HAVS Tier 4 Assessment

All Tier 4 assessments are conducted face-to-face by Dr Maarten Van Kets, an HSE-certified occupational physician with over 15 years in vibration medicine. Every exam is performed personally at our London Bridge (SE1 2PR) or Orpington (BR6 0FE) clinics — or on-site for 4+ workers.

Why Is Tier 4 Assessment Necessary?

Hand-arm vibration causes irreversible nerve and vascular damage. Tier 4 is mandatory under Control of Vibration at Work Regulations 2005 (Regulation 7) when symptoms are present or exposure exceeds the Exposure Limit Value (ELV = 5 m/s² A(8)). Tier 3 (nurse-led) cannot diagnose — it only flags cases for referral. We skip the delay.

What Does Tier 4 Include?

Full clinical evaluation + 4 objective tests (HSE L140 ACOP standard):

• Clinical history and Stockholm Workshop Scale staging (vascular & sensorineural)
• Vibrotactile Perception Threshold (VPT) — measures nerve damage
• Thermotactile Perception Threshold (TPT) — cold/hot sensitivity
• Grip strength — using dynamometer
• Purdue Pegboard Test — fine motor dexterity & coordination
• Diagnosis, staging, and work fitness decision
• HSE-compliant report with restrictions if needed

Who Needs Tier 4 & When?

• Workers with: Numbness, tingling, finger blanching, reduced grip
• Or using: High-vibration tools > ELV (e.g. breakers, grinders, rivet guns)
• When:
  • After Tier 3 referral (we accept direct)
  • Diagnosed or suspected HAVS
  • Return-to-work after symptoms
  • Legal or insurance requirement

Why Skip Tier 3 and Come Direct?

• No delays: Tier 3 cannot diagnose — only refer
• Dr Van Kets is certified for Tier 4
• One visit = full diagnosis + certificate
• Accepted by HSE, insurers, and contractors

Benefits of Our Service

• Compliance: Full HSE L140 ACOP compliance
• Accuracy: GMC-registered, HSE-certified physician only
• Flexibility: Clinic or on-site nationwide
• Efficiency: Next-day report and fitness decision