Employment law
Periodic medical check-ups in Mali: the follow-up you owe every employee, every year
Ségou, the carding shop of Filature du Delta. A fine cotton dust floats in the neon light and settles on the operators’ hair. Nobody is coughing yet. But the day an employee develops a respiratory disease, the company will have to prove that it had them examined every year.
Filature du Delta and the people mentioned in this article are fictitious: they are used as examples only.
1. What exactly are we talking about?
Filature du Delta employs 140 people in Ségou, including two 17-year-old apprentices and eight carding operators exposed to cotton dust. They all had a pre-employment examination. Since then, nobody has seen a doctor again.
The periodic medical check-up is the examination that the occupational doctor carries out on each employee at regular intervals throughout the contract. It complements the pre-employment examination: the first checks fitness at the start, the second monitors how health evolves in contact with the work.
This obligation stems from a general rule: every undertaking must provide its workers with a medical and health service designed, in particular, to prevent any harm to their health caused by their work (Social Security Code, article 36; Labour Code, article L.177). This service is provided by the local inter-company medical centre (CMIE), which all employers must join (Social Security Code, article 37).
Why this rule? Because a work-related illness often develops silently. A regular examination detects it early, when a change of job is still enough.
The most common mistake
Believing that the pre-employment examination covers the whole career. It says nothing about the health of an employee exposed to dust or noise for five years. See our article Pre-employment medical examination.
The pre-employment examination opens the file. Periodic check-ups keep it up to date.
2. The frequency: once a year, and more often for some
All workers must be examined at least once a year. Those under 18 are examined every three months (Social Security Code, article 44).
The same article requires special monitoring, meaning closer follow-up whose frequency the doctor sets, for several categories of employees:
- employees exposed to dangerous work, in particular women and children under the conditions of article L.185 of the Labour Code;
- pregnant women;
- mothers of a child under two;
- people with injuries and disabilities.
| Employee | Minimum frequency |
|---|---|
| Employee aged 18 or over | Once a year |
| Employee under 18 | Every three months |
| Employee under special monitoring | Set by the occupational doctor |
Example. Filature du Delta plans its check-ups for the year.
130 adult employees not exposed: 130 check-ups per year
2 apprentices aged 17: 2 × 4 = 8 check-ups per year
8 carding operators exposed to dust: frequency set by the doctor, at least 8 check-ups per year
Minimum total: 130 + 8 + 8 = 146 check-ups to schedule
Mistake to avoid: waiting until an apprentice turns 18 to organise the first quarterly check-up. The three-month rule applies from hiring.
What you need to do
- Draw up an annual schedule of check-ups for each employee, showing their age and job.
- Tell the occupational doctor about exposed jobs, pregnant employees and mothers of a child under two.
- Schedule a check-up every three months for each employee under 18.
3. The return-to-work examination: three cases, no more
Awa, a spinning operator, returns after four weeks off with typhoid. Her team leader wants to put her straight back on her machine. He must first send her to the CMIE.
The return-to-work examination is the check carried out when the employee returns, to assess any link between working conditions and the illness and whether they can resume their former job or need to be retrained. It is compulsory in three cases (Social Security Code, article 45):
- after an absence due to an occupational disease, whatever its length;
- after an absence of more than three weeks due to a non-occupational illness;
- after repeated absences totalling more than fifteen days in the same six-month period.
Example. Awa was off sick for four weeks: that is more than three weeks, so the return-to-work examination is compulsory. Her colleague Bakary missed 6 days in February, 5 days in April and 6 days in June.
Bakary’s absences over the six-month period: 6 + 5 + 6 = 17 days
17 days is more than 15 days in the six-month period
Return-to-work examination compulsory when he returns in June
Why this rule? An employee returning in a weakened state to an exposed job risks relapse or accident. The return-to-work examination serves to adapt the job before it is too late.
What the text does not say
Article 45 does not mention non-occupational accidents: it covers illness. You may request an examination in that case, but do not present as a legal obligation something that is not.
Occupational disease, more than three weeks off sick, more than fifteen days in six months: three routes to the return-to-work examination.
What you need to do
- Keep a count of each employee’s sickness absences, six months at a time.
- Send the employee to the CMIE before they actually resume work in each of the three cases.
- Adapt the job according to the doctor’s opinion before putting the employee back to work.
4. What the occupational doctor expects from you
The check-up is not just a medical appointment. It creates obligations for the employer.
- Pay for the time spent. Time spent on examinations is taken from working hours without any deduction from pay, or paid as normal working time. During periodic check-ups, additional tests needed to screen for occupational diseases are paid for by the employer (Social Security Code, article 46).
- Listen to the doctor. The doctor advises management and staff delegates on hygiene, safety and job adaptation, and you must take their opinions into account, in particular on changes of job or position (articles 47 and 48).
- Inform the doctor. You must tell them the composition of the products used in the establishment (article 47).
For their part, the doctor reports to the employer any occupational diseases they discover, and notifies infectious and contagious diseases within twenty-four hours to the district doctor and the labour inspector (article 49).
When a check-up reveals an occupational disease
An occupational disease is an illness caused by habitual exposure to a harmful agent at work and listed in the tables annexed to the Social Security Code. If the annual check-up reveals one, it must be declared in the same way as an accident at work (article 141): within 48 hours at the latest, to the INPS and the regional labour inspectorate (article 71; Labour Code, article L.176).
Upstream, an employer using work processes likely to cause occupational diseases must declare this by registered letter to the labour inspector and the INPS before work begins (article 140).
What you need to do
- Give the occupational doctor the list of products and dusts each job exposes employees to.
- Declare to the INPS and the labour inspectorate within 48 hours any occupational disease revealed by a check-up.
- Pay for the screening tests requested during periodic check-ups.
5. A closer look: the inspector’s role for women and children
The labour inspector may require a doctor to examine a woman or a child to check that their work does not exceed their strength. This examination is a right if the person concerned requests it. If the work is found to be beyond their strength, the employee must be assigned to suitable work; failing that, the contract is terminated by the employer’s act (Labour Code, article L.188).
For Filature du Delta, this means that a 17-year-old apprentice carrying cotton bales that are too heavy can, on request, obtain an examination. If the doctor finds the limit exceeded, the company must move him to another job, or bear a termination attributed to it.
What a missed check-up costs
An undertaking that does not comply with the prevention measures required by law, or with the labour inspector’s instructions on the matter, faces a fine of XOF 25,000 to 250,000 (Social Security Code, article 244). Medical examinations are among these measures: the company’s medical service has a prevention role (article 36). Without a record of check-ups, you will also be unable to show that an employee’s illness was being monitored.
Key takeaways in 6 points
- Have each employee examined at least once a year by the CMIE doctor.
- Schedule a check-up every three months for employees under 18.
- Tell the doctor about employees under special monitoring: dangerous jobs, pregnant women, mothers of a child under two, people with disabilities.
- Arrange a return-to-work examination after an occupational disease, more than three weeks off sick or more than fifteen days of absence in the six-month period.
- Pay for the time spent on check-ups and, during periodic check-ups, for occupational disease screening tests.
- Declare within 48 hours any occupational disease discovered during a check-up.