There are 5 levels of HAVS health surveillance assessment identified in the Control of Vibration at Work Regulations: Level 1 – this is a questionnaire which should be issued to new starters who are likely to be exposed to HAVS and used to check previous exposure and symptom history. If problems are identified on this questionnaire, they should be referred to an Occupational Health Nurse or doctor who is specially qualified in HAVS screening for a level 3 or 4 HAVS screening. Individuals should be cleared fit to work with vibration. Level 2 – this is an annual questionnaire which should be issued to all employees exposed to vibration levels over the first action level. It is required annually. If problems are identified on this questionnaire, they should be referred to an Occupational Health Nurse or doctor who is specially qualified in HAVS screening for a level 3 or 4 HAVS screening. Level 3 –this is a screening assessment undertaken every three years which should be carried out for all employees exposed to vibration levels over the first action level.  It involves a questionnaire and lots of tests to check for circulatory, neurological and musculo-skeletal problems. It is also used to investigate problems at levels 1 or 2 and for monitoring those who have been diagnosed with HAVS to ensure it is stable. Level 4 – this is carried out when someone has been identified with symptoms consistent with HAVS at level 3 assessment and a diagnosis by a doctor is required. It may also be required to monitor newly diagnosed employees to ensure that their symptoms remain stable. If a diagnosis is made, the incident must be reported under RIDDOR. It builds on from the level 3 medical to include formal clinical examination and diagnosis. Level 5 – this assessment is undertaken at Specialist Centres located regionally and is used to confirm diagnosis where the case is complex or where clarity is required for legal purposes. It is not used routinely.