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The European Directive 2002/44/EC and the Italian Decree 187/2005 establish the minimum health and safety requirements regarding the exposure of workers to the risks arising from mechanical vibration. Excessive exposure to hand-arm vibration from powered processes or tools can cause disorders in the vascular, neurological and musculoskeletal systems of the upper limbs. Long-term occupational exposure to intense whole-body vibration is associated with an increased risk for disorders of the lumbar spine and the connected nervous system. The prevention of injuries or disorders caused by mechanical vibration at the workplace requires the implementation of administrative, technical and medical procedures. The role of the occupational health physician in the implementation of the health surveillance of vibration-exposed workers is discussed in the light of the requirements established by the European and Italian regulations. The health surveillance of vibration-exposed workers consists of pre-employment medical screening and subsequent clinical examinations at regular intervals. The aims of health surveillance are to make the worker aware of the hazards connected with exposure to mechanical vibration, to obtain baseline health data for comparison with the findings of subsequent periodical health examinations, to verify the presence of pathological conditions which may increase the risk of adverse health effects due to vibration exposure, to make a diagnosis of occupational or work-related disease, and to check the long-term effectiveness of preventive measures.