OSH system at national level - France

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  IOM

Philippe Jandrot, INRS, France (2012)

Katell Daniault, DGT (update, 2017)

1-Occupational safety and health legislative framework

The first protective measures for health and safety at work were issued during the 19th century, targeting vulnerable populations : miners (law of 21 April 1810), children (law of 22 March 1841). Then the law of 9 April 1898 establishing the reponsability of the employer in case of accidents in the enterprise is a milestone in the compensation of occupational risks. Then, Social Security was established in France by the Order of 4 October 1945[1]. Subsequently, occupational health medecine was organised and health safety and working conditions committees (CHSCT) were introduced in companies. Since the 1980s, it is the EC that has given a major impetus to the modernisation of safety and health at work. An important step in this evolution was the Framework Directive on Workers Health and Safety (Council Directive 89/391/EEC of 12 June 1989) and the specific directives linked to it. In France, the Framework Directive was transposed by Law No. 91-1414 of 31 December 1991[2] amending the Labour Code and the Public Health Code in order to promote the prevention of occupational risks. This law also transposes the EEC directives No. 89/392 of 14 June1989, No 89/686 of 21 December 1989, No 89/655 and 656 of 30 November 1989, No. 88/379 of 7 June 1988 and No. 89/654 of 30 November 1989 into French legislation.

According to that law, employers must personally ensure compliance with laws and regulations. They must take all necessary measures to ensure the safety and protect their workers’ health based on an assessment of risks identified in the company. They must follow a general health and safety policy: avoid risks, assess risks that cannot be avoided, combat risks at the source, adapt work to workers, replace dangerous products and processes by ones that are less or not at all dangerous, plan prevention measures, give priority to collective protection measures over personal protection measures and provide workers with appropriate information. Other key prevention actors are occupational health services that can be internal or external to the enterprise, workers and bodies representing them, notably health, safety and working conditions committees[3].


Main legislative acts:
The laws and decrees on occupational safety and health are assembled in the fourth part of the French Labour Code[4]. The laws and decrees on the public health are assembled in the French Publich Health Code[5]. The laws and decrees on the social security system are assembled in the French Social Security Code[6].


Important specific laws and decrees :

  • Law 91-1414 of 31 December 1991 amending the Labour Code and the Public Health Code to promote the prevention of occupational risks and transposing European directives on health and safety at work[7]
  • Decree 2001-1016 of 5 November 2001 establishing a document for the assessment of risks to the health and safety of workers[8]
  • Decree 2008-1156 of 7 November 2008 on work equipment and personal protective equipment[9]
  • Decree 2010-78 of 21 January 2010 on informing employees about the risks to their health and safety[10]
  • Decree 2011-1480 of 9 November 2011 on work equipment and personal protective equipment[11]
  • Decree 2010-750 of 2 July 2010 on the protection of workers against risks arising from artificial optical radiation[12]
  • Decree 2010-1016 of 30 August 2010 concerning the obligations of employers regarding the use of electrical installations in workplaces[13]
  • Decree 2010-1017 of 30 August 2010 on the obligations of project owners undertaking the construction or renovation of buildings designed to receive workers concerning the design and implementation of electrical installations[14]
  • Decree 2010-1018 of 30 August 2010 on various provisions relating to the prevention of electrical risks in the workplace[15]
  • Decree 2010-1118 of 22 September 2010 concerning work operations on electrical installations or in their vicinity[16]
  • Decree 2011-629 of 3 June 2011 on the protection of the population against health risks related to exposure to asbestos in buildings[17]
  • Law 2011-867 of 20 July 2011 on the organisation of occupational medicine[18]
  • Decree 2012-135 of 30 January 2012 on the organisation of occupational medicine[19]
  • Decree 2012-137 of 30 January 2012 on the organisation and operation of occupational health services[20]
  • Decree 2012-232 of 17 February 2012 on the annual declaration of substances in nanoparticulate state pursuant to Article L. 523-4 of the Environment Code[21]
  • Decree 2012-233 of 17 February 2012 concerning the designation of the bodies referred to in Article L. 523-3 of the Environment Code[22]
  • Decree 2012-530 of 19 April 2012 concerning the placing on the market and supervision of substances and mixtures[23]
  • Decree 2012-746 of 9 May 2012 setting limit values for occupational exposure to certain chemical agents[24]
  • Decree 2013‑607 of 9 July 2013 transposing directive 2010/32/EU of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector signed by the European social partners HOSPEEM and EPSU on 17 July 2009[25]
  • Law 2014-40 of 20 Januray 2014 for sustainability and justice of the pension system (creating the personel account on strain)[26]
  • Decree 2015-443 of 17 April 2015 on a derogation procedure provided in article L. 4153-9 of the Labour Code for young workers under 18[27]
  • Decree 2015-612 and decree 2015-613 of 3 June 2015 transposing directive 2014/27/EU and modifying the Labour Code to align with EU Regulation N°1272/2008 on classification, labelling and packaging of substances and mixtures[28]
  • Decree 2015-789 of 29 June 2015 on risks of exposure to asbestos[29]
  • Decree 2015-968 of 31 July 2015 on the new missions and functioning of the National Agency for Improvement of Working Conditions (ANACT)[30]
  • Law 2015-994 of 17 August 2015 on Social Dialogue and Employment[31]
  • Order 2016-413 of 7 April 2016 on the control of application of Labour law[32]
  • Law 2016-1088 of 8 August 2016 on labour, modernisation of social dialogue, and securing career paths[33]
  • Decree 2016-868 of 29 June 2016 on the consultation procedure involving the employee representative bodies[34]
  • Decree 2016-1834 of 22 December 2016 on organisation, missions, composition and functioning of the Working Conditions Advisory Board (COCT) and regional committees[35]
  • Decree 2016-1908 of 27 December 2016 on modernisation of occupational health services[36]

2-National strategy and programmes

French National Occupational Health Plan
In 2004 the French Government adopted the first Occupational Health Plan (Plan Santé au Travail, PST) for 2005-2009[37]. It aimed to reform France's occupational risk prevention system The second Occupational Health Plan (PST2)[38] covered the period 2010-2014 and was launched in 2010. The approach to drawing up the second plan was largely participative. It involved not only the relevant government departments and agencies, but also the occupational safety and health (OSH) bodies and all of the social partners through the Working Conditions Advisory Board (Conseil d’Orientation sur les Conditions de Travail, COCT) [39][40]. PST2 had two major objectives :

  • To reduce exposure to the risks of occupational accident and disease. To this end, two more precise objectives are assigned for the period of the plan: to stabilise the number of occupational diseases and to reduce occupational accidents by 25%,
  • To develop an active prevention policy against clearly identified risks and for the benefit of the most sensitive sectors of activity or categories of the population.

The third Occupational Health Plan (PST3) covering the period 2016 to 2020 was officially presented to the Working Conditions Advisory Board ("Conseil d'Orientation sur les Conditions de Travail" - COCT) in 2015. [41]. The overall objective of the PST3 is to put prevention at the core of safety and health at work and to promote a prevention culture with a special focus on work health promotion. Important instruments for an effective prevention culture are risk assessment, information, and training. Prevention will focus on:

  • Classic risks (slip, trips and falls, dangerous substances, risks in transport))
  • Management and organisational risks (psychosocial risks, work-related strain)
  • Emergent risks (endocrine disruptors, nanomaterial, digital technologies)

The new strategy is based on a renewal of the social dialogue, including more social partners. It was the first time the Ministry of Labour had entrusted the social partners with the task of developing guidelines for the Occupational health Plan, while involving all workplace health and safety stakeholders in its preparation. The new strategy highlights the link between safety health and the quality of working life and aims at simplifying regulations.

The new strategy is structured around three axes and ten operational objectives leading to actions, to improve the consistency as well as the effectivity (applicability) of the plan [41]:

  1. Strategic axis 1 : Primary prevention and prevention culture
    1. Operational objective 1 : Promotion of prevention culture
    2. Operational objective 2: Prevention of work-related strain
    3. Operational objective 3: Target priority risks
  2. Strategic axis 2 : Quality of working life, job retention and performance
    1. Operational objective 4: Quality of working life
    2. Operational objective 5: Job retention
    3. Operational objective 6: Transversality: OSH and public health
  3. Supporting axis: Social dialogue and system of actors
    1. Operational objective 7 : Social dialogue
    2. Operational objective 8 : System of actors and offers for micro and SMEs
    3. Operational objective 9 : Simplification
    4. Operational objective 10 : Knowledge, data and research

The Agreement on Objectives and Management (COG) for the Occupational Accidents and Diseases Branch for 2014-2017

The Agreement on Objectives and Management (Convention d’Objectifs et de Gestion, COG) is the contractual document between the French Government and the Occupational Accidents and Diseases (AT-MP) Branch of the French National Health Insurance Fund for Salaried Workers (CNAMTS, Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés). It defines four priorities for actions, and the terms of monitoring and assessing their implementation.[42] It takes into account the focuses adopted by the social partners through the Occupational Accidents and Diseases Commission. These priorities are deployed in 13 operational programmes, accompanied by result indicators and a monitoring schedule[43].

3-Social dialogue

3.1-Social dialogue at national and regional level

The Working Conditions Advisory Board (Conseil d’orientation sur les conditions de travail, COCT)[39][40]
The Working Conditions Advisory Board was established by Decree No. 2008-1217 of 25 November 2008. The COCT is a national body for consultation between social partners and public authorities, headed by the Minister of Labour. The COCT carries out two functions : a consultative role on all legislation on OSH, and an advisory role on OSH public policy orientations (eg, elaboration of the national occupational health plan). This advisory role has been reinforced by the 2016 reform, which created new bodies for dialogue at national and regional level within the COCT [31][35].

The COCT comprises all stakeholders : social partners, ministerial departments, representatives of OSH bodies, and qualified experts.

Each region of France has also established regional Working Conditions Advisory Boards (CROCT) with similar functions and composition.

3.2-Social dialogue at sectoral level

Technical committees
The social dialogue at sectoral level is organised within national and regional committees (Comité Technique National, CTN; Comité Technique Régional, CTR). There are nine national technical committees, each representing a different industrial, trade or services sector. Their action is coordinated by the Occupational Accidents and Diseases Commission of the National Health Insurance Fund for Salaried Workers (CAT/MP, CNAMTS, see chapter 4.2). Equally made up of employer and employee representatives, they are responsible for defining priority risk prevention actions in companies that fall within their specific sectors. They notably carry out studies on occupational hazards and relevant prevention means, and elaborate national prevention recommendations.

There are several regional technical committees in every French region. They are also composed of employer and employee representatives in equal numbers. Their number and scope of action depend on the regional economic activity, and their action is matched to that of the relevant national technical committees. They play an important role as an interface between the CTN and companies as they disseminate information, they identify good practices and they evaluate the application of national prevention recommendations.

Collective agreements
Collective negociation takes place at three levels in France : inter-professional, branch level and company level. In order to complete and develop the provisions of the Labour Code, social partners negotiate and sign, notably at branch level, collective agreements regarding employment, vocational training, working conditions and social guarantees for employees. These agreements make it possible to take into account the specific working conditions of different professions. Most of them have been extended to all the companies in a given sector by an Order of the Minister of Labour[44].

Employer organisations and trade unions are equally represented in the national commission for collective negotiation (Commission nationale de la négociation collective), which advises the government on the application, interpretation and extension of collective agreements[45].

3.3-Social dialogue at enterprise level

Social dialogue on OSH in companies involves the management, and, depending on the size of the enterprise, the Health, Safety, and Working Conditions Committee (CHSCT) and the Staff Delegates.

French Laws No. 82-1097 of 23 December 1982[46], No. 91-1414 of 31 December 1991[47], No. 2003-699 of 30 July 2003[48], and No. 2015-994 of 17 August 2015[31] define the status and the missions of the Health, Safety and Working Conditions Committee (Comité d’Hygiène, de Sécurité et des Conditions de Travail, CHSCT) [49] [50]. All companies with more than 50 employees have to set up such a committee. The CHSCT is to consulted on all OSH related issue in the firm, such as compliance with regulation, prevention plans. It analyses occupational risks, proposes actions for improving working conditions, and is watchful to ensure that legislative and regulatory instructions and guidelines are complied with. The CHSCT can also conduct technical examinations and investigations, in particular in case of an occupational accident or disease. In companies with 11 to 49 employees, staff delegates (délégués du personnel) represent the employees for all OSH related issues, and fulfill the same missions as the CHSCT's. In micro entreprises (under 11 employees) employers must appoint one or several competent employees to handle the prevention of occupational risks in the company.

4-OSH infrastructure

4.1-OSH infrastructure scheme

Figure 1: Occupational safety and health infrastructure in France


Source: [51] [52]

4.2-National competent bodies

Governement

The Ministry of Labour (Ministère du Travail)[53] implements Government policy in the fields of labour, social dialogue, prevention of occupational accidents and diseases, employment, and vocational training.

The General Directorate for Labour (Direction générale du travail - DGT)[54]
The General Directorate for Labour is the arm of the ministry of Labour that prepares, leads, and coordinates labour policy in order to improve collective and individual relations at work, to support and monitor collective agreements, to improve working conditions in companies, and to protect occupational health and safety. To this end, it is in charge of drafting and applying legislative and regulatory texts, and developing actions in that fields.

The Social Security Directorate (Direction de la sécurité sociale - DSS)[55]
The Social Security Directorate (Direction de la Sécurité Sociale, DSS) is attached to the Ministry of Solidarities and Health and to the Ministry for Action and Public Accounts. It oversees the Social Security bodies of the funds of the general social security scheme, of the funds of the basic social security scheme for the self-employed other than in the farming sector, and of the funds of the special social security schemes.

Regional Directorates for Companies, Competition, Consumption, Labour and Employment (Directions Régionales des Entreprises, de la Concurrence, de la Consommation, du Travail et de l’Emploi- DIRECCTEs)[56][57]– Labour Inspectorates[58]
The Labour Inspectorate (Inspection du Travail) services have been attached to the DIRECCTEs that were set up by Decree 2009-1377 of 10 November 2009. Labour inspection is carried out mainly by the labour inspectors and controllers in charge of inspecting companies and informing the public. They check that labour law is being properly implemented, they advise and inform employers, employees and staff representatives about their rights and obligations, and they facilitate out-of-court conciliation between the parties, in particular for collective disputes. The Labour Medical Inspectorate (Inspection Médicale du Travail) constitutes a specific technical support body within the Labour Inspectorate services.

Social Security bodies

French National Health Insurance Fund for Salaried Workers (Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés-CNAMTS)[59][60]
Since the French Law No. 46-2426 of 30 October 1946[61], occupational risk insurance has been incorporated into the assignments of the French Social Security system. In addition to providing compensation, the Social Security bodies also have a risk prevention mission. In 1967, a national Fund dedicated to Health Insurance was set up, namely the CNAMTS. It was also assigned the task of managing occupational risks. The French Law No. of 25 April 1994[62] enabled the Health Insurance – Occupational Risks section (Occupational Accidents and Diseases (AT/MP) Branch) to acquire a certain amount of independence, in particular financial independence, while remaining with the CNAMTS.

Occupational accidents and diseases are insured collectively by the companies. Contribution rates depend on the size of the establishment, on its sector of activity, and on the frequency and seriousness of the accidents or diseases that might be suffered by its employees. The compensation mission consists in meeting the needs of the victims by bearing the expenses incurred by victims of occupational accidents and diseases, by reimbursing treatment expenses, and by paying daily allowances and pensions, annuities or lump sums in the event of permanent disability[63].

The CNAMTS (Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés) is an administrative national public establishment overseen by the Social Security Directorate. Its responsibilities and missions are specified in particular by French Law No. 2004-810 of 13 August 2004[64]. The activities of the CNAMTS consist, in particular, in:

  • defining the focuses, principles, and objectives that guide its action and the action of the French National Health Insurance scheme for salaried workers (the general Social Security scheme, or “Assurance Maladie”), and ensuring that they are implemented,
  • defining and promoting prevention of disease, of occupational accidents, and of occupational disease by taking worthwhile national actions,
  • determining and co-ordinating the activities of the bodies of the network of Health Insurance branches and Occupational Accidents and Diseases branches : regional and local health insurance funds (Caisses primaires d'assurance maladie, CPAMs), occupational health and pension insurance funds (Caisses d’Assurance Retraite et de la Santé au Travail-CARSATs), CRAMIF (Paris Region Regional Health Insurance Fund, Caisse Régionale d’Assurance Maladie d’Île de France), and CGSSs (General Social Security Funds for French overseas territories, Caisses Générales de la Sécurité Sociale)). These local and Regional Health Insurance Funds have, in particular, the mission of assisting companies in assessing the risks of occupational accidents and diseases with a view to preventing those risks, and the mission of taking part in pricing the insurance for occupational accidents and diseases. They advise companies in their risk prevention approach through direct action at the workplace. They also act through collective actions with the various trade sectors, designing risk assessment and risk prevention systems, offering training, and disseminating good practices and distributing financial incentives[65] [66] [67].

The Occupational Accidents and Diseases Commission (Commission des Accidents du Travail et des Maladies Professionnelles, CAT/MP) is in charge of balancing the finances of the Occupational Accidents and Diseases (AT/MP) Branch, of pricing, compensation, and prevention of occupational accidents and diseases. To these ends, it determines the focuses of the Agreement on Objectives and Management (COG, Convention d’Objectifs et de Gestion) for the Branch. It approves the budgets for the French National Fund for the Prevention of Occupational Accidents and Diseases (Fonds National de Prévention des Accidents du Travail et des Maladies Professionnelles, FNPATMP.

French Agricultural Social Security Scheme (Mutualité Sociale Agricole - MSA)[68]
The existence of agricultural mutual benefit societies in France dates back to the 19th century. The role and the responsibilities of the MSA were defined by the Orders of 1945 setting up the French Social Security system. The MSA is the mandatory welfare protection body for farmers and agricultural workers. It covers, in particular, the risks of occupational accidents and diseases in agriculture, landscaping, forestry, and agri-food industries. An Agreement on Objectives and Management (COG, Convention d’Objectifs et de Gestion) defines the mutual commitments of the French State and the MSA. The Central Fund of the MSA (Caisse Centrale de la MSA (CCMSA)) represents the MSA at national level and leads the network of 35 regional funds. A specific occupational health and security plan for the agriculture sector has been adopted for 2016-2020[69].

The Social Security scheme for the self-employed (Régime Social des Indépendants - RSI)[70]
The RSI took over from three previously existing schemes and was set up pursuant to the provisions of French Law No. 2004-1343 of 9 December 2004[71]. It is run by the representatives of its insured parties, who are craftspeople, shopkeepers, and self-employed professionals. It performs a public service mission by managing the mandatory welfare protection of over four million self-employed enterprise managers and of their dependants and beneficiaries, under an Agreement on Objectives and Management signed between the French State and the RSI.

Other schemes
There are 16 other special social security schemes, including the schemes for SNCF (French Railways, Société Nationale des Chemins de Fer) personnel, for civil servants and state workers, for the mining sector, and for the electricity and gas industries.

OSH authorities and inspection services

OSH services

Independent occupational health services and inter-enterprise occupational health services
French law n°46-2195 of October 1946 created occupational health services. French Laws No.2011-867 of 20 July 2011[72] and No.2016-1088 of 8 August 2016 on labour, modernisation of social dialogue, and securing career paths[33] define the missions of both independent and inter-enterprise occupational health services. Depending on the size of the company, OSH services can be dedicated to one company (for big enterprises : independant occupational health services), or common to different companies (for SME's : inter-enterprise occupational health services). Occupational medicine is organised, materially and financially, by employers. It is placed under the surveillance of representatives of the staff of the company, and under the control of the services of the Ministry for Labour.

According to French legislation (Article L.4622-2 of Labour Code), the aim of the occupational physician is to avoid any alteration in the health of employees due to their work. Their missions consist in :

- conducting OSH preventive actions, in order to preserve physical and mental health of employees throughout their career path ;

- advising employers and workers and their representatives (eg the Health, Safety, and Working Conditions Committee (CHSCT)) on OSH issues ;

- ensuring health individual surveillance of workers ;

- contributing to traceability of occupational exposures, and health monitoring.

Occupational physicians are the key actors of OSH services. The working teams also comprise authorised occupational risk prevention officers (IPRPs) and nurses. Law 2016-1088 of 8 August 2016 on labour, modernisation of social dialogue, and securing career paths[33] and decree 2016-1908 of 27 December 2016 on modernisation of occupational health services[36] reinforce the role of these multidisciplinary teams especillay in conducting preventive consultations.

Other OSH bodies

The French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (Institut National de Recherche et de Sécurité pour la prévention des accidents du travail et des maladies professionnelles - INRS)
Founded in 1947, INRS is an independant association under French Law of 1 July 1901. INRS is the scientific and technical expert of the Occupational Accidents and Diseases (AT/MP) Branch, which is mainly funding it. It is managed by a Board of Directors made up equally of representatives from employer organisations and from employee union organisations. Therefore, it is an impartial and independent player.

The main mission of INRS is to develop and promote a culture of prevention of occupational accidents and diseases. This mission meets economic, social, and political requirements, and it is hinged around three main focuses: anticipating, raising awareness, and informing & supporting. In order to pursue its missions successfully, INRS has defined four complementary means of action: Studies & research; assistance; training; and information. INRS has a wide variety of skills in-house: scientific researchers, engineers, physicians, trainers, and information specialists.

The French National Agency for Improvement of Working Conditions (Agence Nationale pour l'Amélioration des Conditions de Travail - ANACT)[73]
The ANACT is an administrative public establishment set up by French Law No. 73-1195 of 27 December 1973. The decree 2015-968 of 31 July 2015 on the new missions and functioning of the ANACT[30] reinforced its national and regional network and focused its missions on working conditions.

The ANACT network for improvement of working conditions is made up of the National Agency, overseen by the Ministry for Labour, and 17 Regional Agencies (ARACTs, Agences Régionales pour l’Amélioration des Conditions de Travail), which are independant associations under French Law of 1 July 1901. The national agency relies on a tripartite governance (including the governement), and the regional agencies have bipartite boards, bringing together equally representatives of employer and employee organisations.

The ANACT network helps companies and other organisations to develop innovative projects concerning labour, and encourages them to place labour on the same level as the other economic determinants (products, markets, technologies, etc). Its work plan is defined in a Performance and Objectives Agreement with the General directorate of Labour.

The French Professional Agency for Risk Prevention in Building and Civil Engineering (Organisme Professionnel de Prévention du Bâtiment et des Travaux Publics - OPPBTP)[74]
The OPPBTP was set up in 1947. Its role and organisation were specified by Decree No. 85-682 of 4 July 1985[75]. Its missions are to advise, train, and inform the players in the building and civil engineering sector as regards risk prevention, safety, health, and the improvement of working conditions. Its governance is bipartite, as national and regional boards are made up of five representatives of employer federations and of five representatives of employee union organisations.

The OPPBTP has a staff of 300, who are mainly engineers and technicians from the building and civil engineering sector, distributed throughout France and organised into 18 agencies. The Secretary-General, a representative of the CNAMTS (French National Health Insurance Fund, Caisse Nationale de l’Assurance Maladie), and a representative of the Minister for Labour attend the sessions of the Board of the national committee with consultative votes.

The French National Agency for Food, Environmental and Occupational Health and Safety (Agence Nationale de Sécurité Sanitaire de l'Alimentation, de l'Environnement et du Travail - ANSES)[76]
Set up by Order No. 2010-18 of 7 January 2010, ANSES is an administrative public establishment placed under the supervision of the Ministers for Health, Agriculture, the Environment, Labour, and Consumption[77].

Its mission consist in risk assessment, as well as expertise and scientific and technical support for drawing up legislative and regulatory provisions and for implementing risk management measures.

With a view to accomplishing its missions, the ANSES organises collective expertise in its field of competence, drawing in particular on specialised committees of experts.

The French National Public Health Agency (Santé Publique France)[78]

Santé Publique France was created in April 2016 as the national public health agency, resulting from the merging of the French Institute for Public Health Surveillance (InVS), the French institute for Health Promotion and health Education (Inpes), and the Establishment for Public Health Emergency preparedness and response (Eprus). Santé Publique France serves the population in all aspects of public health based on scientific knowledge, data, and information, including on OSH issues. It supports the government and society in improving the health and well-being of the population, with the objective of reducing social health inequities in all areas of public health : infectious diseases, non infectious diseases, environmental health and occupational health. It contributes to better knowledge of work related diseases, plays an important role in health monitoring on OSH and provide important guidance in order to establish the table of occupational diseases. Santé Publique France analyzes up-to-date knowledge and data on the determinants of health and risk factors, provides decision makers with independant evidence-based guidance and proposes measures to protect the population from health threats, develops evidence-based interventions for prevention and health promotion.

The agency, under the authority of Ministry of Health, is present throughout the national territory with regional units. Operating as a network, cooperation with partners and health professionals, including occupational physicians, enables to combine strengths.

The French Institute for Radiological Protection and Nuclear Safety (Institut de Radioprotection et de Sûreté Nucléaire - IRSN)[79]
The IRSN is a public establishment under the joint supervision of five ministries. The scope of competencies of IRSN covers all of the risks related to ionising radiation, used in industry or in medicine, or related to natural radiation. It is the public expert on research and expertise about nuclear and radiological risks.


Education and training and awareness raising

Legally required training for OSH specialists

Occupational Physicians
There are two ways of becoming qualified to be an occupational physician: through specialised studies or via certification by the French medical association (l'Ordre National des Médecins). To obtain the university degree in occupational medicine, a qualifying training period of three years is required following six years of specialised studies. Practicing physicians (from France or European Union member states) also have access to this qualifying training. In addition to the teaching of theory, the training includes placements: four semesters in departments/services approved for the occupational medicine specialised studies qualification, and four clinical semesters in departments/services approved for other specialities. The certification concerns physicians enrolled in the French medical association’s register (Table de l’Ordre) specialised in another medical field. Applications are dealt with in regional councils on the basis of a statement from a special national qualification commission.

Consultant Engineers from the CARSATs, CRAMs, and CGSSs
Consultant engineers working in the Regional Health Insurance Funds play a key role as prevention advisors in companies. The course preparing for approval as a consultant engineer is a post-recruitment training course for OSH engineers at CARSATs (Caisses d’Assurance Retraite et de la Santé au Travail), CRAMs (Caisses Régionales d’Assurance Maladie), and CGSSs (Caisses Générales de la Sécurité Sociale). It constitutes the probationary period prior to approval as a consultant engineer.

The training is in two stages: a first period of three months in the OSH department of the CARSAT, CRAM, or CGSS and a second period of nine months during which the trainee consultant engineer alternates between theory training sequences, time for writing their OSH thesis, and time for work related to their future career. The theory part of this training is organised by the National Higher Institute of Social Security (EN3S, Ecole Nationale Supéreure de la Sécurité Sociale) in partnership with INRS (Institut National de Recherche et de Sécurité); the practical part takes place at the CARSATs, CRAMs, and CGSSs. Validation of the course is based on two oral examinations that consist in presenting a subject to an administrative examining board on the topic addressed during the training, and presenting a thesis to a technical examining board.

Safety training that is mandatory for non-specialists in OSH
There are two types of safety training: one is general and enables the employee to gain a good command of their working environment, and the other is specific and relates to the specific risks of the job or workstation. Among such specialist training, there is also training specific to staff representatives on CHSCTs (Health, Safety and Working Conditions Committees, Comités d’Hygiène, de Sécurité et des Conditions de Travail). Depending on the applicable regulatory texts, these training sessions are organised either by the employer with the assistance of the occupational physician and of the staff representatives, or by training bodies approved by prefectoral orders. They have only a regional remit. The list of approved training bodies is available on the Labour Ministry’s website [80]. In all, there are thus about twenty legally-required training sessions, e.g. for employees operating or driving certain work machinery (such as hoisting equipment, self-propelled trucks, etc.) or working at heights, or who are exposed to particular chemical risks[81].


Other vocational training

Academic and technical training
Several universities propose Bachelor’s or Master’s Degree level training in the field of health, quality, safety and the environment. There is also training more specifically focused on occupational health, in particular for technicians (who do two years of vocational training after obtaining a baccalaureate), proposed by the University Institutes of Technology (IUTs, Instituts Universitaires de Technologie). Their career opportunities include jobs as managers or technicians in the fields of hygiene, quality, safety and environment (HSQE), and also as IPRPs[82].

Continuing training
At the level of the enterprise, continuing training constitutes an effective means of action for taking OSH forward. INRS (Institut National de Recherche et de Sécurité), the CARSATs (Caisses d’Assurance Retraite et de la Santé au Travail), and the CRAMs (Caisses Régionales d’Assurance Maladie), and the authorised training bodies propose a large number of training sessions for OSH specialists, management, occupational physicians, trainers, and also for all categories of the public. These training sessions deal with fundamentals, work organisation, management, and the methods and tools of OSH[83].

Distance training
INRS also proposes distance training for supplementing the range of training on offer, and for facilitating access to training for the largest possible number of people in order to contribute to creating a culture of prevention.


Awareness raising networks

Raising awareness of OSH in VSEs and SMEs
One of the challenges for the Ministry for Labour’s Occupational Health Plan is to encourage very small enterprises (VSEs) and small and medium-sized enterprises (SMEs) to commit themselves to risk prevention approaches. To succeed in this challenge, the Ministry has, in particular, put awareness–raising actions in place in partnership with various players such as the ANACT, the ARACTs, the ANSES, the Chambers of Commerce and Industry (CCIs, Chambres de Commerce et d’Industrie), the CCMSA (Caisse Centrale de la Mutualité Sociale Agricole), the CNAMTS-DRP (Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés), DIRECCTEs (Directions Régionales des Entreprises, de la Concurrence, de la Consommation, du Travail et de l’Emploi), INRS (Institut National de Recherche et de Sécurité), etc. These actions involve giving information about tools and approaches for risk prevention in the companies, and disseminating them.


Specialized technical, medical and scientific institutions

Research institutes

French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (Institut National de Recherche et de Sécurité - INRS).
The reference national institute in France is INRS Research accounts for 40% of its activity. The research projects conducted by INRS either internally or in collaboration with other French or European research establishments relate not only to chemical, biological, and mechanical risks, and to risks caused by noise, vibration and electromagnetic fields, but also to issues such as nanotechnologies and nanoparticles, occupational cancers, work organisation, health, safety, and well-being at work, occupational allergies, etc[84].

French National Institute for Health and Medical Research (Institut National de la Santé et de la Recherche Médicale- INSERM) and Atomic Energy and Alternative Energies Commission (Commissariat à l’Energie Atomique et aux énergies alternatives - CEA)
Major research projects related to occupational safety and health are conducted in particular at the INSERM concerning the relationship between cancers and the working environment, and at CEA on nanomaterials.

Institute for Radiological Protection and Nuclear Safety (Institut de Radioprotection et Sûreté Nucléaire - IRSN)
IRSN creates representative models and tools for simulating phenomena associated with nuclear and radiological risks, and contributes to improve knowledge on societal issues related to risk management.

Standardization agencies and networks

French Standards Association (Association Française de Normalisation - AFNOR)
Standardisation and promotion of standardisation are handled by AFNOR and its delegated bodies and approved by the Minister for Industry. AFNOR is under the supervision of the Ministry for Industry. It represents France at the CEN (European Committee for Standardisation) and at the ISO (International Organization for Standardization).

The technical work on standards is conducted through major standardization programs. Each program is steered by a Strategy Committee (CoS, Comité Stratégique), and the Occupational Safety and Health Strategy Committee (CoS Santé et Sécurité au Travail) covers OSH topics.

EUROGIP
EUROGIP is a public interest group formed by the CNAMTS (Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés) and INRS (Institut National de Recherche et de Sécurité), set up to study issues relating to insurance for and prevention of occupational accidents and diseases at European level. Through its publications, EUROGIP contributes to raise awareness on standards and their benefits for OSH. It also coordinates a network of experts who take part in drafting European and international standards relating to occupational safety and health, and provides the secretarial services for coordination of French bodies notified for regulatory certification of machinery and personal protective equipment. EUROGIP is a stakeholder in Euroshnet, the European network of OSH players involved in standardization, testing, and certification.


Institutions and organisations

Ministère du Travail- http://travail-emploi.gouv.fr/

COCT – Conseil d’orientation sur les conditions de travail http://www.travail-emploi-sante.gouv.fr/espaces,770/travail,771/institutionnel,799/le-ministere,808/le-ministere,149/le-conseil-d-orientation-sur-les,1455/

DGT – Direction Générale du Travail http://www.travail-emploi-sante.gouv.fr/le-ministere,149/presentation-et-organigrammes,294/le-ministre-du-travail-de-l-emploi,741/la-direction-generale-du-travail,5601.html

DRP – Direction des Risques Professionnels http://www.risquesprofessionnels.ameli.fr/qui-sommes-nous/notre-organisation/dossier/44/

DSS – Direction de la Sécurité sociale http://www.securite-sociale.fr/Presentation-de-la-Direction-de-la-Securite-sociale

MEDEF – Mouvement des entreprises en France http://www.medef.com/medef-corporate.html

CGPME – Confédération générale des petites et moyennes entreprises http://www.cgpme.fr/

UPA – Union professionnelle et artisanale http://www.upa.fr/index.php

UNAPL – Union nationale des professions libérales http://www.unapl.fr/

CNPL – Chambre nationale des professions libérales http://www.cnpl.org/

FNSEA – Fédération nationale des syndicats d’exploitants agricoles http://www.fnsea.fr/

CFDT – Confédération Française Démocratique du Travail http://www.cfdt.fr/rewrite/site/3926/site-de-la-confederation.htm?idRubrique=4599

CFTC – Confédération française des travailleurs chrétiens http://www.cftc.fr/

CFE-CGC – Confédération française de l’encadrement – Confédération générale des cadres http://www.cfecgc.org/

CGT – Confédération générale du travail http://www.cgt.fr/

CGT FO – Confédération générale du travail – Force ouvrière http://www.force-ouvriere.fr/


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Links for further reading

CLEISS - Centre des Liaisons Européennes et Internationales de Sécurité Sociale (2012). The French Social Security System. http://www.cleiss.fr/docs/regimes/regime_france/an_index.html
EC – European Commission, Employment, Social Affairs & Inclusion (2012). Social protection systems – MISSOC. http://ec.europa.eu/social/main.jsp?catId=815&langId=en
EC – European Commission, Employment and Social Affairs, Social Protection Social Inclusion, Social Protection (2012). MISSOC. http://ec.europa.eu/employment_social/missoc/db/public/compareTables.do?lang=en
EC – European Commission, Employment and Social Affairs, Your social security rights in France. http://ec.europa.eu/employment_social/empl_portal/SSRinEU/Your%20social%20security%20rights%20in%20France_en.pdf
ADECRI – Protection sociale française, Social protection in France. http://www.adecri.org/images/stories/the_french_social_protection_system.pdf]
June 2015