# Development of an interdisciplinary consensus statement for assessing fitness for work at heights in the South African construction industry: a virtual Modified Nominal Group Technique study

## TL;DR

This study created a framework for assessing if construction workers are fit to work at heights, using expert consensus to guide safer practices in South Africa.

## Contribution

The paper introduces an interdisciplinary consensus statement for assessing fitness for work at heights in construction, based on expert input and structured consensus methods.

## Key findings

- Consensus was reached on 20 of 27 items in the framework, emphasizing job-specific and risk-based assessments.
- The framework incorporates physical, cognitive, environmental, and psychosocial factors in fitness evaluations.
- Revisions included clearer terminology and the role of a competent, authorized person in assessments.

## Abstract

Falls from heights are a leading cause of occupational injury and death globally, with construction workers disproportionately affected. In South Africa, employers must ensure that workers performing fall-risk tasks are certified as fit to work at heights, yet regulations provide little guidance on how such assessments should be conducted. Within a broader two-phase research project undertaken by the authors, Phase 1 comprised a scoping review that identified limited peer-reviewed evidence and a lack of standardised frameworks for assessing fitness for work at heights, followed by a qualitative study that found inconsistent, predominantly medicalised assessment practices that inadequately reflect job-specific risks and demands. In response, a draft interdisciplinary consensus statement was developed. This study reports Phase 2, a structured expert consensus process undertaken to systematically revise and consolidate the draft consensus statement.

A virtual Modified Nominal Group Technique was conducted with six experts from occupational medicine, occupational health nursing, occupational therapy, and construction health and safety. Participants reviewed the draft consensus statement prior to a facilitated online discussion, followed by an anonymous post-session rating survey. Quantitative ratings were analysed using medians and interquartile ranges against predefined consensus criteria, while qualitative data from transcripts, field notes, and participant annotations were analysed using directed qualitative content analysis.

Consensus was achieved on 20 of 27 items, indicating strong support for the draft statement’s overall structure and intent. Items not reaching consensus mainly concerned definitional clarity, occupational risk-exposure profiling, and follow-up procedures. Revisions focused on clarifying terminology; strengthening guidance on occupational risk exposure and worker–job specification; recognising behavioural and psychosocial factors alongside physical, cognitive, and environmental considerations; and introducing the concept of a competent, registered and authorised person.

This study presents an interdisciplinary consensus statement, developed through expert consensus, providing a principles- and process-based framework for assessing fitness for work at heights. It promotes consistent, transparent, job-specific, risk-based fitness assessments beyond generic medical certification. Future efforts should focus on translating this framework into practical tools and evaluating its feasibility across various construction settings.

The online version contains supplementary material available at 10.1186/s12995-026-00500-0.