Occupational health and safety

Index

Our goals and ambitions

We consider occupational health and safety (OHS) highly relevant. Our Group-wide ambition is to prevent all work-related accidents, both for direct employees and third parties, and to continuously improve workplace safety. In the healthcare products and healthcare services market segments, we manage our occupational health and safety measures in line with specific targets and ambitions, which are mainly defined at local level. We are guided by, for example, data collection on preventive occupational health and safety, which we are successively expanding.

	Timeframe	Status 2023	Further information
Definition of a Group-wide KPI (Lost Time Injury Frequency Rate - LTIFR), which will serve and be reported on as a long-term performance indicator.	Ongoing	Fresenius Kabi, Fresenius Vamed, and Fresenius Helios in Spain already use LTIFR as a performance indicator. Process at Fresenius Helios in Germany ongoing.	Reporting and systems Compensation Report
Fresenius Kabi: LTIFR < 3.0	Ongoing	The target was achieved. In the reporting year, the rate was 2.8.	Reporting and systems
Fresenius Kabi: Integration¹ of all production sites into the ISO 45001 management system by the end of 2023.	End of 2023	The goal was achieved. 100% of the production sites have been integrated. The next step will be certification at the sites integrated in 2023.	Guidelines and regulations
¹Implementation is concluded at all Fresenius Kabi production sites. The certification issuance from the individual certification companies may extend into 2024.

Our approach

Ensuring the health and safety of our employees is an essential part of our corporate responsibility. The Fresenius Code of Conduct states that we must take all necessary measures to protect our employees and to prevent work-related accidents. All business segments focus on preventive measures and promote employees’ responsible conduct when it comes to occupational health and safety. Occupational safety concepts are adapted to the specific business models of each business segment. Our concepts focus on occupational health and safety within production, as well as occupational health management for employees in our healthcare facilities or administration.

We promote the health of our employees with various programs and offers. The return of employees to work after an illness is governed by the workplace reintegration management system. For more information, please refer to Workplace reintegration management.

Organization and responsibilities

Occupational health and safety within the Fresenius Group is organized on a decentralized and country-specific level. Within the Group Management Board, the Chief Executive Officers (CEOs) of our business segments are responsible for operational management. Responsibility and management for occupational health and safety is regulated by the respective Management Boards of the business segments, their committees, or management functions and is embedded in the local organizations. They decide on the management approaches and responsibilities, e. g., via a business allocation plan. The business allocation plan of the Group Management Board does not provide for a separate department for this purpose.

Occupational safety specialists in the business segments advise and support on all issues relating to occupational health and safety. This includes, for example, determining the need for risk assessments as well as monitoring their preparation, implementation, and effectiveness. At local level, we work closely with responsible accident insurance providers and local authorities – always in the interests of our employees and temporary workers.

In addition, ISO 45001-certified sites as well as all clinics, subsidiaries and service companies of Fresenius Helios in Germany have an occupational health and safety committee. In addition, national requirements are to be applied, which may include the provision to establish health and safety committees. At their regular, e. g., quarterly meetings, these committees discuss identified risks and possible measures and review the effectiveness of the defined measures. At clinic locations in Germany and Spain, local employee representatives have introduced similar committees. At Fresenius Vamed, staff from temporary employment agencies can also participate in occupational health and safety committees or are informed about decisions.

In the healthcare services market segment, various committees monitor compliance with occupational health and safety regulations as part of their regular meetings. They also monitor potential incidents in the different divisions and countries.

We record and report data on occupational health and safety – such as health-related absences, occupational diseases, or accidents – for example on a monthly or quarterly basis, to identify deviations. If deviations occur, our specialists initiate root cause analyses and evaluations; corrective or preventive actions are implemented where necessary.

The risk reporting process ensures that the Group Management Board is informed about occupational health and safety, i. e., about risks or incidents that could have a significant impact on business operations, the reputation, or the value chain of the Group and its business segments.

Consolidation takes place at Group level as part of our annual non-financial reports. The Supervisory Board is informed at least annually about the results. Further information can be found in the Opportunities and Risk Report and in the Compliance section.

Reporting and systems

We use notification systems or reporting processes for accidents at work to document and analyze all work-related accidents and incidents for our own employees and partly for temporary workers or other third parties working on our premises. Local management assesses these incident investigation reports. At Fresenius Kabi, global OHS management is responsible for these assessments. The goal is to decide whether technical improvements, additional working equipment, instructions, or further training are required to avoid reoccurrence in future and to improve occupational health and safety for employees. We also document first aid cases and unsafe situations, including near misses. These are taken into account in the occupational health and safety analysis.

In accordance with legal requirements, all business segments document work-related fatal accidents in their respective internal risk management systems. They use locally defined reporting channels to inform the safety specialists directly responsible. Depending on process design and severity, regional or global OHS management functions may be notified as well. HR departments also immediately report serious and fatal accidents to the competent authorities and accident insurance organizations. Furthermore, as soon as work-related accidents with fatalities occur, we immediately review existing work processes and initiate a risk assessment.

In the reporting year 2023, no work-related fatalities occurred among employees in the Fresenius Group that were attributable to misconduct or inadequate occupational health and safety. In one case, there was an incident involving a third-party fatality. The official investigations have not yet been completed.

	2023	2022	2021¹
Own employees	0	0	5
Temporary workers²	0	0	0
Third-party fatality incidents at own sites³	1	0	2
¹ Data without the business segment Fresenius Vamed.
² Recording only in the business segment Fresenius Kabi.
³ Only recorded in the business segments Fresenius Kabi and Helios Germany; incidents with official investigation.

Work-related accidents are reported immediately in the respective systems as soon as they are known of. Central functions are subsequently informed about accidents. Furthermore, we collect Lost Time Injury Frequency Rate (LTIFR) data for internal reporting or are in the process of calculating this indicator at all Fresenius Helios locations in Germany.

In the healthcare products market segment, occupational accidents are categorized according to their severity and reported to the responsible central OHS function – and to other relevant functions depending on the severity of an incident. This is how, for example, work-related accidents that result in at least one day of absence are reported to the central OHS function within two working days; other, less severe accidents without or with less than one day of absence are reported on a quarterly basis. Accidents that lead to at least one calendar day absence from work are investigated, and the results are documented in bespoke reports. We calculate LTIFR¹ from data collected on occupational accidents and their severity and use it as an indicator to measure performance; the LTIFR decreased to 2.8 in 2023, due to a lower number of minor lost-time cases compared to the previous year In 2023, slip, trip, and fall accidents and cuts occurred most frequently. We also consider the lost time injury severity rate (LTISR)² in the analysis. Occupational health and safety reports are submitted to the Management Board and other relevant functions of Fresenius Kabi on a quarterly basis.

LTIFR¹	2023	2022
Fresenius Kabi	2.8	2.9
Helios Spain	14.6	16.2
Fresenius Vamed	12.5	16.7
¹ LTIFR: Number of work-related accidents resulting in at least one day of absence from work in relation to 1,000,000 working hours. In 2023, Fresenius Vamed adjusted the scope of reporting.

¹ LTIFR: Number of work-related accidents resulting in at least one day of absence from work in relation to 1,000,000 working hours. In 2023, Fresenius Vamed adjusted the scope of reporting.

² LTISR: Number of days absent due to work-related accidents in relation to 1,000,000 working hours.

In the healthcare services market segment, we have a Critical Incident Reporting System (CIRS) for critical incidents and near misses at all hospitals. Based on ISO 45001 and regulatory requirements, our hospitals are required to report work-related accidents and their causes, absences, illnesses and absenteeism, as well as other key performance indicators (KPIs), for example in an SAP system, and to transmit them to the social security authorities. Regular, i. e., at least semi-annual, time management reports that document absences and absenteeism and their development are recorded and evaluated locally in hospitals.

In 2023, Fresenius Helios introduced a comprehensive system for recording accidents at work and commuting accidents in Germany. For this purpose, a data tool for determining the LTIFR was implemented in all Helios clinics in Germany. At Fresenius Helios in Spain and Fresenius Vamed, the LTIFR is already being recorded. In the reporting year, the LTIFR decreased compared to the previous year. This is partly due to the reinforcement of OHS training and the improved follow-up processes following accidents.

In addition, on-site coordination serves the purpose of checking the effectiveness of risk assessments and of local management approaches to occupational safety and health protection. In the healthcare services market segment, occupational safety and hygiene specialists as well as occupational physicians monitor compliance with occupational medicine, occupational safety, and occupational health requirements and their management in accordance with public regulations. They cooperate continuously and across segments and develop improvement processes.

The most common types of injuries, accidents, and illnesses in the hospital sector were needlestick and cut injuries, musculoskeletal injuries such as contusions or fractures resulting from falls, and commuting accidents, as well as assaults by patients or relatives on our employees. Typical occupational illnesses in the post-acute area relate to the intervertebral discs, back, or shoulder.

To prevent injuries in the future, Fresenius Helios, for example, updated its central instructions on the prevention of needlestick injuries, radiation protection, and handling tuberculosis in the reporting year.

In the Fresenius Group, no violations of internal health and safety policies whose impact would have been material for the financial position or reputation of the company were reported via our reporting channel. Further information can be found in the Opportunities and Risk Report.

Guidelines and regulations

In occupational health and safety, all sites are subject to the respective local laws and regulations. Compliance with these regulations is ensured at local level. In addition to legal requirements, internal guidelines and directives such as management manuals and standard operating procedures also play a significant role in occupational health and safety. The Group-wide Fresenius Code of Conduct is complemented by business segments’ own guidelines governing occupational health and safety, such as the Clinical Code of Conduct for the areas of rehabilitation and nursing as well as for medical personnel in the healthcare services market segment.

The internal requirements are supplemented by corresponding internationally recognized standards for management systems such as ISO 45001 at some sites and other certifications in accordance with ISO or national standards, e. g., SwissReha. The overarching goal of the ISO 45001 management system is to continuously improve occupational health and safety management, to align it with internationally recognized methods, and to ensure the effectiveness of existing procedures and systems. To drive this forward, we are consistently expanding the number of entities certified with this standard. We have the ambition to create a uniform occupational health and safety management system in all areas of the company in order to optimize occupational health and safety in a standardized manner.

The management systems as well as applicable occupational health and safety regulations and instructions for employees of the Fresenius Group also apply to individuals with temporary employment contracts. This ensures that people performing work on a company site or in our buildings are protected to the necessary extent.

Our commitment in the market segments regarding OHS is supported, monitored, and certified by external partners or regulatory bodies.

in %	Coverage¹
External standards (ISO 45001)	91
In the healthcare products market segment²	100
In the healthcare services market segment	89
Regulatory standards (e. g., local requirements)	100
Internal standards	100
¹ Coverage applies to entities already certified or for which a certification is planned, depending on the applicability of standards or policies. The certification issuance from the individual certification companies may extend into the following year.
² For ten entities, the certification process was finalized, the certificates were not submitted, yet.

Local managers review our approach to occupational health and safety e. g. once a year for continued suitability, appropriateness, and effectiveness, and to identify potential for improvement. Regular, in some cases annual, internal audits support the verification of data and management approaches for entities certified in accordance with ISO 45001 and for those without certification. In this way, we ensure compliance with internal guidelines and regulatory provisions. The management system of our production sites, for example, is audited and certified annually by TÜV Rheinland. If other external institutions conduct audits, these are coordinated with local management.

In 2023, we conducted more than 50 internal reviews to verify compliance with applicable requirements, consistently analyze existing procedures, validate processes, and effectively optimize occupational health and safety management.

The number of health and safety audits depends on the size of the individual sites and the range of activities carried out there. More than 30 certification audits were performed by external organizations.

Risk assessments

The OHS system includes processes for identifying hazards and deficiencies, assessing risks for potential incidents, and determining control, correction, or mitigation as well as prevention and improvement measures. These risk assessments are an important part of our occupational health and safety management.

Physical as well as mental or psychosocial health and safety risks are identified, analyzed, and evaluated at workplace level and reduced to an acceptable level through targeted measures, or even eliminated completely. The assessments include hazards that arise from work-related activities in the immediate vicinity of the workplace, as well as those that exist outside of the workplace but that may still affect workplace health and safety and health for employees. Risk assessments include all employees who perform or have access to routine and non-routine activities at workplaces. All current and planned workplaces, workflows, (OHS) processes, and tasks and their design are assessed – as are human factors such as individual behavior. The design of workplace infrastructure, equipment, and materials, whether provided by us or by third parties, is also included.

Corresponding risk assessments are carried out regularly – usually annually, but at least every three years – and in close consultation with the respective department heads and local experts responsible. In the production sector as well as in the hospital sector, employees are included in the risk assessment. Documentation is recorded in relevant safety and health protection documents. Key risk areas are identified via accident reports or employee input and undergo rigorous assessment. In addition, risk areas in clinics and in production are also examined preventively for potential hazards. Our assessments are implemented in accordance with applicable legal requirements for risk assessments as well as the requirements for ISO 45001 certification and the implementation of necessary controls. In Spain, for example, sexual violence is part of the risk assessments as required by Spanish regulations.

In addition, processes are in place for dealing with particularly vulnerable employees. These include pregnant women, women who have recently given birth or are breastfeeding, employees with recognized impairments or disabilities, minors, and employees who are particularly susceptible (temporarily or permanently) to the risks associated with their work due to personal or socio-occupational characteristics or their physical constitution. The purpose is to take special preventive and protective measures through the health monitoring service tailored to their positions or activities – for example, by adapting their workplace or transferring their activity to another one.

If an entity, be it in production or in clinical settings, uses biological agents, these substances are evaluated in accordance with applicable legal regulations. The corresponding internal risk assessment is recorded in a health and safety document and preventive measures are established before the respective process is initiated. In addition, hazardous materials inventories are maintained in the clinical area.

Training

The Fresenius Group conducts regular occupational health and safety training to prevent incidents in its fields of operation. To prevent work-related injuries and occupational accidents, all new employees receive safety training at the very beginning of their employment, and standard training at least annually thereafter. For incident scenarios with high risks, training takes place more frequently. Helios Germany, for example, conducts quarterly drills on power failure scenarios, in different parts of the building each time.

Our standardized approach to occupational health and safety is complemented by training modules for specific workplace risks. In our clinics, employee health and safety training courses cover, besides general topics, specific areas such as hand hygiene, safely handling work equipment, and hazardous chemicals, as well as emergency prevention and response. Training provided at production sites focuses on, among other topics, safely handling work equipment and chemicals, and emergency prevention and response.

All business segments employ specialists or representatives for (occupational) safety. Vamed Technical Services, for example, runs a dedicated safety center. It is responsible for the safety-related operational support. In order to maintain and further develop their competence, all safety specialists are subject to an area-specific training program adapted to the respective needs of the organization. In addition, the manager of the safety center is certified as quality, safety, risk, and environmental manager and as lead auditor.

At Fresenius Kabi, the global OHS function checks not only compliance with applicable standards during internal audits, but also, for example, the training matrix and whether relevant training has been carried out. Any relevant deviations will be included into the local and global Corrective and Preventive Action (CAPA) list, to ensure any potential gaps are closed systematically. In 2023, all health and safety specialists of Fresenius Kabi were offered one global training session. Furthermore, all sessions are available at the global EHS(Environment, Health and Safety)- and OHS Intranet page.

In the reporting year, Fresenius Helios in Spain evaluated its occupational health and safety training in the hospital. Based on this content review, Helios Spain updated its training on specific workplace risks to meet new regulations and make the courses more user-friendly. More than 30,000 training sessions were offered in which around 16,000 employees participated. The increase in the number of trainings in Spain is a requirement of the JCI accreditation. The segment is preparing the JCI (Joint Commission International) accreditation of additional centers and also the reaccreditation in 2024.

Workplace reintegration management

Statutory workplace reintegration management programs are in place at Fresenius sites in Germany and Austria.

In Germany, employees who were unable to work for more than six weeks within a year (either one prolonged absence or multiple absences) are entitled to a reintegration procedure. In close cooperation with the person concerned, local site management coordinates with relevant employee representatives to assess the options for overcoming an employee’s inability to work. They also assess which services or assistance can prevent future instances of extended health-related absences. The aim is to make workplace reintegration flexible and as needs-oriented as possible, thereby ensuring that employees can return to work long-term. In a first step, affected employees are informed in writing about their options as well as about the structure and participants of an initial return-to-work conversation. In this context, it is also important to transparently communicate the goals of workplace reintegration management as well as the type and scope of data collected and used for this purpose.

Potential further measures resulting from this initial conversation can also involve additional groups and individuals – as agreed upon with the person concerned.

In Austria, affected employees receive what is known as a reintegration allowance from responsible social insurance agencies. This allowance is granted for the duration of part-time employment and in addition to an employee’s salary. As in the case of partial retirement, the allowance should compensate for a large share of financial losses.

In Spain, a medical examination of the employees concerned is carried out by the Risk Prevention Service after longer periods of sick leave involving extended hospitalization. This examination reassesses the returning employee’s fitness for the workplace, which supports a quick return-to-work process. Furthermore, subsequent tailored measures to protect an employee’s health and well-being can be coordinated and implemented. The services provided by each respective local occupational health management unit also support the reintegration measures, e. g., sports and health offers.

In the United States, we provide a Short-Term Disability program for sick leaves. Eligible employees are granted up to 25 weeks’ leave of absence and receive between 60% and 100% of their normal wage. Upon their return, employees are retrained to facilitate their reintegration.

In the Dominican Republic, our internal medical unit provides physical and emotional support to employees on long-term sick leave when needed in accordance with legal requirements. If employees are able to return to work, we offer them a position with the lowest possible health risk considering business needs and personal qualifications. In addition, affected employees are supported by the internal medical unit and labor relations for a certain period of time.

Patient safety

In addition to employee health and safety, patient and user safety at our facilities is also of great importance. For information on patient safety in the context of medical treatment, please refer to the Patient and product safety section on. In the hospital sector, we have also implemented various measures to protect patients from hazardous situations outside of medical treatment. Such hazardous situations can be, for example, fires, power outages, or weather-related circumstances, such as ice on parking lots or hospital access ramps in winter. If such situations occur, appropriate emergency and fire protection plans are in place, for example to ensure the evacuation of patients. Hospital staff are prepared for such crisis situations through annual mandatory training. Business continuity plans for crisis situations complement existing safety measures.

Promoting health and well-being

Complementing our comprehensive occupational health and safety measures, we have developed further voluntary country-specific offers that promote employee health, well-being, and healthy lifestyles. These offers are organized on a decentralized basis so that they can be tailored to the needs of our employees as precisely as possible. On the one hand, our offers are aimed at promoting and maintaining physical health and include, for example, vaccination programs and preventive medical check-ups by our company doctors. On the other hand, there are contacts, hotlines, and information focusing on mental health issues. In Germany and Spain, Fresenius provides courses on nutrition and physical activity, as well as on emotional management. In addition, employees and their families receive external and anonymous psychological counseling if needed.