all 8 items; 85% included at least 5 components, and 35.1% had 6. The patient's last name was always included. Only 4.2% of the request forms included the prescriber's telephone number; 8% did not include the date and 17.2% (n = 45) did not state the clinical findings. On 30% of the forms, symptoms were the only clinical information listed; 23.7% (n = 62) stated the purpose of the examination (that is, the diagnosis to be confirmed or ruled out). The rate of missing information was highest in the requests for conventional radiography (49.5% compared to 38% with ultrasound and 12.3% for CT scans). CONCLUSION: The request forms for imaging examinations provided inadequate administrative and clinical data, especially those for conventional radiography. This missing information makes it harder to perform and interpret these examinations. An electronic request form with mandatory fields might improve the overall quality of the forms.

Feasibility of road traffic injury surveillance integrating police and health insurance data sets in the Dominican Republic.

OBJECTIVE: To assess the feasibility of semiautomated linking of road traffic injury (RTI) cases in different data sets in low- and middle-income countries. METHODS: The study population consisted of RTI cases in the Dominican Republic in 2010 and were identified in police and health insurance data sets. After duplicates were removed and fatality reporting was corrected by using forensic data, police and health insurance RTI records were linked if they had the same province, collision date, and gender of RTI cases and similar age within five years. A multinomial logistic regression model assessed the likelihood of being in only one of the data sets. RESULTS: One of five records was a duplicate, including 21.1% of 6 396 police and 16.2% of 6 178 insurance records. Health insurance data recorded 43 of 417 deaths as only injured. Capture - recapture estimated that both data sets recorded one of five RTI cases. Characteristics associated with increased likelihood (P < 0.05) of being only in the police data set were female gender [adjusted odds ratio (OR) = 2.5], age ≥ 16 years (OR = 1.7), collision in the regions of Cibao Northeast (OR = 4.1) and Valdesia (OR = 6.4), day of occurrence from Tuesday to Saturday (ORs from 1.5 to 2.9), month of occurrence from October to December (ORs from 1.6 to 4.5), and occupant of four-wheeled vehicles (OR = 5.4) or trucks (OR = 5.3). CONCLUSIONS: Consistent semiautomated linking procedures were feasible to ascertain the RTI burden in the Dominican Republic and could be improved by standardized coding of police and health insurance RTI reporting.

Feasibility of road traffic injury surveillance integrating police and health insurance data sets in the Dominican Republic / Factibilidad de la vigilancia de las lesiones por accidentes de tránsito mediante la integración de los conjuntos de datos de la policía y del seguro nacional de salud en la República Dominicana

OBJECTIVE: To assess the feasibility of semiautomated linking of road traffic injury (RTI) cases in different data sets in low- and middle-income countries. METHODS: The study population consisted of RTI cases in the Dominican Republic in 2010 and were identified in police and health insurance data sets. After duplicates were removed and fatality reporting was corrected by using forensic data, police and health insurance RTI records were linked if they had the same province, collision date, and gender of RTI cases and similar age within five years. A multinomial logistic regression model assessed the likelihood of being in only one of the data sets. RESULTS: One of five records was a duplicate, including 21.1% of 6 396 police and 16.2% of 6 178 insurance records. Health insurance data recorded 43 of 417 deaths as only injured. Capture - recapture estimated that both data sets recorded one of five RTI cases. Characteristics associated with increased likelihood (P < 0.05) of being only in the police data set were female gender [adjusted odds ratio (OR) = 2.5], age ≥ 16 years (OR = 1.7), collision in the regions of Cibao Northeast (OR = 4.1) and Valdesia (OR = 6.4), day of occurrence from Tuesday to Saturday (ORs from 1.5 to 2.9), month of occurrence from October to December (ORs from 1.6 to 4.5), and occupant of four-wheeled vehicles (OR = 5.4) or trucks (OR = 5.3). CONCLUSIONS: Consistent semiautomated linking procedures were feasible to ascertain the RTI burden in the Dominican Republic and could be improved by standardized coding of police and health insurance RTI reporting.

OBJETIVO: Evaluar la factibilidad de la vinculación semiautomática de los registros de casos de lesiones por accidentes de tránsito (LAT) de diferentes conjuntos de datos en países de ingresos bajos y medianos. MÉTODOS: La población de estudio la constituían los casos de LAT ocurridos en la República Dominicana en el 2010 y registrados en los conjuntos de datos de la policía y del seguro nacional de salud. Después de eliminar los casos duplicados y corregir la notificación de defunciones a partir de los datos forenses, se vincularon los registros de LAT de la policía y el seguro de enfermedad si los casos correspondían a la misma provincia, fecha de colisión y sexo, y la edad era similar con una diferencia no superior a cinco años. Se evaluó la probabilidad de aparecer únicamente en uno de los conjuntos de datos mediante un modelo de regresión logística polinómica. RESULTADOS: Uno de cada cinco registros estaba duplicado (21,1% de los 6 396 registros de la policía y 16,2% de los 6 178 registros del seguro). En el conjunto de datos del seguro nacional de salud se registraron 43 de las 417 defunciones como únicamente lesionados. Mediante el método de captura-recaptura se calculó que en ambos conjuntos de datos se registraban uno de cada cinco casos de LAT. Las características asociadas con una mayor probabilidad (P < 0,05) de aparecer únicamente en el conjunto de datos de la policía fueron el sexo femenino (razón de posibilidades ajustada [OR] = 2,5), la edad ≥ 16 años (OR = 1,7), la colisión en las regiones del nordeste de Cibao (OR = 4,1) y Valdesia (OR = 6,4), el día del accidente de martes a sábado (OR de 1,5 a 2,9), el mes del accidente de octubre a diciembre (OR de 1,6 a 4,5) y los ocupantes de vehículos de cuatro ruedas (OR = 5,4) o camiones (OR = 5,3). CONCLUSIONES: Los procedimientos sistemáticos de vinculación semiautomatizada se mostraron factibles para evaluar la carga de LAT en la República Dominicana, y se podrían mejorar mediante la codificación estandarizada de las notificaciones de LAT de la policía y del seguro nacional de salud.

[Simplifying post-treatment rehabilitation claim forms]. / Ein Weg aus dem Dickicht des Formulardschungels bei der Einleitung von Anschlussrehabilitation bzw. Anschlussheilverfahren.

Many different claim forms are used when starting rehabilitation following inpatient treatment, resulting in high administrative overheads for hospital staff, financial institutions and government agencies as well as patient allocation inefficiencies. We describe the problems ensuing on multiple and incompatible claim forms. On the basis of a survey of extant forms, we describe the content of a unified claim form that can be accepted by all insurers and which is optimised for hospital use. A model procedure for the development of a nationwide unified claim form allows for the assessment of the task's complexity and duration. Nevertheless, quality of care and efficiency considerations support a recommendation of standardisation of rehabilitation claim forms. On this basis the authors appeal to all relevant health-care players to enter into the enterprise of standardisation and to pursue this goal consistently.

Epilepsy and social security: general aspects of the insured claimants and medical decisions.

BACKGROUND: Epilepsy affects adults at productive age and interferes with their ability to work. However, the granting of social security benefits to these patients has not received sufficient attention. This article aims to provide a profile of individuals with a previous diagnosis of epilepsy that file claims for social security benefits and a profile of the medical advisory decisions that support the concession of these benefits. PARTICIPANTS: A sample of thirty individuals with illness-related problems due to epilepsy was selected from the claimants that receive Social Security Incapacity/Sickness benefits. METHODS: An exploratory data analysis of the 188 Social Security medical files of the thirty claimants was performed using the clinical and epidemiological information and the medical advisory criteria. RESULTS: The mean age of the claimants was 39 years and most of them were males in jobs that do not require a lot of schooling. The first claim was filed within an average of four years of employment. On average, each worker files a claim every three months, which entitles him/her to receive incapacity/sickness benefits for seventeen months. The frequency of seizures and the medications used by the claimants were registered in 60% of the medical files. In addition, the description of the physical and neurological exam was incomplete in 50% of the files. Furthermore, 60% of the files did not include the argument or the clinical evidence that was used to justify the concession of a benefit. CONCLUSION: The medical advisory decisions on epileptic workers tend to be inconsistent, overly lenient and generally lacking in clinical evidence. The disparities among the granted benefits indicate the need for the National Social Security System to review and draft specific guidelines for epilepsy.

[Informatics support for risk assessment and identification of preventive measures in small and micro-enterprises: occupational hazard datasheets]. / II supporto informativo alla valutazione dei rischi ed alla individuazione delle misure preventive nelle piccole e micro imprese: le schede di rischio professionale.

BACKGROUND: Risk assessment is the fundamental process of an enterprise's prevention system and is the principal mandatory provision contained in the Health and Safety Law (Legislative Decree 81/2008) amended by Legislative Decree 106/2009. In order to properly comply with this obligation also in small-sized enterprises, the appropriate regulatory bodies should provide the enterprises with standardized tools and methods for identifying, assessing and managing risks. OBJECTIVES: To assist in particular small and micro-enterprises (SMEs) with risk assessment, by providing a flexible tool that can also be standardized in the form of a datasheet, that can be updated with more detailed information on the various work contexts in Italy. METHODS: Official efforts to provide Italian SMEs with information may initially make use of the findings of research conducted by ISPESL over the past 20 years, thanks in part to cooperation with other institutions (Regions, INAIL-National Insurance Institute for Occupational Accidents and Diseases), which have led to the creation of an information system on prevention consisting of numerous databases, both statistical and documental ("National System of Surveillance on fatal and serious accidents", "National System of Surveillance on work-related diseases", "Sector hazard profiles" database, "Solutions and Best Practices" database, "Technical Guidelines" database, "Training packages for prevention professionals in enterprises" database). With regard to evaluation criteria applicable within the enterprise, the possibility of combining traditional and uniform areas of assessment (by sector or by risk factor) with assessments by job/occupation has become possible thanks to the cooperation agreement made in 2009 by ISPESL, the ILO (International Labour Organisation) of Geneva and IIOSH (Israel Institute for Occupational Health and Hygiene) regarding the creation of an international Database (HDODB) based on risk datasheets per occupation. The project sets out to assist in particular small and micro-enterprises with risk assessment, providing a flexible and standardized tool in the form of a datasheet, that can be updated with more detailed information on the various work contexts in Italy. RESULTS: The model proposed by ISPESL selected the ILO's "Hazard Datasheet on Occupation" as an initial information tool to steer efforts to assess and manage hazards in small and micro-enterprises. In addition to being an internationally validated tool, the occupation datasheet has a very simple structure that is very effective in communicating and updating information in relation to the local context. CONCLUSIONS: According to the logic based on the providing support to enterprises by means of a collaborative network among institutions, local supervisory services and social partners, standardised hazard assessment procedures should be, irrespective of any legal obligations, the preferred tools of an "updatable information system" capable of providing support for the need to improve the process of assessing and managing hazards in enterprises.